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Objective: The prevalence of mental illness among those in prison is much higher than in the community; however, very few studies have examined whether rates have changed over time, in line with increasing self-reported rates in the community. Methods: This study compares the prevalence of self-reported mental illness, self-harm and suicidal thoughts/behaviours, and drug and alcohol use across three waves (2001, 2009 and 2015) of health surveys involving men and women in New South Wales prisons and compared these rates with published community-level findings. Results: The prevalence of those reporting any mental health diagnosis increased significantly across the three surveys, even after adjustment for socio-demographic and criminal justice variables that also changed over time. Individuals surveyed in 2015 were more likely to report a mental health diagnosis than those surveyed in 2001 (adjusted odds ratio = 2.66, 95% confidence interval = [2.16, 3.27]). The prevalence of self-harm and suicidal thoughts and behaviours remained stable across the three surveys, while self-reported regular drug use decreased over the period. Women experienced a far greater burden of mental illness than men across all three surveys and experienced more growth in the prevalence of most psychiatric disorders. Conclusion: These findings have important implications for public and prison health systems given the poor social, health and criminal justice outcomes of those imprisoned with mental illness, both in custody and post-release.

Guilt, shame, and moral injury (MI) are common reactions following exposure to traumatic events and are associated with greater severity of several mental health problems, including posttraumatic stress disorder (PTSD), depression, increased risk of suicidal ideation and poorer psychosocial functioning. Trauma-Informed Guilt Reduction (TrIGR) is a transdiagnostic psychotherapy to address guilt, shame, and MI stemming from traumatic events. The primary goals of TrIGR are to help patients accurately appraise their trauma and to re-engage with their values in order to lead a more meaningful life. This paper presents the rationale, design, and methodology of a two-site randomized controlled trial (RCT) examining the efficacy of TrIGR compared to Supportive Care Therapy (SCT) in a sample of U.S. veterans (N = 145) who endorse guilt related to a traumatic event that occurred during military deployment. This study is the first RCT powered to investigate TrIGR's efficacy on reducing posttraumatic guilt, as measured by the Trauma Related Guilt Inventory (TRGI), in comparison to an active control condition. In addition, the study will examine a range of secondary and exploratory outcomes including shame, quality of life, suicidal ideation, substance use, and PTSD and depression symptoms. Findings from this efficacy study will be essential in informing future efficacy and effectiveness trials.

Patients who use cannabis for medical reasons may benefit from discussions with clinicians about health risks of cannabis and evidence-based treatment alternatives. However, little is known about the prevalence of medical cannabis use in primary care and how often it is documented in patient electronic health records (EHR).To estimate the primary care prevalence of medical cannabis use according to confidential patient survey and to compare the prevalence of medical cannabis use documented in the EHR with patient report.This study is a cross-sectional survey performed in a large health system that conducts routine cannabis screening in Washington state where medical and nonmedical cannabis use are legal. Among 108 950 patients who completed routine cannabis screening (between March 28, 2019, and September 12, 2019), 5000 were randomly selected for a confidential survey about cannabis use, using stratified random sampling for frequency of past-year use and patient race and ethnicity. Data were analyzed from November 2020 to December 2021.Survey measures of patient-reported past-year cannabis use, medical cannabis use (ie, explicit medical use), and any health reason(s) for use (ie, implicit medical use).Survey data were linked to EHR data in the year before screening. EHR measures included documentation of explicit and/or implicit medical cannabis use. Analyses estimated the primary care prevalence of cannabis use and compared EHR-documented with patient-reported medical cannabis use, accounting for stratified sampling and nonresponse.Overall, 1688 patients responded to the survey (34% response rate; mean [SD] age, 50.7 [17.5] years; 861 female [56%], 1184 White [74%], 1514 non-Hispanic [97%], and 1059 commercially insured [65%]). The primary care prevalence of any past-year patient-reported cannabis use on the survey was 38.8% (95% CI, 31.9%-46.1%), whereas the prevalence of explicit and implicit medical use were 26.5% (95% CI, 21.6%-31.3%) and 35.1% (95% CI, 29.3%-40.8%), respectively. The prevalence of EHR-documented medical cannabis use was 4.8% (95% CI, 3.45%-6.2%). Compared with patient-reported explicit medical use, the sensitivity and specificity of EHR-documented medical cannabis use were 10.0% (95% CI, 4.4%-15.6%) and 97.1% (95% CI, 94.4%-99.8%), respectively.These findings suggest that medical cannabis use is common among primary care patients in a state with legal use, and most use is not documented in the EHR. Patient report of health reasons for cannabis use identifies more medical use compared with explicit questions about medical use.

Key Points Question Among primary care patients, what is the prevalence of electronic health record documentation of medical cannabis use and health conditions for which cannabis use might have benefits and risks? Findings In this cross-sectional study of 185 565 patients, 2% had past-year medical cannabis use documented in their electronic health records. Among patients with documented medical cannabis use, 44.5% had documented health conditions for which cannabis use might confer benefits, and 54.5% had conditions for which it might confer risks. Meaning These findings suggest that primary care practitioners should be prepared to discuss potential risks as well as potential benefits of cannabis use with patients., Importance Many people use cannabis for medical reasons despite limited evidence of therapeutic benefit and potential risks. Little is known about medical practitioners’ documentation of medical cannabis use or clinical characteristics of patients with documented medical cannabis use. Objectives To estimate the prevalence of past-year medical cannabis use documented in electronic health records (EHRs) and to describe patients with EHR-documented medical cannabis use, EHR-documented cannabis use without evidence of medical use (other cannabis use), and no EHR-documented cannabis use. Design, Setting, and Participants This cross-sectional study assessed adult primary care patients who completed a cannabis screen during a visit between November 1, 2017, and October 31, 2018, at a large health system that conducts routine cannabis screening in a US state with legal medical and recreational cannabis use. Exposures Three mutually exclusive categories of EHR-documented cannabis use (medical, other, and no use) based on practitioner documentation of medical cannabis use in the EHR and patient report of past-year cannabis use at screening. Main Outcomes and Measures Health conditions for which cannabis use has potential benefits or risks were defined based on National Academies of Sciences, Engineering, and Medicine’s review. The adjusted prevalence of conditions diagnosed in the prior year were estimated across 3 categories of EHR-documented cannabis use with logistic regression. Results A total of 185 565 patients (mean [SD] age, 52.0 [18.1] years; 59% female, 73% White, 94% non-Hispanic, and 61% commercially insured) were screened for cannabis use in a primary care visit during the study period. Among these patients, 3551 (2%) had EHR-documented medical cannabis use, 36 599 (20%) had EHR-documented other cannabis use, and 145 415 (78%) had no documented cannabis use. Patients with medical cannabis use had a higher prevalence of health conditions for which cannabis has potential benefits (49.8%; 95% CI, 48.3%-51.3%) compared with patients with other cannabis use (39.9%; 95% CI, 39.4%-40.3%) or no cannabis use (40.0%; 95% CI, 39.8%-40.2%). In addition, patients with medical cannabis use had a higher prevalence of health conditions for which cannabis has potential risks (60.7%; 95% CI, 59.0%-62.3%) compared with patients with other cannabis use (50.5%; 95% CI, 50.0%-51.0%) or no cannabis use (42.7%; 95% CI, 42.4%-42.9%). Conclusions and Relevance In this cross-sectional study, primary care patients with documented medical cannabis use had a high prevalence of health conditions for which cannabis use has potential benefits, yet a higher prevalence of conditions with potential risks from cannabis use. These findings suggest that practitioners should be prepared to discuss potential risks and benefits of cannabis use with patients., This cross-sectional study describes the prevalence and clinical characteristics of primary care patients with cannabis use documented in their electronic health records.

Nephron-sparing surgery in the form of partial nephrectomy is increasingly becoming the standard of care in patients with small renal tumours. Oncological outcomes for partial nephrectomy are equivalent to radical nephrectomy, however, clamping of the hilar vessels to allow resection of tumours during partial nephrectomy may cause ischaemic damage to the kidney and result in long-term renal impairment. We carried out a retrospective review of 43 patients undergoing laparoscopic partial nephrectomy (LPN) and assessed functional and oncological outcomes. The operative technique initially utilised a thulium laser, with later cases using the LigaSure™ vessel sealing device. All patients underwent preoperative cross sectional imaging and anatomical classification accordingly. Forty three patients underwent LPN in our unit from 2006 to 2014. The mean (range) tumour diameter on preoperative cross sectional imaging was 28.2 (12–49) mm. All cases had a warm ischaemia time of zero, as hilar vessels were not clamped in any case. The mean (range) preoperative estimated glomerular filtration rate (eGFR) was 73 (37 to >90) ml/min/1.73 m2 and was not significantly different to the post-operative mean (range) eGFR of 71 (31 to >90) ml/min/1.73 m2. 34 (79%) of the tumours were found to be malignant. Positive surgical margins were found in one case. The mean (range) follow-up time in our cohort was 61.6 (24–127) months and no patient has had a local or distant recurrence. Zero ischaemia laparoscopic partial nephrectomy appears to be a safe and oncologically satisfactory procedure for the management of small localised kidney tumours.

Octreotide is a somatostatin analog known for its role in the treatment of acute variceal bleeding, enterocutaneous fistula and carcinoid syndrome. The reduction of portal pressure from splanchnic vasoconstriction has been attributed to the inhibition of nitric oxide synthesis, guanylate cyclase and release of glucagon. Octreotide has many therapeutic applications as a result of the ubiquitous nature of somatostatin receptors throughout the body. The effects of octreotide on vascular tone make it potentially useful in the treatment of intraoperative vasoplegia, hypotension with low systemic vascular resistance with preserved cardiac output that is refractory to adrenergic agonists. We present a case in which a patient undergoing thymoma resection developed vasoplegia that was effectively treated with octreotide. We believe that this case illustrates the need for further investigation on the potential efficacy of octreotide as an adjunct for the treatment of vasoplegia and other forms of shock.

Introduction Post-traumatic stress disorder (PTSD) has been linked to a variety of adverse mental and physical health outcomes including distressed relationships. Involving romantic partners in PTSD treatment appears to be a promising new avenue for PTSD treatment; however, additional research is necessary to clarify veteran preferences for inclusion of significant others in treatment and relationship characteristics that may influence such preferences. Accordingly, the present study was designed to evaluate Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans' desire to include romantic partners in trauma-focused care (n = 74) and to explore psychological and relationship variables associated with preference for partner inclusion in PTSD treatment. Materials and methods This study surveyed male (N = 74) OEF/OIF/OND combat veterans seeking mental health services at a Veterans Health Administration PTSD treatment program. Relationships between PTSD symptoms, romantic relationship functioning, and interest in including their romantic partner in PTSD treatment were examined. Results Consistent with previous research, OEF/OIF/OND veterans seeking treatment at a specialty PTSD program report low relationship satisfaction. The majority of participants reported that PTSD symptoms interfere with relationship functioning; specifically, numbing symptoms were a significant predictor of PTSD-related relationship impairment. A minority (26%) of participants reported a desire to include their romantic partner in PTSD treatment. Greater behavioral avoidance and communication difficulties were associated with increased interest in including a romantic partner in PTSD treatment. Conclusion We confirmed that OEF/OIF/OND veterans seeking PTSD treatment experience PTSD-related problems in romantic relationships, low-relationship satisfaction, and relationship satisfaction was positively associated with perceived communication and problem-solving skills. A minority of veterans were interested in involving significant others in their PTSD treatment; however, in the present study, veterans were not given information about the various ways that a romantic partner might be involved in treatment, and they were not presented with specific conjoint therapies (e.g., Cognitive-Behavioral Conjoint Therapy for PTSD, Strategic Approach Therapy). For veterans with PTSD, relationship distress, and communication difficulties, conjoint psychotherapies may offer a way of increasing engagement in PTSD treatment by parsimoniously addressing multiple treatment targets at once (PTSD symptoms, relationship distress, communication problems) and providing veteran-centered care.

In patients with large gland volume, open prostatectomy/adenoma enucleation remains a valuable surgical option in treating large obstructing prostates. We report our series of open prostatectomies spanning 32 years from a single institution.We retrospectively reviewed all patients who underwent open prostatectomy between 1980 and 2012. Patient demographical, clinical, pre- and postoperative data and final histology were retrieved from hospital in-patient enquiry system and chart review.A total of 161 patients underwent Millin's prostatectomy by seven surgeons between 1980 and 2012. The mean blood loss was 1,381 mls (range 300-3,675 mls). One-third (34%) of patients (n = 55) received a blood transfusion. The mean weight of prostate tissue removed was 119 g (median 112 g, range 17-372 g). 6.6 % of pathological specimens revealed incidental prostate cancer, of which 78% were well differentiated (Gleason score ≤ 6). The mean weight of prostate tissue removed in patients who received a transfusion was 124 g. Trial of micturition (TOM) was performed at a mean of 9 days (median 9 days, range 5-25 days) with 94% of patients having a successful trial of voiding. 6% of cases early in the series failed to void initially, but did so at later removal of catheter while still in hospital. 45 patients (28%) of patients developed peri- or postoperative complications. There were three deaths (1.9%).Open Millin's prostatectomy popularized over half a century ago continues to be a valuable option for the surgical treatment of high-volume prostate glands with excellent outcomes for patients.

Whereas the classical histological hallmarks of Alzheimer's disease (AD) are deposition of amyloid-containing plaques and development of neurofibrillary tangles, there is also clear evidence of inflammatory changes accompanied by the presence of activated microglia and astrocytosis. However, at this time, it remains uncertain whether inflammatory changes contribute to pathogenesis of the disease or if they are secondary to deposition of amyloid-β or other pathological changes. A greater understanding of the sequence of events would clearly improve development of strategies to delay progression of the disease. There is a realistic expectation that advances in imaging technology may provide the key to uncovering this sequence. In this study, we employed non-invasive imaging techniques to examine changes in tissue state in hippocampus and cortex of transgenic mice which overexpress amyloid-β protein precursor and presenilin 1 and show that the observed increase in T1 relaxation time was associated with astrogliosis while the decrease in T2 relaxation time was associated with microglial activation. We explored the possibility that interferon-γ might trigger glial activation and demonstrate a genotype-related infiltration of macrophages and natural killer cells, which release interferon-γ. The evidence suggests that IFNγ triggers glial activation and expression of proinflammatory cytokines, and these changes, in turn, contribute to the decrease in long-term potentiation.

Amyotrophic lateral sclerosis (ALS) is a progressive, fatal and incurable neurodegenerative disorder. Motor neurone degeneration can be caused by genetic mutation but the exact etiology of the disease, particularly for sporadic illness, still remains unclear. Therapeutics which target known pathogenic mechanisms involved in ALS, such as protein aggregation, oxidative stress, apoptosis, inflammation, endoplasmic reticulum stress and mitochondria dysfunction, are currently being pursued in order to provide neuroprotection which may be able to slow down, or perhaps even halt, disease progression. This present review focuses on the compounds which have been recently evaluated using the SOD1 mouse model, the most widely used preclinical model for ALS research.

This paper presents an approach to integration of model checking into component-based development of software systems. This approach assists in development of highly reliable component-based software systems and reduces the complexity of verifying these systems by utilizing their compositional structures. Temporal properties of a software component are specified, verified, and packaged with the component. Selection of a component for reuse considers not only its functionality but also its temporal properties. When a component is composed from other components, a property of the component is verified on an abstraction of the component. The abstraction is constructed from environment assumptions of the component and verified properties of its sub-components. A general component model that enables component verification is defined. Component verification is discussed in the context of the instantiation of the general component model on an Asynchronous Interleaving Message-passing computation model. This approach has been applied to improve reliability of instances of TinyOS, a component-based run-time system for networked sensors. A case study on TinyOS is included, which illustrates the applicability of this approach, the detection of a bug, and the reduction in model checking complexity.

This study aims to assess quality of life outcomes, continence, rates of pouchitis and predictors of pouchitis for patients undergoing laparoscopic versus open three-stage ileal pouch-anal anastomosis (IPAA) surgery in our institution. Forty-two patients having had three-stage (IPAA) surgery were identified. One was excluded as they had undergone pouchectomy. A postal questionnaire followed by telephone contact was undertaken. The questionnaire was based on The Gastrointestinal Quality of Life Index (GIQLI) and Wexner/Cleveland Clinic Faecal Incontinence Symptom Severity Scoring Systems. Our aim was to assess morbidity, quality of life, incidence of pouchitis and continence following restorative panproctocolectomy and IPAA. Thirty-five patients completed the response. The median age at colectomy of our patient population was 32 years. 57 % were male and 43 % were female. 54.3 % of cases were carried out laparoscopically. 8/19 patients who had laparoscopic surgery had pouchitis (42.1 %) versus 9/16 patients who had open surgery (56.3 %). The median Wexner score was 0. Nine patients (25.7 %) had a GIQLI score that was within or above the range reported for healthy controls. The rate of complications was 31.7 % for emergency cases and 25.7 % for elective cases. The rate of pouchitis in this group was 48.5 %. Overall pelvic sepsis rate was 12.8 %. Ileal pouch-anal anastomosis is a successful and well-tolerated procedure with 94 % of patients opting to have the surgery again. Preliminary results do not show any significant difference in the incidence of pouchitis following laparoscopic surgery.

S-Connect is a new high speed, scalable interconnect system that has been developed to support networks of workstations to efficiently share computing resources. It uses off-the-shelf CMOS technology to directly drive fiber-optic systems at speeds greater than 1 Gbit/sec and can realize bisection bandwidths comparable to high-end MPP systems while being >10x more cost-effective. S-Connect systems do not rely on centralized switches, but rather are composed of adaptive, topology independent routing elements that are integrated into each node. The S-Connect routing algorithm is optimized for fine grained, irregular traffic and is designed to support high traffic loads, that can utilize most of the physically available bandwidth. Such traffic is typical of a distributed shared memory system, which is one of the intended applications. S-Connect innovations include a novel distributed phase locking method that allows global synchronization, HW support for multiple message priorities, in-band monitoring and control facilities, and a low overhead channel protocol that supports multiple in-transit messages on the same fiber.The first version of the S-Connect switching element has been successfully implemented in a commercial, 0.65 µm CMOS process.

The I/O bottleneck in parallel computer systems has recently begun receiving increasing interest. Most attention has focused on improving the performance of I/O devices using fairlylow-levelparallelism in techniques such as disk striping and interleaving. Widely applicable solutions, however, will require an integrated approach which addresses the problem at multiple system levels, including applications, systems software, and architecture. We propose that within the context of such an integrated approach, scheduling parallel I/O operations will become increasingly attractive and can potentially provide substantial performance benefits.We describe a simple I/O scheduling problem and present approximate algorithms for its solution. The costs of using these algorithms in terms of execution time, and the benefits in terms of reduced time to complete a batch of I/O operations, are compared with the situations in which no scheduling is used, and in which an optimal scheduling algorithm is used. The comparison is performed both theoretically and experimentally. We have found that, in exchange for a small execution time overhead, the approximate scheduling algorithms can provide substantial improvements in I/O completion times.

1. Pneumoperitoneum provides a simple, easily reversible and useful procedure for use in the treatment of pulmonary tuberculosis.

Diels-Alder reactions of the chiral enone ester 1 proceed in high yield with addition exclusively to the less hindred Si-face to give adducts of type 5.

Diels–Alder additions to keto ester 2 proceed in moderate to high yields with a variety of dienes under selected Lewis acid and thermal conditions. Thermal conditions provide the highest total yields for non-functionalized dienes, but Lewis acid catalysts, particularly stannic chloride, provide highly selective additions in greater net yields. A study of several functionalized dienes shows that zinc chloride is particularly effective in catalyzing additions to 2. No difference in stereoselectivity is observed between zinc chloride and thermal reactions for highly functionalized dienes. The significance of the regiochemical and stereochemical results of the Diels–Alder reactions is discussed.

The Lewis acid catalyzed Diels–Alder reactions of dienyl phosphate esters 1 and 2 were examined. 2-Diethylphosphoryloxy-1,3-butadiene (1) was found to react with a variety of α,β-unsaturated carbonyl compounds under Lewis acid catalysis with excellent regioselectivity to give synthetically useful cyclohexene derivatives. The adducts were produced in accordance with the normal rules governing the Diels–Alder addition. In the presence of stannic chloride acyclic α,β-unsaturated ketones such as ethyl vinyl ketone and methyl vinyl ketone reacted rapidly with diene phosphate 1 to give exclusively the para-addition products 8 and 9 in excellent yields. When diene 1 was treated with the complex cyclic enone ester 14 in the presence of ferric chloride the single para-rule adduct 15 was obtained in good yield. The stannic chloride catalyzed Diels–Alder reactions of trans-2-diethylphosphoryloxy-1,3-pentadiene (2) were also studied. Diene phosphate 2 reacted efficiently with a number of acyclic α,β-unsaturated keton...

Several 2-carbalkoxy-2-cyclohepten-1-ones were prepared and their Diels–Alder characteristics examined in order to develop a facile general approach to the synthesis of cycloheptane ring-containing...

The first Diels–Alder addition of a diene to a cyclooctenone dienophile has been observed. Three activated cyclooctenone dienophiles 1, 2, and 3 are studied with a variety of simple and functionali...

Aim To determine the strengths and limitations of current approaches used in economic analyses of advanced cancer care. Methods We conducted a systematic review of EMBASE, AMED, PsycINFO, CINAHL, and MEDLINE from inception to June 2010 using search terms advanced or terminal illness, cancer, and cost or economic studies. We included studies that reported economic evaluations using decision analytical models, within patients with advanced cancer, with any intervention and published in English. We extracted data on health system context, model type, model time horizon and model outcomes. Results 28 papers were eligible for inclusion, the majority of these were undertaken in Europe or USA. 17 Markov models and 10 decision trees were identified. Most (z) models used lifetime horizons but (x) used curtailed horizons without any clear rationale between studies for time horizon selected. Model outcomes varied; most used quality of life (QOL), but some used survival, and one estimated the likelihood of effective pain management. Measurement of QOL was the most commonly cited limitation in all models. (Z) studies relied on healthcare professionals9 valuations of QOL rather than patients9 own valuations. Conclusion We found no consistent model type or time horizon used in studies assessing cost effectiveness of interventions in advanced cancer. In models with shorter durations, additional future costs such should be considered such as those related to further operative procedures, or palliative treatments. The validity of these models may be weakened by using utility values that are not derived directly from patients with advanced cancer.

We report a 34-year-old female with a de novo balanced reciprocal translocation involving 2q37.2 and 7q36.3. She has a unique combination of multiple congenital malformations that include redundant skin, complete tissue syndactyly of the hands and feet, hirsutism, polycystic ovaries and bilateral anterior chamber eye anomalies. Her son has inherited the unbalanced product (46,XY,der(2) t(2;7)(q37.2;q36.3). He has a similar clinical picture with additional features including complex congenital heart disease, post axial polydactyly, hypotonia and global developmental delay. The breakpoints may indicate the location of the gene(s) responsible for this unique combination of features.

The problems of resource allocation, configuration and reconfiguration and network control must be solved before reconfigurable array computers can be effectively utilized. The interconnection networks proposed for these systems vary so that there has been no common or optimal solution proposed to these problems. This paper defines and describes the objectives, design, implementation and use of a network controller for a reconfigurable array computer, the Texas Reconfigurable Array Computer (TRAC). The objectives for the network controller are defined by management of the system state, the requirements of the operating system for functionality and the interface the network presents to the operating system. These objectives may be expected to have at least some commonality across most reconfigurable network architectures. The structure of the network controller given herein may offer guidance for development of controllers for other reconfigurable network architectures.

This paper presents an algorithm for the formation of configurations connecting processors to memory and I/O devices on rectangular SW banyan networks with equivalent processor resources as the base nodes and equivalent memory and I/O resources as the apex nodes. Given a set of resource configuration requests, the algorithm always finds a partition of the network that meets the requests in space and time complexity linear with respect to the number of resources in the network.

A three-crystal, Ge(Li)NaI spectrometer has been developed to measure neutron capture γ-ray spectra at the Livermore 100 MeV electron linear accelerator. Design criteria are discussed. Circuits and techniques to optimize performance in an electron linac environment are presented. Some useful data analysis techniques for extraction of peak energies and intensities are given. A technique is discussed for using the simple response function of a three-crystal spectrometer to unfold unresolved data to find the incident gg-ray spectrum.

A three-part experiment was conducted to determine the accuracy, repeatability and linearity of a human hand manipulating the DataGlove. Accuracy and repeatability of finger flexure were investigated with repeated measurements of three calibration positions. Linearity of finger flexure was investigated with steady finger and thumb curling motions. Accuracy and repeatability of hand location and orientation were investigated with repeated measurements of six hand positions. Finger flexure mean accuracy was 6º for the four fingers and 11º for the thumb, repeatability was 3º for the four fingers and 9º for the thumb, and linearity varied from 2 to 5º. Although the mean location accuracy was 1 inch and the mean orientation accuracy was 17º, the position and orientation receiver was observed to twist on the glove back. Across all subjects, the location repeatability was 0.5 inch, while the orientation repeatability was 9º. However, the within-subject location repeatability was 0.13 inches, while the orientation repeatability was 2º.

An introduction to the Gypsy programming and specification language is given. Gypsy is a high-level programming language with facilities for general programming and also for systems programming that is oriented toward communications processing. This includes facilities for concurrent processes and process synchronization. Gypsy also contains facilities for detecting and processing errors that are due to the actual running of the program in an imperfect environment. The specification facilities give a precise way of expressing the desired properties of the Gypsy programs. All of the features of Gypsy are fully verifiable, either by formal proof or by validation at run time. An overview of the language design and a detailed example program are given.

Explants of rabbit spleen, responding to sheep erythrocytes in vitro, were exposed to ionizing radiation at different times in culture. Radiation was found to depress the development of specific haemolysin-producing cells (PFC) at subsequent times, while cells already engaged in haemolysin production were relatively resistant to radiation. The depressing effects of radiation on PFC was most marked at times when the rate of increase of PFC was highest. Recovery from low doses (less than 2 Gy) occurred while higher doses of radiation had persistent depressing effects on the level of PFC. Assessment of synthesis of other macromolecules in these irradiated cultures showed that protein synthesis was highly resistant and DNA synthesis was sensitive like the immune response. Irradiation in hypoxic conditions showed that this protected the tissues from damage by radiation and there were also indications of enhancement of repair of this damage. Finally it was found that the results obtained with these cultures correlated well with previous studies of intact mice.

Magnitude and mass distributions are deduced from radio echo data for sporadic meteors and for various meteor showers. The frequency of sporadic meteors is found to increase by 2.5 times per unit increase in magnitude over the range 0m-10m. This corresponds to an inverse square law for the differential mass distribution. Results obtained for shower meteors in the magnitude ranges 0m to 2m and 5m to 7m cannot in general be represented simply by an inverse power law of meteor masses with constant exponent s. The Arietids are found to have s>2 over the whole range of magnitudes investigated whereas the Perseids, Quadrantids and Geminids appear to have s

The records of 300 patients with diverticula of the colon have been reviewed. Clinical diagnosis of diverticulosis requires roentgenographic confirmation. Diverticulitis is suggested by the presence of localized pain and tenderness, a palpable mass which changes in size, inflammation, bloody stools with otherwise negative findings, and recurrence of episodes. Medical management of uncomplicated diverticulosis is advocated. Definitive indications for surgical intervention in complicated cases have been outlined; these include true complications, possibly malignant lesions, and localized, recurrent, and persistent diverticulitis in carefully selected cases. Prophylactic operation is not generally favored but may be justified in well-selected cases in view of the morbidity associated with complicated surgical procedures.

1. We herewith add six illustrative case reports of acute intestinal obstruction due to cecal volvulus to the limited literature on the subject. Three of our cases were post-operative equaling the total published instances encountered in our review of the literature. Our statistical study reveals an incidence of only 1.4 per cent among 411 cases of acute intestinal obstruction. 2. A clinical diagnosis of acute cecal volvulus is seldom made since there are no diagnostic criteria that render a clinical diagnosis feasible. However, cecal volvulus must be considered in making a diagnosis in obscure cases of intestinal obstruction. 3. Chronic cecal volvulus is an entity rarely encountered and probably overlooked in many instances of unexplained abdominal pain.

It is impossible to do justice to the President's Address by a short abstract, Its most important feature is, that it fully recognises the real as well as the apparent increase of insanity and allied nervous disorders amongst us. The former position was maintained some years ago by Dr. C. Browne, when he endeavoured to show that the usual explanations brought forward to account for the numerical increase were falsified by the experience of the West Riding Asylum, of which he was at that time the Superintendent.

Although it would be untrue to say that this is a valuable contribution to science, yet that it is an important addition to medical literature no one will deny. In it we see fresh evidence of the fact that asylum physicians are becoming more and more alive to the necessity for asserting themselves, and showing themselves in their true colours. If they do nothing else they will furnish an excellent answer to certain disappointed men who, having failed to establish themselves in practice, have assumed the dignity of censors of their medical brethren. Judging all men by their own standard, they have not failed to single out asylum physicians as an object of attack, and have charged them with all the sins of incompetence, negligence, and ignorance. For nearly a year these unfortunate men could hardly take up a medical paper without seeing a violent attack on the manner in which they performed their duties, and not only did the medical journals assail them, but also a certain portion of the daily press, taking its cue from these writers, heaped on abuse and censure until the most impartial reader began to think that the asylum doctors must be a set of the most unmitigated ruffians under the sun. Of the unfairness of this we will say nothing now; we hope that a more generous spirit will prevail in future, and that physicians in asylums will rather be encouraged to do well than violently abused for occasionally making those mistakes to which all human beings are liable.

The two principal factors in precipitation of functional disturbance are quality of individual and quantity of trauma.An erroneous diagnosis of physical illness followed by medical or surgical treatment tends to fix the neurotic state, but the greatest harm occurs when a patient with a conversion reaction dies with an untreated malignant disease.Successful management of functional gastrointestinal disturbance encompasses dietetic therapy, pharmacologic aids, creation of insight, correction of rigid states, reeducation, and adjunctive measures.The comparative effectiveness of various tranquilizers and antidepressants is reviewed, and experience with the nonbarbiturate sedative thalidomide is presented.