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Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos as soon as they are discovered. Clinics also should have written policies in place for reducing and disclosing errors. This document was reviewed and affirmed in 2015 and replaces the earlier document of the same name (Fertil Steril 2011;96:1312–4).

The use of intrafamilial gamete donors and surrogates is generally ethically acceptable when all participants are fully informed and counseled, but arrangements that replicate the results of true consanguineous or incestuous unions should be prohibited, child to parent arrangements are generally unacceptable, and parent to child arrangements are acceptable in limited situations. Programs that choose to participate in intrafamilial arrangements should be prepared to spend additional time counseling participants and ensuring that they have made free, informed decisions.

Realizing the Web's full potential will require the development and support of agents that function as schedulers, planners, and searchers who, with minimal direction, can serve as an omnipresent staff of advisers, secretaries, brokers, and research assistants. Electronic commerce has brought this capability tantalizingly near. Organizations and individuals have connected an enormous variety of products and services to the Internet, making them accessible to other programs through simple communication protocols. Now the AI community must determine how it can build intelligent agents to exploit these services. One strategy would change the Web itself, making it accessible to existing AI modeling, and reasoning techniques. In this semantic Web, service and content providers would mark pages in accordance with standardized conventions designed to reduce ambiguity and make automated reasoning easier. The paper considers the development of a distributed intelligence and bringing agents to the Web. It discusses DAML-S which provides support for composite services, combinations of simpler services, or behaviors, and the coordination mechanisms, or reactive plans, used to combine those behaviors.

Many researchers are working towards the goal of a semantic Web — a Web that is unambiguously computer interpretable, and thus very accessable to artificial intelligence. A semantic Web would allow artificial agents to do the work of searching for and utilizing services required by humans or organizations. DAML-S is a Web service ontology intended to facilitate the semantic Web by describing the properties and capabilities of Web-accessible services in an unambiguous, computer-interpretable form. In this chapter, we propose that an important new perspective on the semantic Web can be obtained by regarding its content as behavioral intelligence. The services encoded in DAML-S can then be viewed as specifications either for extensions of the user-owned agents attempting to exploit the services, or as independent, collaborative agents that can be ‘awakened’ to assist the user agents. We draw on our experience in agent development to elaborate the specification, particularly of the process ontology of DAML-S, in order to support this vision.

This volume is intended to help advance the field of artificial neural networks along the lines of complexity present in animal brains. In particular, we are interested in examining the biological phenomena of modularity and specialized learning. These topics are already the subject of research in another area of artificial intelligence. The design of complete autonomous agents (CAA), such as mobile robots or virtual reality characters, has been dominated by modular architectures and context-driven action selection and learning. In this chapter, we help bridge the gap from neuroscience to artificial neural networks (ANN) by incorporating CAA. We do this both directly, by using CAA as a metaphor to consider requirements for ANN, and indirectly, by using CAA research to better understand and model neuroscience. We discuss the strengths and the limitations of these forms of modeling, and propose as future work extensions to CAA inspired by neuroscience.

1. ABSTRACT It is not always possible or practical to store very large data sets in a relational database. For example, in a rapidly changing large-scale environment with distributed control, such as the World-Wide Web, a strict relational approach is not feasible. Nevertheless, it is desirable for a user to be able to make SQL queries on the entire data set, because SQL is well known, supported, and understood. We introduce “just-in-time databases”, which allow the user to query the entire data set as though it were in a relational database. The underlying engine brings data into the relational database only when it is required by user queries. We describe how “just-in-time databases” are implemented, using the WorldWide Web as an example. 1.1

Background: Brief intervention (BI) to reduce hazardous drinking and negative consequences such as injury has been effective when given in the emergency department (ED). The effectiveness and effect of BI has varied between injured and uninjured ED patients. This study compares injured and uninjured ED patients who admit to alcohol and marijuana use to determine their need and their readiness for BI. Patients and Methods: Participants volunteered to enter a randomized controlled trial of BI to reduce hazardous alcohol and marijuana use. Adult ED patients who had had alcohol in the last month and smoked marijuana in the last year were recruited. Those patients who were admitted to hospital, were under police custody, or were seeking treatment for substance use or psychiatric disorder were excluded. Research assistants interviewed participants using a validated questionnaire. Data were analyzed using SAS (version 9.1). Binominal tests of proportions, t-test analyses, and transformations were conducted as appropriate. Results: Injured (n = 249) and uninjured (n = 266) study participants reported very high, statistically equivalent (P > 0.05), rates of binge drinking (4-5 days/month), marijuana use (13 days/month), driving under the influence of marijuana or alcohol (>49% in the last 3 months), injury (>83% in the last year), and other negative consequences (>64% in the last 3 months) prior to their ED visit. These behaviors and the consequences demonstrate a need for change. Both injured and uninjured subjects were ready to change (>56%) and confident they could change (>91%) alcohol and marijuana use. Discussion: ED patients who admit to alcohol and marijuana use also use other hazardous substances and participate in high-risk behaviors. In both injured and uninjured patients who admit using alcohol and marijuana, the ED visit is an opportunity to deliver BI to reduce alcohol and marijuana use and associated risk behaviors and the subsequent injury and negative consequences. Given their risk behaviors and experience of negative consequences, members of both injured and uninjured groups have an equal need for BI. Fortunately, in both groups, a high number of members express motivation to change.

Various regimens are recommended for replacing sex steroids in ovarian failure patients attempting donor embryo transfer. We histologically assessed endometrial biopsies obtained on simulated cycle day 26 from functionally agonadal patients (n = 19) receiving hormone replacement according to three different regimens: Regimen 1, oral micronized estradiol (E 2 ) 2 mg days 1–5, 4 mg days 6–9, 6 mg days 10–13, 4 mg days 14–28, with progesterone vaginal suppositories, 100 mg day 15 followed by 200 mg days 16–28; Regimen 2, oral micronized E 2 1 mg days 1–5, 2 mg days 6–9, 6 mg days 10–13, 2 mg days 14–28, with progesterone vaginal suppositories, 100 mg day 15 followed by 200 mg days 16–28; Regimen 3: oral micronized E 2 1 mg days 1–5, 2 mg days 6–9, 6 mg days 10–13, 2 mg days 14–28, progesterone 50 mg intramuscularly delivered day 15 followed by 100 mg intramuscularly days 16–28. Biopsies were interpreted according to Noyes criteria. While all regimens resulted in variable degrees of stromal pseudodecidualization, Regimen 1 biopsies uniformly demonstrated glandular abnormalities consistent with excessive estrogen stimulation. This included aberrant maturation, intraluminal papillary excrescences and variations in epithelium size and stratification. Regimen 2 biopsies were morphologically normal in most patients, yet many manifested minor variations in gland maturity. Only Regimen 3 biopsies were consistently normal on day 26 or slightly advanced in maturation. We conclude that endometrial morphology differs according to the hormone replacement preparation and route of administration. A combination of oral E 2 and intramuscular progesterone, given according to Regimen 3 design, reliably produces in-phase secretory endometrium morphologically indistinguishable from a natural spontaneous cycle.

Norethindrone (NET) has been used for cycle programming and may result in attenuated responses to controlled ovarian hyperstimulation. The effects of NET on gonadotropin secretion, its bioavailability to the ovary, and its effect on ovarian steroidogenesis in vivo and in vitro were assessed. Endogenous secretion of luteinizing hormone and follicle-stimulating hormone was attenuated by 59% and 50%, respectively, after 2 weeks of orally administered NET. Twelve hours after a single 10-mg oral dose, significant levels of NET were measured in samples of peripheral (8.8 +/- 1.9 ng/mL) and ovarian venous blood (10.5 +/- 3.1 ng/mL), follicular fluid (7.1 +/- 2.1 ng/mL), and homogenates of ovarian tissue (8.0 +/- 0.6 ng/g). Furthermore, NET was detectable in follicular fluid 2 weeks after its withdrawal (863 +/- 149 pg/mL). However, there were no effects of NET on follicular fluid levels of estradiol and progesterone in vivo or on luteinized granulosa cell steroidogenesis in vitro. We conclude that when used for cycle programming in in vitro fertilization, NET does not inhibit ovarian steroidogenesis but does affect the hypothalamic-pituitary axis.

The purpose of this study was to determine the steroid production of cultured porcine follicle cells grown in serum-free media. Theca cells (TC) and granulosa cells (GC) from large porcine follicles (greater than 8 mm) were dispersed and plated as monolayer cultures in serum-free media. Media were removed from the cultures at 3, 6, 12, 24, 48, 72, 96, and 120 h and assayed for estradiol, progesterone, testosterone and androstenedione. Both GC and TC were capable of producing progesterone, androgens and estradiol in serum-free media. GC were responsive to human chorionic gonadotropin and follicle-stimulating hormone while TC were only responsive to human chorionic gonadotropin. Growth factors, particularly insulin, appeared to enhance ovarian cells’ steroidogenesis.

A transvaginal microendoscopic technique has been developed for safely exploring the human fallopian tube from the utero tubal ostium to the fimbria and adjacent peritoneal cavity. Falloposcopy was performed without complication or evidence of endotubal damage in 44 women, 38 of whom also underwent a concurrent laparoscopy. Eight women with normal tubes served as controls and 36 women with tubal damage underwent falloposcopy in an attempt to document endotubal defects. Previous salpingectomy in 13 women and ostial obstruction in 4 cases left 71 tubes available for falloposcopy. Technical failures, defined as an inability to negotiate the tubal lumen in the absence of obstructive disease occurred in 8 of 71 (11%) procedures. In 63 successful procedures, the tubal lumen was considered to be falloposcopically normal in 28 cases (44%) and contained defects ranging from partial to total obstruction secondary to intraluminal fibrosis within the intramural, isthmic, and ampullary segments in the remaining 35 tubes (56%). Falloposcopy provides a nonincisional modality for defining the normal and abnormal surface anatomy of the tubal epithelium.

Phosphofructokinase (ATP:D-fructose-6-phosphate 1-phosphotransferase, EC 2.7.1.11) was partially purified from the livers of genetically diabetic mice (C57BL/KsJ-db) and their lean littermates (C57BL/KsJ). These genetically diabetic mice have been shown to be hyperglucagonemic and to exhibit symptoms resembling those of maturity-onset diabetes in humans. Two isoenzymes of phosphofructokinase were obtained after DEAE-Sephadex chromatography of extracts of livers from either normal or diabetic animals. One of these isozymes, peak II, from the genetically diabetic mice was shown to be more sensitive to ATP inhibition at physiological pH than the peak II isozyme from the normal animals. In addition, the peak II isozyme from the diabetic mice exhibited decreased affinity for fructose 6-phosphate. The altered kinetic properties of phosphofructokinase from diabetic animals are markedly similar to those recently reported for liver phosphofructokinase isolated from normal animals after glucagon treatment. Our results suggest that increased glucagon levels in diabetes may lead to altered regulation of phosphofructokinase in this disease.

The purpose of this study was to evaluate and compare thin-section magnetic resonance imaging (MRI) and high-resolution computed tomography (CT) in patients with suspected pituitary adenomas. Twenty-two patients (19 women and three men) with hyperprolactinemia (N = 16), increased growth hormone secretion (N = 2), increased corticotropin secretion (N = 1), and nonsecreting adenomas (N = 3) were studied with both contrast-enhanced, high-resolution CT scanning and thin-section MRI. Contrast-enhanced examinations consisted of contiguous 1.5-mm coronal sections during contrast infusion. The MRI examinations consisted of spin-echo T1- and T2-weighted sequences with a 2.5-3.0-mm slice thickness on the coronal and sagittal planes. Fourteen women had similar findings on CT and MRI (four macroadenomas, six microadenomas, one wide stalk, two empty sellas, and one normal study). The remaining eight subjects had conflicting results: CT findings were compatible with a microadenoma in all eight patients, whereas MRI detected one enlarged pituitary, two empty sellas (one with prolapse of the optic chiasm) without evidence of adenoma, and five normal examinations. Thus, both studies detected macroadenomas accurately, but CT was frequently unable to diagnose correctly an empty sella. Because patients with possible microadenomas were not submitted to surgery, the accuracy of either radiologic method cannot be assessed at this time. However, we suggest that MRI is superior to CT because of its inherently greater soft-tissue contrast, which allows clear visualization of the optic chiasm, optic nerves, cavernous sinuses, and carotid arteries.