Sigmoid gallstone ileus: a challenging diagnosis

Gallstone ileus is a rare (1%–4%) complication of gallstone disease. Gallstones entering the gastrointestinal tract by penetration may cause obstruction at any point along their course through the tract; however, they have a predilection to obstruct the smaller-caliber lumen of the small intestine (80.1%) or stomach (14.2%). The condition is seen more commonly in the elderly who often have significant co-morbidities. Gallstone ileus causing large bowel obstruction is rare. We report the case of a 95-year-old woman who presented with a history of abdominal pain without fever, nausea, vomiting, or diarrhea. Computed tomography of the abdomen and pelvis with oral contrast revealed a high-density structure within the lumen of the distal sigmoid colon, initially suspected to be a foreign body. Medical management failed and surgical intervention was not possible. Autopsy revealed peritonitis and a rupture of the sigmoid colon at the site of a cylindrical stone found impacted in an area of fibrotic narrowing with multiple diverticula. A necrotic, thick-walled gallbladder had an irregular stone in its lumen that was a fracture match with the stone in the sigmoid. Adhesions, but no discrete fistula, were identified between the gallbladder and the adjacent transverse colon. The immediate cause of death was peritonitis caused by colonic perforation by the gallstone impacted at an area of diverticular narrowing. To our knowledge, such autopsy findings have not been previously reported

HST Fine Guidance Sensor Astrometric Parallaxes for Three Dwarf Novae: SS Aurigae, SS Cygni, and U Geminorum

We report astrometric parallaxes for three well known dwarf novae obtained using the Fine Guidance Sensors on the Hubble Space Telescope. We found a parallax for SS Aurigae of Pi = 5.00 +/- 0.64 mas, for SS Cygni we found Pi = 6.02 +/- 0.46 mas, and for U Geminorum we obtained Pi = 10.37 +/- 0.50 mas. These represent the first true trigonometric parallaxes of any dwarf novae. We briefly compare these results with previous distance estimates. This program demonstrates that with a very modest amount of HST observing time, the Fine Guidance Sensors can deliver parallaxes of unrivaled precision.Comment: 15 pages, 2 Table

Kepler Mission Stellar and Instrument Noise Properties

Kepler Mission results are rapidly contributing to fundamentally new discoveries in both the exoplanet and asteroseismology fields. The data returned from Kepler are unique in terms of the number of stars observed, precision of photometry for time series observations, and the temporal extent of high duty cycle observations. As the first mission to provide extensive time series measurements on thousands of stars over months to years at a level hitherto possible only for the Sun, the results from Kepler will vastly increase our knowledge of stellar variability for quiet solar-type stars. Here we report on the stellar noise inferred on the timescale of a few hours of most interest for detection of exoplanets via transits. By design the data from moderately bright Kepler stars are expected to have roughly comparable levels of noise intrinsic to the stars and arising from a combination of fundamental limitations such as Poisson statistics and any instrument noise. The noise levels attained by Kepler on-orbit exceed by some 50% the target levels for solar-type, quiet stars. We provide a decomposition of observed noise for an ensemble of 12th magnitude stars arising from fundamental terms (Poisson and readout noise), added noise due to the instrument and that intrinsic to the stars. The largest factor in the modestly higher than anticipated noise follows from intrinsic stellar noise. We show that using stellar parameters from galactic stellar synthesis models, and projections to stellar rotation, activity and hence noise levels reproduces the primary intrinsic stellar noise features.Comment: Accepted by ApJ; 26 pages, 20 figure

Autopsy Standardized Mortality Review: A Pilot Study Offering a Methodology for Improved Patient Outcomes

A standardized mortality review of hospital autopsies identified discrepancies between clinical diagnoses and autopsy findings, unexpected deaths, adequacy of diagnostic workup, presence of adverse event, and type of a quality issue if present. The standardized review elements were chosen based on a review of quality metrics commonly used by hospitals. The review was completed by the pathologist based on their initial autopsy findings. The final autopsy report was later reviewed to confirm the initial review findings. Major discrepancies in diagnosis were categorized as class I or II based on the modified Goldman criteria. Ninety-six hospital autopsy cases from January 2015 to February 2018 were included in the study. The overall major discrepancy rate was 27%. Class I discrepancies, where a diagnosis found at autopsy might have improved survival had it been made premortem, were identified in 16% of cases. Categories associated with increased discrepancy rates included unexpected deaths, inadequate workup, abnormal labs or imaging not addressed, and certain quality issues. Deaths not expected at admission but expected at the time of death, those with adverse events, those within 48 hours of a procedure, those within 48 hours of admission, those with physician-specific quality issues, and those with system or process issues were not significantly related to diagnostic accuracy

Photometric variability in the old open cluster M 67. II. General Survey

We use differential CCD photometry to search for variability in BVI among 990 stars projected in and around the old open cluster M 67. In a previous paper we reported results for 22 cluster members that are optical counterparts to X-ray sources; this study focuses on the other stars in our observations. A variety of sampling rates were employed, allowing variability on time scales ranging from \sim 0.3 hours to \sim 20 days to be studied. Among the brightest sources studied, detection of variability as small as sigma approx 10 mmag is achieved (with > 3 sigma confidence); for the typical star observed, sensitivity to variability at levels sigma approx 20 mmag is achieved. The study is unbiased for stars with 12.5 < B < 18.5, 12.5 < V < 18.5, and 12 < I < 18 within a radius of about 10 arcmin from the cluster centre. In addition, stars with 10 < BVI < 12.5 were monitored in a few small regions in the cluster. We present photometry for all 990 sources studied, and report the variability characteristics of those stars found to be variable at a statistically significant level. Among the variables, we highlight several sources that merit future study, including stars located on the cluster binary sequence, stars on the giant branch, blue stragglers, and a newly discovered W UMa system.Comment: 12 pages, including 6 figures and 5 tables. Tables 1 and 3 only available in electronic version of paper. Accepted by A&

A Far-Ultraviolet Survey of 47 Tucanae.II The Long-Period Cataclysmic Variable AKO 9

We present time-resolved, far-ultraviolet (FUV) spectroscopy and photometry of the 1.1 day eclipsing binary system AKO 9 in the globular cluster 47 Tucanae. The FUV spectrum of AKO 9 is blue and exhibits prominent C IV and He II emission lines. The spectrum broadly resembles that of long-period, cataclysmic variables in the galactic field. Combining our time-resolved FUV data with archival optical photometry of 47 Tuc, we refine the orbital period of AKO 9 and define an accurate ephemeris for the system. We also place constraints on several other system parameters, using a variety of observational constraints. We find that all of the empirical evidence is consistent with AKO 9 being a long-period dwarf nova in which mass transfer is driven by the nuclear expansion of a sub-giant donor star. We therefore conclude that AKO 9 is the first spectroscopically confirmed cataclysmic variable in 47 Tuc. We also briefly consider AKO 9's likely formation and ultimate evolution. Regarding the former, we find that the system was almost certainly formed dynamically, either via tidal capture or in a 3-body encounter. Regarding the latter, we show that AKO 9 will probably end its CV phase by becoming a detached, double WD system or by exploding in a Type Ia supernova.Comment: 40 pages, 11 figures, to appear in the Dec 20 issue of ApJ; minor changes to match final published versio

Hubble Space Telescope Transmission Spectroscopy of the Exoplanet HD 189733b: High-altitude atmospheric haze in the optical and near-UV with STIS

We present Hubble Space Telescope optical and near-ultraviolet transmission spectra of the transiting hot-Jupiter HD189733b, taken with the repaired Space Telescope Imaging Spectrograph (STIS) instrument. The resulting spectra cover the range 2900-5700 Ang and reach per-exposure signal-to-noise levels greater than 11,000 within a 500 Ang bandwidth. We used time series spectra obtained during two transit events to determine the wavelength dependance of the planetary radius and measure the exoplanet's atmospheric transmission spectrum for the first time over this wavelength range. Our measurements, in conjunction with existing HST spectra, now provide a broadband transmission spectrum covering the full optical regime. The STIS data also shows unambiguous evidence of a large occulted stellar spot during one of our transit events, which we use to place constraints on the characteristics of the K dwarf's stellar spots, estimating spot temperatures around Teff~4250 K. With contemporaneous ground-based photometric monitoring of the stellar variability, we also measure the correlation between the stellar activity level and transit-measured planet-to-star radius contrast, which is in good agreement with predictions. We find a planetary transmission spectrum in good agreement with that of Rayleigh scattering from a high-altitude atmospheric haze as previously found from HST ACS camera. The high-altitude haze is now found to cover the entire optical regime and is well characterised by Rayleigh scattering. These findings suggest that haze may be a globally dominant atmospheric feature of the planet which would result in a high optical albedo at shorter optical wavelengths.Comment: 14 pages, 14 figures, 4 tables, accepted to MNRAS, revised version has minor change

Maternal smoking during pregnancy increases the risk of recurrent wheezing during the first years of life (BAMSE)

BACKGROUND: Exposure to cigarette smoking during foetal and early postnatal life may have implications for lung health. The aim of this study was to assess the possible effects of such exposure in utero on lower respiratory disease in children up to two years of age. METHODS: A birth cohort of 4089 newborn infants was followed for two years using parental questionnaires. When the infant was two months old the parents completed a questionnaire on various lifestyle factors, including maternal smoking during pregnancy and after birth. At one and two years of age information was obtained by questionnaire on symptoms of allergic and respiratory diseases as well as on environmental exposures, particularly exposure to environmental tobacco smoke (ETS). Adjustments were made for potential confounders. RESULTS: When the mother had smoked during pregnancy but not after that, there was an increased risk of recurrent wheezing up to two years' age, OR(adj )= 2.2, (95% CI 1.3 – 3.6). The corresponding OR was 1.6, (95% CI 1.2 – 2.3) for reported exposure to ETS with or without maternal smoking in utero. Maternal smoking during pregnancy but no exposure to ETS also increased the risk of doctor's diagnosed asthma up to two years of age, OR(adj )= 2.1, (95% CI 1.2 – 3.7). CONCLUSION: Exposure to maternal cigarette smoking in utero is a risk factor for recurrent wheezing, as well as doctor's diagnosed asthma in children up to two yearsof age

Preparation of Kepler lightcurves for asteroseismic analyses

The Kepler mission is providing photometric data of exquisite quality for the asteroseismic study of different classes of pulsating stars. These analyses place particular demands on the pre-processing of the data, over a range of timescales from minutes to months. Here, we describe processing procedures developed by the Kepler Asteroseismic Science Consortium (KASC) to prepare light curves that are optimized for the asteroseismic study of solar-like oscillating stars in which outliers, jumps and drifts are corrected.Comment: Accepted for publication in MNRAS. 5 pages, 2 figure