This is the second of a two-part summary of a National Institutes of Health conference on fecal incontinence (FI) that summarizes current treatments and identifies research priorities. Conservative ...medical management consisting of patient education, fiber supplements or antidiarrheals, behavioral techniques such as scheduled toileting, and pelvic floor exercises restores continence in up to 25% of patients. Biofeedback, often recommended as first-line treatment after conservative management fails, produces satisfaction with treatment in up to 76% and continence in 55%; however, outcomes depend on the skill of the therapist, and some trials are less favorable. Electrical stimulation of the anal mucosa is ineffective, but continuous electrical pulsing of sacral nerves produces a ≥50% reduction in FI frequency in a median 73% of patients. Tibial nerve electrical stimulation with needle electrodes is promising but remains unproven. Sphincteroplasty produces short-term clinical improvement in a median 67%, but 5-year outcomes are poor. Injecting an inert bulking agent around the anal canal led to ≥50% reductions of FI in up to 53% of patients. Colostomy is used as a last resort because of adverse effects on quality of life. Several new devices are under investigation but not yet approved. FI researchers identify the following priorities for future research: (1) trials comparing the effectiveness, safety, and cost of current therapies; (2) studies addressing barriers to consulting for care; and (3) translational research on regenerative medicine. Unmet patient needs include FI in special populations (e.g., neurological disorders and nursing home residents) and improvements in behavioral treatments.
Summary
Background
The effect of low‐dose aspirin on endoscopic ulcer incidence in cyclo‐oxygenase‐2‐selective inhibitor or non‐selective non‐steroidal anti‐inflammatory drug users remains ...controversial.
Aim
To compare prospectively the incidence of endoscopic ulcers in healthy subjects receiving low‐dose aspirin plus celecoxib or naproxen.
Methods
In this double‐blind, placebo‐controlled, 1‐week study, subjects (50–75 years) were randomized to receive aspirin 325 mg o.d. plus either celecoxib 200 mg o.d., naproxen 500 mg b.d., or placebo. Baseline and end of study endoscopies were performed. The primary end point was incidence of one or more gastric and duodenal ulcers.
Results
A lower incidence of gastric and duodenal ulcers was seen in celecoxib/aspirin‐treated subjects (19%) vs. naproxen/aspirin (27%; RR: 0.63, 95% CI: 0.44–0.92). Both naproxen/aspirin and celecoxib/aspirin groups demonstrated a higher incidence of gastric and duodenal ulcers vs. placebo/aspirin (8%; RR: 3.7, 95% CI: 1.8–7.6 and RR: 2.6, 95% CI: 1.2–5.8, respectively).
Conclusions
Fewer endoscopic ulcers were observed in patients treated with celecoxib/aspirin vs. naproxen/aspirin. However, celecoxib/aspirin was associated with a significantly higher incidence of gastric and duodenal ulcers than aspirin alone. Further studies are required to determine the generalizability of these findings in the aspirin users and to determine the appropriate strategy to minimize risk in susceptible patients.
Context. The potentially hazardous asteroid (85990) 1999 JV6 has been a target of previously published thermal-infrared observations and optical photometry. It has been identified as a promising ...candidate for possible Yarkovsky-O’Keefe-Radzievskii-Paddack (YORP) effect detection. Aims. The YORP effect is a small thermal-radiation torque considered to be a key factor in spin-state evolution of small Solar System bodies. In order to detect YORP on 1999 JV6 we developed a detailed shape model and analysed the spin-state using both optical and radar observations. Methods. For 1999 JV6, we collected optical photometry between 2007 and 2016. Additionally, we obtained radar echo-power spectra and imaging observations with Arecibo and Goldstone planetary radar facilities in 2015, 2016, and 2017. We combined our data with published optical photometry to develop a robust physical model. Results. We determine that the rotation pole resides at negative latitudes in an area with a 5° radius close to the south ecliptic pole. The refined sidereal rotation period is 6.536787 ± 0.000007 h. The radar images are best reproduced with a bilobed shape model. Both lobes of 1999 JV6 can be represented as oblate ellipsoids with a smaller, more spherical component resting at the end of a larger, more elongated component. While contact binaries appear to be abundant in the near-Earth population, there are only a few published shape models for asteroids in this particular configuration. By combining the radar-derived shape model with optical light curves we determine a constant-period solution that fits all available data well. Using light-curve data alone we determine an upper limit for YORP of 8.5 × 10−8 rad day−2. Conclusions. The bifurcated shape of 1999 JV6 might be a result of two ellipsoidal components gently merging with each other, or a deformation of a rubble pile with a weak-tensile-strength core due to spin-up. The physical model of 1999 JV6 presented here will enable future studies of contact binary asteroid formation and evolution.
The object P/2013 P5 PANSTARRS was discovered in August 2013, displaying a cometary tail, but its orbital elements indicated that it was a typical member of the inner asteroid main belt. We monitored ...the object from 2013 August 30 until 2013 October 05 using the CFHT 3.6 m telescope, the NTT, the CA 1.23 m telescope, the Perkins 1.8 m and the 0.6 m TRAPPIST telescope. We also propose that the components of a contact binary might gently rub and produce the observed emission. Volatile sublimation might also explain what appears as cometary activity over a period of 8 months. However, while main belt comets best explained by ice sublimation are found in the outskirts of the main belt, where water ice is believed to be able to survive buried in moderately large objects for the age of the solar system deeply, the presence of volatiles in an object smaller than 300 m in radius would be very surprising in the inner asteroid belt.
We present results from broad-band V- and R-filter observations obtained at the 4.2-m William Herschel Telescope on La Palma on 2002 July 12–14. A total of six comets were imaged, and their ...heliocentric distances ranged from 2.8 to 6.1 au. The comets observed were 43P/Wolf–Harrington, 129P/Shoemaker–Levy 3, 133P/Elst–Pizarro, 143P/Kowal–Mrkos, P/1998 U4 (Spahr) and P/2001 H5 (NEAT). A detailed surface brightness profile analysis indicates that three of the targeted comets (43P/Wolf–Harrington, 129P/Shoemaker–Levy 3 and P/1998 U4) were visibly active, and the remaining three comets were stellar in appearance. Further analysis shows that for the three ‘stellar-like’ comets the possible coma contribution to the observed flux does not exceed 12.2 per cent, and in the case of comet 143P/Kowal–Mrkos the coma contribution is expected to be as low as 1 per cent, and so the resulting photometry most likely represents that of the projected nucleus surface. Effective radii for the inactive comets range from 1.02 to 4.56 km, and the effective radius upper limits for the active comets range from 1.94 to 4.15 km. We assume an albedo and phase coefficient of 0.04 and 0.035 mag deg−1, respectively, with the exception of comets 133P/Elst–Pizarro and 143P/Kowal–Mrkos for which phase coefficients were previously measured. These values are compared with previous measurements, and for comet 43P/Wolf–Harrington we find that the nucleus axial ratio a/b could be as large as 2.44. For the active comets we measured dust production levels in terms of the Afρ quantity. Spectral gradients were extracted for two of the inactive comets from their measured broad-band colour indices, and compared with the rest of the comet population for which (V − R) colour and spectral gradient values exist. We find a spectral gradient for 143P/Kowal–Mrkos of 9.9 ± 8.1 per cent/100 nm, which is very typical of Jupiter-family comets, the majority of which have reflectivity gradients in the range 0–13 per cent (100 nm)−1. The spectral gradient for comet 133P/Elst–Pizarro is amongst the bluest yet measured. We measure a (V − R) colour index value of 0.14 ± 0.11 for the nucleus of 133P/Elst–Pizarro which is considerably lower than previous measurements. A possible explanation for this difference is considered.
This randomized, controlled trial involving patients with complicated intraabdominal infections and proper source control showed similar outcomes after fixed-duration antimicrobial therapy (4 days) ...and after a longer course (approximately 8 days).
Complicated intraabdominal infection continues to be a common problem worldwide. Approximately 300,000 cases of appendicitis occur each year in the United States,
1
and at least twice that many cases of non-appendiceal infection require management.
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Morbidity ranges from 5% among patients evaluated in broad observational studies
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–
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to close to 50% in some cohorts, such as the elderly or critically ill.
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,
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Despite the diversity of specific processes in these infections, the basic tenets of management are similar: resuscitate patients who have the systemic inflammatory response syndrome (SIRS), control the source of contamination, remove most of the infected or necrotic material, . . .
Recently over 62 pairs of asteroids have been shown to have very similar orbital elements. Backward integration of their orbits indicates that the asteroids in each pair likely had very close ...encounters at low relative velocities, consistent with models of the spin-up and rotational fission of asteroids. Although linked dynamically, the observation of highly similar spectra would suggest that the asteroids share a common composition, which we would expect if they formed from a common parent body.
We have begun an observational campaign whose aim is to obtain optical and/or NIR spectra of a large sample of these unbound asteroid pairs to determine whether the asteroids in each pair exhibit similar spectra. We present optical spectroscopic observations of four complete pairs obtained using the William Herschel Telescope. We find that the components of pairs 1979-13732 and 19289-278067 share very similar spectra and likely have a common origin. Our current spectra of 17198-229056 are sufficiently different to suggest that they do not have a common origin, although this is contrary to the strong dynamical linkup of these asteroids demonstrated in the current paper and previous studies. Further observations of this pair are encouraged to examine why the spectra are so different. It is unclear whether the spectra of the final pair, 11842-228747, are a match due to the low S/N of the secondary's spectrum. We discuss the process of space weathering and present new dynamical analyses which confirm the previously estimated ages of the observed pairs. The time-scale for space weathering appears to be longer than 1 Myr for at least some pairs. We also present an efficient method which can be used to determine the positional convergence of unbound asteroid pairs.
A device has been developed with moveable liquid nitrogen and liquid helium volumes that is capable of reaching over 2m into the coldest regions of a cryostat or dilution refrigerator and reliably ...extracting or installing a target of solid, polarized hydrogen deuteride (HD). This Transfer Cryostat incorporates a cylindrical neodymium rare-earth magnet that is configured as a Halbach dipole, which is maintained at 77K and produces a 0.1T field around the HD target. Multiple layers provide a hermetic 77K-shield as the device is used to maintain a target at 2K during a transfer between cryostats. Tests with frozen-spin HD show very little polarization loss for either H (−1±2%, relative) or D (0±3%, relative) over typical transfer periods. Multiple target transfers with this apparatus have shown an overall reliability of about 95% per transfer, which is a significant improvement over earlier versions of the device.
Context. Models have shown that asteroids can undergo fission if their rate of rotation is steadily increased. The forces acting to pull the asteroid apart exceed the material strength and ...gravitational force holding the asteroid together and material can escape from the surface of the asteroid. Initially forming a binary asteroid system, the components are capable of decoupling at low relative velocity from their mutual orbit if their mass ratio is less than 0.2. A number of asteroids with very similar orbital elements have been shown to have had very recent (<1 Myr) encounters at distances smaller than the Hill sphere radius of the larger of the asteroids. The mass ratio of the asteroids in each pair is estimated to be less than 0.2, suggesting that these unbound pairs are the result of rotational fission. Aims. We determine whether the asteroids in one such unbound pair, (7343) Ockeghem and (154 634) 2003 XX28, share a common composition, indicative of asteroids formed from a common parent and further constrain a likely formation age for this pair. Methods. We have obtained spectroscopic observations of each asteroid covering the wavelength range 0.45 to 1.0 microns. Using thermal observations we have measured the size and albedo of (7343) Ockeghem. Combined with optical lightcurve data of both asteroids, we have constrained the size and density of the asteroids and estimated the strength of the Yarkovsky force experienced by both. This improved physical information has been used in new dynamical simulations of the asteroids’ orbits to better constrain a formation time of this pair. Results. We find that the asteroids have very similar spectra consistent with an S-type taxonomy. The geometric albedo of (7343) Ockeghem, 0.20 ± 0.06 is consistent with this classification. The mass ratio range of the asteroids assuming an equal density, 0.007 to 0.065, is consistent with models of unbound asteroid pair formation. A new dynamical analysis has indicated that an absolute lower limit for the age of this pair is 400 kyr with a more likely age around 560 kyr, lower than a previous estimate of 800 kyr.
Context. Comets are believed to hold a relatively pristine record of the physical and chemical processes that occurred during the formation and evolution of the solar system. Thorough investigations ...of these small bodies, such as the one that will be performed by the ESA/Rosetta cornerstone mission, are thus supposed to bring strong and unique constraints on the origins of the solar system. Aims. Because comet 67P/Churyumov-Gerasimenko was only recently selected as the target for the ESA/Rosetta mission, there has been little opportunity to study its pre-perihelion activity. This phase is, however, very important for the mission, since the global mapping of the nucleus and the choice of landing site for Philae will be performed during this pre-perihelion phase. Here, we report previously unpublished data of the last pre-perihelion passage of this comet, observed between May and September 2008. Methods. The gas and dust activity of comet 67P/Churyumov-Gerasimenko are studied through visible spectroscopy and broadband imaging, respectively, covering a range of pre-perihelion heliocentric distances between 2.99 and 2.22 AU. Results. The data we have gathered on the dust activity are consistent with trends observed by other authors and show a strong asymmetry between the pre- and post-perihelion phases of the orbit. The spectra do not show any lines due to the emission of volatiles, and upper limits on their production rates are typically one order of magnitude lower than at the equivalent post-perihelion heliocentric distances. The asymmetry in the pre- and post-perihelion phases of the activity may be due to a dusty crust quenching the activity at the surface of 67P. We estimate that this crust could be about 12 cm thick, although not uniform across the surface. Even if no gas is individually detected, the coma surface brightness profiles might indicate a possible contamination from gaseous species emitted before the comet actually reaches perihelion.
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