The critically ill patient after hepatobiliary surgery

BACKGROUND: We analyzed the causes and results of utilization of critical care services in the special care unit in patients after surgical procedures performed by the hepatobiliary surgical service during a 23-month period. RESULTS: Thirty-two of 537 patients (6.0%) required postoperative admission to the special care unit. Twenty-one patients were admitted directly from operating room or from recovery room because of inability to wean from ventilator (n = 10), hypovolemic shock (n = 4), myocardial ischemia or infarction (n = 2), sepsis (n = 2), upper gastrointestinal bleeding (n = 2), and acute renal failure (n =1). Eleven postoperative patients were admitted from floor care for respiratory failure (n = 4), cardiac dysrhythmia or infarction (n = 4), sepsis (n = 2), and upper gastrointestinal bleeding (n = 1). Thirty-eight per cent of patients (n = 12) admitted to the special care unit after surgery died. By multivariate analysis, total postoperative stay in the special care unit that was greater than median total duration of stay of 4.5 days was the only independent predictor of mortality (P = 0.041). CONCLUSIONS: Respiratory failure was the predominant component of all complications after hepatobiliary surgery. No clinically useful predictors of eventual outcome could be identified

Process of discovery: A fourth-year translational science course

The Liaison Committee on Medical Education notes the importance of educating medical students on clinical and translational research principles.To describe a fourth-year course, “Process of discovery,” which addresses teaching these principles, and to discuss students’ perceptions of the course.Core components and pedagogical methods of this course are presented. Course assessment was performed with specific pre- and post-course assessments.During academic years 2004 to 2009, 562 students were enrolled, with assessment response rate of 94% pre-course and 85% post-course. The students’ self-assessment of their current understanding of clinical and translation research significantly increased, as well as their understanding of how clinical advances will take place over the next decade.A fourth-year course teaching clinical and translational research is successful, is seen as a positive experience and can meet the requirements for including clinical and translational research in the medical school curriculum

Angular 21 cm Power Spectrum of a Scaling Distribution of Cosmic String Wakes

Cosmic string wakes lead to a large signal in 21 cm redshift maps at redshifts larger than that corresponding to reionization. Here, we compute the angular power spectrum of 21 cm radiation as predicted by a scaling distribution of cosmic strings whose wakes have undergone shock heating.Comment: 13 pages, 6 figures; v2: minor modifications, journal versio

The distribution of extremal points of Gaussian scalar fields

We consider the signed density of the extremal points of (two-dimensional) scalar fields with a Gaussian distribution. We assign a positive unit charge to the maxima and minima of the function and a negative one to its saddles. At first, we compute the average density for a field in half-space with Dirichlet boundary conditions. Then we calculate the charge-charge correlation function (without boundary). We apply the general results to random waves and random surfaces. Furthermore, we find a generating functional for the two-point function. Its Legendre transform is the integral over the scalar curvature of a 4-dimensional Riemannian manifold.Comment: 22 pages, 8 figures, corrected published versio

Clinical outcome and virological characteristics of hepatitis B-related acute liver failure in the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72563/1/j.1365-2893.2005.00581.x.pd

The East Greenland Coastal Current : structure, variability, and forcing

Author Posting. © Elsevier B.V. , 2008. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Progress In Oceanography 78 (2008): 58-77, doi:10.1016/j.pocean.2007.09.006.The subtidal circulation of the southeast Greenland shelf is described using a set of high-resolution hydrographic and velocity transects occupied in summer 2004. The main feature is the East Greenland Coastal Current (EGCC), a low-salinity, high-velocity jet with a wedge-shaped hydrographic structure characteristic of other surface buoyancydriven currents. The EGCC was observed along the entire Greenland shelf south of Denmark Strait, while the transect north of the strait showed only a weak shelf flow. This observation, in conjunction with water mass considerations and other supporting evidence, suggests that the EGCC is an inner branch of the East Greenland Current (EGC) that forms south of Denmark Strait. It is argued that bathymetric steering is the most likely reason why the EGC apparently bifurcates at this location. Repeat sections occupied at Cape Farewell between 1997 and 2004 show that the alongshelf wind stress can have a strong influence on the structure and strength of the EGCC and EGC on timescales of 2-3 days. Accounting for the wind-induced effects, the volume transport of the combined EGCC/EGC system is roughly constant (~2 Sv) over the study domain, from 68°N to Cape Farewell near 60°N. The corresponding freshwater transport increases by roughly 60% over this distance (59 to 96 mSv, referenced to a salinity of 34.8). This trend is consistent with a simple freshwater budget of the EGCC/EGC system that accounts for meltwater runoff, melting sea-ice and icebergs, and net precipitation minus evaporation.This work was funded by the National Science Foundation grant OCE-0450658. DS was also partially supported by the Woods Hole Oceanographic Institution Academic Programs Office

An Improved Photometric Calibration of the Sloan Digital Sky Survey Imaging Data

We present an algorithm to photometrically calibrate wide field optical imaging surveys, that simultaneously solves for the calibration parameters and relative stellar fluxes using overlapping observations. The algorithm decouples the problem of "relative" calibrations, from that of "absolute" calibrations; the absolute calibration is reduced to determining a few numbers for the entire survey. We pay special attention to the spatial structure of the calibration errors, allowing one to isolate particular error modes in downstream analyses. Applying this to the Sloan Digital Sky Survey imaging data, we achieve ~1% relative calibration errors across 8500 sq.deg. in griz; the errors are ~2% for the u band. These errors are dominated by unmodelled atmospheric variations at Apache Point Observatory. These calibrations, dubbed "ubercalibration", are now public with SDSS Data Release 6, and will be a part of subsequent SDSS data releases.Comment: 16 pages, 17 figures, matches version accepted in ApJ. These calibrations are available at http://www.sdss.org/dr

Performance of the double multilayer monochromator on the NSLS wiggler beam line X25

A tunable, double multilayer x-ray monochromator has recently been implemented on the National Synchrotron Light Source (NSLS) X25 wiggler beam line. It is based on a parallel pair of tungsten-boron-carbide multilayer films grown on silicon substrates and purchased from Osmic, Inc. of Troy, Michigan, USA. It acts as an optional alternative to the conventional double silicon crystal monochromator, and uses the same alignment mechanism. Two other NSLS beam lines also have had this kind of monochromator installed recently, following the lead of the NSLS X20C IBM/MIT beam line which has used a double multilayer monochromator for several years. Owing to the 100 times broader bandwidth of a multilayer x-ray monochromator, compared with a silicon monochromator, the multilayer monochromator has the obvious advantage of delivering 100 times the flux of a silicon monochromator, and thereby makes more efficient use of the continuous synchrotron radiation spectrum, yet preserves the narrow collimation of the incident synchrotron beam. In particular, multilayer x-ray bandwidths, on the order of 1%, are well-matched to x-ray undulator linewidths. Performance results for the X25 multilayer monochromator are presented, comparing it with the silicon monochromator. Of note is its short- and long-term performance as an x-ray monochromator delivering the brightness of the wiggler source in the presence of the high-power white beam. Detailed measurements of its spatial beam profile and wavelength dispersion have been made, and it is shown how its resolution could be improved when desired. Finally, its peculiar, anisotropic resolution function in reciprocal space, and its bearing upon x-ray crystallography and scattering experiments, will be discussed, and highlighted by the results of a protein crystallography experiment. © 1997 American Institute of Physics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87844/2/71_1.pd