Management of an Accessory Bile Duct Leak Following Pancreaticoduodenectomy: A Novel Approach Utilizing a Percutaneous and Endoscopic Rendezvous.

Biliary leaks are uncommon but morbid complications of pancreaticoduodenectomies, which have historically been managed with percutaneous drainage, reoperation, or a combination of both. We report a de novo percutaneous-endoscopic hepaticojejunostomy from an anomalous right hepatic duct injured during pancreaticoduodenectomy to the afferent bowel limb. The percutaneous-endoscopic hepaticojejunostomy was stented to allow for tract formation with successful stent removal after 5.5 months. One year after the creation of the percutaneous-endoscopic hepaticojejunostomy, the patient remains clinically well without evidence of biliary leak or obstruction

The miscarriage circle of care:towards leveraging online spaces for social support

BACKGROUND: Lack of social support during and after miscarriage can greatly affect mental wellbeing. With miscarriages being a common experience, there remains a discrepancy in the social support received after a pregnancy is lost. METHOD: 42 people who had experienced at least one miscarriage took part in an Asynchronous Remote Community (ARC) study. The study involved 16 activities (discussions, creative tasks, and surveys) in two closed, secret Facebook groups over eight weeks. Descriptive statistics were used to analyse quantitative data, and content analysis was used for qualitative data. RESULTS: There were two main miscarriage care networks, formal (health care providers) and informal (friends, family, work colleagues). The formal care network was the most trusted informational support source, while the informal care network was the main source of tangible support. However, often, participants’ care networks were unable to provide sufficient informational, emotional, esteem, and network support. Peers who also had experienced miscarriage played a crucial role in addressing these gaps in social support. Technology use varied greatly, with smartphone use as the only common denominator. While there was a range of online support sources, participants tended to focus on only a few, and there was no single common preferred source. DISCUSSION: We propose a Miscarriage Circle of Care Model (MCCM), with peer advisors playing a central role in improving communication channels and social support provision. We show how the MCCM can be used to identify gaps in service provision and opportunities where technology can be leveraged to fill those gaps

Characterizations of tropospheric turbulence and stability layers from aircraft observations

[1] Velocity, temperature, and specific humidity data collected by aircraft at 20-Hz resolution are analyzed for stability and turbulence parameters. Over 100 vertical profiles (mostly over the ocean) with a total of over 300 km in vertical airspace sampled are used. The compiled statistics show that anisotropy in the velocity fluctuations prevail down to the smallest spatial separations measured. A partitioning of convective versus dynamical instability indicates that in the free troposphere, the ratio of shear-produced turbulence to convectively produced turbulence increases from roughly 2:1 for weak turbulence (ϵ 10⁻⁴ m² s⁻³). For the boundary layer, this ratio is close to 1:1 for weak turbulence and roughly 2:1 for strong turbulence. There is also a correlation between the strength of the vertical shear in horizontal winds and the turbulence intensity. In the free troposphere the turbulence intensity is independent of the degree of static stability, whereas in the boundary layer the turbulence intensity increases with a fall in static stability. Vertical humidity gradients correlate with static stability for strong humidity gradients, which supports the basic notion that stable layers impede vertical mixing of trace gases and aerosols. Vertical shear correlates with vertical humidity gradient, so it appears that the effect of differential advection creating tracer gradients dominates the effect of differential advection destroying tracer gradients through shear-induced turbulence.United States. National Aeronautics and Space Administration (Grant NCC1-415)United States. National Aeronautics and Space Administration (Grant NAG1-2306

SPITZER: Accretion in Low Mass Stars and Brown Dwarfs in the Lambda Orionis Cluster

We present multi-wavelength optical and infrared photometry of 170 previously known low mass stars and brown dwarfs of the 5 Myr Collinder 69 cluster (Lambda Orionis). The new photometry supports cluster membership for most of them, with less than 15% of the previous candidates identified as probable non-members. The near infrared photometry allows us to identify stars with IR excesses, and we find that the Class II population is very large, around 25% for stars (in the spectral range M0 - M6.5) and 40% for brown dwarfs, down to 0.04 Msun, despite the fact that the H(alpha) equivalent width is low for a significant fraction of them. In addition, there are a number of substellar objects, classified as Class III, that have optically thin disks. The Class II members are distributed in an inhomogeneous way, lying preferentially in a filament running toward the south-east. The IR excesses for the Collinder 69 members range from pure Class II (flat or nearly flat spectra longward of 1 micron), to transition disks with no near-IR excess but excesses beginning within the IRAC wavelength range, to two stars with excess only detected at 24 micron. Collinder 69 thus appears to be at an age where it provides a natural laboratory for the study of primordial disks and their dissipation.Comment: ApJ, in pres

Do functional status and Medicare claims data improve the predictive accuracy of an electronic health record mortality index? Findings from a national Veterans Affairs cohort

BackgroundElectronic health record (EHR) prediction models may be easier to use in busy clinical settings since EHR data can be auto-populated into models. This study assessed whether adding functional status and/or Medicare claims data (which are often not available in EHRs) improves the accuracy of a previously developed Veterans Affairs (VA) EHR-based mortality index.MethodsThis was a retrospective cohort study of veterans aged 75 years and older enrolled in VA primary care clinics followed from January 2014 to April 2020 (n = 62,014). We randomly split participants into development (n = 49,612) and validation (n = 12,402) cohorts. The primary outcome was all-cause mortality. We performed logistic regression with backward stepwise selection to develop a 100-predictor base model using 854 EHR candidate variables, including demographics, laboratory values, medications, healthcare utilization, diagnosis codes, and vitals. We incorporated functional measures in a base + function model by adding activities of daily living (range 0-5) and instrumental activities of daily living (range 0-7) scores. Medicare data, including healthcare utilization (e.g., emergency department visits, hospitalizations) and diagnosis codes, were incorporated in a base + Medicare model. A base + function + Medicare model included all data elements. We assessed model performance with the c-statistic, reclassification metrics, fraction of new information provided, and calibration plots.ResultsIn the overall cohort, mean age was 82.6 years and 98.6% were male. At the end of follow-up, 30,263 participants (48.8%) had died. The base model c-statistic was 0.809 (95% CI 0.805-0.812) in the development cohort and 0.804 (95% CI 0.796-0.812) in the validation cohort. Validation cohort c-statistics for the base + function, base + Medicare, and base + function + Medicare models were 0.809 (95% CI 0.801-0.816), 0.811 (95% CI 0.803-0.818), and 0.814 (95% CI 0.807-0.822), respectively. Adding functional status and Medicare data resulted in similarly small improvements among other model performance measures. All models showed excellent calibration.ConclusionsIncorporation of functional status and Medicare data into a VA EHR-based mortality index led to small but likely clinically insignificant improvements in model performance

Unveiling the Complex World of Extracellular Vesicles: Novel Characterization Techniques and Manufacturing Considerations

Extracellular vesicles (EVs) function as potent mediators of intercellular communication for many in vivo processes, contributing to both health and disease related conditions. Given their biological origins and diverse functionality from correspondingly unique cargo compositions, both endogenous and modified EVs are garnering attention as promising therapeutic modalities and vehicles for targeted therapeutic delivery applications. Their diversity in composition, however, has revealed a significant need for more comprehensive analytical-based characterization methods, and manufacturing processes that are consistent and scalable. In this review, we explore the dynamic landscape of EV research and development efforts, ranging from novel isolation approaches, to their analytical assessment through novel characterization techniques, and to their production by industrial-scale manufacturing process considerations. Expanding the horizon of these topics to EVs for in-human applications, we underscore the need for stringent development and adherence to Good Manufacturing Practice (GMP) guidelines. Wherein, the intricate interplay of raw materials, production in bioreactors, and isolation practices, along with analytical assessments compliant with the Minimal Information for Studies of Extracellular Vesicles (MISEV) guidelines, in conjunction with reference standard materials, collectively pave the way for standardized and consistent GMP production processes

New Low-Mass Members of the Taurus Star-Forming Region

Briceno et al. recently used optical imaging, data from the Two-Micron All-Sky Survey (2MASS), and follow-up spectroscopy to search for young low-mass stars and brown dwarfs in 8 square degrees of the Taurus star-forming region. By the end of that study, there remained candidate members of Taurus that lacked the spectroscopic observations needed to measure spectral types and determine membership. In this work, we have obtained spectroscopy of the 22 candidates that have A_V<=8, from which we find six new Taurus members with spectral types of M2.75 through M9. The new M9 source has the second latest spectral type of the known members of Taurus (~0.02 M_sun). Its spectrum contains extremely strong emission in H_alpha (W~950 A) as well as emission in He I 6678 A and the Ca II IR triplet. This is the least massive object known to exhibit emission in He I and Ca II, which together with the strong H_alpha are suggestive of intense accretion.Comment: to be published in The Astrophysical Journal, 13 pages, 6 figures, also found at http://cfa-www.harvard.edu/sfgroup/preprints.htm

Past and future of a century old Citrus tristeza virus collection: a California citrus germplasm tale.

Citrus tristeza virus (CTV) isolates collected from citrus germplasm, dooryard and field trees in California from 1914 have been maintained in planta under quarantine in the Citrus Clonal Protection Program (CCPP), Riverside, California. This collection, therefore, represents populations of CTV isolates obtained over time and space in California. To determine CTV genetic diversity in this context, genotypes of CTV isolates from the CCPP collection were characterized using multiple molecular markers (MMM). Genotypes T30, VT, and T36 were found at high frequencies with T30 and T30+VT genotypes being the most abundant. The MMM analysis did not identify T3 and B165/T68 genotypes; however, biological and phylogenetic analysis suggested some relationships of CCPP CTV isolates with these two genotypes. Phylogenetic analysis of the CTV coat protein (CP) gene sequences classified the tested isolates into seven distinct clades. Five clades were in association with the standard CTV genotypes T30, T36, T3, VT, and B165/T68. The remaining two identified clades were not related to any standard CTV genotypes. Spatiotemporal analysis indicated a trend of reduced genotype and phylogenetic diversity as well as virulence from southern California (SC) at early (1907-1957) in comparison to that of central California (CC) isolates collected from later (1957-2009) time periods. CTV biological characterization also indicated a reduced number and less virulent stem pitting (SP) CTV isolates compared to seedling yellows isolates introduced to California. This data provides a historical insight of the introduction, movement, and genetic diversity of CTV in California and provides genetic and biological information useful for CTV quarantine, eradication, and disease management strategies such as CTV-SP cross protection