Endoscopic Retrograde Cholangiopancreatography Treatment of Cholecystitis: Possible? Yes; Practical??

Classically, until now, the management of cholecystitis has consisted of immediate and judicious clinical assessment of the affected patient, interpolating into the assessment of the physical findings and results from appropriate laboratory, x-ray, and scanning techniques (sonography and scintigraphy) to formulate a clinical impression. Usually, after the diagnosis has been established, the patient is subjected to a cholecystectomy, although the timing of the surgery may vary depending on the clinical condition of the patient. Alternatives to this management (cholecystectomy, medical management) scheme have been suggested, but these are dependent upon the clinical condition ofthe patient and considerations of risks. Percutaneous drainage of the gallbladder or cholecystostomy is sufficient enough to provide drainage, relieve obstruction, and the consequences of infection, i.e., sepsis, and prevent perforation. A contributory role of endoscopic retrograde cholangiopancreatography (ERCP) in this schema has not been a consideration. An ERCP is rarely employed for therapy (or diagnosis) when cholecystitis is suspected but it might assume a more significant role if it is considered an efficacious alternative in specific conditions. We have had the unusual experience of managing 11 patients with cholecystitis employing ERCP and its therapeutic modalities, i.e., sphincterotomy, selective cannulation of the cystic duct, and relieving obstruction of that structure by catheter displacement of an obstructing stone. Endoscopic techniques providing decompression of the gallbladder are described, and the feasibility of utilizing endoscopic procedures for treatment of cholecystitis will be given consideration

Thermodynamic Profiles of Galaxy Clusters from a Joint X-ray/SZ Analysis

We jointly analyze Bolocam Sunyaev-Zeldovich (SZ) effect and Chandra X-ray data for a set of 45 clusters to derive gas density and temperature profiles without using spectroscopic information. The sample spans the mass and redshift range $3 \times 10^{14} M_{\odot} \le M_{500} \le 25 \times 10^{14} M_{\odot}$ and $0.15\le z \le 0.89$. We define cool-core (CC) and non-cool core (NCC) subsamples based on the central X-ray luminosity, and 17/45 clusters are classified as CC. In general, the profiles derived from our analysis are found to be in good agreement with previous analyses, and profile constraints beyond $r_{500}$ are obtained for 34/45 clusters. In approximately 30% of the CC clusters our analysis shows a central temperature drop with a statistical significance of $>3\sigma$; this modest detection fraction is due mainly to a combination of coarse angular resolution and modest S/N in the SZ data. Most clusters are consistent with an isothermal profile at the largest radii near $r_{500}$, although 9/45 show a significant temperature decrease with increasing radius. The sample mean density profile is in good agreement with previous studies, and shows a minimum intrinsic scatter of approximately 10% near $0.5 \times r_{500}$. The sample mean temperature profile is consistent with isothermal, and has an intrinsic scatter of approximately 50% independent of radius. This scatter is significantly higher compared to earlier X-ray-only studies, which find intrinsic scatters near 10%, likely due to a combination of unaccounted for non-idealities in the SZ noise, projection effects, and sample selection.Comment: 42 pages, 52 figure

A Comparison and Joint Analysis of Sunyaev-Zel'dovich Effect Measurements from Planck and Bolocam for a set of 47 Massive Galaxy Clusters

We measure the SZ signal toward a set of 47 clusters with a median mass of $9.5 \times 10^{14}$ M$_{\odot}$ and a median redshift of 0.40 using data from Planck and the ground-based Bolocam receiver. When Planck XMM-like masses are used to set the scale radius $\theta_{\textrm{s}}$, we find consistency between the integrated SZ signal, $Y_{\textrm{5R500}}$, derived from Bolocam and Planck based on gNFW model fits using A10 shape parameters, with an average ratio of $1.069 \pm 0.030$ (allowing for the $\simeq 5$% Bolocam flux calibration uncertainty). We also perform a joint fit to the Bolocam and Planck data using a modified A10 model with the outer logarithmic slope $\beta$ allowed to vary, finding $\beta = 6.13 \pm 0.16 \pm 0.76$ (measurement error followed by intrinsic scatter). In addition, we find that the value of $\beta$ scales with mass and redshift according to $\beta \propto M^{0.077 \pm 0.026} \times (1+z)^{-0.06 \pm 0.09}$. This mass scaling is in good agreement with recent simulations. We do not observe the strong trend of $\beta$ with redshift seen in simulations, though we conclude that this is most likely due to our sample selection. Finally, we use Bolocam measurements of $Y_{500}$ to test the accuracy of the Planck completeness estimate. We find consistency, with the actual number of Planck detections falling approximately $1 \sigma$ below the expectation from Bolocam. We translate this small difference into a constraint on the the effective mass bias for the Planck cluster cosmology results, with $(1-b) = 0.93 \pm 0.06$.Comment: Updated to include one additional co-author. Also some minor changes to the text based on initial feedbac

Comparison of Two Methods for Improving Distance Perception in Virtual Reality

Distance is commonly underperceived in virtual environments (VEs) compared to real environments. Past work suggests that displaying a replica VE based on the real surrounding environment leads to more accurate judgments of distance, but that work has lacked the necessary control conditions to firmly make this conclusion. Other research indicates that walking through a VE with visual feedback improves judgments of distance and size. This study evaluated and compared those two methods for improving perceived distance in VEs. All participants experienced a replica VE based on the real lab. In one condition, participants visually previewed the real lab prior to experiencing the replica VE, and in another condition they did not. Participants performed blind-walking judgments of distance and also judgments of size in the replica VE before and after walking interaction. Distance judgments were more accurate in the preview compared to no preview condition, but size judgments were unaffected by visual preview. Distance judgments and size judgments increased after walking interaction, and the improvement was larger for distance than for size judgments. After walking interaction, distance judgments did not differ based on visual preview, and walking interaction led to a larger improvement in judged distance than did visual preview. These data suggest that walking interaction may be more effective than visual preview as a method for improving perceived space in a VE

Stent Scraping for Histology: An Alternative Method for Obtaining Tissue to Rule out Neoplasia

Despite improvement in diagnostic modalities, confirmation of a histologic diagnosis of cancer of the biliary tree and pancreas remains elusive. Attempts to collect positive cytology specimens from vigorous brushings or washings obtained at endoscopy or percutaneously are often unsuccessful. In our unit, we have increased the yield by obtaining tissue scraped from prostheses that have been previously placed in either the bile duct or the pancreatic duct. The stents are first flushed with saline to collect cytology specimens, after which, they are bisected and scraped, and these contents are prepared in a manner similar to that used to prepare biopsy samples. Twelve of 16 scraped samples, 9 bile duct and 3 pancreas, were positive for adenocarcinoma. The cytology specimens were positive in only 4 of the 12. We recommend this method of sampling from material contained within prostheses as an adjunct when previous brushings, washings, or biopsies are negative

Foldit Standalone: a video game-derived protein structure manipulation interface using Rosetta

Summary: Foldit Standalone is an interactive graphical interface to the Rosetta molecular modeling package. In contrast to most command-line or batch interactions with Rosetta, Foldit Standalone is designed to allow easy, real-time, direct manipulation of protein structures, while also giving access to the extensive power of Rosetta computations. Derived from the user interface of the scientific discovery game Foldit (itself based on Rosetta), Foldit Standalone has added more advanced features and removed the competitive game elements. Foldit Standalone was built from the ground up with a custom rendering and event engine, configurable visualizations and interactions driven by Rosetta. Foldit Standalone contains, among other features: electron density and contact map visualizations, multiple sequence alignment tools for template-based modeling, rigid body transformation controls, RosettaScripts support and an embedded Lua interpreter

Old Massive Globular Clusters and the Stellar Halo of the Dwarf Starburst Galaxy NGC 4449

We use Hubble Space Telescope imaging to show that the nearby dwarf starburst galaxy NGC 4449 has an unusual abundance of luminous red star clusters. Joint constraints from integrated photometry, low-resolution spectroscopy, dynamical mass-to-light ratios, and resolved color-magnitude diagrams provide evidence that some of these clusters are old globular clusters. Spectroscopic data for two massive clusters suggest intermediate metallicities ([Fe/H] ~ -1) and subsolar Mg enhancement ([Mg/Fe] ~ -0.1 to -0.2). One of these clusters may be the nucleus of a tidally disrupting dwarf galaxy; the other is very massive (~ 3 x 10^6 M_sun). We have also identified a population of remote halo globular clusters. NGC 4449 is consistent with an emerging picture of the ubiquity of stellar halos among dwarf galaxies, and study of its globular clusters may help distinguish between accretion and in situ scenarios for such halos.Comment: 15 pages, AJ in pres

The cryomechanical design of MUSIC: a novel imaging instrument for millimeter-wave astrophysics at the Caltech Submillimeter Observatory

MUSIC (Multicolor Submillimeter kinetic Inductance Camera) is a new facility instrument for the Caltech Submillimeter Observatory (Mauna Kea, Hawaii) developed as a collaborative effect of Caltech, JPL, the University of Colorado at Boulder and UC Santa Barbara, and is due for initial commissioning in early 2011. MUSIC utilizes a new class of superconducting photon detectors known as microwave kinetic inductance detectors (MKIDs), an emergent technology that offers considerable advantages over current types of detectors for submillimeter and millimeter direct detection. MUSIC will operate a focal plane of 576 spatial pixels, where each pixel is a slot line antenna coupled to multiple detectors through on-chip, lumped-element filters, allowing simultaneously imaging in four bands at 0.86, 1.02, 1.33 and 2.00 mm. The MUSIC instrument is designed for closed-cycle operation, combining a pulse tube cooler with a two-stage Helium-3 adsorption refrigerator, providing a focal plane temperature of 0.25 K with intermediate temperature stages at approximately 50, 4 and 0.4 K for buffering heat loads and heat sinking of optical filters. Detector readout is achieved using semi-rigid coaxial cables from room temperature to the focal plane, with cryogenic HEMT amplifiers operating at 4 K. Several hundred detectors may be multiplexed in frequency space through one signal line and amplifier. This paper discusses the design of the instrument cryogenic hardware, including a number of features unique to the implementation of superconducting detectors. Predicted performance data for the instrument system will also be presented and discussed