Infected Necrosis in Severe Pancreatitis - Combined Nonsurgical Multi-Drainage with Directed Transabdominal High-Volume Lavage in Critically Ill Patients

Background: Infection of pancreatic necrosis is a life-threatening complication during the course of acute pancreatitis. In critically ill patients, surgical or extended endoscopic interventions are associated with high morbidity and mortality. Minimally invasive procedures on the other hand are often insufficient in patients suffering from large necrotic areas containing solid or purulent material. We present a strategy combining percutaneous and transgastric drainage with continuous high-volume lavage for treatment of extended necroses and liquid collections in a series of patients with severe acute pancreatitis. Patients and Methods: Seven consecutive patients with severe acute pancreatitis and large confluent infected pancreatic necrosis were enrolled. In all cases, the first therapeutic procedure was placement of a CT-guided drainage catheter into the fluid collection surrounding peripancreatic necrosis. Thereafter, a second endosonographically guided drainage was inserted via the gastric or the duodenal wall. After communication between the separate drains had been proven, an external to internal directed high-volume lavage with a daily volume of 500 ml up to 2,000 ml was started. Results: In all patients, pancreatic necrosis/liquid collections could be resolved completely by the presented regime. No patient died in the course of our study. After initiation of the directed high-volume lavage, there was a significant clinical improvement in all patients. Double drainage was performed for a median of 101 days, high-volume lavage for a median of 41 days. Several endoscopic interventions for stent replacement were required (median 8). Complications such as bleeding or perforation could be managed endoscopically, and no subsequent surgical therapy was necessary. All patients could be dismissed from the hospital after a median duration of 78 days. Conclusion: This approach of combined percutaneous/endoscopic drainage with high-volume lavage shows promising results in critically ill patients with extended infected pancreatic necrosis and high risk of surgical intervention. Neither surgical nor endoscopic necrosectomy was necessary in any of our patients. Copyright (C) 2009 S. Karger AG, Basel and IA

'Too Much Serendipity': The Tension between Information Seeking and Encountering at the Library Shelves

The physical library shelves are regularly the site of serendipitous information discoveries, and are often sought out for this purpose. However, while some drawbacks to the shelves as information gateways have been documented, none to our knowledge relate to their capacity for facilitating serendipity. We present findings from a qualitative study of serendipity at the library shelves. This study uncovered a new drawback that we term the "seeking-encountering tension". On one hand, this tension entices people towards the relatively high-risk, high-reward activity of exploring new information avenues discovered serendipitously and, on the other, draws them back towards the relative safety of goal-directed information-seeking. We discuss some of the factors that contribute to this tension, and provide design suggestions for mitigating it. Understanding this tension can inform the design of physical and digital information environments that provide users the agency to switch between more and less focused information-seeking at will

Parasitic helminth infections and the control of human allergic and autoimmune disorders

The profile of global health today presents a striking reciprocal distribution between parasitic diseases in many of the world’s lower-income countries, and ever-increasing levels of inflammatory disorders such as allergy, autoimmunity and inflammatory bowel diseases in the more affluent societies. Attention is particularly focused on helminth worm parasites, which are associated with protection from allergy and inflammation in both epidemiological and laboratory settings. One mechanistic explanation of this is that helminths drive the regulatory arm of the immune system, abrogating the ability of the host to expel the parasites, while also dampening reactivity to many “bystander” specificities. Interest has therefore heightened into whether helminth parasites, or their products, hold therapeutic potential for immunological disorders of the developed world. In this narrative review, progress across a range of trials is discussed, together with prospects for isolating individual molecular mediators from helminths that may offer defined new therapies for inflammatory conditions

New physics, the cosmic ray spectrum knee, and pppp cross section measurements

We explore the possibility that a new physics interaction can provide an explanation for the knee just above $10^6$ GeV in the cosmic ray spectrum. We model the new physics modifications to the total proton-proton cross section with an incoherent term that allows for missing energy above the scale of new physics. We add the constraint that the new physics must also be consistent with published $pp$ cross section measurements, using cosmic ray observations, an order of magnitude and more above the knee. We find that the rise in cross section required at energies above the knee is radical. The increase in cross section suggests that it may be more appropriate to treat the scattering process in the black disc limit at such high energies. In this case there may be no clean separation between the standard model and new physics contributions to the total cross section. We model the missing energy in this limit and find a good fit to the Tibet III cosmic ray flux data. We comment on testing the new physics proposal for the cosmic ray knee at the Large Hadron Collider.Comment: 17 pages, 4 figure

Extending Sensitivity for Low-Mass Neutral Heavy Lepton Searches

We point out the importance of two-body final states of weak isosinglet neutral heavy leptons predicted in several models of new physics beyond the standard model. We concentrate on muon-type neutral heavy leptons $L_\mu^0$ with mass $M<2$ GeV which can be searched for with increased sensitivity at a new round of neutrino experiments at CERN and Fermilab. Providing explicit decay rate formulae for the $e e \nu$, $e\mu \nu$, $\mu \mu \nu$, $\pi \mu$, $\rho \mu$, and $a_1\mu$ final states, we use general scaling features to estimate sensitivity of $L_\mu^0$ searches in current and future experiments, emphasizing the importance of the $\pi \mu$ decay mode.Comment: 14 pages, 8 figure

A High Statistics Search for Ultra-High Energy Gamma-Ray Emission from Cygnus X-3 and Hercules X-1

We have carried out a high statistics (2 Billion events) search for ultra-high energy gamma-ray emission from the X-ray binary sources Cygnus X-3 and Hercules X-1. Using data taken with the CASA-MIA detector over a five year period (1990-1995), we find no evidence for steady emission from either source at energies above 115 TeV. The derived upper limits on such emission are more than two orders of magnitude lower than earlier claimed detections. We also find no evidence for neutral particle or gamma-ray emission from either source on time scales of one day and 0.5 hr. For Cygnus X-3, there is no evidence for emission correlated with the 4.8 hr X-ray periodicity or with the occurrence of large radio flares. Unless one postulates that these sources were very active earlier and are now dormant, the limits presented here put into question the earlier results, and highlight the difficulties that possible future experiments will have in detecting gamma-ray signals at ultra-high energies.Comment: 26 LaTeX pages, 16 PostScript figures, uses psfig.sty to be published in Physical Review

Additive and Multiplicative Noise Driven Systems in 1+1 Dimensions: Waiting Time Extraction of Nucleation Rates

We study the rate of true vacuum bubble nucleation numerically for a phi^4 field system coupled to a source of thermal noise. We compare in detail the cases of additive and multiplicative noise. We pay special attention to the choice of initial field configuration, showing the advantages of a version of the quenching technique. We advocate a new method of extracting the nucleation time scale that employs the full distribution of nucleation times. Large data samples are needed to study the initial state configuration choice and to extract nucleation times to good precision. The 1+1 dimensional models afford large statistics samples in reasonable running times. We find that for both additive and multiplicative models, nucleation time distributions are well fit by a waiting time, or gamma, distribution for all parameters studied. The nucleation rates are a factor three or more slower for the multiplicative compared to the additive models with the same dimensionless parameter choices. Both cases lead to high confidence level linear fits of ln(nucleation time) vs. 1/T plots, in agreement with semiclassical nucleation rate predictions.Comment: 38 pages, 20 figures, 6 table

Past and present distribution, densities and movements of blue whales <i>Balaenoptera musculus</i> in the Southern Hemisphere and northern Indian Ocean

1Blue whale locations in the Southern Hemisphere and northern Indian Ocean were obtained from catches (303 239), sightings (4383 records of =8058 whales), strandings (103), Discovery marks (2191) and recoveries (95), and acoustic recordings.2Sighting surveys included 7 480 450 km of effort plus 14 676 days with unmeasured effort. Groups usually consisted of solitary whales (65.2%) or pairs (24.6%); larger feeding aggregations of unassociated individuals were only rarely observed. Sighting rates (groups per 1000 km from many platform types) varied by four orders of magnitude and were lowest in the waters of Brazil, South Africa, the eastern tropical Pacific, Antarctica and South Georgia; higher in the Subantarctic and Peru; and highest around Indonesia, Sri Lanka, Chile, southern Australia and south of Madagascar.3Blue whales avoid the oligotrophic central gyres of the Indian, Pacific and Atlantic Oceans, but are more common where phytoplankton densities are high, and where there are dynamic oceanographic processes like upwelling and frontal meandering.4Compared with historical catches, the Antarctic (‘true’) subspecies is exceedingly rare and usually concentrated closer to the summer pack ice. In summer they are found throughout the Antarctic; in winter they migrate to southern Africa (although recent sightings there are rare) and to other northerly locations (based on acoustics), although some overwinter in the Antarctic.5Pygmy blue whales are found around the Indian Ocean and from southern Australia to New Zealand. At least four groupings are evident: northern Indian Ocean, from Madagascar to the Subantarctic, Indonesia to western and southern Australia, and from New Zealand northwards to the equator. Sighting rates are typically much higher than for Antarctic blue whales.6South-east Pacific blue whales have a discrete distribution and high sighting rates compared with the Antarctic. Further work is needed to clarify their subspecific status given their distinctive genetics, acoustics and length frequencies.7Antarctic blue whales numbered 1700 (95% Bayesian interval 860–2900) in 1996 (less than 1% of original levels), but are increasing at 7.3% per annum (95% Bayesian interval 1.4–11.6%). The status of other populations in the Southern Hemisphere and northern Indian Ocean is unknown because few abundance estimates are available, but higher recent sighting rates suggest that they are less depleted than Antarctic blue whales.</li