While selected pancreatic diseases may be best treated by total pancreatectomy (TP), the anticipa... more While selected pancreatic diseases may be best treated by total pancreatectomy (TP), the anticipated sequelae of pancreatic insufficiency make TP an undesirable alternative. Our aim was to determine if patients undergoing TP have a worse quality of life (QoL) than age-and gender-matched controls and poor long-term glycemic control. Ninety-nine patients undergoing TP from 1985 through 2002 were identified. The 34 survivors with no recurrent malignancy were surveyed with the Short Form-36 (SF-36), the Audit of Diabetes Dependent QoL (ADD QoL), the European Organization for Research and Treatment in Cancer Pancreas 26 (EORTC PAN 26), and our institutional questionnaire. Operative morbidity and mortality were 32% and 5%, respectively. Three late postoperative deaths (3%) were attributed to hypoglycemia. Of the 34 surviving patients, 27 (79%) agreed to participate at a mean of 7.5 years postoperatively. Seven patients had required 12 hospitalizations for poor glycemic control. Per the SF-36, two domains (role physical and general health) were decreased compared with an age-and gendermatched national population (P ! .05). The ADD QoL demonstrated an overall decrease in QoL related specifically to the diabetes mellitus (P ! .01), but comparison with insulin-dependent diabetics from other causes showed no significant difference in QoL. The EORTC PAN 26 instrument also showed measurable effects on QoL. Total pancreatectomy can be performed safely. QoL after TP is decreased compared with age-and gender-matched controls but not with diabetes from other causes; however, the changes are not overwhelming. TP should remain a viable option but in selected patients.
This study examines the mechanisms resulting in the penetration into a deep mountain valley of mo... more This study examines the mechanisms resulting in the penetration into a deep mountain valley of momentum that is associated with a cross-mountain flow and wave activity aloft. The study is based on the observational data analysis and numerical simulations. The observations used in the analysis come from two recent field campaigns, the Sierra Rotors Project (2004) and the Terrain-induced Rotor Experiment (2006). The numerical simulations have been performed using the Coupled Ocean Atmosphere Mesoscale Prediction System (COAMPS) and involve both real case and idealized experiments. Data from a network of surface observing stations in Owens Valley was used to identify Intensive Observing Periods with westerly wind events and to detect the onset time of westerlies. Pairs of simultaneous upstream and downstream radiosonde soundings bracketing the time of onset were examined to determine whether significant changes in the upstream wind speed and stability structure or differences between upstream and valley temperature due to diurnal heating within the valley were occurring at the time of onset. The real case sensitivity experiments on a selected number of SRP and T-REX events were used to examine the effect of the downstream mountain range, radiative heating, and moisture on the onset of westerlies. The simulation results show that the downstream mountain range usually has a weakening effect on the mountain wave and surface flow, while the absence of diurnal heating weakens or destroys the surface westerlies if strong dynamic forcing is not present. The effects of condensation processes seems to depend on the flow structure and amount of cloud in the baseline simulations. The idealized simulations with linear positive wind shear profiles show that, in the absence of diurnal heating, the flow cannot penetrate to the valley floor unless the ratio Nh/U decreases to near 2 and the Richardson number decreases to near 4 or a strong inversion is located at the mountain crest. When the effect of surface heating is included, weaker flows can penetrate the valley in approximately 6-7 hours, while surface cooling significantly weakens the wave structure.
While selected pancreatic diseases may be best treated by total pancreatectomy (TP), the anticipa... more While selected pancreatic diseases may be best treated by total pancreatectomy (TP), the anticipated sequelae of pancreatic insufficiency make TP an undesirable alternative. Our aim was to determine if patients undergoing TP have a worse quality of life (QoL) than age-and gender-matched controls and poor long-term glycemic control. Ninety-nine patients undergoing TP from 1985 through 2002 were identified. The 34 survivors with no recurrent malignancy were surveyed with the Short Form-36 (SF-36), the Audit of Diabetes Dependent QoL (ADD QoL), the European Organization for Research and Treatment in Cancer Pancreas 26 (EORTC PAN 26), and our institutional questionnaire. Operative morbidity and mortality were 32% and 5%, respectively. Three late postoperative deaths (3%) were attributed to hypoglycemia. Of the 34 surviving patients, 27 (79%) agreed to participate at a mean of 7.5 years postoperatively. Seven patients had required 12 hospitalizations for poor glycemic control. Per the SF-36, two domains (role physical and general health) were decreased compared with an age-and gendermatched national population (P ! .05). The ADD QoL demonstrated an overall decrease in QoL related specifically to the diabetes mellitus (P ! .01), but comparison with insulin-dependent diabetics from other causes showed no significant difference in QoL. The EORTC PAN 26 instrument also showed measurable effects on QoL. Total pancreatectomy can be performed safely. QoL after TP is decreased compared with age-and gender-matched controls but not with diabetes from other causes; however, the changes are not overwhelming. TP should remain a viable option but in selected patients.
This study examines the mechanisms resulting in the penetration into a deep mountain valley of mo... more This study examines the mechanisms resulting in the penetration into a deep mountain valley of momentum that is associated with a cross-mountain flow and wave activity aloft. The study is based on the observational data analysis and numerical simulations. The observations used in the analysis come from two recent field campaigns, the Sierra Rotors Project (2004) and the Terrain-induced Rotor Experiment (2006). The numerical simulations have been performed using the Coupled Ocean Atmosphere Mesoscale Prediction System (COAMPS) and involve both real case and idealized experiments. Data from a network of surface observing stations in Owens Valley was used to identify Intensive Observing Periods with westerly wind events and to detect the onset time of westerlies. Pairs of simultaneous upstream and downstream radiosonde soundings bracketing the time of onset were examined to determine whether significant changes in the upstream wind speed and stability structure or differences between upstream and valley temperature due to diurnal heating within the valley were occurring at the time of onset. The real case sensitivity experiments on a selected number of SRP and T-REX events were used to examine the effect of the downstream mountain range, radiative heating, and moisture on the onset of westerlies. The simulation results show that the downstream mountain range usually has a weakening effect on the mountain wave and surface flow, while the absence of diurnal heating weakens or destroys the surface westerlies if strong dynamic forcing is not present. The effects of condensation processes seems to depend on the flow structure and amount of cloud in the baseline simulations. The idealized simulations with linear positive wind shear profiles show that, in the absence of diurnal heating, the flow cannot penetrate to the valley floor unless the ratio Nh/U decreases to near 2 and the Richardson number decreases to near 4 or a strong inversion is located at the mountain crest. When the effect of surface heating is included, weaker flows can penetrate the valley in approximately 6-7 hours, while surface cooling significantly weakens the wave structure.
Uploads
Papers by Brian Billings