Laparoscopic repair of a large interstitially incarcerated inguinal hernia

A 68 year old female presented for elective repair of an abdominal wall hernia. Preoperative CT imaging revealed a right inguinal hernia defect with hernia contents coursing cephalad between the external and internal abdominal oblique muscles. This was consistent with an interstitial inguinal hernia, a rare entity outside of post- traumatic hernias. At operation the hernia contents were reduced laparoscopically. The hernia was then repaired by transitioning to the totally extraperitoneal (TEP) approach using a 15cm X 15cm piece of polyester mesh. The patient had an uneventful recovery. Interstitial hernias are rare, difficult to diagnose and potentially dangerous if left untreated. There is no consensus on the ideal repair of these unique hernias. This represents a minimally invasive repair of an unusual hernia, with a novel approach to diagnose and manage the hernia and its redundant sac.

Infrared observations of the saturnian system from voyager 1

During the passage of Voyager 1 through the Saturn system, the infrared instrument acquired spectral and radiometric data on Saturn, the rings, and Titan and other satellites. Infrared spectra of Saturn indicate the presence of H(2), CH(4), NH(3), PH(3), C(2)H(2), C(2)H(6), and possibly C(3)H(4) and C(3)H(8). A hydrogen mole fraction of 0.94 is inferred with an uncertainty of a few percent, implying a depletion of helium in the atmosphere of Saturn relative to that of Jupiter. The atmospheric thermal structure of Saturn shows hemisphere asymmetries that are consistent with a response to the seasonally varying insolation. Extensive small-scale latitudinal structure is also observed. On Titan, positive identifications of infrared spectral features are made for CH(4), C(2)H(2), C(2)H(4), C(2)H(6), and HCN; tentative identifications are made for C(3)H(4) and C(3)H(8). The infrared continuum opacity on Titan appears to be quite small between 500 and 600 cm(-1), implying that the solid surface is a major contributor to the observed emission over this spectral range; between 500 and 200 cm(-1) theopacity increases with decreasing wave number, attaining an optical thickness in excess of 2 at 200 cm(-1). Temperatures near the 1-millibar level are independent of longitude and local time but show a decrease of approximately 20 K between the equator and north pole, which suggests a seasonally dependent cyclostrophic zonal flow in the stratosphere of approximately 100 meters per second. Measurements of the C ring of Saturn yield a temperature of 85 +/- 1 K and an infrared optical depth of 0.09 +/- 0.01. Radiometer observations of sunlight transmitted through the ring system indicate an optical depth of 10(-1.3 +/-0.3) for the Cassini division. A phase integral of 1.02 +/- 0.06 is inferred for Rhea, which agrees with values for other icy bodies in the solar system. Rhea eclipse observations indicate the presence of surface materials with both high and low thermal inertias, the former most likely a blocky component and the latter a frost.

Infrared observations of the neptunian system

The infrared interferometer spectrometer on Voyager 2 obtained thermal emission spectra of Neptune with a spectral resolution of 4.3 cm(-1). Measurements of reflected solar radiation were also obtained with a broadband radiometer sensitive in the visible and near infrared. Analysis of the strong C(2)H(2) emission feature at 729 cm(-1) suggests an acetylene mole fraction in the range between 9 x 10(-8) and 9 x 10(-7). Vertical temperature profiles were derived between 30 and 1000 millibars at 70 degrees and 42 degrees S and 30 degrees N. Temperature maps of the planet between 80 degrees S and 30 degrees N were obtained for two atmospheric layers, one in the lower stratosphere between 30 and 120 millibars and the other in the troposphere between 300 and 1000 millibars. Zonal mean temperatures obtained from these maps and from latitude scans indicate a relatively warm pole and equator with cooler mid-latitudes. This is qualitatively similar to the behavior found on Uranus even though the obliquities and internal heat fluxes of the two planets are markedly different. Comparison of winds derived from images with the vertical wind shear calculated from the temperature field indicates a general decay of wind speed with height, a phenomenon also observed on the other three giant planets. Strong, wavelike longitudinal thermal structure is found, some of which appears to be associated with the Great Dark Spot. An intense, localizd cold region is seen in the lower stratosphere, which does not appear to be correlated with any visible feature. A preliminary estimate of the effective temperature of the planet yields a value of 59.3 +/- 1.0 kelvins. Measurements of Triton provide an estimate of the daytime surface temperature of 38(+3)(-4) kelvins.

Venous thromboembolism--prophylactic and therapeutic practice guideline

BACKGROUND

Pharmacological prophylactic anticoagulation in many countries, including South Africa, is under-prescribed, which unfortunately results in unacceptable morbidity and mortality in a substantial number of patients.

METHOD

The Southern African Society of Thrombosis and Haemostasis reviewed the available literature as well as guidelines from other societies. Specialties represented on the committees included anaesthetics, cardiology, clinical haematology, critical care, gynaecology, haematopathology, internal medicine, neurology, orthopaedic surgery, pulmonology and vascular surgery. A draft document was produced, which was revised by consensus agreement. To avoid local bias, the guidelines were adjudicated by recognised independent international external experts. RESULTS AND CONCLUSION. A concise, practical guideline for thrombo-prophylaxis and treatment in medical and surgical patients has been produced for South African conditions. These guidelines will hopefully lead to improved anticoagulation practice in this country, which we believe will directly benefit patient outcomes.

Two variants in Ankyrin 3 (ANK3) are independent genetic risk factors for bipolar disorder

Two recent reports have highlighted ANK3 as a susceptibility gene for bipolar disorder (BD). We first reported association between BD and the ANK3 marker rs9804190 in a genome-wide association study (GWAS) of two independent samples (Baum et al., 2008). Subsequently, a meta-analysis of GWAS data based on samples from the US and the UK reported association with a different ANK3 marker, rs10994336 (Ferreira et al., 2008). The markers lie about 340 kb apart in the gene. Here, we test both markers in additional samples and characterize the contribution of each marker to BD risk. Our previously reported findings at rs9804190, which had been based on DNA pooling, were confirmed by individual genotyping in the National Institute of Mental Health (NIMH) waves 1-4 (P=0.05; odds ratio (OR)=1.24) and German (P=0.0006; OR=1.34) samples. This association was replicated in an independent US sample known as NIMH wave 5 (466 cases, 212 controls; P=0.017; OR=1.38). A random-effects meta-analysis of all three samples was significant (P=3 x 10(-6); OR=1.32), with no heterogeneity. Individual genotyping of rs10994336 revealed a significant association in the German sample (P=0.0001; OR=1.70), and similar ORs in the NIMH 1-4 and NIMH 5 samples that were not significant at the P<0.05 level. Meta-analysis of all three samples supported an association with rs10994336 (P=1.7 x 10(-5); OR=1.54), again with no heterogeneity. There was little linkage disequilibrium between the two markers. Further analysis suggested that each marker contributed independently to BD, with no significant marker x marker interaction. Our findings strongly support ANK3 as a BD susceptibility gene and suggest true allelic heterogeneity.

Utility of routine serial computed tomography for blunt intracranial injury

BACKGROUND

To determine the utility of routine serial head computed tomography (H-CT) for predicting need for invasive neurosurgical intervention in patients with blunt intracranial injuries (BICI).

METHODS

Patients treated at a Level I trauma center with BICI over a 4-year period were reviewed.

RESULTS

Of the 4,273 blunt trauma patients evaluated, 9.7% (415/4,273) were diagnosed as having BICI. Invasive intervention (craniotomy, ICP monitoring, ventriculostomy, or angiogram) was performed in 41.2% (171/415) of patients with BICI. Of these, 94.7% (162/171) had the procedure performed as a result of the initial H-CT. The remaining 5.3% (9/171) had the intervention performed as a result of a subsequent H-CT. Serial H-CT documented worsening of BICI in 32.3% (64/198) of the patients, but only those who had significant corresponding clinical deterioration had an invasive procedure as a result.

CONCLUSION

In patients with an unchanged or normal neurologic exam, a routine serial H-CT did not influence subsequent invasive neurosurgical intervention.

Evaluation of a fiberoptic blood gas monitor in neonates with congenital heart disease

BACKGROUND

Blood gas analysis is extremely important in perioperative management of neonates with congenital heart disease, where ventilator manipulation of the pulmonary vascular resistance is crucial. Delays in blood gas analysis resulting from transport of samples to a central laboratory may compromise management of these patients. Furthermore, neonates with congenital heart defects may have lower arterial oxygen (PaO2) levels due to intracardiac right-to-left shunting. We evaluated the Sensicath System in neonatal patients following cardiac surgery by simultaneously measuring specimens on the central laboratory blood gas analyzer.

METHODS

After patients returned from the operating room, the Sensicath System was connected to the arterial line. Blood was pulled across the sensor and re-infused to the patient after analysis. The accuracy and precision of the Sensicath System blood gas analysis results were assessed by comparison to simultaneous samples analyzed with a Corning 855 analyzer. The specimen-result turnaround time was recorded. 97 samples from 5 patients were compared.

RESULTS

Blood gas analysis results from the Sensicath System showed acceptable accuracy and precision: partial pressure of oxygen (PO2), r2 = 0.89, bias = -4.5 mm Hg, precision = 11.8; partial pressure of carbon dioxide (PCO2), r2 = 0.59, bias = -0.4 mm Hg, precision 6.2; pH, r2 = 0.78, bias = 0.03 mm Hg, precision 0.03. The central lab specimen-result turnaround time was 13.8 +/- 7.1 minutes. The Sensicath System provided results after a 60-second analysis time with no blood loss.

CONCLUSIONS

When compared to a Corning 855 blood gas analyzer, the Sensicath System was found to provide acceptable blood gas values, with no iatrogenic blood loss. This system may be especially helpful in infants with congenital heart defects, since rapid results are necessary for optimal patient care.

Efficacy and safety of ten day moxifloxacin 400 mg once daily in the treatment of patients with community-acquired pneumonia. Community Acquired Pneumonia Study Group

Community-acquired pneumonia (CAP) remains a common and serious illness with approximately 2-4 million cases reported annually. Management of CAP is therapeutically challenging due to the increasing prevalence of penicillin- and macrolide-resistant pneumococci and beta-lactamase producing Haemophilus influenzae, as well as the increased recognition of 'atypical' pathogens, such as Chlamydia pneumoniae and Mycoplasma pneumoniae, and the frequent need for empiric therapy. We aimed to evaluate the safety and efficacy of moxifloxacin in the treatment of patients with CAP. To do this we carried out a prospective, uncontrolled, non-blind, Phase III clinical trial, in 27 U.S. centers. Patients included in the study were over 18 years of age with signs and symptoms of CAP confirmed by evidence of a new or progressive infiltrate on chest radiograph. The intervention used was moxifloxacin 400 mg PO once daily for 10 days. Sputum samples were collected pretherapy for Gram stain and culture for typical organisms. Culture and serological testing for Chlamydia pneumoniae and Mycoplasma pneumoniae was also performed. Susceptibility to moxifloxacin was determined by disk diffusion and MIC. Clinical and bacteriological responses were determined at the end of therapy (0-6 days post-therapy), follow-up (14-35 days post-therapy) and overall (end of therapy plus follow-up). Analyses were performed on both valid for efficacy and intent-to-treat populations. The primary efficacy variable was overall clinical resolution. Of 254 patients enrolled in the Study, 196 patients were included in the efficacy analyses. The majority of patients were male (58%) and Caucasian (85%) with a mean age of 49 years (range: 18 to 85 years). Only 3% of patients were hospitalized pretherapy. The most common pretherapy organisms identified, by culture or serology, in the valid for efficacy population (i.e. 147 organisms among 116 patients), were: Chlamydia pneumoniae (n=63; 54%), Mycoplasma pneumoniae (n=29; 25%), Streptococcus pneumoniae (n=14; 12%) and Haemophilus influenzae (n=13; 10%). End of therapy, follow-up and overall clinical resolution rates for the valid for efficacy population were 94%, 93% and 93%, respectively. The 95% CI for the overall clinical resolution rate was 88.1%, 95.9%. The overall bacteriological response for patients diagnosed by culture or serological criteria, was 91% (95% CI=84%, 96%). For patients who only met serological criteria for infection, the overall bacteriological response was 94% (60/64). Bacterial response rates for the four most commonly isolated pathogens were: 89% (56/63) for C. pneumoniae, 93% (27/29) for M. pneumoniae, 93% (13/14) for S. pneumoniae and 85% (11/13) for H. influenzae. Drug-related adverse events were reported in 33% (85/254) of moxifloxacin-treated patients. Nausea (9%), diarrhea (6%) and dizziness (4%) were the most commonly reported adverse events. Atypical organisms were isolated in high frequency among patients with CAP. Moxifloxacin 400 mg once daily for 10 days was effective and well-tolerated in the treatment of these adult patients with CAP. Moxifloxacin offers an effective treatment alternative for CAP due to both typical and atypical bacterial pathogens.

Comparison of laparoscopic ultrasonography and fluorocholangiography in 300 patients undergoing laparoscopic cholecystectomy

BACKGROUND

This study compares laparoscopic ultrasonography to fluorocholangiography in detecting common bile duct (CBD) stones and delineating biliary anatomy.

METHODS

A prospective nonrandomized study of 300 consecutive patients undergoing laparoscopic cholecystectomy in a university hospital was performed. After port placement but before dissection, laparoscopic ultrasonography of the extrahepatic CBD was performed in both transverse and longitudinal planes. Cystic duct fluorocholangiography was attempted in all patients.

RESULTS

Of 300 patients, CBD stones were detected in 26 (9%) with 25 of these (96%) detected on laparoscopic ultrasonography. Sonography identified the location and size of the CBD as well as anomalous anatomy prior to dissection. No CBD injuries were encountered. End-fire transducers were easier to use than rigid or flexible side-fire transducers; all gave excellent image quality.

CONCLUSIONS

In this large study, laparoscopic ultrasonography and fluorocholangiography were equally sensitive in detecting CBD stones. Sonography delineates the biliary anatomy noninvasively and does not require dissection or opening of the biliary system. Laparoscopic ultrasonography may improve the safety of laparoscopic cholecystectomy, especially in cases of acute inflammation or distorted anatomy.

Causal diagrams for epidemiologic research

Causal diagrams have a long history of informal use and, more recently, have undergone formal development for applications in expert systems and robotics. We provide an introduction to these developments and their use in epidemiologic research. Causal diagrams can provide a starting point for identifying variables that must be measured and controlled to obtain unconfounded effect estimates. They also provide a method for critical evaluation of traditional epidemiologic criteria for confounding. In particular, they reveal certain heretofore unnoticed shortcomings of those criteria when used in considering multiple potential confounders. We show how to modify the traditional criteria to correct those shortcomings.

Logarithmic-Time Updates and Queries in Probabilistic Networks

Traditional databases commonly support efficient query and update procedures that operate in time which is sublinear in the size of the database. Our goal in this paper is to take a first step toward dynamic reasoning in probabilistic databases with comparable efficiency. We propose a dynamic data structure that supports efficient algorithms for updating and querying singly connected Bayesian networks. In the conventional algorithm, new evidence is absorbed in O(1) time and queries are processed in time O(N), where N is the size of the network. We propose an algorithm which, after a preprocessing phase, allows us to answer queries in time O(log N) at the expense of O(log N) time per evidence absorption. The usefulness of sub-linear processing time manifests itself in applications requiring (near) real-time response over large probabilistic databases. We briefly discuss a potential application of dynamic probabilistic reasoning in computational biology.

Causal inference from indirect experiments

An indirect experiment is a study in which randomized control is replaced by randomized encouragement, that is, subjects are encouraged, rather than forced, to receive a given treatment program. The purpose of this paper is to bring to the attention of experimental researchers simple mathematical results that enable us to assess, from indirect experiments, the strength with which causal influences operate among variables of interest. The results reveal that despite the laxity of the encouraging instrument, data from indirect experimentation can yield significant and sometimes accurate information on the impact of a program on the population as a whole, as well as on the particular individuals who participated in the program.

Prospective evaluation of the safety and efficacy of laparoscopic jejunostomy

We prospectively assessed the safety and efficacy of laparoscopic jejunostomy done by 11 surgeons in 8 medical centers using the T-fastener technique. In all, 23 men and 13 women aged 19 to 84 (mean, 59) years required enteral feeding, but could not undergo gastrostomy and had no contraindication to laparoscopy. Of these patients, 12 had head and neck cancer and 11 had neurologic swallowing dysfunction. The procedure took 25 to 180 minutes (mean, 75). Three (8%) early cases were converted to open jejunostomy because of accidental enterotomies caused by inappropriate techniques that were avoided in later cases. Minor technical problems, such as passing a needle through the back wall of the jejunum, occurred in 7 patients, but they were easily corrected and produced no complications. Feedings were routinely begun within 24 hours of the surgical procedure. All jejunostomy catheters functioned well. This is a safe and effective technique when done by experienced laparoscopic surgeons, and serious complications are rare.

Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome

The impact of a new therapy that includes pressure-controlled inverse ratio ventilation followed by extracorporeal CO2 removal on the survival of patients with severe ARDS was evaluated in a randomized controlled clinical trial. Computerized protocols generated around-the-clock instructions for management of arterial oxygenation to assure equivalent intensity of care for patients randomized to the new therapy limb and those randomized to the control, mechanical ventilation limb. We randomized 40 patients with severe ARDS who met the ECMO entry criteria. The main outcome measure was survival at 30 days after randomization. Survival was not significantly different in the 19 mechanical ventilation (42%) and 21 new therapy (extracorporeal) (33%) patients (p = 0.8). All deaths occurred within 30 days of randomization. Overall patient survival was 38% (15 of 40) and was about four times that expected from historical data (p = 0.0002). Extracorporeal treatment group survival was not significantly different from other published survival rates after extracorporeal CO2 removal. Mechanical ventilation patient group survival was significantly higher than the 12% derived from published data (p = 0.0001). Protocols controlled care 86% of the time. Average PaO2 was 59 mm Hg in both treatment groups. Intensity of care required to maintain arterial oxygenation was similar in both groups (2.6 and 2.6 PEEP changes/day; 4.3 and 5.0 FIO2 changes/day). We conclude that there was no significant difference in survival between the mechanical ventilation and the extracorporeal CO2 removal groups. We do not recommend extracorporeal support as a therapy for ARDS. Extracorporeal support for ARDS should be restricted to controlled clinical trials.

Ethical implications of standardization of ICU care with computerized protocols

Ethical issues related to the use of computerized protocols to control mechanical ventilation of patients with Acute Respiratory Distress Syndrome (ARDS) are identical to the ethical issues surrounding the use of any therapy or intervention. Four ethical principles must be considered: nonmaleficence, beneficence, autonomy, and distributed justice. The major ethical challenges to computerized protocol use as a specific application of clinical decision support tools are found within the principles of nonmaleficence and of beneficence. The absence of credible outcome data on which ARDS patient survival probabilities with different therapeutic options could be based is a constraint common to most ICU clinical decision making. Clinicians are thus deprived of the knowledge necessary to define benefit and are limited to beneficent intention in clinical decisions. Computerized protocol controlled decision making for the clinical management of mechanical ventilation for ARDS patients is ethically defensible. It is as well supported as most ICU therapy options.

The microvascular distribution of cardioplegic solution in the piglet heart. Retrograde versus antegrade delivery

The uniform distribution of cardioplegic solution to all areas of the microvasculature is considered critical for myocardial protection. Despite this, little information exists regarding the ability of retrogradely infused cardioplegic solution to perfuse the microvasculature of the heart. In this report, the microvascular distribution of retrogradely delivered cardioplegic solution was studied by means of a technique to quantitatively demonstrate capillary perfusion. Duroc piglet hearts were subjected to either antegrade (n = 4) or retrograde (n = 8) perfusion fixation with 2.5% glutaraldehyde and subsequently perfused with NTB-2 (an intracapillary marker). The results indicate that retrogradely delivered NTB-2 consistently perfused the anterior half of the intraventricular septum and the anterior and lateral free walls of the left ventricle but inconsistently perfused the posterior half of the intraventricular septum, the posterior wall of the left ventricle, and a small paraseptal region of the right ventricle. The remainder of the right ventricle was not perfused. In contradistinction, all regions of the heart were consistently perfused by the antegrade technique. In regions of the heart in which retrograde microvascular perfusion occurred, no statistical difference was found in the quantitative degree of capillary perfusion achieved by either the antegrade or retrograde technique. These results have important implications for planning strategies of myocardial protection and suggest that further investigation concerning the microvascular distribution of retrogradely delivered cardioplegic solution in human beings is merited.

Frequent amplification of the bcl-1 locus in poorly differentiated squamous cell carcinoma of the lung. The Lung Cancer Study Group

The bcl-1 locus on chromosome 11 at band q13 has been shown to be rearranged in some chronic B lymphoid malignancies with the t(11;14)(q13;q32). Chromosome 11 abnormalities occur in solid tumors including squamous cell cancers and adenocarcinomas. We have recently reported the frequency amplification of the bcl-1 locus in squamous cell carcinomas of head and neck origin, and increased copy number also has been found in some breast adenocarcinomas. In this investigation, we analyzed the arrangement, copy number and expression of this locus in 111 primary non-small cell lung cancers. Bcl-1 was found to be amplified three- to 10-fold in seven fresh tumors. Whereas none of 51 adenocarcinomas showed bcl-1 amplification, six of 46 squamous cell carcinomas revealed an increase in bcl-1 copy number. This amplification was more frequently associated with larger and more poorly differentiated tumors. None of the cancers showed rearrangement of this locus.

Improved neonatal heart preservation with an intracellular cardioplegia and storage solution

The optimal conditions for preservation of the neonatal heart for transplantation remain uncertain. An isolated, working neonatal piglet heart model was used to compare a standard extracellular-like cardioplegic solution followed by storage at 4 degrees C in normal saline for 12 hr (n = 8) to cardioplegia and storage at 4 degrees C for 24 hr in an intracellular-like solution (n = 7). Seven of eight hearts in the 12-hr Extracellular Group failed to regain function, with a maximum stroke work index (SWI), developed at a left ventricular end-diastolic pressure (LVEDP) of 9 mm Hg of 0.91 +/- 0.30 x 10(3) erg/g (mean +/- standard error of the mean), 7.1% of nonpreserved control hearts. In contrast, all hearts arrested and stored for 24 hr in the intracellular solution regained function with a maximum SWI, again at a LVEDP of 9 mm Hg of 9.51 +/- 1.98 X 10(3) erg/g, 73.7% of control (P less than 0.05). Ultrastructural changes seen by electron microscopy paralleled the functional results. We conclude that an intracellular arrest and storage solution may be superior to conventional solutions for extended preservation of the neonatal heart.

Surgical options for complex transposition of the great arteries

Between September 1976 and November 1987, 53 patients underwent surgical treatment by the same surgeon for "complex transposition of the great arteries" with ventricular septal defect or severe left ventricular outflow tract obstruction, or both. Six patients with transposition and left ventricular outflow tract obstruction underwent atrial rerouting and direct relief of the left ventricular outflow tract obstruction. Twenty-two patients presented with transposition plus ventricular septal defect; 15 of these patients underwent atrial rerouting and ventricular septal defect closure and 7 underwent an arterial switch procedure. Twenty-five patients presented with transposition plus ventricular septal defect and left ventricular outflow tract obstruction, 23 of whom underwent a Rastelli procedure. There were one early death (mortality rate 1.9%; 90% confidence limits 0-7%) and three late deaths (mortality rate 5.8%) during a mean follow-up period of 42 months (range 2 to 124). These results show that 1) atrial rerouting is an appropriate surgical procedure for transposition of the great arteries with left ventricular outflow tract obstruction; 2) the arterial switch procedure provides excellent early correction of transposition with ventricular septal defect and is currently the preferred procedure for this lesion; and 3) the Rastelli procedure can be performed with a low early mortality rate and excellent long-term results for transposition with ventricular septal defect and left ventricular outflow tract obstruction.

Differential modification of morphine and methadone dependence by interferon alpha

Subcutaneous implantation of a pellet of methadone was presented as a novel method for the establishment of physical dependence upon this agent and it was compared to (1) the state of physical dependence induced by multiple injections of methadone, administered over several days, and (2) the dependence established by injections of morphine and the implantation of a morphine pellet. Comparable signs of drug dependence were observed in rats treated with both morphine and methadone following the administration of the opiate antagonist naloxone. The administration of interferon-alpha significantly attenuated the severity of the withdrawal syndrome in dependent rats after chronic exposure to morphine and to a lesser extent after morphine and methadone in combination. In contrast, alpha interferon did not affect 6 of the 7 abstinence signs in animals dependent upon methadone alone. The observations suggest that the states of physical dependence upon morphine and methadone may be separate phenomena that involve different physiological mechanisms. Thus, interferon may be a useful adjunct in the treatment of subjects dependent upon morphine but not in those dependent on methadone.

Infrared Observations of the Uranian System

The infrared interferometer spectrometer (IRIS) on Voyager 2 recorded thermal emission spectra of Uranus between 200 and 400 cm(-1) and of Miranda and Ariel between 200 and 500 cm(-1) with a spectral resolution of 4.3 cm(-1). Reflected solar radiation was also measured with a single-channel radiometer sensitive in the visible and near infrared. By combining IRIS spectra with radio science results, a mole fraction for atmospheric helium of 0.15 +/- 0.05 (mass fraction, 0.26 +/- 0.08) is found. Vertical temperature profiles between 60 and 900 millibars were derived from average polar and equatorial spectra. Temperatures averaged over a layer between 400 to 900 millibars show nearly identical values at the poles and near the equator but are 1 or 2 degrees lower at mid-latitudes in both hemispheres. The cooler zone in the southern hemisphere appears darker in reflected sunlight than the adjacent areas. An upper limit for the effective temperature of Uranus is 59.4 kelvins. Temperatures of Miranda and Ariel at the subsolar point are 86 +/- 1 and 84 +/- 1 kelvins, respectively, implying Bond albedos of 0.24 +/- 0.06 and 0.31 +/- 0.06, respectively. Estimates of phase integrals suggest that these satellites have unusual surface microstructure.

3,4-Diphenyl-1H-pyrazole-1-propanamine antidepressants

A small series of compounds is described in which a narrow SAR has identified N,N-dimethyl-3,4-diphenyl-1H-pyrazole-1-propanamine, 3, as a potential antidepressant with reduced side effects. The isomeric N,N-dimethyl-4,5-diphenyl-1H-pyrazole-1-propanamine was completely inactive in the primary antidepressant screens. Compounds were synthesized by Michael addition of acrylonitrile to diphenylpyrazole followed by reductive alkylation of the resultant diphenylpyrazolepropionitriles. Compound 3 was equipotent with imipramine in standard antidepressant assays in animals but showed no significant anticholinergic action and did not antagonize the antihypertensive effects of clonidine and guanethidine.

Some recent results in heuristic search theory

The paper summarizes recent analytical investigations of the mathematical properties of heuristics and their influence on the performance of common search techniques. The results are reported without proofs together with discussions of motivations and interpretations. The highlights include the following: the optimality of A*; relations between the precision of the heuristic estimates and the average complexity of the search; comparisons of the average complexities of A* and BACKTRACKING; procedures for comparing and combining nonadmissible heuristic functions; the influence of the weight w (in f = (l - w) g + wh) on the complexity of A*; the pruning power of alphabeta, SSS*, and SCOUT; the effect of successor ordering on search complexity, and the effect of search depth of the quality of decisions in game-playing.

Parasympatholytic (anticholinergic) esters of the isomeric 2-tropanols. 2. Non-glycolates

The 19 esters in Table I were prepared from (+)-2 alpha-tropanol, (-)-2 beta-tropanol, (+/-)-3-quinuclidinol, and a variety of non-glycolic acids in order to compare their central and peripheral activities with those of the glycolates reported in the previous paper. The results (Table II) showed that esters 6 and 17 were approximately equivalent to one another and to atropine, that 8 was equal in both central and peripheral activity to reference glycolates, that 9 and 19 were less active than 8 but 9 had a substantially reduced central activity, and that 10 and 11 were more active than the methoxy analogue reported earlier.

Studies in semi-admissible heuristics

The paper introduces three extensions of the A* search algorithm which improve the search efficiency by relaxing the admissibility condition. 1) A* employs an admissible heuristic function but invokes quicker termination conditions while still guaranteeing that the cost of the solution found will not exceed the optimal cost by a factor greater than 1 + . 2) R¿* may employ heuristic functions which occasionally violate the admissibility condition, but guarantees that at termination the risk of missing the opportunity for further cost reduction is at most ¿. 3) R¿*,* is a speedup version of R¿*, combining the termination condition of A* with the risk-admissibility condition of R¿*. The Traveling Salesman problem was used as a test vehicle to examine the performances of the algorithms A* and R¿*. The advantages of A* are shown to be significant in difficult problems, i.e., problems requiring a large number of expansions due to the presence of many subtours of roughly equal costs. The use of R¿* is shown to produce a 4:1 reduction in search time with only a minor increase in final solution cost.

GODDESS: A Goal-Directed Decision Structuring System

This paper describes an operational version of a computerized, domain-independent, decision support system which is based on a novel, goal-directed structure for representing decision problems. The structure allows the user to state relations among aspects, effects, conditions, and goals, in addition to actions and states which are the basic components of the traditional decision tree approach. The program interacts with the user in a stylized English-like dialogue, starting with the stated objectives and proceeding to unravel the more detailed means by which these objectives can be realized. At any point in time, the program focuses the user's attention on the issues which are most crucial to the problem at hand. The structure used is more compatible with the way people encode knowledge about problems and actions, and therefore promises to offer the following advantages: 1) judgments and beliefs issued by the user constitute a more valid representation of the user's experience; and 2) the user may be guided toward the discovery of action alternatives he otherwise would not have identified.

Infrared Observations of the Saturnian System from Voyager 2

During the passage of Voyager 2 through the Saturn system, infrared spectral and radiometric data were obtained for Saturn, Titan, Enceladus, Tethys, Iapetus, and the rings. Combined Voyager 1 and Voyager 2 observations of temperatures in the upper troposphere of Saturn indicate a seasonal asymmetry between the northern and southern hemispheres, with superposed small-scale meridional gradients. Comparison of high spatial resolution data from the two hemispheres poleward of 60 degrees latitude suggests an approximate symmetry in the small-scale structure, consistent with the extension of a symmetric system of zonal jets into the polar regions. Longitudinal variations of 1 to 2 K are observed. Disk- averaged infrared spectra of Titan show little change over the 9-month interval between Voyager encounters. By combining Voyager 2 temperature measurements with ground-based geometric albedo determinations, phase integrals of 0.91 +/- 0.13 and 0.89 +/- 0.09 were derived for Tethys and Enceladus, respectively. The subsolar point temperature of dark material on Iapetus must exceed 110 K. Temperatures (and infrared optical depths) for the A and C rings and for the Cassini division are 69 +/- 1 K (0.40 +/- 0.05), 85 +/- 1 K (0.10 +/- 0.03), and 85 +/- 2 K (0.07 +/- 0.04), respectively.

Infrared Observations of the Jovian System from Voyager 2

Infrared spectra obtainedfrom Voyager 2 have provided additional data on the Jovian system, complementing those obtained from Voyager 1. The abundance ratio of ethane to acetylene in Jupiter's atmosphere appears to be about three times larger in the polar regions than at lower latitudes. A decidedly hemispherical asymmetry exists, with somewhat higher ratios prevailing in northern latitudes. An overall increase in the abundance ratio by a factor of about 1.7 appears to have occurred between the Voyager 1 and 2 encounters. Global brightness temperature maps of Jupiter at 226 and 602 cm(-1) exhibit a large amount of local- and planetary-scale structure, as well as temporal variability. Although heterogeneous cloud structure and ammonia concentration in the lower troposphere may contribute to the appearance of the 226-cm(-1) map, the detail in the 602-cm(-1) maps probably represents the actual horizontal thermal structure near the tropopause and suggests that dynamical heating and cooling processes are important. Low-latitude surface temperatures on the Galilean satellites rangefrom approximately 80 K on the dark sides to 155 K at the subsolar point on Callisto. Below a thin insulating layer, the thermal inertia of Callisto is somewhat greater than that of Earth's moon. Upper limits on the infrared optical depth of the Jovian ring rangingfrom approximately 3 x 10(-4) at 250 cm(-1) to 3 x 10(-3) at 600 cm(-1) have been found.

Discovery of Currently Active Extraterrestrial Volcanism

The infrared spectroscopy and radiometry investigation has obtained spectra of Jupiter and its satellites between approximately 180 and 2500 cm(-1) with a spectral resolution of 4.3 cm(-1). The Jupiter spectra show clear evidence of H(2), CH(4) C(2)H(2), C(2)H(6), CH(3)D, NH(3), PH(3), H(2)O, and GeH(4). A helium concentration of 0.11 +/- 0.03 by volume is obtained. Meridional temperature cross sections show considerable structure. At high latitudes, the stratosphere is warmer in the north than in the south. The upper troposphere and lower stratosphere are locally cold over the Great Red Spot. Amalthea is warmer than expected. Considerable thermal structure is observed on Io, including a relatively hot region in the vicinity of a volcanic feature.

Asymptotic properties of discrete unitary transforms

A method for studying the asymptotic behavior of discrete transformations is developed using numerical quadrature theory. This method allows a more convenient examination of the correlation properties of common unitary transforms for large block sizes. As a practical result of this method it is shown that the discrete cosine transform is asymptotically optimal for all finite-order Markov signals.

Capacity and error estimates for boolean classifiers with limited complexity

This paper extends the notions of capacity and distribution-free error estimation to nonlinear Boolean classifiers on patterns with binary-valued features. We establish quantitative relationships between the dimensionality of the feature vectors (d), the combinational complexity of the decision rule (c), the number of samples in the training set (n), and the classification performance of the resulting classifier. Our results state that the discriminating capacity of Boolean classifiers is given by the product dc, and the probability of ambiguous generalization is asymptotically given by (n/dc 1)-i 0(1Og d)/d) for large d, and n = O(dc). In addition we show that if a fraction v of the training samples is misclassified then the probability of error (r) in subsequent samples satisfies P(17r - vl > e) : 2.773 exp (dc - e2n/8) for all distributions, regardless of how the classifier was discovered.

(exo, exo)-2-Aryltropane-3-carboxylic esters, hypoglycemic agents with accompanying analgesic activity

(exo, exo)-2-Aryltropane-3-carboxylic esters of types 6, 7, and 10 lower circulating blood glucose levels by 60--80%. This activity is accompanied by an analgesic activity roughly equal to that of codeine. Both of these activities reside in the 1R enantiomer and extensive structure-activity studies failed to separate them. The specific opioid antagonist nalorphine blocks the analgesic activity but does not diminish the hypoglycemic action. Conformational integrity afforded by the ethylene bridge is neccessary for the observed activities.

Effect of apomorphine and its N-propyl homologue on ethanol withdrawal head twitches in mice

Collier, Hammond & Schneider (1976) reported that apomorphine, given orally, decreased the incidence of head twitches induced by ethanol withdrawal. These results were confirmed in the present study. Moreover, the N-propyl homologue of apomorphine was about 45 times more potent than apomorphine in affecting head twitching.

Parasympatholytic (anticholinergic) esters of the isomeric 2-tropanols. 1. Glycolates

The 38 esters in Table I were prepared from the four isomeric 2-tropanols and a variety of racemic glycolic acids and their optical isomers. Anticholinergic activity in mice was measured in the peripheral nervous system (mydriasis) and in the central nervous system (anti-tremorine) and compared with that of atropine, scopolamine, and racemic 2-quinuclidinyl benzilate. The results (Table III) showed that several esters (such as 8, 12, 14, and 21) had significantly greater activity in both the peripheral and central nervous systems than did the reference compounds. Esters of (+)-2alpha-tropanol were more potent than those of either its epimer (-)-2beta-tropanol or its optical isomer(-)-2alpha-tropanol. Esters derived from (-)-glycolic acids were uniformly more potent than those from the (+)-glycolic acids. Esters of (+)-2alpha-notropanol and five of its N-substituted derivatives had markedly decreased activity. Peripheral/central activity ratios and time-activity profiles for five active compounds are discussed and compared with those of the reference compounds.

Chylous ascites: the first reported surgical cure by direct ligation

A patient with apparently intractable chylous ascites was finally explored after the administration of preoperative lipophilic dye. This made identification of a leaking lacteal possible and ligation resulted in a cure.