Frequency Control of Multi-Pulse 2-micron Laser Transmitter for Atmospheric Carbon Dioxide Measurement

Laser sources with highly stabilized emission wavelength is of paramount importance for a long term atmospheric carbon dioxide (CO2) measurement from a space platform. Integrated Path Differential Absorption (IPDA) lidar is a promising instrument for such a task. The design of a laser transmitter, with emphasis on the method used to control and select several wavelengths, is presented. This multi-pulsed, injection seeded, 2-m transmitter uses a Ho:Tm:YLF laser crystal which has matching emission to the absorption of CO2 in the R30 spectroscopic area. The injection seeded laser produces triple single longitudinal mode transform limited line width pulses with a total of 80 mJ at a repetition rate of 50 Hz

Wavelength Locking to CO2 Absorption Line-Center for 2-Micron Pulsed IPDA Lidar Application

An airborne 2-micron triple-pulse integrated path differential absorption (IPDA) lidar is currently under development at NASA Langley Research Center (LaRC). This IPDA lidar system targets both atmospheric carbon dioxide (CO2) and water vapor (H2O) column measurements. Independent wavelength control of each of the transmitted laser pulses is a key feature for the success of this instrument. The wavelength control unit provides switching, tuning and locking for each pulse in reference to a 2-micron CW (Continuous Wave) laser source locked to CO2 line-center. Targeting the CO2 R30 line center, at 2050.967 nanometers, a wavelength locking unit has been integrated using semiconductor laser diode. The CO2 center-line locking unit includes a laser diode current driver, temperature controller, center-line locking controller and CO2 absorption cell. This paper presents the CO2 center-line locking unit architecture, characterization procedure and results. Assessment of wavelength jitter on the IPDA measurement error will also be addressed by comparison to the system design

Progress on Development of an Airborne Two-Micron IPDA Lidar for Water Vapor and Carbon Dioxide Column Measurements

An airborne 2 micron triple-pulse integrated path differential absorption (IPDA) lidar is currently under development at NASA Langley Research Center (LaRC). This lidar targets both atmospheric carbon dioxide (CO2) and water vapor (H2O) column measurements, simultaneously. Advancements in the development of this IPDA lidar are presented in this paper. Updates on advanced two-micron triple-pulse high-energy laser transmitter will be given including packaging and lidar integration status. In addition, receiver development updates will also be presented. This includes a state-of-the-art detection system integrated at NASA Goddard Space Flight Center. This detection system is based on a newly developed HgCdTe (MCT) electron-initiated avalanche photodiode (e-APD) array. Future plan for IPDA lidar system for ground integration, testing and flight validation will be discussed

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

The FANCM:p.Arg658* truncating variant is associated with risk of triple-negative breast cancer

Abstract: Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic variants in DNA repair genes BRCA1, BRCA2, PALB2, ATM, and CHEK2 are associated with breast cancer risk. FANCM, which encodes for a DNA translocase, has been proposed as a breast cancer predisposition gene, with greater effects for the ER-negative and triple-negative breast cancer (TNBC) subtypes. We tested the three recurrent protein-truncating variants FANCM:p.Arg658*, p.Gln1701*, and p.Arg1931* for association with breast cancer risk in 67,112 cases, 53,766 controls, and 26,662 carriers of pathogenic variants of BRCA1 or BRCA2. These three variants were also studied functionally by measuring survival and chromosome fragility in FANCM−/− patient-derived immortalized fibroblasts treated with diepoxybutane or olaparib. We observed that FANCM:p.Arg658* was associated with increased risk of ER-negative disease and TNBC (OR = 2.44, P = 0.034 and OR = 3.79; P = 0.009, respectively). In a country-restricted analysis, we confirmed the associations detected for FANCM:p.Arg658* and found that also FANCM:p.Arg1931* was associated with ER-negative breast cancer risk (OR = 1.96; P = 0.006). The functional results indicated that all three variants were deleterious affecting cell survival and chromosome stability with FANCM:p.Arg658* causing more severe phenotypes. In conclusion, we confirmed that the two rare FANCM deleterious variants p.Arg658* and p.Arg1931* are risk factors for ER-negative and TNBC subtypes. Overall our data suggest that the effect of truncating variants on breast cancer risk may depend on their position in the gene. Cell sensitivity to olaparib exposure, identifies a possible therapeutic option to treat FANCM-associated tumors

The Molecular Origin and Taxonomy of Mucinous Ovarian Carcinoma

Mucinous ovarian carcinoma (MOC) is a unique subtype of ovarian cancer with an uncertain etiology, including whether it genuinely arises at the ovary or is metastatic disease from other organs. In addition, the molecular drivers of invasive progression, high-grade and metastatic disease are poorly defined. We perform genetic analysis of MOC across all histological grades, including benign and borderline mucinous ovarian tumors, and compare these to tumors from other potential extra-ovarian sites of origin. Here we show that MOC is distinct from tumors from other sites and supports a progressive model of evolution from borderline precursors to high-grade invasive MOC. Key drivers of progression identified are TP53 mutation and copy number aberrations, including a notable amplicon on 9p13. High copy number aberration burden is associated with worse prognosis in MOC. Our data conclusively demonstrate that MOC arise from benign and borderline precursors at the ovary and are not extra-ovarian metastases

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Airborne Testing of 2-μm Pulsed IPDA Lidar for Active Remote Sensing of Atmospheric Carbon Dioxide

The capability of an airborne 2-μm integrated path differential absorption (IPDA) lidar for high-accuracy and high-precision active remote sensing of weighted-average column dry-air volume mixing ratio of atmospheric carbon dioxide (XCO2) is demonstrated. A test flight was conducted over the costal oceanic region of the USA to assess instrument performance during severe weather. The IPDA targets CO2 R30 absorption line using high-energy 2-μm laser transmitter. HgCdTe avalanche photodiode detection system is used in the receiver. Updated instrument model included range correction factor to account for platform attitude. Error budget for XCO2 retrieval predicts lower random error for longer sensing column length. Systematic error is dominated by water vapor (H2O) through dry-air number density derivation, followed by H2O interference and ranging related uncertainties. IPDA XCO2 retrieval results in 404.43 ± 1.23 ppm, as compared to 405.49 ± 0.01 ppm from prediction models, using consistent reflectivity and steady elevation oceanic surface target. This translates to 0.26% and 0.30% relative accuracy and precision, respectively. During gradual spiral descend, IPDA results in 404.89 ± 1.19 ppm as compared model of 404.75 ± 0.73 ppm indicating 0.04% and 0.23% relative accuracy, respectively. Challenging cloud targets limited retrieval accuracy and precision to 2.56% and 4.78%, respectively, due to H2O and ranging errors