Geometric Heat Engines Featuring Power that Grows with Efficiency

Thermodynamics places a limit on the efficiency of heat engines, but not on their output power or on how the power and efficiency change with the engine's cycle time. In this Letter, we develop a geometrical description of the power and efficiency as a function of the cycle time, applicable to an important class of heat engine models. This geometrical description is used to design engine protocols that attain both the maximal power and maximal efficiency at the fast driving limit. Furthermore, using this method, we also prove that no protocol can exactly attain the Carnot efficiency at nonzero power.

Self-similar modes of coherent diffusion

Self-similar solutions of the coherent diffusion equation are derived and measured. The set of real similarity solutions is generalized by the introduction of a nonuniform phase, based on the elegant Gaussian modes of optical diffraction. In a light-storage experiment, the complex solutions are imprinted on a gas of diffusing atoms, and the self-similar evolution of both their amplitude and phase pattern is demonstrated. An algebraic decay depending on the mode order is measured. Notably, as opposed to the regular diffusion spreading, a subset of the solutions exhibits a self-similar contraction.

Electromagnetically induced transparency and light storage in an atomic Mott insulator

We experimentally demonstrate electromagnetically induced transparency and light storage with ultracold 87Rb atoms in a Mott insulating state in a three-dimensional optical lattice. We have observed light storage times of approximately 240 ms, to our knowledge the longest ever achieved in ultracold atomic samples. Using the differential light shift caused by a spatially inhomogeneous far detuned light field we imprint a "phase gradient" across the atomic sample, resulting in controlled angular redirection of the retrieved light pulse.

Observation of a localization transition in quasiperiodic photonic lattices

We report the observation of the signature of a localization phase transition for light in one-dimensional quasiperiodic photonic lattices, by directly measuring wave transport inside the lattice. Below the predicted transition point an initially narrow wave packet expands as it propagates, while above the transition expansion is fully suppressed. In addition, we measure the effect of focusing nonlinear interaction on the propagation and find it increases the width of the localized wave packets.

Universal spectra of coherent atoms in a recurrent random walk

We report an experiment that directly measures the Laplace transform of the recurrence probability in one dimension using electromagnetically induced transparency (EIT) of coherent atoms diffusing in a vapor cell filled with buffer gas. We find a regime where the limiting form of the complex EIT spectrum is universal and only depends on the effective dimensionality in which the random recurrence takes place. In an effective one-dimensional diffusion setting, the measured spectrum exhibits power-law dependence over two decades in the frequency domain with a critical exponent of 0.56 close to the expected value 0.5.

Storing images in warm atomic vapor

Reversible and coherent storage of light in an atomic medium is a promising method with possible applications in many fields. In this work, arbitrary two-dimensional images are slowed and stored in warm atomic vapor for up to 30 micros, utilizing electromagnetically induced transparency. Both the intensity and the phase patterns of the optical field are maintained. The main limitation on the storage resolution and duration is found to be the diffusion of atoms. A technique analogous to phase-shift lithography is employed to diminish the effect of diffusion on the visibility of the reconstructed image.

Topological stability of stored optical vortices

We report an experiment in which an optical vortex is stored in a vapor of Rb atoms. Because of its 2pi phase twist, this mode, also known as the Laguerre-Gauss mode, is topologically stable and cannot unwind even under conditions of strong diffusion. For comparison, we stored a Gaussian beam with a dark center and a uniform phase. Contrary to the optical vortex, which stays stable for over 100 micros, the dark center in the retrieved flat-phased image was filled with light after a storage time as short as 10 micros. The experiment proves that higher electromagnetic modes can be converted into atomic coherences and that modes with phase singularities are robust to decoherence effects such as diffusion. This opens the possibility to more elaborate schemes for classical and quantum information storage in atomic vapors.

Value of spiral CT in hemodynamically stable patients following blunt chest trauma

INTRODUCTION

Features of spiral CT (SCT)-fast scanning, dynamic injection of contrast allowing optimal vessel opacification, and supplemental multiplanar imaging-promises to provide increased accuracy in the diagnosis of acute and non acute thoracic vascular disease. Recent work demonstrating the cost effective triage of hemodynamically stable patients after blunt chest trauma for angiography based on dynamic CT findings has prompted an investigation into the accuracy of SCT in this clinical setting.

METHODS

A retrospective review of all patients seen in the emergency department over the period of one year for aortic, thoracic, or blunt chest trauma evaluation was performed (74 patients) and all SCT scans available were reviewed and data reformatted for optimal delineation of pathology using maximum intensity projection and multiplanar reformation. The accuracy and predictive positive and negative values of SCT were calculated with respect to angiography, surgical, and/or clinical follow up evaluation.

RESULTS

Twenty three (31%) patients went directly to angiography owing to mediastinal widening on chest film and hemodynamic instability, of which four were positive and required emergent surgery. Seven hemodynamically stable patients (9%) had noncontrast SCT owing to mediastinal widening on chest film, all of which had angiography with none having great vessel trauma. Fourty four hemodynamically stable patients (60%) had contrast enhanced SCT (ceSCT), of which five (11%) were abnormal and underwent angiography, four of these were positive for aortic damage, one for a subclavian artery laceration. Of the remaining 39 patients who had normal ceSCT; five had angiography, all of which were normal. Of the remaining 34 patients that had normal ceSCT none had adverse outcome on clinical follow-up, minimum of 12 months.

CONCLUSION

The predictive positive value for aortic trauma of ceSCT in blunt trauma is 80%, with a predictive negative value of 100%, indicating that it is feasible for SCT to be a first line exam in blunt chest trauma in the future.

Preoperative screening for lung volume reduction surgery: usefulness of combining thin-section CT with physiologic assessment

OBJECTIVE

This study was performed to assess the usefulness of preoperative thin-section CT alone and in combination with physiologic measurements in emphysema patients being evaluated for lung volume reduction surgery.

SUBJECTS AND METHODS

Six 1-mm collimation sections through the chest were obtained in 20 patients being evaluated for lung volume reduction surgery. Extent and severity of emphysema were assessed by visually scoring the images. CT scores ranged from 0 to 144. Inspiratory resistance was measured in 12 of 20 patients and was also used to discriminate between responders (change in forced expiratory volume in 1 sec, > or = 150 ml after surgery) and nonresponders (change in forced expiratory volume in 1 sec, < 150 ml after surgery).

RESULTS

Four of 20 patients with mild emphysema as revealed by thin-section CT (scores of < 50) did not improve lung function after lung volume reduction surgery. Eight of the remaining 16 patients with moderate to severe emphysema as revealed by thin-section CT (scores of > 50) underwent inspiratory resistance measurement. Those seven patients whose inspiratory resistance measurement exceeded 8.5 cm H2O/l per second did not respond favorably to lung volume reduction surgery (change in forced expiratory volume in 1 sec, < 150 ml). The remaining five patients whose inspiratory resistance measurement was less than 8.5 cm H2O/l per second responded favorably to lung volume reduction surgery. Thus, only five of the 20 patients showed improvement in forced expiratory volume in 1 sec after surgery.

CONCLUSION

Our data suggest that among patients with moderate to severe emphysema who are being examined for lung volume reduction surgery, the combination of radiologic and physiologic assessment is more accurate for predicting a favorable response to lung volume reduction surgery than radiologic assessment alone. However, in patients with chronic obstructive pulmonary disease by the American Thoracic Society criteria, mild emphysema as revealed on thin-section CT virtually precludes further workup because these patients are unlikely to respond favorably to lung volume reduction surgery.

Does the computerized display of charges affect inpatient ancillary test utilization?

BACKGROUND

The computerized display of charges for ancillary tests in outpatients has been found to affect physician-ordering behavior, but this issue has not been studied in inpatients.

OBJECTIVE

To assess whether the computerized display of charges for clinical laboratory or radiological tests affected physician-ordering behavior.

PATIENTS AND METHODS

Two prospective controlled trials, randomized by patient, were performed. Each trial included all medical and surgical inpatients at 1 large teaching hospital during 4 and 7 months: 3536 intervention and 3554 control inpatients in the group with clinical laboratory tests, and 8728 intervention and 8653 control inpatients in the group with radiological tests. The intervention consisted of the computerized display of charges for tests at the time of ordering.

MAIN OUTCOME MEASURES

The number of clinical laboratory and radiological tests ordered per admission and the charges for these tests.

RESULTS

For the clinical laboratory tests, during a 4-month study period, patients in the intervention group had 4.5% fewer tests ordered, and the total charges for these tests were 4.2% lower, although neither difference was statistically significant. Compared with historical controls from the same 4-month period a year before, the charges for the tests per admission had decreased 13.3%, but the decrease was temporally correlated with a restriction of future ordering of tests, and not with the introduction of the display of charges. For the radiological tests, during a 7-month period, the intervention group had almost identical numbers of tests ordered and charges for these tests.

CONCLUSIONS

The computerized display of charges had no statistically significant effect on the number of clinical laboratory tests or radiological procedures ordered or performed, although small trends were present for clinical laboratory tests. More intensive interventions may be needed to affect physician test utilization.

Ga-67 scintigraphy and computed tomography in the diagnosis of pneumocystis carinii pneumonia in patients with AIDS. A prospective comparison

A prospective evaluation of Ga-67 scintigraphy and transmission computed tomography was performed in 70 consecutive patients with AIDS who were suspected of having Pneumocystis carinii pneumonia. Studies were evaluated independently by two observers. Receiver operating characteristic curves were plotted. Although scintigraphy had a higher true-positive ratio at any false-positive ratio, statistically the areas under the two receiver operating characteristic curves were not significantly different. However, at an FP rate of 15% to 20% (one in the clinically reasonable range), the sensitivity for scintigraphy was 0.84 and for CT 0.80; corresponding specificities were 0.82 and 0.64, respectively, for the two modalities. It seems from these data that gallium imaging is probably superior to CT in detecting P. carinii pneumonia in this group of patients.

Extrapleural pneumonectomy, chemotherapy, and radiotherapy in the treatment of diffuse malignant pleural mesothelioma

Malignant pleural mesothelioma has been considered a uniformly fatal disease associated with a median survival of 4 to 18 months. Extrapleural pneumonectomy alone has proved disappointing in the treatment of this disease, as have chemotherapy and radiotherapy. From 1980 to 1990, 31 patients with pleural mesothelioma underwent multimodality therapy that included extrapleural pneumonectomy with resection of the pericardium and diaphragm. The age of the patients was 53.4 +/- 8.6 years; 26 were male. All patients had the pathologic diagnosis reviewed before treatment. At thoracotomy six patients had residual (unresectable) gross disease, and in 23 there was histologic evidence of disease at the resection margin. The perioperative morbidity and mortality rates were 19% and 6%, respectively. The mean length of hospital stay for the 29 patients who survived the operation was 10.9 +/- 3.5 days. Postoperatively 26 patients received cyclophosphamide, doxorubicin, and cis-platinum chemotherapy with or without radiotherapy. The survival rates were 70% at 1 year and 48% at 2 years. Trends toward improved survival in the patients with complete resections approached but did not reach statistical significance. These data suggest that this multimodality protocol can be administered with acceptable morbidity and mortality. Prospective trials are justified to further clarify the role of this approach.

Pulmonary edema after aneurysm surgery is modified by mannitol

Abdominal aortic aneurysmectomy (AAA) results in thromboxane (Tx)A2 generation, a rise in mean pulmonary artery pressure (MPAP), leukopenia, and noncardiogenic pulmonary edema. This study tests whether mannitol, a hydroxyl radical scavenger, modifies these events. Patients received mannitol 0.2 g/kg (n = 14) or saline (n = 12) intravenously before infrarenal aortic clamping. With saline, 30 minutes after clamping, plasma TxB2 levels rose from 124 to 290 pg/mL (p less than 0.01), and MPAP rose from 19 to 27 mmHg (p less than 0.01). Aortic clamp release led to further increases in plasma TxB2 to 378 pg/mL (p less than 0.01) and MPAP to 34 mmHg (p less than 0.01). The white blood count (WBC) fell from 9800 to 4400/mm3 (p less than 0.01). Four to eight hours after surgery, physiologic shunting (Q[sc]S[xsc]/Q[sc]T[xsc]) rose from 9% to 20% (p less than 0.01) and peak inspiratory pressure (PIP) increased from 22 to 32 cmH2O (p less than 0.01). Chest radiography demonstrated pulmonary edema while the pulmonary wedge pressure was 12 mmHg, excluding left ventricular failure. By 24 hours pulmonary edema resolved and the PIP and PaO2 returned to baseline. Mannitol treatment relative to saline, during and after aortic clamping reduced plasma TxB2 levels to 155 and 198 pg/mL, respectively (p less than 0.01); MPAP to 21 and 26 mmHg (p less than 0.01); minimized the decline in WBC to 5850/mm3 (p less than 0.01), and the postoperative rise in Q[sc]S[xsc]/Q[sc]T[xsc] to 12%, and PIP to 28 cmH2O (both p less than 0.01). Chest radiography showed no pulmonary edema. Finally in vitro studies documented that mannitol 1 to 10(-4)M, but not dextrose, in a dose-dependent manner inhibited Tx synthesis by ADP-activated platelets. These data indicate that mannitol maintains pulmonary function after AAA by limiting ischemia-induced thromboxane synthesis.

Noncardiogenic pulmonary edema after abdominal aortic aneurysm surgery

Limb ischemia in experimental animals leads to white blood cell (WBC) and thromboxane (Tx)A2 dependent pulmonary dysfunction. This study examines the pulmonary sequelae of lower torso ischemia in 20 consecutive patients aged 63 +/- 5 years (mean +/- SEM) who underwent elective abdominal aortic aneurysm surgery. After 30 minutes of aortic cross-clamping, plasma TxB2 levels had risen from 77 +/- 26 pg/ml to 359 +/- 165 pg/ml (p less than 0.01) and was temporally related to increases in mean pulmonary artery pressure (MPAP) from 18 +/- 1 to 23 +/- 3 mmHg (p less than 0.01), as well as to increases in pulmonary vascular resistance (PVR) from 0.07 +/- 0.02 to 0.12 +/- 0.02 mmHg sec/ml (p less than 0.01). Each time that the aortic clamp was repositioned and with final declamping, after 83 +/- 10 minutes, there were further increases in MPAP to a peak of 32 +/- 2 mmHg (p less than 0.01) and in PVR to 0.26 +/- 0.030 mmHg sec/ml (p less than 0.01), corresponding to a plasma TxB2 level of 406 +/- 177 pg/ml (p less than 0.01). MPAP and PVR returned to baseline values within 30 minutes of declamping. Ten minutes after removal of the aortic clamp, platelet levels had fallen from 180 +/- 41 to 97 +/- 17 X 10(3)/mm3 (p less than 0.01) and WBC levels from 8900 +/- 1100 to 4700 +/- 400/mm3 (p less than 0.01). Both platelets and WBC returned towards normal levels, but at 24 hours, while WBC was elevated at 13000 +/- 900/mm3 (p less than 0.01), platelets were 44% of baseline at 135 +/- 14 X 10(3)/mm3 (p less than 0.01). Four to 8 hours after surgery, pulmonary dysfunction was manifest by increases in physiologic shunt from 9 +/- 2% to 16 +/- 2% (p less than 0.01), and peak inspiratory pressure (PIP) from 23 +/- 2 to 33 +/- 2 cmH2O (p less than 0.01). Chest radiography demonstrated interstitial pulmonary edema in all patients, whereas pulmonary artery wedge pressure was 12 +/- 2 mmHg, excluding the possibility of left ventricular failure. After 24 hours, pulmonary edema had resolved, and the PIP and PaO2 had both returned to baseline. These data indicate that reperfusion of the ischemic lower torso leads to the synthesis of TxA2, an event temporally related to pulmonary hypertension and transient leukopenia with subsequent pulmonary microvascular injury manifest by interstitial edema.

Sequential germ cell tumor without prior involvement of the testes

We report on a patient who presented with a metastatic germ cell tumor and had a normal testicular examination. A complete response ensued following combination chemotherapy. A sequential germ cell tumor of the testes developed 20 months after the chemotherapy was stopped. This occurrence of clinically evident disease in the testes is consistent with either a second primary tumor or with recurrent disease from an occult focus not eradicated by prior systemic chemotherapy. Our case is compared to other cases of sequential germ cell tumors reported in the literature.