Background-Numerous studies have shown that diabetes mellitus (DM) is not identified and, consequently, inadequately treated in a substantial proportion of the patients in the general population. We know very little about the extent and the consequences of undiagnosed diabetes in the risk group of patients with coronary heart diseases. The objective of this study was therefore to determine the prevalence and the risks of undiagnosed DM among patients with coronary artery bypass. Methods and Results-The data of 7310 patients who have undergone coronary bypass operations between 1996 and 2003 were analyzed. Depending on their diagnosis on admission and their fasting plasma glucose (FPG) level, these patients were classified as known diabetics, undiagnosed diabetics (FPG Ն126 mg/dL), or as nondiabetics (FPG Ͻ126 mg/dL) and were compared in terms of their preoperative, intraoperative, and postoperative characteristics. Among the patients with coronary bypass that we examined, we found a prevalence of diagnosed diabetics of 29.6%. The prevalence of patients with undiagnosed DM (FPG Ն126 mg/dL) was 5.2%. In comparison with the other groups (non-DM versus undiagnosed DM versus known DM), the undiagnosed diabetics more frequently required resuscitation (1.7% versus 4.2% versus 1.5%; PϽ0.01) and reintubation (2.1% versus 5.0% versus 3.5%; PϽ0.01) and often showed a longer period of ventilation Ͼ1 day (5.6% versus 10.5% versus 7.4%; PϽ0.01). Perioperative mortality rate was highest in this group (0.9% versus 2.4% versus 1.4%; PϽ0.01). Conclusions-This study is the first to publish the prevalence of undiagnosed diabetes mellitus in cardiac surgery. During the perioperative and postoperative courses, these patients displayed a substantially higher morbidity and mortality rate.

The implementation of two neural network algorithms for visuo-motor control of an industrial robot (Puma 562) is reported. The first algorithm uses a vector quantization technique, the ;neural-gas' network, together with an error correction scheme based on a Widrow-Hoff-type learning rule. The second algorithm employs an extended self-organizing feature map algorithm. Based on visual information provided by two cameras, the robot learns to position its end effector without an external teacher. Within only 3000 training steps, the robot-camera system is capable of reducing the positioning error of the robot's end effector to approximately 0.1% of the linear dimension of the work space. By employing adaptive feedback the robot succeeds in compensating not only slow calibration drifts, but also sudden changes in its geometry. Hardware aspects of the robot-camera system are discussed.

The buildup of so-called "greenhouse gases" in the atmosphere -COz in particular -appears to be having an adverse impact on the global climate. This paper briefly reviews current expectations with regard to physical and biological effects, their potential costs to society, and likely costs of abatement. For a "worst case" scenario it is impossible to assess, in economic terms, the full range of possible nonlinear synergistic effects. In the "most favorable" (although not necessarily "likely") case (of slow-paced climate change), however, it seems likely that the impacts are within the "affordable" range, at least in the industrialized countries of the world. In the "third world" the notion of affordability is of doubtful relevance, making the problem of quantitative evaluation almost impossible. We tentatively assess the lower limit of quantifiable climate-induced damages at US$30 to US$35 per ton of T O 2 equivalent", worldwide, with the higher level of damages being concentrated in regions most adversely affected by sea-level rise. The non-quantifiable environmental damages are also significant and should by no means be disregarded.The costs and benefits of (1) reducing CFC use, and (2) reducing fossil fuel consumption, as a means of abatement, are considered in some detail. This strategy has remarkably high indirect benefits in terms of reduced air pollution damage and even direct cost savings to consumers. The indirect benefits of reduced air pollution and its associated health and environmental effects from fossil-fuel combustion in the industrialized countries range from US$20 to US$60 per ton of COz eliminated. In addition, there is good evidence that modest (e.g., 25%) reductions in COz emissions may be achievable by the USA (and, by implication, for other countries) by a combination of increased energy efficiency and restructuring that would permit simultaneous direct economic benefits (savings) to energy consumers of the order of US$50 per ton of COz saved. A higher level of overall emissions reductionpossibly approaching 50% -could probably be achieved, at little or no net cost, by taking advantage of these savings.We suggest the use of taxes on fossil fuel extraction (or a carbon tax) as a reasonable way of inducing the structural changes that would be required to achieve significant reduction in energy use and COz emissions. To minimize the economic burden (and create a political constituency in support of the approach) we suggest the substitution of resource-based taxes in general for other types of taxes (on labor, income, real estate, or trade) that are now the main sources of government revenue. While it is conceded that it would be difficult to calculate the "optimal" tax on extractive resources, we do not think this is a necessary prerequisite to policy-making. In fact, we note that the existing tax system has never been optimized according to theoretical principles, and is far from optimal by any reasonable criteria.

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