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What does Brother Partridge think after William shares his life story?
A. He believes William is being punished for his former sins
B. He believes William is a criminal
C. He believes William is going to murder him
D. He believes William is the second coming
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Charity Case By JIM HARMON Illustrated by DICK FRANCIS [Transcriber's Note: This etext was produced from Galaxy Science Fiction December 1959. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Certainly I see things that aren't there and don't say what my voice says—but how can I prove that I don't have my health? When he began his talk with "You got your health, don't you?" it touched those spots inside me. That was when I did it. Why couldn't what he said have been "The best things in life are free, buddy" or "Every dog has his day, fellow" or "If at first you don't succeed, man"? No, he had to use that one line. You wouldn't blame me. Not if you believe me. The first thing I can remember, the start of all this, was when I was four or five somebody was soiling my bed for me. I absolutely was not doing it. I took long naps morning and evening so I could lie awake all night to see that it wouldn't happen. It couldn't happen. But in the morning the bed would sit there dispassionately soiled and convict me on circumstantial evidence. My punishment was as sure as the tide. Dad was a compact man, small eyes, small mouth, tight clothes. He was narrow but not mean. For punishment, he locked me in a windowless room and told me to sit still until he came back. It wasn't so bad a punishment, except that when Dad closed the door, the light turned off and I was left there in the dark. Being four or five, I didn't know any better, so I thought Dad made it dark to add to my punishment. But I learned he didn't know the light went out. It came back on when he unlocked the door. Every time I told him about the light as soon as I could talk again, but he said I was lying. One day, to prove me a liar, he opened and closed the door a few times from outside. The light winked off and on, off and on, always shining when Dad stuck his head inside. He tried using the door from the inside, and the light stayed on, no matter how hard he slammed the door. I stayed in the dark longer for lying about the light. Alone in the dark, I wouldn't have had it so bad if it wasn't for the things that came to me. They were real to me. They never touched me, but they had a little boy. He looked the way I did in the mirror. They did unpleasant things to him. Because they were real, I talked about them as if they were real, and I almost earned a bunk in the home for retarded children until I got smart enough to keep the beasts to myself. My mother hated me. I loved her, of course. I remember her smell mixed up with flowers and cookies and winter fires. I remember she hugged me on my ninth birthday. The trouble came from the notes written in my awkward hand that she found, calling her names I didn't understand. Sometimes there were drawings. I didn't write those notes or make those drawings. My mother and father must have been glad when I was sent away to reform school after my thirteenth birthday party, the one no one came to. The reform school was nicer. There were others there who'd had it about like me. We got along. I didn't watch their shifty eyes too much, or ask them what they shifted to see. They didn't talk about my screams at night. It was home. My trouble there was that I was always being framed for stealing. I didn't take any of those things they located in my bunk. Stealing wasn't in my line. If you believe any of this at all, you'll see why it couldn't be me who did the stealing. There was reason for me to steal, if I could have got away with it. The others got money from home to buy the things they needed—razor blades, candy, sticks of tea. I got a letter from Mom or Dad every now and then before they were killed, saying they had sent money or that it was enclosed, but somehow I never got a dime of it. When I was expelled from reform school, I left with just one idea in mind—to get all the money I could ever use for the things I needed and the things I wanted. It was two or three years later that I skulked into Brother Partridge's mission on Durbin Street. The preacher and half a dozen men were singing Onward Christian Soldiers in the meeting room. It was a drafty hall with varnished camp chairs. I shuffled in at the back with my suitcoat collar turned up around my stubbled jaw. I made my hand shaky as I ran it through my knotted hair. Partridge was supposed to think I was just a bum. As an inspiration, I hugged my chest to make him think I was some wino nursing a flask full of Sneaky Pete. All I had there was a piece of copper alloy tubing inside a slice of plastic hose for taking care of myself, rolling sailors and the like. Who had the price of a bottle? Partridge didn't seem to notice me, but I knew that was an act. I knew people were always watching every move I made. He braced his red-furred hands on the sides of his auctioneer's stand and leaned his splotched eagle beak toward us. "Brothers, this being Thanksgiving, I pray the good Lord that we all are truly thankful for all that we have received. Amen." Some skin-and-bones character I didn't know struggled out of his seat, amening. I could see he had a lot to be thankful for—somewhere he had received a fix. "Brothers," Partridge went on after enjoying the interruption with a beaming smile, "you shall all be entitled to a bowl of turkey soup prepared by Sister Partridge, a generous supply of sweet rolls and dinner rolls contributed by the Early Morning Bakery of this city, and all the coffee you can drink. Let us march out to The Stars and Stripes Forever , John Philip Sousa's grand old patriotic song." I had to laugh at all those bums clattering the chairs in front of me, scampering after water soup and stale bread. As soon as I got cleaned up, I was going to have dinner in a good restaurant, and I was going to order such expensive food and leave such a large tip for the waiter and send one to the chef that they were going to think I was rich, and some executive with some brokerage firm would see me and say to himself, "Hmm, executive material. Just the type we need. I beg your pardon, sir—" just like the razor-blade comic-strip ads in the old magazines that Frankie the Pig sells three for a quarter. I was marching. Man, was I ever marching, but the secret of it was I was only marking time the way we did in fire drills at the school. They passed me, every one of them, and marched out of the meeting room into the kitchen. Even Partridge made his way down from the auctioneer's stand like a vulture with a busted wing and darted through his private door. I was alone, marking time behind the closed half of double doors. One good breath and I raced past the open door and flattened myself to the wall. Crockery was ringing and men were slurping inside. No one had paid any attention to me. That was pretty odd. People usually watch my every move, but a man's luck has to change sometime, doesn't it? Following the wallboard, I went down the side of the room and behind the last row of chairs, closer, closer, and halfway up the room again to the entrance—the entrance and the little wooden box fastened to the wall beside it. The box was old and made out of some varnished wood. There was a slot in the top. There wasn't any sign anywhere around it, but you knew it wasn't a mailbox. My hand went flat on the top of the box. One finger at a time drew up and slipped into the slot. Index, fore, third, little. I put my thumb in my palm and shoved. My hand went in. There were coins inside. I scooped them up with two fingers and held them fast with the other two. Once I dropped a dime—not a penny, milled edge—and I started to reach for it. No, don't be greedy. I knew I would probably lose my hold on all the coins if I tried for that one. I had all the rest. It felt like about two dollars, or close to it. Then I found the bill. A neatly folded bill in the box. Somehow I knew all along it would be there. I tried to read the numbers on the bill with my fingertips, but I couldn't. It had to be a one. Who drops anything but a one into a Skid Row collection box? But still there were tourists, slummers. They might leave a fifty or even a hundred. A hundred! Yes, it felt new, crisp. It had to be a hundred. A single would be creased or worn. I pulled my hand out of the box. I tried to pull my hand out of the box. I knew what the trouble was, of course. I was in a monkey trap. The monkey reaches through the hole for the bait, and when he gets it in his hot little fist, he can't get his hand out. He's too greedy to let go, so he stays there, caught as securely as if he were caged. I was a man, not a monkey. I knew why I couldn't get my hand out. But I couldn't lose that money, especially that century bill. Calm, I ordered myself. Calm. The box was fastened to the vertical tongue-and-groove laths of the woodwork, not the wall. It was old lumber, stiffened by a hundred layers of paint since 1908. The paint was as thick and strong as the boards. The box was fastened fast. Six-inch spike nails, I guessed. Calmly, I flung my whole weight away from the wall. My wrist almost cracked, but there wasn't even a bend in the box. Carefully, I tried to jerk my fist straight up, to pry off the top of the box. It was as if the box had been carved out of one solid piece of timber. It wouldn't go up, down, left or right. But I kept trying. While keeping a lookout for Partridge and somebody stepping out of the kitchen for a pull on a bottle, I spotted the clock for the first time, a Western Union clock high up at the back of the hall. Just as I seen it for the first time, the electricity wound the spring motor inside like a chicken having its neck wrung. The next time I glanced at the clock, it said ten minutes had gone by. My hand still wasn't free and I hadn't budged the box. "This," Brother Partridge said, "is one of the most profound experiences of my life." My head hinged until it lined my eyes up with Brother Partridge. The pipe hung heavy in my pocket, but he was too far from me. "A vision of you at the box projected itself on the crest of my soup," the preacher explained in wonderment. I nodded. "Swimming right in there with the dead duck." "Cold turkey," he corrected. "Are you scoffing at a miracle?" "People are always watching me, Brother," I said. "So now they do it even when they aren't around. I should have known it would come to that." The pipe was suddenly a weight I wanted off me. I would try robbing a collection box, knowing positively that I would get caught, but I wasn't dumb enough to murder. Somebody, somewhere, would be a witness to it. I had never got away with anything in my life. I was too smart to even try anything but the little things. "I may be able to help you," Brother Partridge said, "if you have faith and a conscience." "I've got something better than a conscience," I told him. Brother Partridge regarded me solemnly. "There must be something special about you, for your apprehension to come through miraculous intervention. But I can't imagine what." "I always get apprehended somehow, Brother," I said. "I'm pretty special." "Your name?" "William Hagle." No sense lying. I had been booked and printed before. Partridge prodded me with his bony fingers as if making sure I was substantial. "Come. Let's sit down, if you can remove your fist from the money box." I opened up my fingers and let the coins ring inside the box and I drew out my hand. The bill stuck to the sweat on my fingers and slid out along with the digits. A one, I decided. I had got into trouble for a grubby single. It wasn't any century. I had been kidding myself. I unfolded the note. Sure enough, it wasn't a hundred-dollar bill, but it was a twenty, and that was almost the same thing to me. I creased it and put it back into the slot. As long as it stalled off the cops, I'd talk to Partridge. We took a couple of camp chairs and I told him the story of my life, or most of it. It was hard work on an empty stomach; I wished I'd had some of that turkey soup. Then again I was glad I hadn't. Something always happened to me when I thought back over my life. The same thing. The men filed out of the kitchen, wiping their chins, and I went right on talking. After some time Sister Partridge bustled in and snapped on the overhead lights and I kept talking. The brother still hadn't used the phone to call the cops. "Remarkable," Partridge finally said when I got so hoarse I had to take a break. "One is almost— almost —reminded of Job. William, you are being punished for some great sin. Of that, I'm sure." "Punished for a sin? But, Brother, I've always had it like this, as long as I can remember. What kind of a sin could I have committed when I was fresh out of my crib?" "William, all I can tell you is that time means nothing in Heaven. Do you deny the transmigration of souls?" "Well," I said, "I've had no personal experience—" "Of course you have, William! Say you don't remember. Say you don't want to remember. But don't say you have no personal experience!" "And you think I'm being punished for something I did in a previous life?" He looked at me in disbelief. "What else could it be?" "I don't know," I confessed. "I certainly haven't done anything that bad in this life." "William, if you atone for this sin, perhaps the horde of locusts will lift from you." It wasn't much of a chance, but I was unused to having any at all. I shook off the dizziness of it. "By the Lord Harry, Brother, I'm going to give it a try!" I cried. "I believe you," Partridge said, surprised at himself. He ambled over to the money box on the wall. He tapped the bottom lightly and a box with no top slid out of the slightly larger box. He reached in, fished out the bill and presented it to me. "Perhaps this will help in your atonement," he said. I crumpled it into my pocket fast. Not meaning to sound ungrateful, I'm pretty sure he hadn't noticed it was a twenty. And then the bill seemed to lie there, heavy, a lead weight. It would have been different if I had managed to get it out of the box myself. You know how it is. Money you haven't earned doesn't seem real to you. There was something I forgot to mention so far. During the year between when I got out of the reformatory and the one when I tried to steal Brother Partridge's money, I killed a man. It was all an accident, but killing somebody is reason enough to get punished. It didn't have to be a sin in some previous life, you see. I had gotten my first job in too long, stacking boxes at the freight door of Baysinger's. The drivers unloaded the stuff, but they just dumped it off the truck. An empty rear end was all they wanted. The freight boss told me to stack the boxes inside, neat and not too close together. I stacked boxes the first day. I stacked more the second. The third day I went outside with my baloney and crackers. It was warm enough even for November. Two of them, dressed like Harvard seniors, caps and striped duffer jackets, came up to the crate I was dining off. "Work inside, Jack?" the taller one asked. "Yeah," I said, chewing. "What do you do, Jack?" the fatter one asked. "Stack boxes." "Got a union card?" I shook my head. "Application?" "No," I said. "I'm just helping out during Christmas." "You're a scab, buddy," Long-legs said. "Don't you read the papers?" "I don't like comic strips," I said. They sighed. I think they hated to do it, but I was bucking the system. Fats hit me high. Long-legs hit me low. I blew cracker crumbs into their faces. After that, I just let them go. I know how to take a beating. That's one thing I knew. Then lying there, bleeding to myself, I heard them talking. I heard noises like make an example of him and do something permanent and I squirmed away across the rubbish like a polite mouse. I made it around a corner of brick and stood up, hurting my knee on a piece of brown-splotched pipe. There were noises on the other angle of the corner and so I tested if the pipe was loose and it was. I closed my eyes and brought the pipe up and then down. It felt as if I connected, but I was so numb, I wasn't sure until I unscrewed my eyes. There was a big man in a heavy wool overcoat and gray homburg spread on a damp centerfold from the News . There was a pick-up slip from the warehouse under the fingers of one hand, and somebody had beaten his brains out. The police figured it was part of some labor dispute, I guess, and they never got to me. I suppose I was to blame anyway. If I hadn't been alive, if I hadn't been there to get beaten up, it wouldn't have happened. I could see the point in making me suffer for it. There was a lot to be said for looking at it like that. But there was nothing to be said for telling Brother Partridge about the accident, or murder, or whatever had happened that day. Searching myself after I left Brother Partridge, I finally found a strip of gray adhesive tape on my side, out of the fuzzy area. Making the twenty the size of a thick postage stamp, I peeled back the tape and put the folded bill on the white skin and smoothed the tape back. There was only one place for me to go now. I headed for the public library. It was only about twenty blocks, but not having had anything to eat since the day before, it enervated me. The downstairs washroom was where I went first. There was nobody there but an old guy talking urgently to a kid with thick glasses, and somebody building a fix in one of the booths. I could see charred matches dropping down on the floor next to his tennis shoes, and even a few grains of white stuff. But he managed to hold still enough to keep from spilling more from the spoon. I washed my hands and face, smoothed my hair down, combing it with my fingers. Going over my suit with damp toweling got off a lot of the dirt. I put my collar on the outside of my jacket and creased the wings with my thumbnail so it would look more like a sports shirt. It didn't really. I still looked like a bum, but sort of a neat, non-objectionable bum. The librarian at the main desk looked sympathetically hostile, or hostilely sympathetic. "I'd like to get into the stacks, miss," I said, "and see some of the old newspapers." "Which newspapers?" the old girl asked stiffly. I thought back. I couldn't remember the exact date. "Ones for the first week in November last year." "We have the Times microfilmed. I would have to project them for you." "I didn't want to see the Times ," I said, fast. "Don't you have any newspapers on paper?" I didn't want her to see what I wanted to read up on. "We have the News , bound, for last year." I nodded. "That's the one I wanted to see." She sniffed and told me to follow her. I didn't rate a cart to my table, I guess, or else the bound papers weren't supposed to come out of the stacks. The cases of books, row after row, smelled good. Like old leather and good pipe tobacco. I had been here before. In this world, it's the man with education who makes the money. I had been reading the Funk & Wagnalls Encyclopedia. So far I knew a lot about Mark Antony, Atomic Energy, Boron, Brussels, Catapults, Demons, and Divans. I guess I had stopped to look around at some of the titles, because the busy librarian said sharply, "Follow me." I heard my voice say, "A pleasure. What about after work?" I didn't say it, but I was used to my voice independently saying things. Her neck got to flaming, but she walked stiffly ahead. She didn't say anything. She must be awful mad, I decided. But then I got the idea she was flushed with pleasure. I'm pretty ugly and I looked like a bum, but I was young. You had to grant me that. She waved a hand at the rows of bound News and left me alone with them. I wasn't sure if I was allowed to hunt up a table to lay the books on or not, so I took the volume for last year and laid it on the floor. That was the cleanest floor I ever saw. It didn't take me long to find the story. The victim was a big man, because the story was on the second page of the Nov. 4 edition. I started to tear the page out, then only memorized the name and home address. Somebody was sure to see me and I couldn't risk trouble just now. I stuck the book back in line and left by the side door. I went to a dry-cleaner, not the cheapest place I knew, because I wouldn't be safe with the change from a twenty in that neighborhood. My suit was cleaned while I waited. I paid a little extra and had it mended. Funny thing about a suit—it's almost never completely shot unless you just have it ripped off you or burned up. It wasn't exactly in style, but some rich executives wore suits out of style that they had paid a lot of money for. I remembered Fredric March's double-breasted in Executive Suite while Walter Pidgeon and the rest wore Ivy Leagues. Maybe I would look like an eccentric executive. I bought a new shirt, a good used pair of shoes, and a dime pack of single-edged razor blades. I didn't have a razor, but anybody with nerve can shave with a single-edge blade and soap and water. The clerk took my two bucks in advance and I went up to my room. I washed out my socks and underwear, took a bath, shaved and trimmed my hair and nails with the razor blade. With some soap on my finger, I scrubbed my teeth. Finally I got dressed. Everything was all right except that I didn't have a tie. They had them, a quarter a piece, where I got the shoes. It was only six blocks—I could go back. But I didn't want to wait. I wanted to complete the picture. The razor blade sliced through the pink bath towel evenly. I cut out a nice modern-style tie, narrow, with some horizontal stripes down at the bottom. I made a tight, thin knot. It looked pretty good. I was ready to leave, so I started for the door. I went back. I had almost forgotten my luggage. The box still had three unwrapped blades in it. I pocketed it. I hefted the used blade, dulled by all the work it had done. You can run being economical into stinginess. I tossed it into the wastebasket. I had five hamburgers and five cups of coffee. I couldn't finish all of the French fries. "Mac," I said to the fat counterman, who looked like all fat countermen, "give me a Milwaukee beer." He stopped polishing the counter in front of his friend. "Milwaukee, Wisconsin, or Milwaukee, Oregon?" "Wisconsin." He didn't argue. It was cold and bitter. All beer is bitter, no matter what they say on TV. I like beer. I like the bitterness of it. It felt like another, but I checked myself. I needed a clear head. I thought about going back to the hotel for some sleep; I still had the key in my pocket (I wasn't trusting it to any clerk). No, I had had sleep on Thanksgiving, bracing up for trying the lift at Brother Partridge's. Let's see, it was daylight outside again, so this was the day after Thanksgiving. But it had only been sixteen or twenty hours since I had slept. That was enough. I left the money on the counter for the hamburgers and coffee and the beer. There was $7.68 left. As I passed the counterman's friend on his stool, my voice said, "I think you're yellow." He turned slowly, his jaw moving further away from his brain. I winked. "It was just a bet for me to say that to you. I won two bucks. Half of it is yours." I held out the bill to him. His paw closed over the money and punched me on the biceps. Too hard. He winked back. "It's okay." I rubbed my shoulder, marching off fast, and I counted my money. With my luck, I might have given the counterman's friend the five instead of one of the singles. But I hadn't. I now had $6.68 left. "I still think you're yellow," my voice said. It was my voice, but it didn't come from me. There were no words, no feeling of words in my throat. It just came out of the air the way it always did. I ran. Harold R. Thompkins, 49, vice-president of Baysinger's, was found dead behind the store last night. His skull had been crushed by a vicious beating with a heavy implement, Coroner McClain announced in preliminary verdict. Tompkins, who resided at 1467 Claremont, Edgeway, had been active in seeking labor-management peace in the recent difficulties.... I had read that a year before. The car cards on the clanking subway and the rumbling bus didn't seem nearly so interesting to me. Outside the van, a tasteful sign announced the limits of the village of Edgeway, and back inside, the monsters of my boyhood went bloomp at me. I hadn't seen anything like them in years. The slimy, scaly beasts were slithering over the newspaper holders, the ad card readers, the girl watchers as the neat little carbon-copy modern homes breezed past the windows. I ignored the devils and concentrated on reading the withered, washed-out political posters on the telephone poles. My neck ached from holding it so stiff, staring out through the glass. More than that, I could feel the jabberwocks staring at me. You know how it is. You can feel a stare with the back of your neck and between your eyes. They got one brush of a gaze out of me. The things abruptly started their business, trying to act casually as if they hadn't been waiting for me to look at them at all. They had a little human being of some sort. It was the size of a small boy, like the small boy who looked like me that they used to destroy when I was locked up with them in the dark. Except this was a man, scaled down to child's size. He had sort of an ugly, worried, tired, stupid look and he wore a shiny suit with a piece of a welcome mat or something for a necktie. Yeah, it was me. I really knew it all the time. They began doing things to the midget me. I didn't even lift an eyebrow. They couldn't do anything worse to the small man than they had done to the young boy. It was sort of nostalgic watching them, but I really got bored with all that violence and killing and killing the same kill over and over. Like watching the Saturday night string of westerns in a bar. The sunlight through the window was yellow and hot. After a time, I began to dose. The shrieks woke me up. For the first time, I could hear the shrieks of the monster's victim and listen to their obscene droolings. For the very first time in my life. Always before it had been all pantomime, like Charlie Chaplin. Now I heard the sounds of it all. They say it's a bad sign when you start hearing voices. I nearly panicked, but I held myself in the seat and forced myself to be rational about it. My own voice was always saying things everybody could hear but which I didn't say. It wasn't any worse to be the only one who could hear other things I never said. I was as sane as I ever was. There was no doubt about that. But a new thought suddenly impressed itself on me. Whatever was punishing me for my sin was determined that I turn back before reaching 1467 Claremont.
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A. He believes William is being punished for his former sins
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What is the size of the dataset?
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### Introduction
In contrast to traditional content distribution channels like television, radio and newspapers, Internet opened the door for direct interaction between the content creator and its audience. Young people are now gaining more frequent access to online, networked media. Although most of the time, their Internet use is harmless, there are some risks associated with these online activities, such as the use of social networking sites (e.g., Twitter, Facebook, Reddit). The anonymity and freedom provided by social networks makes them vulnerable to threatening situations on the Web, such as trolling. Trolling is “the activity of posting messages via a communications network that are intended to be provocative, offensive or menacing” BIBREF0 . People who post such comments are known as trolls. According to hardaker2010trolling, a troll's “real intention(s) is/are to cause disruption and/or trigger or exacerbate conflict for the purpose of their own amusement”. Worse still, the troll's comments may have a negative psychological impact on his target/victim and possibly others who participated in the same conversation. It is therefore imperative to identify such comments and perhaps even terminate the conversation before it evolves into something psychological disruptive for the participants. Monitoring conversations is a labor-intensive task: it can potentially place a severe burden on the moderators, and it may not be an effective solution when traffic is heavy. This calls for the need to develop automatic methods for identifying malicious comments, which we will refer to as trolling attempts in this paper. In fact, there have recently been some attempts to automatically identify comments containing cyberbullying (e.g., van2015detection), which corresponds to the most severe cases of trolling BIBREF0 . However, we believe that it is important not only to identify trolling attempts, but also comments that could have a negative psychological impact on their recipients. As an example, consider the situation where a commenter posts a comment with the goal of amusing others. However, it is conceivable that not everybody would be aware of these playful intentions, and these people may disagree or dislike the mocking comments and take them as inappropriate, prompting a negative reaction or psychological impact on themselves. In light of this discussion, we believe that there is a need to identify not only the trolling attempts, but also comments that could have a negative psychological impact on its receipts. To this end, we seek to achieve the following goals in this paper. First, we propose a comprehensive categorization of trolling that allows us to model not only the troll's intention given his trolling attempt, but also the recipients' perception of the troll's intention and subsequently their reaction to the trolling attempt. This categorization gives rise to very interesting problems in pragmatics that involve the computational modeling of intentions, perceived intentions, and reactions to perceived intentions. Second, we create a new annotated resource for computational modeling of trolling. Each instance in this resource corresponds to a suspected trolling attempt taken from a Reddit conversation, it's surrounding context, and its immediate responses and will be manually coded with information such as the troll's intention and the recipients' reactions using our proposed categorization of trolling. Finally, we identify the instances that are difficult to classify with the help of a classifier trained with features taken from the state of the art, and subsequently present an analysis of these instances. To our knowledge, our annotated resource is the first one of its sort that allows computational modeling on both the troll's side and the recipients' side. By making it publicly available, we hope to stimulate further research on this task. We believe that it will be valuable to any NLP researcher who is interested in the computational modeling of trolling. ### Related Work
In this section, we discuss related work in the areas of trolling, bullying, abusive language detection and politeness, as they intersect in their scope and at least partially address the problem presented in this work. In the realm of psychology, bishop2013effect and bishop2014representations elaborate a deep description of a troll's personality, motivations, effects on the community that trolls interfere in and the criminal and psychological aspects of trolls. Their main focus are flaming (trolls), and hostile and aggressive interactions between users BIBREF1 . On the computational side, mihaylov2015finding address the problem of identifying manipulation trolls in news community forums. Not only do they focus solely on troll identification, but the major difference with this work is that all their predictions are based on non-linguistic information such as number of votes, dates, number of comments and so on. In a networks related framework, kumar2014accurately and guha2004propagation present a methodology to identify malicious individuals in a network based solely on the network's properties rather than on the textual content of comments. cambria2010not propose a method that involves NLP components, but fail to provide an evaluation of their system. There is extensive work on detecting offensive and abusive language in social media BIBREF2 and BIBREF3 . There are two clear differences between their work and ours. One is that trolling is concerned about not only abusive language but also a much larger range of language styles and addresses the intentions and interpretations of the commenters, which goes beyond the linguistic dimension. The other is that we are additionally interested in the reactions to trolling attempts, real or perceived, because we argued that this is a phenomenon that occurs in pairs through the interaction of at least two individuals, which is different from abusive language detection. Also, xu2012learning, xu2012fast and xu2013examination address bullying traces. Bullying traces are self-reported events of individuals describing being part of bullying events, but we believe that the real impact of computational trolling research is not on analyzing retrospective incidents, but on analyzing real-time conversations. chen2012detecting use lexical and semantic features to determine sentence offensiveness levels to identify cyberbullying, offensive or abusive comments on Youtube. On Youtube as well, dinakar2012common identified sensitive topics for cyberbullying. dadvar2014experts used expert systems to classify between bullying and no bullying in posts. van2015detection predict fine-grained categories for cyberbullying, distinguishing between insults and threats and identified user roles in the exchanges. Finally, hardaker2010trolling argues that trolling cannot be studied using established politeness research categories. ### Trolling Categorization
In this section, we describe our proposal of a comprehensive trolling categorization. While there have been attempts in the realm of psychology to provide a working definition of trolling (e.g., hardaker2010trolling, bishop2014representations), their focus is mostly on modeling the troll's behavior. For instance, bishop2014representations constructed a “trolling magnitude” scale focused on the severity of abuse and misuse of internet mediated communications. bishop2013effect also categorized trolls based on psychological characteristics focused on pathologies and possible criminal behaviors. In contrast, our trolling categorization seeks to model not only the troll's behavior but also the impact on the recipients, as described below. Since one of our goals is to identify trolling events, our datasets will be composed of suspected trolling attempts (i.e., comments that are suspected to be trolling attempts). In other words, some of these suspected trolling attempts will be real trolling attempts, and some of them won't. So, if a suspected trolling attempt is in fact not a trolling attempt, then its author will not be a troll. To cover both the troll and the recipients, we define a (suspected trolling attempt, responses) pair as the basic unit that we consider for the study of trolling, where “responses” are all the direct responses to the suspected trolling attempt. We characterize a (suspected trolling attempt, responses) pair using four aspects. Two aspects describe the trolling attempt: (1) Intention (I) (what is its author's purpose?), and (2) Intention Disclosure (D) (is its author trying to deceive its readers by hiding his real (i.e., malicious) intentions?). The remaining two aspects are defined on each of the (direct) responses to the trolling attempt: (1) Intention Interpretation (R) (what is the responder's perception of the troll's intention?), and (2) the Response strategy (B) (what is the responder's reaction?). Two points deserve mention. First, R can be different from I due to misunderstanding and the fact that the troll may be trying to hide his intention. Second, B is influenced by R, and the responder's comment can itself be a trolling attempt. We believe that these four aspects constitute interesting, under-studied pragmatics tasks for NLP researchers. The possible values of each aspect are described in Table TABREF1 . As noted before, since these are suspected trolling attempts, if an attempt turns out not to be a trolling attempt, its author will not be a troll. For a given (suspected trolling attempt, responses) pair, not all of the 189 (= INLINEFORM0 ) combinations of values of the four aspects are possible. There are logical constraints that limit plausible combinations: a) Trolling or Playing Intentions (I) must have Hidden or Exposed Intention Disclosure (D), b) Normal intentions (I) can only have None Intention disclosure (D) and c) Trolling or Playing interpretation (R) cannot have Normal response strategy (B). ### Conversation Excerpts
To enable the reader to better understand this categorization, we present two example excerpts taken from the original (Reddit) conversations. The first comment on each excerpt, generated by author C0, is given as a minimal piece of context. The second comment, written by the author C1 in italics, is the suspected trolling attempt. The rest of the comments comprise all direct responses to the suspected trolling comment. Example 1. [noitemsep,nolistsep] Yeah, cause that's what usually happens. Also, quit following me around, I don't want a boyfriend. [noitemsep,nolistsep] I wasn't aware you were the same person.... I've replied to a number of stupid people recently, my bad [noitemsep,nolistsep] Trollname trollpost brotroll In this example, C1 is teasing of C0, expecting to provoke or irritate irritate, and he is clearly disclosing her trolling intentions. In C0's response, we see that he clearly believe that C1 is trolling, since is directly calling him a “brotroll” and his response strategy is frustrate the trolling attempt by denouncing C1 troll's intentions “trollpost” and true identity “brotroll”. Example 2. [noitemsep,nolistsep] Please post a video of your dog doing this. The way I'm imagining this is adorable. [noitemsep,nolistsep] I hope the dog gets run over by a truck on the way out of the childrens playground. [noitemsep,nolistsep] If you're going to troll, can you at least try to be a bit more Haha I hope the cancer kills you. convincing? In this example, we observe that C0's first comment is making a polite request (Please). In return, C1 answer is a mean spirited comment whose intention is to disrupt and possible hurtful C0. Also, C1's comment is not subtle at all, so his intention is clearly disclosed. As for C2, she is clearly acknowledging C1's trolling intention and her response strategy is a criticism which we categorize as frustrate. Now, in C0's second comment, we observe that his interpretation is clear, he believes that C1 is trolling and the negative effect is so tangible, that his response strategy is to troll back or counter-troll by replying with a comparable mean comment. ### Corpus and Annotation
Reddit is popular website that allows registered users (without identity verification) to participate in fora grouped by topic or interest. Participation consists of posting stories that can be seen by other users, voting stories and comments, and comments in the story's comment section, in the form of a forum. The forums are arranged in the form of a tree, allowing nested conversations, where the replies to a comment are its direct responses. We collected all comments in the stories' conversation in Reddit that were posted in August 2015. Since it is infeasible to manually annotate all of the comments, we process this dataset with the goal of extracting threads that involve suspected trolling attempts and the direct responses to them. To do so, we used Lucene to create an inverted index from the comments and queried it for comments containing the word “troll” with an edit distance of 1 in order to include close variations of this word, hypothesizing that such comments would be reasonable candidates of real trolling attempts. We did observe, however, that sometimes people use the word troll to point out that another user is trolling. Other times, people use the term to express their frustration about a particular user, but there is no trolling attempt. Yet other times people simply discuss trolling and trolls without actually observing one. Nonetheless, we found that this search produced a dataset in which 44.3% of the comments are real trolling attempts. Moreover, it is possible for commenters to believe that they are witnessing a trolling attempt and respond accordingly even where there is none due to misunderstanding. Therefore, the inclusion of comments that do not involve trolling would allow us to learn what triggers a user's interpretation of trolling when it is not present and what kind of response strategies are used. For each retrieved comment, we reconstructed the original conversation tree it appears in, from the original post (i.e., the root) to the leaves, so that its parent and children can be recovered. We consider a comment in our dataset a suspected trolling attempt if at least one of its immediate children contains the word troll. For annotation purposes, we created snippets of conversations exactly like the ones shown in Example 1 and Example 2, each of which consists of the parent of the suspected trolling attempt, the suspected trolling attempt, and all of the direct responses to the suspected trolling attempt. We had two human annotators who were trained on snippets (i.e., (suspected trolling attempt, responses) pairs) taken from 200 conversations and were allowed to discuss their findings. After this training stage, we asked them to independently label the four aspects for each snippet. We recognize that this limited amount of information is not always sufficient to recover the four aspects we are interested in, so we give the annotators the option to discard instances for which they couldn't determine the labels confidently. The final annotated dataset consists of 1000 conversations composed of 6833 sentences and 88047 tokens. The distribution over the classes per trolling aspect is shown in the table TABREF19 in the column “Size”. Due to the subjective nature of the task we did not expect perfect agreement. However, on the 100 doubly-annotated snippets, we obtained substantial inter-annotator agreement according to Cohen's kappa statistic BIBREF4 for each of the four aspects: Intention: 0.788, Intention Disclosure: 0.780, Interpretation: 0.797 and Response 0.776. In the end, the annotators discussed their discrepancies and managed to resolve all of them. ### Trolling Attempt Prediction
In this section, we make predictions on the four aspects of our task, with the primary goal of identifying the errors our classifier makes (i.e., the hard-to-classify instances) and hence the directions for future work, and the secondary goal of estimating the state of the art on this new task using only shallow (i.e., lexical and wordlist-based) features. ### Feature Sets
For prediction we define two sets of features: (1) a basic feature set taken from Van Hee's van2015detection paper on cyberbullying prediction, and (2) an extended feature set that we designed using primarily information extracted from wordlists and dictionaries. N-gram features. We encode each lemmatized and unlemmatized unigram and bigram collected from the training comments as a binary feature. In a similar manner, we include the unigram and bigram along with their POS tag as in BIBREF5 . To extract these features we used Stanford CoreNLP BIBREF6 . Sentiment Polarity. The overall comment's emotion could be useful to identify the response and intention in a trolling attempt. So, we apply the Vader Sentiment Polarity Analyzer BIBREF7 and include four features, one per each measurement given by the analyzer: positive, neutral, negative and a composite metric, each as a real number value. Emoticons. Reddit's comments make extensive use of emoticons. We argue that some emoticons are specifically used in trolling attempts to express a variety of emotions, which we hypothesize would be useful to identify a comment's intention, interpretation and response. For that reason, we use the emoticon dictionary developed hogenboom2015exploiting. We create a binary feature whose value is one if at least one of these emoticons is found in the comment. Harmful Vocabulary. In their research on bullying, nitta2013detecting identified a small set of words that are highly offensive. We create a binary feature whose value is one if the comment contains at least one of these words. Emotions Synsets. As in xu2012fast, we extracted all lemmas associated with each WordNet BIBREF8 synset involving seven emotions (anger, embarrassment, empathy, fear, pride, relief and sadness) as well as the synonyms of these emotion words extracted from the English merriam2004merriam dictionary. We create a binary feature whose value is one if any of these synsets or synonyms appears in the comment. Swearing Vocabulary. We manually collected 1061 swear words and short phrases from the internet, blogs, forums and smaller repositories . The informal nature of this dictionary resembles the type of language used by flaming trolls and agitated responses, so we encode a binary feature whose value is one when at least one such swear word is found in the comment. Swearing Vocabulary in Username. An interesting feature that is suggestive of the intention of a comment is the author's username. We found that abusive and annoying commenters contained cursing words in their usernames. So, we create a binary feature whose value is one if a swear word from the swearing vocabulary is found in their usernames. Framenet. We apply the SEMAFOR parser BIBREF9 to each sentence in every comment, and construct three different types of binary features: every frame name that is present in the sentence, the frame name and the target word associated with it, and the argument name along with the token or lexical unit in the sentence associated with it. We believe that some frames are especially interesting from the trolling perspective. We hypothesize that these features are useful for identifying trolling attempts in which semantic and not just syntactic information is required. Politeness cues. danescu2013computational identified cues that signal polite and impolite interactions among groups of people collaborating online. Based on our observations of trolling examples, it is clear that flaming, hostile and aggressive interactions between users BIBREF1 and engaged or emotional responses would use impolite cues. In contrast, neutralizing and frustrating responses to the troll avoid falling in confrontation and their vocabulary tends to be more polite. So we create a binary feature whose value is one if at least one cue appears in the comment. GloVe Embeddings. All the aforementioned features constitute a high dimensional bag of words (BOW). Word embeddings were created to overcome certain problems with the BOW representation, like sparsity, and weight in correlations of semantically similar words. For this reason, and following nobata2016abusive, we create a distributed representation of the comments by averaging the word vector of each lowercase token in the comment found in the Twitter corpus pre-trained GloVe vectors BIBREF10 . The resulting comment vector representation is a 200 dimensional array that is concatenated with the existing BOW. ### Results
Using the features described in the previous subsection, we train four independent classifiers using logistic regression, one per each of the four prediction tasks. All the results are obtained using 5-fold cross-validation experiments. In each fold experiment, we use three folds for training, one fold for development, and one fold for testing. All learning parameters are set to their default values except for the regularization parameter, which we tuned on the development set. In Table TABREF19 the leftmost results column reports F1 score based on majority class prediction. The next section (Single Feature Group) reports F1 scores obtained by using one feature group at a time. The goal of the later set of experiments is to gain insights about feature predictive effectiveness. The right side section (All features) shows the system performance measured using recall, precision, and F-1 as shown when all features described in section SECREF13 are used. The majority class prediction experiment is simplest baseline to which we can can compare the rest of the experiments. In order to illustrate the prediction power of each feature group independent from all others, we perform the “Single Feature Group”, experiments. As we can observe in Table TABREF19 there are groups of features that independently are not better than the majority baseline, for example, the emoticons, politeness cues and polarity are not better disclosure predictors than the majority base. Also, we observe that only n-grams and GloVe features are the only group of features that contribute to more than a class type for the different tasks. Now, the “All Features” experiment shows how the interaction between feature sets perform than any of the other features groups in isolation. The accuracy metric for each trolling task is meant to provide an overall performance for all the classes within a particular task, and allow comparison between different experiments. In particular, we observe that GloVe vectors are the most powerful feature set, accuracy-wise, even better than the experiments with all features for all tasks except interpretation. The overall Total Accuracy score reported in table TABREF19 using the entire feature set is 549. This result is what makes this dataset interesting: there is still lots of room for research on this task. Again, the primary goal of this experiment is to help identify the difficult-to-classify instances for analysis in the next section. ### Error Analysis
In order to provide directions for future work, we analyze the errors made by the classifier trained on the extended features on the four prediction tasks. Errors on Intention (I) prediction: The lack of background is a major problem when identifying trolling comments. For example, “your comments fit well in Stormfront” seems inoffensive on the surface. However, people who know that Stormfront is a white supremacist website will realize that the author of this comment had an annoying or malicious intention. But our system had no knowledge about it and simply predicted it as non-trolling. These kind of errors reduces recall on the prediction of trolling comments. A solution would be to include additional knowledge from anthologies along with a sentiment or polarity. One could modify NELL BIBREF12 to broaden the understanding of entities in the comments. Non-cursing aggressions and insults This is a challenging problem, since the majority of abusive and insulting comments rely on profanity and swearing. The problem arises with subtler aggressions and insults that are equally or even more annoying, such as “Troll? How cute.” and “settle down drama queen”. The classifier has a more difficult task of determining that these are indeed aggressions or insults. This error also decreases the recall of trolling intention. A solution would be to exploit all the comments made by the suspected troll in the entire conversation in order to increase the chances of finding curse words or other cues that lead the classifier to correctly classify the comment as trolling. Another source of error is the presence of controversial topic words such as “black”,“feminism”, “killing”, “racism”, “brown”, etc. that are commonly used by trolls. The classifier seems too confident to classify a comment as trolling in the presence of these words, but in many cases they do not. In order to ameliorate this problem, one could create ad-hoc word embeddings by training glove or other type of distributed representation on a large corpus for the specific social media platform in consideration. From these vectors one could expect a better representation of controversial topics and their interactions with other words so they might help to reduce these errors. Errors on Disclosure (D) prediction: A major source of error that affects disclosure is the shallow meaning representation obtained from the BOW model even when augmented with the distributional features given by the glove vectors. For example, the suspected troll's comment “how to deal with refugees? How about a bullet to the head” is clearly mean-spirited and is an example of disclosed trolling. However, to reach that conclusion the reader need to infer the meaning of “bullet to the head” and that this action is desirable for a vulnerable group like migrants or refugees. This problem produces low recall for the disclosed prediction task. A solution for this problem may be the use of deeper semantics, where we represent the comments and sentences in their logical form and infer from them the intended meaning. Errors on Interpretation (R) prediction: it is a common practice from many users to directly ask the suspected troll if he/she is trolling or not. There are several variations of this question, such as “Are you a troll?” and “not sure if trolling or not”. While the presence of a question like these seems to give us a hint of the responder's interpretation, we cannot be sure of his interpretation without also considering the context. One way to improve interpretation is to exploit the response strategy, but the response strategy in our model is predicted independently of interpretation. So one solution could be similar to the one proposed above for the disclosure task problem: jointly learning classifiers that predict both variables simultaneously. Another possibility is to use the temporal sequence of response comments and make use of older response interpretation as input features for later comments. This could be useful since commenters seem to influence each other as they read through the conversation. Errors on Response Strategy (B) prediction: In some cases there is a blurry line between “Frustrate” and “Neutralize”. The key distinction between them is that there exists some criticism in the Frustrate responses towards the suspected troll's comment, while “Neutralizing” comments acknowledge that the suspected troll has trolling intentions, but gives no importance to them. For example, response comments such as “oh, you are a troll” and “you are just a lame troll” are examples of this subtle difference. The first is a case of “neutralize” while the second is indeed criticizing the suspected troll's comment and therefore a “frustrate” response strategy. This kind of error affects both precision and recall for these two classes. A possible solution could be to train a specialized classifier to disambiguate between “frustrate” and “neutralize” only. Another challenging problem is the distinction between the classes “Troll” and “Engage”. This is true when the direct responder is intensely flared up with the suspected comment to the point that his own comment becomes a trolling attempt. A useful indicator for distinguishing these cases are the presence of insults, and to detect them we look for swear words, but as we noted before, there is no guarantee that swear words are used for insulting. This kind of error affects the precision and recall for the “troll” and “engage” classes. A solution to this problem may be the inclusion of longer parts of the conversation. It is typical in a troll-engaged comment scheme to observe longer than usual exchanges between two users, and the comments evolve in very agitated remarks. One may then use this information to disambiguate between the two classes. ### Conclusion and Future Work
We presented a new view on the computational modeling of trolling in Internet fora where we proposed a comprehensive categorization of trolling attempts that for the first time considers trolling from not only the troll's perspective but also the responders' perspectives. This categorization gives rise to four interesting pragmatics tasks that involve modeling intensions, perceived intensions, and reactions. Perhaps most importantly, we create an annotated dataset that we believe is the first of its sort. We intend to make publicly available with the hope of stimulating research on trolling. Table 1: Classes for trolling aspects: Intention, Intention Disclosure, Intention Interpretation and Response Strategy. Size refers to the percentage per class, in parenthesis is the total number of instances in the dataset. Table 2: Experiments Results. Below the “mjr” header, we report F1 scores the the majority class prediction we report F1 scores for the four aspects of trolling: Intention, Intentions Disclosure, Interpretation, and Response strategy. Also, below the “Single Feature Group” header, we report F1 scores as before, when the feature group indicated in the column headers is the only feature group used for classifier. The column headers abbreviations stand for: Emoticons, Harmful Vocabulary, Emotion Synsets, Swearing Vocabulary, Swearing Vocabulary in Usernames, Framenet, Politeness cues, n-grams (actual n-grams and n-grams appended with their corresponding part of speech tag) and Glove embeddings in that order. Below the “All Features” header we report Recall, Precision and F1 score, respectively, when all features are use for prediction. All experiments are performed using a logistic regression classifier per task. The last column reports the class distribution in percentage per task. The last row of each trolling aspect reports accuracy (the percentage of instances correctly classified). The last row in the table reports total accuracy, the percentage of correctly classified instances considering all aspects.
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1000 conversations composed of 6833 sentences and 88047 tokens
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What wouldn't the author say of Malick?
A. he knows how to bring out the beauty amongst war
B. he told a well-rounded story of war
C. he's a philosophical thinker
D. he did more than just make a war movie
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War and Pieces No movie in the last decade has succeeded in psyching out critics and audiences as fully as the powerful, rambling war epic The Thin Red Line , Terrence Malick's return to cinema after 20 years. I've sat through it twice and am still trying to sort out my responses, which run from awe to mockery and back. Like Saving Private Ryan , the picture wallops you in the gut with brilliant, splattery battle montages and Goyaesque images of hell on earth. But Malick, a certified intellectual and the Pynchonesque figure who directed Badlands and Days of Heaven in the 1970s and then disappeared, is in a different philosophical universe from Steven Spielberg. Post-carnage, his sundry characters philosophize about their experiences in drowsy, runic voice-overs that come at you like slow bean balls: "Why does nature vie with itself? ... Is there an avenging power in nature, not one power but two?" Or "This great evil: Where's it come from? What seed, what root did it grow from? Who's doin' this? Who's killin' us, robbin' us of life and light?" First you get walloped with viscera, then you get beaned by blather. Those existential speculations don't derive from the screenplay's source, an archetypal but otherwise down-to-earth 1962 novel by James Jones (who also wrote From Here to Eternity ) about the American invasion of the South Pacific island of Guadalcanal. They're central to Malick's vision of the story, however, and not specious. In the combat genre, the phrase "war is hell" usually means nothing more than that it's a bummer to lose a limb or two, or to see your buddy get his head blown off. A true work of art owes us more than literal horrors, and Malick obliges by making his theater of war the setting for nothing less than a meditation on the existence of God. He tells the story solemnly, in three parts, with a big-deal cast (Sean Penn, Nick Nolte, John Cusack) and a few other major stars (John Travolta, Woody Harrelson, George Clooney) dropping by for cameos. After an Edenic prelude, in which a boyishly idealistic absent without leave soldier, Pvt. Witt (Jim Caviezel), swims with native youths to the accompaniment of a heavenly children's choir, the first part sees the arrival of the Allied forces on the island, introduces the principal characters (none of whom amounts to a genuine protagonist), and lays out the movie's geographical and philosophical terrain. The centerpiece--the fighting--goes on for over an hour and features the most frantic and harrowing sequences, chiefly the company's initially unsuccessful frontal assault on a Japanese hilltop bunker. The coda lasts nearly 40 minutes and is mostly talk and cleanup, the rhythms growing more relaxed until a final, incongruous spasm of violence--whereupon the surviving soldiers pack their gear and motor off to another South Pacific battle. In the final shot, a twisted tree grows on the waterline of the beach, the cycle of life beginning anew. The Thin Red Line has a curious sound-scape, as the noise of battle frequently recedes to make room for interior monologues and Hans Zimmer's bump-bump, minimalist New Age music. Pvt. Bell (Ben Chaplin) talks to his curvy, redheaded wife, viewed in deliriously sensual flashbacks. ("Love: Where does it come from? Who lit this flame in us?") Lt. Col. Tall (Nolte), a borderline lunatic passed over one too many times for promotion and itching to win a battle no matter what the human cost, worries groggily about how his men perceive him. The dreamer Witt poses folksy questions about whether we're all a part of one big soul. If the movie has a spine, it's his off-and-on dialogue with Sgt. Welsh (Penn), who's increasingly irritated by the private's beatific, almost Billy Budd-like optimism. Says Welsh, "In this world, a man himself is nothin', and there ain't no world but this one." Replies Witt, high cheekbones glinting, "I seen another world." At first it seems as if Witt will indeed be Billy Budd to Welsh's vindictive Claggart. But if Witt is ultimately an ethereal martyr, Welsh turns out to be a Bogart-like romantic who can't stop feeling pain in the face of an absent God. He speaks the movie's epitaph, "Darkness and light, strife and love: Are they the workings of one mind, the feature of the same face? O my soul, let me be in you now. Look out through my eyes. Look out at the things you made, all things shining." Malick puts a lot of shining things on the screen: soldiers, natives, parrots, bats, rodents, visions of Eden by way of National Geographic and of the Fall by way of Alpo. Malick's conception of consciousness distributes it among the animate and inanimate alike; almost every object is held up for rapturous contemplation. I could cite hundreds of images: A soldier in a rocking boat hovers over a letter he's writing, which is crammed from top to bottom and side to side with script. (You don't know the man, but you can feel in an instant his need to cram everything in.) A small, white-bearded Melanesian man strolls nonchalantly past a platoon of tensely trudging grunts who can't believe they're encountering this instead of a hail of Japanese bullets. Two shots bring down the first pair of soldiers to advance on the hill; a second later, the sun plays mystically over the tall, yellow grass that has swallowed their bodies. John Toll's camera rushes in on a captured Japanese garrison: One Japanese soldier shrieks; another, skeletal, laughs and laughs; a third weeps over a dying comrade. The face of a Japanese soldier encased in earth speaks from the dead, "Are you righteous? Know that I was, too." Whether or not these pearllike epiphanies are strung is another matter. Malick throws out his overarching theme--is nature two-sided, at war with itself?--in the first few minutes but, for all his startling juxtapositions, he never dramatizes it with anything approaching the clarity of, say, Brian De Palma's Casualties of War (1989). Besides the dialogue between Welsh and Witt, The Thin Red Line 's other organizing story involves a wrenching tug of war between Nolte's ambition-crazed Tall and Capt. Staros (Elias Koteas), who refuses an order to send his men on what will surely be a suicidal--and futile--assault on a bunker. But matters of cause and effect don't really interest Malick. Individual acts of conscience can and do save lives, and heroism can win a war or a battle, he acknowledges. But Staros is ultimately sent packing, and Malick never bothers to trace the effect of his action on the Guadalcanal operation. In fact, the entire battle seems to take place in a crazed void. Tall quotes Homer's "rosy-fingered dawn" and orders a meaningless bombardment to "buck the men up--it'll look like the Japs are catching hell." Soldiers shoot at hazy figures, unsure whether they're Japanese or American. Men collide, blow themselves in half with their own mishandled grenades, stab themselves frantically with morphine needles, shove cigarettes up their noses to keep the stench of the dying and the dead at bay. A tiny bird, mortally wounded, flutters in the grass. Malick is convincing--at times overwhelming--on the subject of chaos. It's when he tries to ruminate on order that he gets gummed up, retreating to one of his gaseous multiple mouthpieces: "Where is it that we were together? Who is it that I lived with? Walked with? The brother. ... The friend. ... One mind." I think I'd have an easier time with Malick's metaphysical speculations if I had a sense of some concomitant geopolitical ones--central to any larger musings on forces of nature as viewed through the prism of war. Couldn't it be that the German and Japanese fascist orders were profoundly anti-natural, and that the Allies' cause was part of a violent but natural correction? You don't have to buy into Spielberg's Lincolnesque pieties in Saving Private Ryan to believe that there's a difference between World War II and Vietnam (or, for that matter, World War II and the invasion of Grenada or our spats with Iraq). While he was at Harvard, Malick might have peeled himself off the lap of his pointy-headed mentor, Stanley Cavell, the philosopher and film theorist, and checked out a few of Michael Waltzer's lectures on just and unjust wars. Maybe then he'd view Guadalcanal not in an absurdist vacuum (the soldiers come, they kill and are killed, they leave) but in the larger context of a war that was among the most rational (in its aims, if not its methods) fought in the last several centuries. For all his visionary filmmaking, Malick's Zen neutrality sometimes seems like a cultivated--and pretentious--brand of fatuousness. John Travolta's empty nightclub impersonation of Bill Clinton in Primary Colors (1998) had one positive result: It gave him a jump-start on Jan Schlichtmann, the reckless personal injury lawyer at the center of A Civil Action . Travolta's Schlichtmann is much more redolent of Clinton: slick and selfish and corrupt in lots of ways but basically on the side of the angels, too proud and arrogant to change tactics when all is certainly lost. Schlichtmann pursued--and more or less blew--a civil liability case against the corporate giants Beatrice and W.R. Grace over the allegedly carcinogenic water supply of Woburn, Mass. Boston writer Jonathan Harr, in the book the movie is based on, went beyond the poison in the Woburn wells to evoke (stopping just short of libel) the poison of the civil courts, where platoons of overpaid corporate lawyers can drive opponents with pockets less deep and psyches less stable into bankruptcy and hysteria. Director Steven Zaillian's version doesn't capture the mounting rage that one experiences while reading Harr's book, or even the juicy legal machinations that Francis Ford Coppola giddily manipulated in his underrated adaptation of John Grisham's The Rainmaker (1997). But A Civil Action is a sturdy piece of work, an old-fashioned conversion narrative with some high-tech zip. Schlichtmann doesn't take this "orphan" case--brought by the parents of several children who died of leukemia--because he wants to do good but because he figures that Grace and Beatrice will fork over huge sums of money to keep the parents from testifying publicly about their children's last days. He might succeed, too, if it weren't for Jerome Facher (Robert Duvall), the Beatrice lawyer who knows how to keep Schlichtmann shadowboxing while his small firm's financial resources dwindle to nothing. Zaillian is at his most assured when he cuts back and forth between Facher's Harvard Law School lectures on what not to do in court and Schlichtmann's fumbling prosecution. The sequence has the extra dimension of good journalism: It dramatizes and comments simultaneously. Plus, it gives Duvall a splendid platform for impish understatement. (Duvall has become more fun to watch than just about anyone in movies.) Elsewhere, Zaillian takes a more surface approach, sticking to legal minutiae and rarely digging for the deeper evil. As in his Searching for Bobby Fischer (1993), the outcome of every scene is predictable, but how Zaillian gets from beat to beat is surprisingly fresh. He also gets sterling bit performances from Sydney Pollack as the spookily sanguine Grace CEO, William H. Macy as Schlichtmann's rabbity accountant, and Kathleen Quinlan as the mother of one of the victims. Quinlan knows that when you're playing a woman who has lost a child you don't need to emote--you reveal the emotion by trying not to emote. To the families involved in the Woburn tragedy, the real climax of this story isn't the downbeat ending of the book or the sleight of hand, "let's call the Environmental Protection Agency," upbeat ending of the movie. The climax is the publication of a book that takes the plaintiffs' side and that remains on the best-seller list in hardcover and paperback for years. The climax is the movie starring John Travolta. Beatrice and Grace made out OK legally, but some of us will never use their products again without thinking about Travolta losing his shirt in the name of those wasted-away little kids.
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B. he told a well-rounded story of war
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What does Jerry promise to Professor Coltz without saying explicitly?
A. He plans to reveal the true creators of the Venusian delegate
B. He plans not to share his physics notes with the media
C. He plans not to reveal the true creators of the Venusian delegate
D. He plans to share his physics notes with the media
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The saucer was interesting, but where was the delegate? The DELEGATE FROM VENUS By HENRY SLESAR ILLUSTRATOR NOVICK Everybody was waiting to see what the delegate from Venus looked like. And all they got for their patience was the biggest surprise since David clobbered Goliath. " Let me put it this way," Conners said paternally. "We expect a certain amount of decorum from our Washington news correspondents, and that's all I'm asking for." Jerry Bridges, sitting in the chair opposite his employer's desk, chewed on his knuckles and said nothing. One part of his mind wanted him to play it cagey, to behave the way the newspaper wanted him to behave, to protect the cozy Washington assignment he had waited four years to get. But another part of him, a rebel part, wanted him to stay on the trail of the story he felt sure was about to break. "I didn't mean to make trouble, Mr. Conners," he said casually. "It just seemed strange, all these exchanges of couriers in the past two days. I couldn't help thinking something was up." "Even if that's true, we'll hear about it through the usual channels," Conners frowned. "But getting a senator's secretary drunk to obtain information—well, that's not only indiscreet, Bridges. It's downright dirty." Jerry grinned. "I didn't take that kind of advantage, Mr. Conners. Not that she wasn't a toothsome little dish ..." "Just thank your lucky stars that it didn't go any further. And from now on—" He waggled a finger at him. "Watch your step." Jerry got up and ambled to the door. But he turned before leaving and said: "By the way. What do you think is going on?" "I haven't the faintest idea." "Don't kid me, Mr. Conners. Think it's war?" "That'll be all, Bridges." The reporter closed the door behind him, and then strolled out of the building into the sunlight. He met Ruskin, the fat little AP correspondent, in front of the Pan-American Building on Constitution Avenue. Ruskin was holding the newspaper that contained the gossip-column item which had started the whole affair, and he seemed more interested in the romantic rather than political implications. As he walked beside him, he said: "So what really happened, pal? That Greta babe really let down her hair?" "Where's your decorum?" Jerry growled. Ruskin giggled. "Boy, she's quite a dame, all right. I think they ought to get the Secret Service to guard her. She really fills out a size 10, don't she?" "Ruskin," Jerry said, "you have a low mind. For a week, this town has been acting like the 39 Steps , and all you can think about is dames. What's the matter with you? Where will you be when the big mushroom cloud comes?" "With Greta, I hope," Ruskin sighed. "What a way to get radioactive." They split off a few blocks later, and Jerry walked until he came to the Red Tape Bar & Grill, a favorite hangout of the local journalists. There were three other newsmen at the bar, and they gave him snickering greetings. He took a small table in the rear and ate his meal in sullen silence. It wasn't the newsmen's jibes that bothered him; it was the certainty that something of major importance was happening in the capitol. There had been hourly conferences at the White House, flying visits by State Department officials, mysterious conferences involving members of the Science Commission. So far, the byword had been secrecy. They knew that Senator Spocker, chairman of the Congressional Science Committee, had been involved in every meeting, but Senator Spocker was unavailable. His secretary, however, was a little more obliging ... Jerry looked up from his coffee and blinked when he saw who was coming through the door of the Bar & Grill. So did every other patron, but for different reasons. Greta Johnson had that effect upon men. Even the confining effect of a mannishly-tailored suit didn't hide her outrageously feminine qualities. She walked straight to his table, and he stood up. "They told me you might be here," she said, breathing hard. "I just wanted to thank you for last night." "Look, Greta—" Wham! Her hand, small and delicate, felt like a slab of lead when it slammed into his cheek. She left a bruise five fingers wide, and then turned and stalked out. He ran after her, the restaurant proprietor shouting about the unpaid bill. It took a rapid dog-trot to reach her side. "Greta, listen!" he panted. "You don't understand about last night. It wasn't the way that lousy columnist said—" She stopped in her tracks. "I wouldn't have minded so much if you'd gotten me drunk. But to use me, just to get a story—" "But I'm a reporter , damn it. It's my job. I'd do it again if I thought you knew anything." She was pouting now. "Well, how do you suppose I feel, knowing you're only interested in me because of the Senator? Anyway, I'll probably lose my job, and then you won't have any use for me." "Good-bye, Greta," Jerry said sadly. "What?" "Good-bye. I suppose you won't want to see me any more." "Did I say that?" "It just won't be any use. We'll always have this thing between us." She looked at him for a moment, and then touched his bruised cheek with a tender, motherly gesture. "Your poor face," she murmured, and then sighed. "Oh, well. I guess there's no use fighting it. Maybe if I did tell you what I know, we could act human again." "Greta!" "But if you print one word of it, Jerry Bridges, I'll never speak to you again!" "Honey," Jerry said, taking her arm, "you can trust me like a brother." "That's not the idea," Greta said stiffly. In a secluded booth at the rear of a restaurant unfrequented by newsmen, Greta leaned forward and said: "At first, they thought it was another sputnik." " Who did?" "The State Department, silly. They got reports from the observatories about another sputnik being launched by the Russians. Only the Russians denied it. Then there were joint meetings, and nobody could figure out what the damn thing was." "Wait a minute," Jerry said dizzily. "You mean to tell me there's another of those metal moons up there?" "But it's not a moon. That's the big point. It's a spaceship." "A what ?" "A spaceship," Greta said coolly, sipping lemonade. "They have been in contact with it now for about three days, and they're thinking of calling a plenary session of the UN just to figure out what to do about it. The only hitch is, Russia doesn't want to wait that long, and is asking for a hurry-up summit meeting to make a decision." "A decision about what?" "About the Venusians, of course." "Greta," Jerry said mildly, "I think you're still a little woozy from last night." "Don't be silly. The spaceship's from Venus; they've already established that. And the people on it—I guess they're people—want to know if they can land their delegate." "Their what?" "Their delegate. They came here for some kind of conference, I guess. They know about the UN and everything, and they want to take part. They say that with all the satellites being launched, that our affairs are their affairs, too. It's kind of confusing, but that's what they say." "You mean these Venusians speak English?" "And Russian. And French. And German. And everything I guess. They've been having radio talks with practically every country for the past three days. Like I say, they want to establish diplomatic relations or something. The Senator thinks that if we don't agree, they might do something drastic, like blow us all up. It's kind of scary." She shivered delicately. "You're taking it mighty calm," he said ironically. "Well, how else can I take it? I'm not even supposed to know about it, except that the Senator is so careless about—" She put her fingers to her lips. "Oh, dear, now you'll really think I'm terrible." "Terrible? I think you're wonderful!" "And you promise not to print it?" "Didn't I say I wouldn't?" "Y-e-s. But you know, you're a liar sometimes, Jerry. I've noticed that about you." The press secretary's secretary, a massive woman with gray hair and impervious to charm, guarded the portals of his office with all the indomitable will of the U. S. Marines. But Jerry Bridges tried. "You don't understand, Lana," he said. "I don't want to see Mr. Howells. I just want you to give him something." "My name's not Lana, and I can't deliver any messages." "But this is something he wants to see." He handed her an envelope, stamped URGENT. "Do it for me, Hedy. And I'll buy you the flashiest pair of diamond earrings in Washington." "Well," the woman said, thawing slightly. "I could deliver it with his next batch of mail." "When will that be?" "In an hour. He's in a terribly important meeting right now." "You've got some mail right there. Earrings and a bracelet to match." She looked at him with exasperation, and then gathered up a stack of memorandums and letters, his own envelope atop it. She came out of the press secretary's office two minutes later with Howells himself, and Howells said: "You there, Bridges. Come in here." "Yes, sir !" Jerry said, breezing by the waiting reporters with a grin of triumph. There were six men in the room, three in military uniform. Howells poked the envelope towards Jerry, and snapped: "This note of yours. Just what do you think it means?" "You know better than I do, Mr. Howells. I'm just doing my job; I think the public has a right to know about this spaceship that's flying around—" His words brought an exclamation from the others. Howells sighed, and said: "Mr. Bridges, you don't make it easy for us. It's our opinion that secrecy is essential, that leakage of the story might cause panic. Since you're the only unauthorized person who knows of it, we have two choices. One of them is to lock you up." Jerry swallowed hard. "The other is perhaps more practical," Howells said. "You'll be taken into our confidence, and allowed to accompany those officials who will be admitted to the landing site. But you will not be allowed to relay the story to the press until such a time as all correspondents are informed. That won't give you a 'scoop' if that's what you call it, but you'll be an eyewitness. That should be worth something." "It's worth a lot," Jerry said eagerly. "Thanks, Mr. Howells." "Don't thank me, I'm not doing you any personal favor. Now about the landing tonight—" "You mean the spaceship's coming down?" "Yes. A special foreign ministers conference was held this morning, and a decision was reached to accept the delegate. Landing instructions are being given at Los Alamos, and the ship will presumably land around midnight tonight. There will be a jet leaving Washington Airport at nine, and you'll be on it. Meanwhile, consider yourself in custody." The USAF jet transport wasn't the only secrecy-shrouded aircraft that took off that evening from Washington Airport. But Jerry Bridges, sitting in the rear seat flanked by two Sphinx-like Secret Service men, knew that he was the only passenger with non-official status aboard. It was only a few minutes past ten when they arrived at the air base at Los Alamos. The desert sky was cloudy and starless, and powerful searchlights probed the thick cumulus. There were sleek, purring black autos waiting to rush the air passengers to some unnamed destination. They drove for twenty minutes across a flat ribbon of desert road, until Jerry sighted what appeared to be a circle of newly-erected lights in the middle of nowhere. On the perimeter, official vehicles were parked in orderly rows, and four USAF trailer trucks were in evidence, their radarscopes turning slowly. There was activity everywhere, but it was well-ordered and unhurried. They had done a good job of keeping the excitement contained. He was allowed to leave the car and stroll unescorted. He tried to talk to some of the scurrying officials, but to no avail. Finally, he contented himself by sitting on the sand, his back against the grill of a staff car, smoking one cigarette after another. As the minutes ticked off, the activity became more frenetic around him. Then the pace slowed, and he knew the appointed moment was approaching. Stillness returned to the desert, and tension was a tangible substance in the night air. The radarscopes spun slowly. The searchlights converged in an intricate pattern. Then the clouds seemed to part! "Here she comes!" a voice shouted. And in a moment, the calm was shattered. At first, he saw nothing. A faint roar was started in the heavens, and it became a growl that increased in volume until even the shouting voices could no longer be heard. Then the crisscrossing lights struck metal, glancing off the gleaming body of a descending object. Larger and larger the object grew, until it assumed the definable shape of a squat silver funnel, falling in a perfect straight line towards the center of the light-ringed area. When it hit, a dust cloud obscured it from sight. A loudspeaker blared out an unintelligible order, but its message was clear. No one moved from their position. Finally, a three-man team, asbestos-clad, lead-shielded, stepped out from the ring of spectators. They carried geiger counters on long poles before them. Jerry held his breath as they approached the object; only when they were yards away did he appreciate its size. It wasn't large; not more than fifteen feet in total circumference. One of the three men waved a gloved hand. "It's okay," a voice breathed behind him. "No radiation ..." Slowly, the ring of spectators closed tighter. They were twenty yards from the ship when the voice spoke to them. "Greetings from Venus," it said, and then repeated the phrase in six languages. "The ship you see is a Venusian Class 7 interplanetary rocket, built for one-passenger. It is clear of all radiation, and is perfectly safe to approach. There is a hatch which may be opened by an automatic lever in the side. Please open this hatch and remove the passenger." An Air Force General whom Jerry couldn't identify stepped forward. He circled the ship warily, and then said something to the others. They came closer, and he touched a small lever on the silvery surface of the funnel. A door slid open. "It's a box!" someone said. "A crate—" "Colligan! Moore! Schaffer! Lend a hand here—" A trio came forward and hoisted the crate out of the ship. Then the voice spoke again; Jerry deduced that it must have been activated by the decreased load of the ship. "Please open the crate. You will find our delegate within. We trust you will treat him with the courtesy of an official emissary." They set to work on the crate, its gray plastic material giving in readily to the application of their tools. But when it was opened, they stood aside in amazement and consternation. There were a variety of metal pieces packed within, protected by a filmy packing material. "Wait a minute," the general said. "Here's a book—" He picked up a gray-bound volume, and opened its cover. "'Instructions for assembling Delegate,'" he read aloud. "'First, remove all parts and arrange them in the following order. A-1, central nervous system housing. A-2 ...'" He looked up. "It's an instruction book," he whispered. "We're supposed to build the damn thing." The Delegate, a handsomely constructed robot almost eight feet tall, was pieced together some three hours later, by a team of scientists and engineers who seemed to find the Venusian instructions as elementary as a blueprint in an Erector set. But simple as the job was, they were obviously impressed by the mechanism they had assembled. It stood impassive until they obeyed the final instruction. "Press Button K ..." They found button K, and pressed it. The robot bowed. "Thank you, gentlemen," it said, in sweet, unmetallic accents. "Now if you will please escort me to the meeting place ..." It wasn't until three days after the landing that Jerry Bridges saw the Delegate again. Along with a dozen assorted government officials, Army officers, and scientists, he was quartered in a quonset hut in Fort Dix, New Jersey. Then, after seventy-two frustrating hours, he was escorted by Marine guard into New York City. No one told him his destination, and it wasn't until he saw the bright strips of light across the face of the United Nations building that he knew where the meeting was to be held. But his greatest surprise was yet to come. The vast auditorium which housed the general assembly was filled to its capacity, but there were new faces behind the plaques which designated the member nations. He couldn't believe his eyes at first, but as the meeting got under way, he knew that it was true. The highest echelons of the world's governments were represented, even—Jerry gulped at the realization—Nikita Khrushchev himself. It was a summit meeting such as he had never dreamed possible, a summit meeting without benefit of long foreign minister's debate. And the cause of it all, a placid, highly-polished metal robot, was seated blithely at a desk which bore the designation: VENUS. The robot delegate stood up. "Gentlemen," it said into the microphone, and the great men at the council tables strained to hear the translator's version through their headphones, "Gentlemen, I thank you for your prompt attention. I come as a Delegate from a great neighbor planet, in the interests of peace and progress for all the solar system. I come in the belief that peace is the responsibility of individuals, of nations, and now of worlds, and that each is dependent upon the other. I speak to you now through the electronic instrumentation which has been created for me, and I come to offer your planet not merely a threat, a promise, or an easy solution—but a challenge." The council room stirred. "Your earth satellites have been viewed with interest by the astronomers of our world, and we foresee the day when contact between our planets will be commonplace. As for ourselves, we have hitherto had little desire to explore beyond our realm, being far too occupied with internal matters. But our isolation cannot last in the face of your progress, so we believe that we must take part in your affairs. "Here, then, is our challenge. Continue your struggle of ideas, compete with each other for the minds of men, fight your bloodless battles, if you know no other means to attain progress. But do all this without unleashing the terrible forces of power now at your command. Once unleashed, these forces may or may not destroy all that you have gained. But we, the scientists of Venus, promise you this—that on the very day your conflict deteriorates into heedless violence, we will not stand by and let the ugly contagion spread. On that day, we of Venus will act swiftly, mercilessly, and relentlessly—to destroy your world completely." Again, the meeting room exploded in a babble of languages. "The vessel which brought me here came as a messenger of peace. But envision it, men of Earth, as a messenger of war. Unstoppable, inexorable, it may return, bearing a different Delegate from Venus—a Delegate of Death, who speaks not in words, but in the explosion of atoms. Think of thousands of such Delegates, fired from a vantage point far beyond the reach of your retaliation. This is the promise and the challenge that will hang in your night sky from this moment forward. Look at the planet Venus, men of Earth, and see a Goddess of Vengeance, poised to wreak its wrath upon those who betray the peace." The Delegate sat down. Four days later, a mysterious explosion rocked the quiet sands of Los Alamos, and the Venus spacecraft was no more. Two hours after that, the robot delegate, its message delivered, its mission fulfilled, requested to be locked inside a bombproof chamber. When the door was opened, the Delegate was an exploded ruin. The news flashed with lightning speed over the world, and Jerry Bridges' eyewitness accounts of the incredible event was syndicated throughout the nation. But his sudden celebrity left him vaguely unsatisfied. He tried to explain his feeling to Greta on his first night back in Washington. They were in his apartment, and it was the first time Greta had consented to pay him the visit. "Well, what's bothering you?" Greta pouted. "You've had the biggest story of the year under your byline. I should think you'd be tickled pink." "It's not that," Jerry said moodily. "But ever since I heard the Delegate speak, something's been nagging me." "But don't you think he's done good? Don't you think they'll be impressed by what he said?" "I'm not worried about that. I think that damn robot did more for peace than anything that's ever come along in this cockeyed world. But still ..." Greta snuggled up to him on the sofa. "You worry too much. Don't you ever think of anything else? You should learn to relax. It can be fun." She started to prove it to him, and Jerry responded the way a normal, healthy male usually does. But in the middle of an embrace, he cried out: "Wait a minute!" "What's the matter?" "I just thought of something! Now where the hell did I put my old notebooks?" He got up from the sofa and went scurrying to a closet. From a debris of cardboard boxes, he found a worn old leather brief case, and cackled with delight when he found the yellowed notebooks inside. "What are they?" Greta said. "My old school notebooks. Greta, you'll have to excuse me. But there's something I've got to do, right away!" "That's all right with me," Greta said haughtily. "I know when I'm not wanted." She took her hat and coat from the hall closet, gave him one last chance to change his mind, and then left. Five minutes later, Jerry Bridges was calling the airlines. It had been eleven years since Jerry had walked across the campus of Clifton University, heading for the ivy-choked main building. It was remarkable how little had changed, but the students seemed incredibly young. He was winded by the time he asked the pretty girl at the desk where Professor Martin Coltz could be located. "Professor Coltz?" She stuck a pencil to her mouth. "Well, I guess he'd be in the Holland Laboratory about now." "Holland Laboratory? What's that?" "Oh, I guess that was after your time, wasn't it?" Jerry felt decrepit, but managed to say: "It must be something new since I was here. Where is this place?" He followed her directions, and located a fresh-painted building three hundred yards from the men's dorm. He met a student at the door, who told him that Professor Coltz would be found in the physics department. The room was empty when Jerry entered, except for the single stooped figure vigorously erasing a blackboard. He turned when the door opened. If the students looked younger, Professor Coltz was far older than Jerry remembered. He was a tall man, with an unruly confusion of straight gray hair. He blinked when Jerry said: "Hello, Professor. Do you remember me? Jerry Bridges?" "Of course! I thought of you only yesterday, when I saw your name in the papers—" They sat at facing student desks, and chatted about old times. But Jerry was impatient to get to the point of his visit, and he blurted out: "Professor Coltz, something's been bothering me. It bothered me from the moment I heard the Delegate speak. I didn't know what it was until last night, when I dug out my old college notebooks. Thank God I kept them." Coltz's eyes were suddenly hooded. "What do you mean, Jerry?" "There was something about the Robot's speech that sounded familiar—I could have sworn I'd heard some of the words before. I couldn't prove anything until I checked my old notes, and here's what I found." He dug into his coat pocket and produced a sheet of paper. He unfolded it and read aloud. "'It's my belief that peace is the responsibility of individuals, of nations, and someday, even of worlds ...' Sound familiar, Professor?" Coltz shifted uncomfortably. "I don't recall every silly thing I said, Jerry." "But it's an interesting coincidence, isn't it, Professor? These very words were spoken by the Delegate from Venus." "A coincidence—" "Is it? But I also remember your interest in robotics. I'll never forget that mechanical homing pigeon you constructed. And you've probably learned much more these past eleven years." "What are you driving at, Jerry?" "Just this, Professor. I had a little daydream, recently, and I want you to hear it. I dreamed about a group of teachers, scientists, and engineers, a group who were suddenly struck by an exciting, incredible idea. A group that worked in the quiet and secrecy of a University on a fantastic scheme to force the idea of peace into the minds of the world's big shots. Does my dream interest you, Professor?" "Go on." "Well, I dreamt that this group would secretly launch an earth satellite of their own, and arrange for the nose cone to come down safely at a certain time and place. They would install a marvelous electronic robot within the cone, ready to be assembled. They would beam a radio message to earth from the cone, seemingly as if it originated from their 'spaceship.' Then, when the Robot was assembled, they would speak through it to demand peace for all mankind ..." "Jerry, if you do this—" "You don't have to say it, Professor, I know what you're thinking. I'm a reporter, and my business is to tell the world everything I know. But if I did it, there might not be a world for me to write about, would there? No, thanks, Professor. As far as I'm concerned, what I told you was nothing more than a daydream." Jerry braked the convertible to a halt, and put his arm around Greta's shoulder. She looked up at the star-filled night, and sighed romantically. Jerry pointed. "That one." Greta shivered closer to him. "And to think what that terrible planet can do to us!" "Oh, I dunno. Venus is also the Goddess of Love." He swung his other arm around her, and Venus winked approvingly. THE END Transcriber's Note: This etext was produced from Amazing Science Fiction Stories October 1958. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note.
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C. He plans not to reveal the true creators of the Venusian delegate
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Why does Gile volunteer for the ship in the end?
A. He hasn’t accepted his mortality, and is trying to make up for it with an act of heroism.
B. He knows that no one else will volunteer, and feels responsible to do so.
C. He fears the end of his life, and wants to try to see his family before he passes.
D. He accepts his mortality, and is willing to spend his last years on the chance to see his family.
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The Dwindling Years He didn’t expect to be last—but neither did he anticipate the horror of being the first! By LESTER DEL REY Illustrated by JOHNS NEARLY TWO hundred years of habit carried the chairman of Exodus Corporation through the morning ritual of crossing the executive floor. Giles made the expected comments, smiled the proper smiles and greeted his staff by the right names, but it was purely automatic. Somehow, thinking had grown difficult in the mornings recently. Inside his private office, he dropped all pretense and slumped into the padding of his chair, gasping for breath and feeling his heart hammering in his chest. He’d been a fool to come to work, he realized. But with the Procyon shuttle arriving yesterday, there was no telling what might turn up. Besides, that fool of a medicist had sworn the shot would cure any allergy or asthma. Giles heard his secretary come in, but it wasn’t until the smell of the coffee reached his nose that he looked up. She handed him a filled cup and set the carafe down on the age-polished surface of the big desk. She watched solicitously as he drank. “That bad, Arthur?” she asked. “Just a little tired,” he told her, refilling the cup. She’d made the coffee stronger than usual and it seemed to cut through some of the thickness in his head. “I guess I’m getting old, Amanda.” She smiled dutifully at the time-worn joke, but he knew she wasn’t fooled. She’d cycled to middle age four times in her job and she probably knew him better than he knew himself—which wouldn’t be hard, he thought. He’d hardly recognized the stranger in the mirror as he tried to shave. His normal thinness had looked almost gaunt and there were hollows in his face and circles under his eyes. Even his hair had seemed thinner, though that, of course, was impossible. “Anything urgent on the Procyon shuttle?” he asked as she continue staring at him with worried eyes. SHE JERKED her gaze away guiltily and turned to the incoming basket. “Mostly drugs for experimenting. A personal letter for you, relayed from some place I never heard of. And one of the super-light missiles! They found it drifting half a light-year out and captured it. Jordan’s got a report on it and he’s going crazy. But if you don’t feel well—” “I’m all right!” he told her sharply. Then he steadied himself and managed to smile. “Thanks for the coffee, Amanda.” She accepted dismissal reluctantly. When she was gone, he sat gazing at the report from Jordan at Research. For eighty years now, they’d been sending out the little ships that vanished at greater than the speed of light, equipped with every conceivable device to make them return automatically after taking pictures of wherever they arrived. So far, none had ever returned or been located. This was the first hope they’d found that the century-long trips between stars in the ponderous shuttles might be ended and he should have been filled with excitement at Jordan’s hasty preliminary report. He leafed through it. The little ship apparently had been picked up by accident when it almost collided with a Sirius-local ship. Scientists there had puzzled over it, reset it and sent it back. The two white rats on it had still been alive. Giles dropped the report wearily and picked up the personal message that had come on the shuttle. He fingered the microstrip inside while he drank another coffee, and finally pulled out the microviewer. There were three frames to the message, he saw with some surprise. He didn’t need to see the signature on the first projection. Only his youngest son would have sent an elaborate tercentenary greeting verse—one that would arrive ninety years too late! Harry had been born just before Earth passed the drastic birth limitation act and his mother had spoiled him. He’d even tried to avoid the compulsory emigration draft and stay on with his mother. It had been the bitter quarrels over that which had finally broken Giles’ fifth marriage. Oddly enough, the message in the next frame showed none of that. Harry had nothing but praise for the solar system where he’d been sent. He barely mentioned being married on the way or his dozen children, but filled most of the frame with glowing description and a plea for his father to join him there! GILES SNORTED and turned to the third frame, which showed a group picture of the family in some sort of vehicle, against the background of an alien but attractive world. He had no desire to spend ninety years cooped up with a bunch of callow young emigrants, even in one of the improved Exodus shuttles. And even if Exodus ever got the super-light drive working, there was no reason he should give up his work. The discovery that men could live practically forever had put an end to most family ties; sentiment wore thin in half a century—which wasn’t much time now, though it had once seemed long enough. Strange how the years seemed to get shorter as their number increased. There’d been a song once—something about the years dwindling down. He groped for the lines and couldn’t remember. Drat it! Now he’d probably lie awake most of the night again, trying to recall them. The outside line buzzed musically, flashing Research’s number. Giles grunted in irritation. He wasn’t ready to face Jordan yet. But he shrugged and pressed the button. The intense face that looked from the screen was frowning as Jordan’s eyes seemed to sweep around the room. He was still young—one of the few under a hundred who’d escaped deportation because of special ability—and patience was still foreign to him. Then the frown vanished as an expression of shock replaced it, and Giles felt a sinking sensation. If he looked that bad— But Jordan wasn’t looking at him; the man’s interest lay in the projected picture from Harry, across the desk from the communicator. “Antigravity!” His voice was unbelieving as he turned his head to face the older man. “What world is that?” Giles forced his attention on the picture again and this time he noticed the vehicle shown. It was enough like an old model Earth conveyance to pass casual inspection, but it floated wheellessly above the ground. Faint blur lines indicated it had been moving when the picture was taken. “One of my sons—” Giles started to answer. “I could find the star’s designation....” Jordan cursed harshly. “So we can send a message on the shuttle, begging for their secret in a couple of hundred years! While a hundred other worlds make a thousand major discoveries they don’t bother reporting! Can’t the Council see anything ?” Giles had heard it all before. Earth was becoming a backwater world; no real progress had been made in two centuries; the young men were sent out as soon as their first fifty years of education were finished, and the older men were too conservative for really new thinking. There was a measure of truth in it, unfortunately. “They’ll slow up when their populations fill,” Giles repeated his old answers. “We’re still ahead in medicine and we’ll get the other discoveries eventually, without interrupting the work of making the Earth fit for our longevity. We can wait. We’ll have to.” THE YOUNGER man stared at him with the strange puzzled look Giles had seen too often lately. “Damn it, haven’t you read my report? We know the super-light drive works! That missile reached Sirius in less than ten days. We can have the secret of this antigravity in less than a year! We—” “Wait a minute.” Giles felt the thickness pushing back at his mind and tried to fight it off. He’d only skimmed the report, but this made no sense. “You mean you can calibrate your guiding devices accurately enough to get a missile where you want it and back?” “ What? ” Jordan’s voice rattled the speaker. “Of course not! It took two accidents to get the thing back to us—and with a half-light-year miss that delayed it about twenty years before the Procyon shuttle heard its signal. Pre-setting a course may take centuries, if we can ever master it. Even with Sirius expecting the missiles and ready to cooperate. I mean the big ship. We’ve had it drafted for building long enough; now we can finish it in three months. We know the drive works. We know it’s fast enough to reach Procyon in two weeks. We even know life can stand the trip. The rats were unharmed.” Giles shook his head at what the other was proposing, only partly believing it. “Rats don’t have minds that could show any real damage such as the loss of power to rejuvenate. We can’t put human pilots into a ship with our drive until we’ve tested it more thoroughly, Bill, even if they could correct for errors on arrival. Maybe if we put in stronger signaling transmitters....” “Yeah. Maybe in two centuries we’d have a through route charted to Sirius. And we still wouldn’t have proved it safe for human pilots. Mr. Giles, we’ve got to have the big ship. All we need is one volunteer!” It occurred to Giles then that the man had been too fired with the idea to think. He leaned back, shaking his head again wearily. “All right, Bill. Find me one volunteer. Or how about you? Do you really want to risk losing the rest of your life rather than waiting a couple more centuries until we know it’s safe? If you do, I’ll order the big ship.” Jordan opened his mouth and for a second Giles’ heart caught in a flux of emotions as the man’s offer hovered on his lips. Then the engineer shut his mouth slowly. The belligerence ran out of him. He looked sick, for he had no answer. NO SANE man would risk a chance for near eternity against such a relatively short wait. Heroism had belonged to those who knew their days were numbered, anyhow. “Forget it, Bill,” Giles advised. “It may take longer, but eventually we’ll find a way. With time enough, we’re bound to. And when we do, the ship will be ready.” The engineer nodded miserably and clicked off. Giles turned from the blank screen to stare out of the windows, while his hand came up to twist at the lock of hair over his forehead. Eternity! They had to plan and build for it. They couldn’t risk that plan for short-term benefits. Usually it was too easy to realize that, and the sight of the solid, time-enduring buildings outside should have given him a sense of security. Today, though, nothing seemed to help. He felt choked, imprisoned, somehow lost; the city beyond the window blurred as he studied it, and he swung the chair back so violently that his hand jerked painfully on the forelock he’d been twisting. Then he was staring unbelievingly at the single white hair that was twisted with the dark ones between his fingers. Like an automaton, he bent forward, his other hand groping for the mirror that should be in one of the drawers. The dull pain in his chest sharpened and his breath was hoarse in his throat, but he hardly noticed as he found the mirror and brought it up. His eyes focused reluctantly. There were other white strands in his dark hair. The mirror crashed to the floor as he staggered out of the office. It was only two blocks to Giles’ residence club, but he had to stop twice to catch his breath and fight against the pain that clawed at his chest. When he reached the wood-paneled lobby, he was barely able to stand. Dubbins was at his side almost at once, with a hand under his arm to guide him toward his suite. “Let me help you, sir,” Dubbins suggested, in the tones Giles hadn’t heard since the man had been his valet, back when it was still possible to find personal servants. Now he managed the club on a level of quasi-equality with the members. For the moment, though, he’d slipped back into the old ways. GILES FOUND himself lying on his couch, partially undressed, with the pillows just right and a long drink in his hand. The alcohol combined with the reaction from his panic to leave him almost himself again. After all, there was nothing to worry about; Earth’s doctors could cure anything. “I guess you’d better call Dr. Vincenti,” he decided. Vincenti was a member and would probably be the quickest to get. Dubbins shook his head. “Dr. Vincenti isn’t with us, sir. He left a year ago to visit a son in the Centauri system. There’s a Dr. Cobb whose reputation is very good, sir.” Giles puzzled over it doubtfully. Vincenti had been an oddly morose man the last few times he’d seen him, but that could hardly explain his taking a twenty-year shuttle trip for such a slim reason. It was no concern of his, though. “Dr. Cobb, then,” he said. Giles heard the other man’s voice on the study phone, too low for the words to be distinguishable. He finished the drink, feeling still better, and was sitting up when Dubbins came back. “Dr. Cobb wants you to come to his office at once, sir,” he said, dropping to his knee to help Giles with his shoes. “I’d be pleased to drive you there.” Giles frowned. He’d expected Cobb to come to him. Then he grimaced at his own thoughts. Dubbins’ manners must have carried him back into the past; doctors didn’t go in for home visits now—they preferred to see their patients in the laboratories that housed their offices. If this kept on, he’d be missing the old days when he’d had a mansion and counted his wealth in possessions, instead of the treasures he could build inside himself for the future ahead. He was getting positively childish! Yet he relished the feeling of having Dubbins drive his car. More than anything else, he’d loved being driven. Even after chauffeurs were a thing of the past, Harry had driven him around. Now he’d taken to walking, as so many others had, for even with modern safety measures so strict, there was always a small chance of some accident and nobody had any desire to spend the long future as a cripple. “I’ll wait for you, sir,” Dubbins offered as they stopped beside the low, massive medical building. It was almost too much consideration. Giles nodded, got out and headed down the hall uncertainly. Just how bad did he look? Well, he’d soon find out. He located the directory and finally found the right office, its reception room wall covered with all the degrees Dr. Cobb had picked up in some three hundred years of practice. Giles felt better, realizing it wouldn’t be one of the younger men. COBB APPEARED himself, before the nurse could take over, and led Giles into a room with an old-fashioned desk and chairs that almost concealed the cabinets of equipment beyond. He listened as Giles stumbled out his story. Halfway through, the nurse took a blood sample with one of the little mosquito needles and the machinery behind the doctor began working on it. “Your friend told me about the gray hair, of course,” Cobb said. At Giles’ look, he smiled faintly. “Surely you didn’t think people could miss that in this day and age? Let’s see it.” He inspected it and began making tests. Some were older than Giles could remember—knee reflex, blood pressure, pulse and fluoroscope. Others involved complicated little gadgets that ran over his body, while meters bobbed and wiggled. The blood check came through and Cobb studied it, to go back and make further inspections of his own. At last he nodded slowly. “Hyper-catabolism, of course. I thought it might be. How long since you had your last rejuvenation? And who gave it?” “About ten years ago,” Giles answered. He found his identity card and passed it over, while the doctor studied it. “My sixteenth.” It wasn’t going right. He could feel it. Some of the panic symptoms were returning; the pulse in his neck was pounding and his breath was growing difficult. Sweat ran down his sides from his armpit and he wiped his palms against his coat. “Any particular emotional strain when you were treated—some major upset in your life?” Cobb asked. Giles thought as carefully as he could, but he remembered nothing like that. “You mean—it didn’t take? But I never had any trouble, Doctor. I was one of the first million cases, when a lot of people couldn’t rejuvenate at all, and I had no trouble even then.” Cobb considered it, hesitated as if making up his mind to be frank against his better judgment. “I can’t see any other explanation. You’ve got a slight case of angina—nothing serious, but quite definite—as well as other signs of aging. I’m afraid the treatment didn’t take fully. It might have been some unconscious block on your part, some infection not diagnosed at the time, or even a fault in the treatment. That’s pretty rare, but we can’t neglect the possibility.” HE STUDIED his charts again and then smiled. “So we’ll give you another treatment. Any reason you can’t begin immediately?” Giles remembered that Dubbins was waiting for him, but this was more important. It hadn’t been a joke about his growing old, after all. But now, in a few days, he’d be his old—no, of course not—his young self again! They went down the hall to another office, where Giles waited outside while Cobb conferred with another doctor and technician, with much waving of charts. He resented every second of it. It was as if the almost forgotten specter of age stood beside him, counting the seconds. But at last they were through and he was led into the quiet rejuvenation room, where the clamps were adjusted about his head and the earpieces were fitted. The drugs were shot painlessly into his arm and the light-pulser was adjusted to his brain-wave pattern. It had been nothing like this his first time. Then it had required months of mental training, followed by crude mechanical and drug hypnosis for other months. Somewhere in every human brain lay the memory of what his cells had been like when he was young. Or perhaps it lay in the cells themselves, with the brain as only a linkage to it. They’d discovered that, and the fact that the mind could effect physical changes in the body. Even such things as cancer could be willed out of existence—provided the brain could be reached far below the conscious level and forced to operate. There had been impossible faith cures for millenia—cataracts removed from blinded eyes within minutes, even—but finding the mechanism in the brain that worked those miracles had taken an incredible amount of study and finding a means of bringing it under control had taken even longer. Now they did it with dozens of mechanical aids in addition to the hypnotic instructions—and did it usually in a single sitting, with the full transformation of the body taking less than a week after the treatment! But with all the equipment, it wasn’t impossible for a mistake to happen. It had been no fault of his ... he was sure of that ... his mind was easy to reach ... he could relax so easily.... He came out of it without even a headache, while they were removing the probes, but the fatigue on the operator’s face told him it had been a long and difficult job. He stretched experimentally, with the eternal unconscious expectation that he would find himself suddenly young again. But that, of course, was ridiculous. It took days for the mind to work on all the cells and to repair the damage of time. COBB LED him back to the first office, where he was given an injection of some kind and another sample of his blood was taken, while the earlier tests were repeated. But finally the doctor nodded. “That’s all for now, Mr. Giles. You might drop in tomorrow morning, after I’ve had a chance to complete my study of all this. We’ll know by then whether you’ll need more treatment. Ten o’clock okay?” “But I’ll be all right?” Cobb smiled the automatic reassurance of his profession. “We haven’t lost a patient in two hundred years, to my knowledge.” “Thanks,” said Giles. “Ten o’clock is fine.” Dubbins was still waiting, reading a paper whose headlined feature carried a glowing account of the discovery of the super-light missile and what it might mean. He took a quick look at Giles and pointed to it. “Great work, Mr. Giles. Maybe we’ll all get to see some of those other worlds yet.” Then he studied Giles more carefully. “Everything’s in good shape now, sir?” “The doctor says everything’s going to be fine,” Giles answered. It was then he realized for the first time that Cobb had said no such thing. A statement that lightning had never struck a house was no guarantee that it never would. It was an evasion meant to give such an impression. The worry nagged at him all the way back. Word had already gone around the club that he’d had some kind of attack and there were endless questions that kept it on his mind. And even when it had been covered and recovered, he could still sense the glances of the others, as if he were Vincenti in one of the man’s more morose moods. He found a single table in the dining room and picked his way through the meal, listening to the conversation about him only when it was necessary because someone called across to him. Ordinarily, he was quick to support the idea of clubs in place of private families. A man here could choose his group and grow into them. Yet he wasn’t swallowed by them, as he might be by a family. Giles had been living here for nearly a century now and he’d never regretted it. But tonight his own group irritated him. He puzzled over it, finding no real reason. Certainly they weren’t forcing themselves on him. He remembered once when he’d had a cold, before they finally licked that; Harry had been a complete nuisance, running around with various nostrums, giving him no peace. Constant questions about how he felt, constant little looks of worry—until he’d been ready to yell at the boy. In fact, he had. Funny, he couldn’t picture really losing his temper here. Families did odd things to a man. HE LISTENED to a few of the discussions after the dinner, but he’d heard them all before, except for one about the super-speed drive, and there he had no wish to talk until he could study the final report. He gave up at last and went to his own suite. What he needed was a good night’s sleep after a little relaxation. Even that failed him, though. He’d developed one of the finest chess collections in the world, but tonight it held no interest. And when he drew out his tools and tried working on the delicate, lovely jade for the set he was carving his hands seemed to be all thumbs. None of the other interests he’d developed through the years helped to add to the richness of living now. He gave it up and went to bed—to have the fragment of that song pop into his head. Now there was no escaping it. Something about the years—or was it days—dwindling down to something or other. Could they really dwindle down? Suppose he couldn’t rejuvenate all the way? He knew that there were some people who didn’t respond as well as others. Sol Graves, for instance. He’d been fifty when he finally learned how to work with the doctors and they could only bring him back to about thirty, instead of the normal early twenties. Would that reduce the slice of eternity that rejuvenation meant? And what had happened to Sol? Or suppose it wasn’t rejuvenation, after all; suppose something had gone wrong with him permanently? He fought that off, but he couldn’t escape the nagging doubts at the doctor’s words. He got up once to stare at himself in the mirror. Ten hours had gone by and there should have been some signs of improvement. He couldn’t be sure, though, whether there were or not. He looked no better the next morning when he finally dragged himself up from the little sleep he’d managed to get. The hollows were still there and the circles under his eyes. He searched for the gray in his hair, but the traitorous strands had been removed at the doctor’s office and he could find no new ones. He looked into the dining room and then went by hastily. He wanted no solicitous glances this morning. Drat it, maybe he should move out. Maybe trying family life again would give him some new interests. Amanda probably would be willing to marry him; she’d hinted at a date once. He stopped, shocked by the awareness that he hadn’t been out with a woman for.... He couldn’t remember how long it had been. Nor why. “In the spring, a young man’s fancy,” he quoted to himself, and then shuddered. It hadn’t been that kind of spring for him—not this rejuvenation nor the last, nor the one before that. GILES TRIED to stop scaring himself and partially succeeded, until he reached the doctor’s office. Then it was no longer necessary to frighten himself. The wrongness was too strong, no matter how professional Cobb’s smile! He didn’t hear the preliminary words. He watched the smile vanish as the stack of reports came out. There was no nurse here now. The machines were quiet—and all the doors were shut. Giles shook his head, interrupting the doctor’s technical jargon. Now that he knew there was reason for his fear, it seemed to vanish, leaving a coldness that numbed him. “I’d rather know the whole truth,” he said. His voice sounded dead in his ears. “The worst first. The rejuvenation...?” Cobb sighed and yet seemed relieved. “Failed.” He stopped, and his hands touched the reports on his desk. “Completely,” he added in a low, defeated tone. “But I thought that was impossible!” “So did I. I wouldn’t believe it even yet—but now I find it isn’t the first case. I spent the night at Medical Center going up the ranks until I found men who really know about it. And now I wish I hadn’t.” His voice ran down and he gathered himself together by an effort. “It’s a shock to me, too, Mr. Giles. But—well, to simplify it, no memory is perfect—even cellular memory. It loses a little each time. And the effect is cumulative. It’s like an asymptotic curve—the further it goes, the steeper the curve. And—well, you’ve passed too far.” He faced away from Giles, dropping the reports into a drawer and locking it. “I wasn’t supposed to tell you, of course. It’s going to be tough enough when they’re ready to let people know. But you aren’t the first and you won’t be the last, if that’s any consolation. We’ve got a longer time scale than we used to have—but it’s in centuries, not in eons. For everybody, not just you.” It was no consolation. Giles nodded mechanically. “I won’t talk, of course. How—how long?” Cobb spread his hands unhappily. “Thirty years, maybe. But we can make them better. Geriatric knowledge is still on record. We can fix the heart and all the rest. You’ll be in good physical condition, better than your grandfather—” “And then....” Giles couldn’t pronounce the words. He’d grown old and he’d grow older. And eventually he’d die! An immortal man had suddenly found death hovering on his trail. The years had dwindled and gone, and only a few were left. He stood up, holding out his hand. “Thank you, Doctor,” he said, and was surprised to find he meant it. The man had done all he could and had at least saved him the suspense of growing doubt and horrible eventual discovery. OUTSIDE ON the street, he looked up at the Sun and then at the buildings built to last for thousands of years. Their eternity was no longer a part of him. Even his car would outlast him. He climbed into it, still partly numbed, and began driving mechanically, no longer wondering about the dangers that might possibly arise. Those wouldn’t matter much now. For a man who had thought of living almost forever, thirty years was too short a time to count. He was passing near the club and started to slow. Then he went on without stopping. He wanted no chance to have them asking questions he couldn’t answer. It was none of their business. Dubbins had been kind—but now Giles wanted no kindness. The street led to the office and he drove on. What else was there for him? There, at least, he could still fill his time with work—work that might even be useful. In the future, men would need the super-light drive if they were to span much more of the Universe than now. And he could speed up the work in some ways still, even if he could never see its finish. It would be cold comfort but it was something. And he might keep busy enough to forget sometimes that the years were gone for him. Automatic habit carried him through the office again, to Amanda’s desk, where her worry was still riding her. He managed a grin and somehow the right words came to his lips. “I saw the doctor, Amanda, so you can stop figuring ways to get me there.” She smiled back suddenly, without feigning it. “Then you’re all right?” “As all right as I’ll ever be,” he told her. “They tell me I’m just growing old.” This time her laugh was heartier. He caught himself before he could echo her mirth in a different voice and went inside where she had the coffee waiting for him. Oddly, it still tasted good to him. The projection was off, he saw, wondering whether he’d left it on or not. He snapped the switch and saw the screen light up, with the people still in the odd, wheelless vehicle on the alien planet. FOR A long moment, he stared at the picture without thinking, and then bent closer. Harry’s face hadn’t changed much. Giles had almost forgotten it, but there was still the same grin there. And his grandchildren had a touch of it, too. And of their grandfather’s nose, he thought. Funny, he’d never seen even pictures of his other grandchildren. Family ties melted away too fast for interstellar travel. Yet there seemed to be no slackening of them in Harry’s case, and somehow it looked like a family, rather than a mere group. A very pleasant family in a very pleasant world. He read Harry’s note again, with its praise for the planet and its invitation. He wondered if Dr. Vincenti had received an invitation like that, before he left. Or had he even been one of those to whom the same report had been delivered by some doctor? It didn’t matter, but it would explain things, at least. Twenty years to Centaurus, while the years dwindled down— Then abruptly the line finished itself. “The years dwindle down to a precious few....” he remembered. “A precious few.” Those dwindling years had been precious once. He unexpectedly recalled his own grandfather holding him on an old knee and slipping him candy that was forbidden. The years seemed precious to the old man then. Amanda’s voice came abruptly over the intercom. “Jordan wants to talk to you,” she said, and the irritation was sharp in her voice. “He won’t take no!” Giles shrugged and reached for the projector, to cut it off. Then, on impulse, he set it back to the picture, studying the group again as he switched on Jordan’s wire. But he didn’t wait for the hot words about whatever was the trouble. “Bill,” he said, “start getting the big ship into production. I’ve found a volunteer.” He’d been driven to it, he knew, as he watched the man’s amazed face snap from the screen. From the first suspicion of his trouble, something inside him had been forcing him to make this decision. And maybe it would do no good. Maybe the ship would fail. But thirty years was a number a man could risk. If he made it, though.... Well, he’d see those grandchildren of his this year—and Harry. Maybe he’d even tell Harry the truth, once they got done celebrating the reunion. And there’d be other grandchildren. With the ship, he’d have time enough to look them up. Plenty of time! Thirty years was a long time, when he stopped to think of it. —LESTER DEL REY
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D. He accepts his mortality, and is willing to spend his last years on the chance to see his family.
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Where was the space craft heading in the end?
A. In orbit around Ganymede
B. To the Space Patrol ship
C. To Koslow Spaceways headquarters
D. A 6-month journey back to Earth
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TOLLIVER'S ORBIT was slow—but it wasn't boring. And it would get you there—as long as you weren't going anywhere anyhow! By H. B. FYFE [Transcriber's Note: This etext was produced from Worlds of If Science Fiction, September 1961. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Johnny Tolliver scowled across the desk at his superior. His black thatch was ruffled, as if he had been rubbed the wrong way. "I didn't ask you to cut out your own graft, did I?" he demanded. "Just don't try to sucker me in on the deal. I know you're operating something sneaky all through the colony, but it's not for me." The big moon-face of Jeffers, manager of the Ganymedan branch of Koslow Spaceways, glowered back at him. Its reddish tinge brightened the office noticeably, for such of Ganymede's surface as could be seen through the transparent dome outside the office window was cold, dim and rugged. The glowing semi-disk of Jupiter was more than half a million miles distant. "Try not to be simple—for once!" growled Jeffers. "A little percentage here and there on the cargoes never shows by the time figures get back to Earth. The big jets in the home office don't care. They count it on the estimates." "You asked any of them lately?" Tolliver prodded. "Now, listen ! Maybe they live soft back on Earth since the mines and the Jovian satellite colonies grew; but they were out here in the beginning, most of them. They know what it's like. D'ya think they don't expect us to make what we can on the side?" Tolliver rammed his fists into the side pockets of his loose blue uniform jacket. He shook his head, grinning resignedly. "You just don't listen to me ," he complained. "You know I took this piloting job just to scrape up money for an advanced engineering degree back on Earth. I only want to finish my year—not get into something I can't quit." Jeffers fidgeted in his chair, causing it to creak under the bulk of his body. It had been built for Ganymede, but not for Jeffers. "Aw, it's not like that," the manager muttered. "You can ease out whenever your contract's up. Think we'd bend a good orbit on your account?" Tolliver stared at him silently, but the other had difficulty meeting his eye. "All right, then!" Jeffers snapped after a long moment. "If you want it that way, either you get in line with us or you're through right now!" "You can't fire me," retorted the pilot pityingly. "I came out here on a contract. Five hundred credits a week base pay, five hundred for hazardous duty. How else can you get pilots out to Jupiter?" "Okay I can't fire you legally—as long as you report for work," grumbled Jeffers, by now a shade more ruddy. "We'll see how long you keep reporting. Because you're off the Callisto run as of now! Sit in your quarters and see if the company calls that hazardous duty!" "Doesn't matter," answered Tolliver, grinning amiably. "The hazardous part is just being on the same moon as you for the next six months." He winked and walked out, deliberately leaving the door open behind him so as to enjoy the incoherent bellowing that followed him. Looks like a little vacation , he thought, unperturbed. He'll come around. I just want to get back to Earth with a clean rep. Let Jeffers and his gang steal the Great Red Spot off Jupiter if they like! It's their risk. Tolliver began to have his doubts the next day; which was "Tuesday" by the arbitrary calender constructed to match Ganymede's week-long journey around Jupiter. His contract guaranteed a pilot's rating, but someone had neglected to specify the type of craft to be piloted. On the bulletin board, Tolliver's name stood out beside the number of one of the airtight tractors used between the dome city and the spaceport, or for hauling cross-country to one of the mining domes. He soon found that there was nothing for him to do but hang around the garage in case a spaceship should land. The few runs to other domes seemed to be assigned to drivers with larger vehicles. The following day was just as boring, and the next more so. He swore when he found the assignment unchanged by "Friday." Even the reflection that it was payday was small consolation. "Hey, Johnny!" said a voice at his shoulder. "The word is that they're finally gonna trust you to take that creeper outside." Tolliver turned to see Red Higgins, a regular driver. "What do you mean?" "They say some home-office relative is coming in on the Javelin ." "What's wrong with that?" asked Tolliver. "Outside of the way they keep handing out soft jobs to nephews, I mean." "Aah, these young punks just come out for a few months so they can go back to Earth making noises like spacemen. Sometimes there's no reason but them for sending a ship back with a crew instead of in an economy orbit. Wait till you see the baggage you'll have to load!" Later in the day-period, Tolliver recalled this warning. Under a portable, double-chambered plastic dome blown up outside the ship's airlock, a crewman helped him load two trunks and a collection of bags into the tractor. He was struggling to suppress a feeling of outrage at the waste of fuel involved when the home-office relative emerged. She was about five feet four and moved as if she walked lightly even in stronger gravity than Ganymede's. Her trim coiffure was a shade too blonde which served to set off both the blue of her eyes and the cap apparently won from one of the pilots. She wore gray slacks and a heavy sweater, like a spacer. "Sorry to keep you waiting," she said, sliding into the seat beside Tolliver. "By the way, just call me Betty." "Sure," agreed Tolliver thinking, Ohmigod! Trying already to be just one of the gang, instead of Lady Betty! Is her old man the treasurer, or does he just know where bodies are buried? "They were making dates," said the girl. "Were they ribbing me, or is it true that none of the four of them goes back with the ship?" "It's true enough," Tolliver assured her. "We need people out here, and it costs a lot to make the trip. They found they could send back loaded ships by 'automatic' flight—that is, a long, slow, economical orbit and automatic signalling equipment. Then they're boarded approaching Earth's orbit and landed by pilots who don't have to waste their time making the entire trip." He followed the signals of a spacesuited member of the port staff and maneuvered out of the dome. Then he headed the tractor across the frozen surface of Ganymede toward the permanent domes of the city. "How is it here?" asked the girl. "They told me it's pretty rough." "What did you expect?" asked Tolliver. "Square dances with champagne?" "Don't be silly. Daddy says I'm supposed to learn traffic routing and the business management of a local branch. They probably won't let me see much else." "You never can tell," said the pilot, yielding to temptation. "Any square inch of Ganymede is likely to be dangerous." I'll be sorry later , he reflected, but if Jeffers keeps me jockeying this creeper, I'm entitled to some amusement. And Daddy's little girl is trying too hard to sound like one of the gang. "Yeah," he went on, "right now, I don't do a thing but drive missions from the city to the spaceport." "Missions! You call driving a mile or so a mission ?" Tolliver pursed his lips and put on a shrewd expression. "Don't sneer at Ganymede, honey!" he warned portentously. "Many a man who did isn't here today. Take the fellow who used to drive this mission!" "You can call me Betty. What happened to him?" "I'll tell you some day," Tolliver promised darkly. "This moon can strike like a vicious animal." "Oh, they told me there was nothing alive on Ganymede!" "I was thinking of the mountain slides," said the pilot. "Not to mention volcanic puffballs that pop out through the frozen crust where you'd least expect. That's why I draw such high pay for driving an unarmored tractor." "You use armored vehicles?" gasped the girl. She was now sitting bolt upright in the swaying seat. Tolliver deliberately dipped one track into an icy hollow. In the light gravity, the tractor responded with a weird, floating lurch. "Those slides," he continued. "Ganymede's only about the size of Mercury, something like 3200 miles in diameter, so things get heaped up at steep angles. When the rock and ice are set to sliding, they come at you practically horizontally. It doesn't need much start, and it barrels on for a long way before there's enough friction to stop it. If you're in the way—well, it's just too bad!" Say, that's pretty good! he told himself. What a liar you are, Tolliver! He enlarged upon other dangers to be encountered on the satellite, taking care to impress the newcomer with the daredeviltry of John Tolliver, driver of "missions" across the menacing wastes between dome and port. In the end, he displayed conclusive evidence in the form of the weekly paycheck he had received that morning. It did not, naturally, indicate he was drawing the salary of a space pilot. Betty looked thoughtful. "I'm retiring in six months if I'm still alive," he said bravely, edging the tractor into the airlock at their destination. "Made my pile. No use pushing your luck too far." His charge seemed noticeably subdued, but cleared her throat to request that Tolliver guide her to the office of the manager. She trailed along as if with a burden of worry upon her mind, and the pilot's conscience prickled. I'll get hold of her after Jeffers is through and set her straight , he resolved. It isn't really funny if the sucker is too ignorant to know better. Remembering his grudge against the manager, he took pleasure in walking in without knocking. "Jeffers," he announced, "this is ... just call her Betty." The manager's jowled features twisted into an expression of welcome as jovial as that of a hungry crocodile. "Miss Koslow!" he beamed, like a politician the day before the voting. "It certainly is an honor to have you on Ganymede with us! That's all, Tolliver, you can go. Yes, indeed! Mr. Koslow—the president, that is: your father—sent a message about you. I repeat, it will be an honor to show you the ropes. Did you want something else, Tolliver?" "Never mind him, Mr. Jeffers," snapped the girl, in a tone new to Tolliver. "We won't be working together, I'm afraid. You've already had enough rope." Jeffers seemed to stagger standing still behind his desk. His loose lips twitched uncertainly, and he looked questioningly to Tolliver. The pilot stared at Betty, trying to recall pictures he had seen of the elder Koslow. He was also trying to remember some of the lies he had told en route from the spaceport. "Wh-wh-what do you mean, Miss Koslow?" Jeffers stammered. He darted a suspicious glare at Tolliver. "Mr. Jeffers," said the girl, "I may look like just another spoiled little blonde, but the best part of this company will be mine someday. I was not allowed to reach twenty-two without learning something about holding on to it." Tolliver blinked. He had taken her for three or four years older. Jeffers now ignored him, intent upon the girl. "Daddy gave me the title of tenth vice-president mostly as a joke, when he told me to find out what was wrong with operations on Ganymede. I have some authority, though. And you look like the source of the trouble to me." "You can't prove anything," declared Jeffers hoarsely. "Oh, can't I? I've already seen certain evidence, and the rest won't be hard to find. Where are your books, Mr. Jeffers? You're as good as fired!" The manager dropped heavily to his chair. He stared unbelievingly at Betty, and Tolliver thought he muttered something about "just landed." After a moment, the big man came out of his daze enough to stab an intercom button with his finger. He growled at someone on the other end to come in without a countdown. Tolliver, hardly thinking about it, expected the someone to be a secretary, but it turned out to be three members of Jeffers' headquarters staff. He recognized one as Rawlins, a warehouse chief, and guessed that the other two might be his assistants. They were large enough. "No stupid questions!" Jeffers ordered. "Lock these two up while I think!" Tolliver started for the door immediately, but was blocked off. "Where should we lock—?" the fellow paused to ask. Tolliver brought up a snappy uppercut to the man's chin, feeling that it was a poor time to engage Jeffers in fruitless debate. In the gravity of Ganymede, the man was knocked off balance as much as he was hurt, and sprawled on the floor. "I told you no questions!" bawled Jeffers. The fallen hero, upon arising, had to content himself with grabbing Betty. The others were swarming over Tolliver. Jeffers came around his desk to assist. Tolliver found himself dumped on the floor of an empty office in the adjoining warehouse building. It seemed to him that a long time had been spent in carrying him there. He heard an indignant yelp, and realized that the girl had been pitched in with him. The snapping of a lock was followed by the tramp of departing footsteps and then by silence. After considering the idea a few minutes, Tolliver managed to sit up. He had his wind back. But when he fingered the swelling lump behind his left ear, a sensation befuddled him momentarily. "I'm sorry about that," murmured Betty. Tolliver grunted. Sorrow would not reduce the throbbing, nor was he in a mood to undertake an explanation of why Jeffers did not like him anyway. "I think perhaps you're going to have a shiner," remarked the girl. "Thanks for letting me know in time," said Tolliver. The skin under his right eye did feel a trifle tight, but he could see well enough. The abandoned and empty look of the office worried him. "What can we use to get out of here?" he mused. "Why should we try?" asked the girl. "What can he do?" "You'd be surprised. How did you catch on to him so soon?" "Your paycheck," said Betty. "As soon as I saw that ridiculous amount, it was obvious that there was gross mismanagement here. It had to be Jeffers." Tolliver groaned. "Then, on the way over here, he as good as admitted everything. You didn't hear him, I guess. Well, he seemed to be caught all unaware, and seemed to blame you for it." "Sure!" grumbled the pilot. "He thinks I told you he was grafting or smuggling, or whatever he has going for him here. That's why I want to get out of here—before I find myself involved in some kind of fatal accident!" "What do you know about the crooked goings-on here?" asked Betty after a startled pause. "Nothing," retorted Tolliver. "Except that there are some. There are rumors, and I had a halfway invitation to join in. I think he sells things to the mining colonies and makes a double profit for himself by claiming the stuff lost in transit. You didn't think you scared him that bad over a little slack managing?" The picture of Jeffers huddled with his partners in the headquarters building, plotting the next move, brought Tolliver to his feet. There was nothing in the unused office but an old table and half a dozen plastic crates. He saw that the latter contained a mess of discarded records. "Better than nothing at all," he muttered. He ripped out a double handful of the forms, crumpled them into a pile at the doorway, and pulled out his cigarette lighter. "What do you think you're up to?" asked Betty with some concern. "This plastic is tough," said Tolliver, "but it will bend with enough heat. If I can kick loose a hinge, maybe we can fool them yet!" He got a little fire going, and fed it judiciously with more papers. "You know," he reflected, "it might be better for you to stay here. He can't do much about you, and you don't have any real proof just by yourself." "I'll come along with you, Tolliver," said the girl. "No, I don't think you'd better." "Why not?" "Well ... after all, what would he dare do? Arranging an accident to the daughter of the boss isn't something that he can pull off without a lot of investigation. He'd be better off just running for it." "Let's not argue about it," said Betty, a trifle pale but looking determined. "I'm coming with you. Is that stuff getting soft yet?" Tolliver kicked at the edge of the door experimentally. It seemed to give slightly, so he knocked the burning papers aside and drove his heel hard at the corner below the hinge. The plastic yielded. "That's enough already, Tolliver," whispered the girl. "We can crawl through!" Hardly sixty seconds later, he led her into a maze of stacked crates in the warehouse proper. The building was not much longer than wide, for each of the structures in the colony had its own hemispherical emergency dome of transparent plastic. They soon reached the other end. "I think there's a storeroom for spacesuits around here," muttered Tolliver. "Why do you want them?" "Honey, I just don't think it will be so easy to lay hands on a tractor. I bet Jeffers already phoned the garage and all the airlocks with some good lie that will keep me from getting through." After a brief search, he located the spacesuits. Many, evidently intended for replacements, had never been unpacked, but there were a dozen or so serviced and standing ready for emergencies. He showed Betty how to climb into one, and checked her seals and valves after donning a suit himself. "That switch under your chin," he said, touching helmets so she could hear him. "Leave it turned off. Anybody might be listening!" He led the way out a rear door of the warehouse. With the heavy knife that was standard suit equipment, he deliberately slashed a four-foot square section out of the dome. He motioned to Betty to step through, then trailed along with the plastic under his arm. He caught up and touched helmets again. "Just act as if you're on business," he told her. "For all anyone can see, we might be inspecting the dome." "Where are you going?" asked Betty. "Right through the wall, and then head for the nearest mine. Jeffers can't be running everything !" "Is there any way to get to a TV?" asked the girl. "I ... uh ... Daddy gave me a good number to call if I needed help." "How good?" "Pretty official, as a matter of fact." "All right," Tolliver decided. "We'll try the ship you just came in on. They might have finished refueling and left her empty." They had to cross one open lane between buildings, and Tolliver was very conscious of moving figures in the distance; but no one seemed to look their way. Reaching the foot of the main dome over the establishment, he glanced furtively about, then plunged his knife into the transparent material. From the corner of his eye, he thought he saw Betty make a startled gesture, but he had his work cut out for him. This was tougher than the interior dome. Finally, he managed to saw a ragged slit through which they could squeeze. There was room to walk between the inner and outer layer, so he moved along a few yards. A little dust began to blow about where they had gone through. He touched helmets once more. "This time," he said, "the air will really start to blow, so get through as fast as you can. If I can slap this piece of plastic over the rip, it may stow down the loss of pressure enough to give us quite a lead before the alarms go off." Through the faceplates, he saw the girl nod, wide-eyed. As soon as he plunged the knife into the outer layer, he could see dusty, moist air puffing out into the near-vacuum of Ganymede's surface. Fumbling, he cut as fast as he could and shoved Betty through the small opening. Squeezing through in his turn, he left one arm inside to spread the plastic sheet as best he could. The internal air pressure slapped it against the inside of the dome as if glued, although it immediately showed an alarming tendency to balloon through the ruptured spot. They'll find it, all right , Tolliver reminded himself. Don't be here when they do! He grabbed Betty by the wrist of her spacesuit and headed for the nearest outcropping of rock. It promptly developed that she had something to learn about running on ice in such low gravity. Until they were out of direct line of sight from the settlement, Tolliver simply dragged her. Then, when he decided that it was safe enough to pause and tell her how to manage better, the sight of her outraged scowl through the face-plate made him think better of it. By the time we reach the ship, she'll have learned , he consoled himself. It was a long mile, even at the pace human muscles could achieve on Ganymede. They took one short rest, during which Tolliver was forced to explain away the dangers of slides and volcanic puffballs. He admitted to having exaggerated slightly. In the end, they reached the spaceship. There seemed to be no one about. The landing dome had been collapsed and stored, and the ship's airlock port was closed. "That's all right," Tolliver told the girl. "We can get in with no trouble." It was when he looked about to make sure that they were unobserved that he caught a glimpse of motion back toward the city. He peered at the spot through the dim light. After a moment, he definitely recognized the outline of a tractor breasting a rise in the ground and tilting downward again. "In fact, we have to get in to stay out of trouble," he said to Betty. He located the switch-cover in the hull, opened it and activated the mechanism that swung open the airlock and extended the ladder. It took him considerable scrambling to boost the girl up the ladder and inside, but he managed. They passed through the airlock, fretting at the time required to seal, pump air and open the inner hatch; and then Tolliver led the way up another ladder to the control room. It was a clumsy trip in their spacesuits, but he wanted to save time. In the control room, he shoved the girl into an acceleration seat, glanced at the gauges and showed her how to open her helmet. "Leave the suit on," he ordered, getting in the first word while she was still shaking her head. "It will help a little on the takeoff." "Takeoff!" shrilled Betty. "What do you think you're going to do? I just want to use the radio or TV!" "That tractor will get here in a minute or two. They might cut your conversation kind of short. Now shut up and let me look over these dials!" He ran a practiced eye over the board, reading the condition of the ship. It pleased him. Everything was ready for a takeoff into an economy orbit for Earth. He busied himself making a few adjustments, doing his best to ignore the protests from his partner in crime. He warned her the trip might be long. "I told you not to come," he said at last. "Now sit back!" He sat down and pushed a button to start the igniting process. In a moment, he could feel the rumble of the rockets through the deck, and then it was out of his hands for several minutes. "That wasn't so bad," Betty admitted some time later. "Did you go in the right direction?" "Who knows?" retorted Tolliver. "There wasn't time to check everything . We'll worry about that after we make your call." "Oh!" Betty looked helpless. "It's in my pocket." Tolliver sighed. In their weightless state, it was no easy task to pry her out of the spacesuit. He thought of inquiring if she needed any further help, but reminded himself that this was the boss's daughter. When Betty produced a memo giving frequency and call sign, he set about making contact. It took only a few minutes, as if the channel had been monitored expectantly, and the man who flickered into life on the screen wore a uniform. "Space Patrol?" whispered Tolliver incredulously. "That's right," said Betty. "Uh ... Daddy made arrangements for me." Tolliver held her in front of the screen so she would not float out of range of the scanner and microphone. As she spoke, he stared exasperatedly at a bulkhead, marveling at the influence of a man who could arrange for a cruiser to escort his daughter to Ganymede and wondering what was behind it all. When he heard Betty requesting assistance in arresting Jeffers and reporting the manager as the head of a ring of crooks, he began to suspect. He also noticed certain peculiarities about the remarks of the Patrolman. For one thing, though the officer seemed well acquainted with Betty, he never addressed her by the name of Koslow. For another, he accepted the request as if he had been hanging in orbit merely until learning who to go down after. They really sent her out to nail someone , Tolliver realized. Of course, she stumbled onto Jeffers by plain dumb luck. But she had an idea of what to look for. How do I get into these things? She might have got me killed! "We do have one trouble," he heard Betty saying. "This tractor driver, Tolliver, saved my neck by making the ship take off somehow, but he says it's set for a six-month orbit, or economy flight. Whatever they call it. I don't think he has any idea where we're headed." Tolliver pulled her back, holding her in mid-air by the slack of her sweater. "Actually, I have a fine idea," he informed the officer coldly. "I happen to be a qualified space pilot. Everything here is under control. If Miss Koslow thinks you should arrest Jeffers, you can call us later on this channel." "Miss Koslow?" repeated the spacer. "Did she tell you—well, no matter! If you'll be okay, we'll attend to the other affair immediately." He signed off promptly. The pilot faced Betty, who looked more offended than reassured at discovering his status. "This 'Miss Koslow' business," he said suspiciously. "He sounded funny about that." The girl grinned. "Relax, Tolliver," she told him. "Did you really believe Daddy would send his own little girl way out here to Ganymede to look for whoever was gypping him?" "You ... you...?" "Sure. The name's Betty Hanlon. I work for a private investigating firm. If old Koslow had a son to impersonate—" "I'd be stuck for six months in this orbit with some brash young man," Tolliver finished for her. "I guess it's better this way," he said meditatively a moment later. "Oh, come on ! Can't they get us back? How can you tell where we're going?" "I know enough to check takeoff time. It was practically due anyhow, so we'll float into the vicinity of Earth at about the right time to be picked up." He went on to explain something of the tremendous cost in fuel necessary to make more than minor corrections to their course. Even though the Patrol ship could easily catch the slow freighter, bringing along enough fuel to head back would be something else again. "We'll just have to ride it out," he said sympathetically. "The ship is provisioned according to law, and you were probably going back anyhow." "I didn't expect to so soon." "Yeah, you were pretty lucky. They'll think you're a marvel to crack the case in about three hours on Ganymede." "Great!" muttered Betty. "What a lucky girl I am!" "Yes," admitted Tolliver, "there are problems. If you like, we might get the captain of that Patrol ship to legalize the situation by TV." "I can see you're used to sweeping girls off their feet," she commented sourly. "The main problem is whether you can cook." Betty frowned at him. "I'm pretty good with a pistol," she offered, "or going over crooked books. But cook? Sorry." "Well, one of us had better learn, and I'll have other things to do." "I'll think about it," promised the girl, staring thoughtfully at the deck. Tolliver anchored himself in a seat and grinned as he thought about it too. After a while , he promised himself, I'll explain how I cut the fuel flow and see if she's detective enough to suspect that we're just orbiting Ganymede!
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A. In orbit around Ganymede
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Who did the ship’s crew expect would meet them on arrival?
A. The other Quest ships
B. Warships on attack
C. A parade
D. Maybe nobody
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THE GIANTS RETURN By ROBERT ABERNATHY Earth set itself grimly to meet them with corrosive fire, determined to blast them back to the stars. But they erred in thinking the Old Ones were too big to be clever. [Transcriber's Note: This etext was produced from Planet Stories Fall 1949. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] In the last hours the star ahead had grown brighter by many magnitudes, and had changed its color from a dazzling blue through white to the normal yellow, of a GO sun. That was the Doppler effect as the star's radial velocity changed relative to the Quest III , as for forty hours the ship had decelerated. They had seen many such stars come near out of the galaxy's glittering backdrop, and had seen them dwindle, turn red and go out as the Quest III drove on its way once more, lashed by despair toward the speed of light, leaving behind the mockery of yet another solitary and lifeless luminary unaccompanied by worlds where men might dwell. They had grown sated with the sight of wonders—of multiple systems of giant stars, of nebulae that sprawled in empty flame across light years. But now unwonted excitement possessed the hundred-odd members of the Quest III's crew. It was a subdued excitement; men and women, they came and stood quietly gazing into the big vision screens that showed the oncoming star, and there were wide-eyed children who had been born in the ship and had never seen a planet. The grownups talked in low voices, in tones of mingled eagerness and apprehension, of what might lie at the long journey's end. For the Quest III was coming home; the sun ahead was the Sun, whose rays had warmed their lives' beginning. Knof Llud, the Quest III's captain, came slowly down the narrow stair from the observatory, into the big rotunda that was now the main recreation room, where most of the people gathered. The great chamber, a full cross-section of the vessel, had been at first a fuel hold. At the voyage's beginning eighty per cent of the fifteen-hundred-foot cylinder had been engines and fuel; but as the immense stores were spent and the holds became radioactively safe, the crew had spread out from its original cramped quarters. Now the interstellar ship was little more than a hollow shell. Eyes lifted from the vision screens to interrogate Knof Llud; he met them with an impassive countenance, and announced quietly, "We've sighted Earth." A feverish buzz arose; the captain gestured for silence and went on, "It is still only a featureless disk to the telescope. Zost Relyul has identified it—no more." But this time the clamor was not to be settled. People pressed round the screens, peering into them as if with the naked eye they could pick out the atom of reflected light that was Earth, home. They wrung each other's hands, kissed, shouted, wept. For the present their fears were forgotten and exaltation prevailed. Knof Llud smiled wryly. The rest of the little speech he had been about to make didn't matter anyway, and it might have spoiled this moment. He turned to go, and was halted by the sight of his wife, standing at his elbow. His wry smile took on warmth; he asked, "How do you feel, Lesra?" She drew an uncertain breath and released it in a faint sigh. "I don't know. It's good that Earth's still there." She was thinking, he judged shrewdly, of Knof Jr. and Delza, who save from pictures could not remember sunlit skies or grassy fields or woods in summer.... He said, with a touch of tolerant amusement, "What did you think might have happened to Earth? After all, it's only been nine hundred years." "That's just it," said Lesra shakily. "Nine hundred years have gone by— there —and nothing will be the same. It won't be the same world we left, the world we knew and fitted in...." The captain put an arm round her with comforting pressure. "Don't worry. Things may have changed—but we'll manage." But his face had hardened against registering the gnawing of that same doubtful fear within him. He let his arm fall. "I'd better get up to the bridge. There's a new course to be set now—for Earth." He left her and began to climb the stairway again. Someone switched off the lights, and a charmed whisper ran through the big room as the people saw each other's faces by the pale golden light of Earth's own Sun, mirrored and multiplied by the screens. In that light Lesra's eyes gleamed with unshed tears. Captain Llud found Navigator Gwar Den looking as smug as the cat that ate the canary. Gwar Den was finding that the actual observed positions of the planets thus far located agreed quite closely with his extrapolations from long unused charts of the Solar System. He had already set up on the calculator a course that would carry them to Earth. Llud nodded curt approval, remarking, "Probably we'll be intercepted before we get that far." Den was jolted out of his happy abstraction. "Uh, Captain," he said hesitantly. "What kind of a reception do you suppose we'll get?" Llud shook his head slowly. "Who knows? We don't know whether any of the other Quests returned successful, or if they returned at all. And we don't know what changes have taken place on Earth. It's possible—not likely, though—that something has happened to break civilization's continuity to the point where our expedition has been forgotten altogether." He turned away grim-lipped and left the bridge. From his private office-cabin, he sent a message to Chief Astronomer Zost Relyul to notify him as soon as Earth's surface features became clear; then he sat idle, alone with his thoughts. The ship's automatic mechanisms had scant need of tending; Knof Llud found himself wishing that he could find some back-breaking task for everyone on board, himself included, to fill up the hours that remained. There was an extensive and well-chosen film library in the cabin, but he couldn't persuade himself to kill time that way. He could go down and watch the screens, or to the family apartment where he might find Lesra and the children—but somehow he didn't want to do that either. He felt empty, drained—like his ship. As the Quest III's fuel stores and the hope of success in man's mightiest venture had dwindled, so the strength had gone out of him. Now the last fuel compartment was almost empty and Captain Knof Llud felt tired and old. Perhaps, he thought, he was feeling the weight of his nine hundred Earth years—though physically he was only forty now, ten years older than when the voyage had begun. That was the foreshortening along the time axis of a space ship approaching the speed of light. Weeks and months had passed for the Quest III in interstellar flight while years and decades had raced by on the home world. Bemusedly Llud got to his feet and stood surveying a cabinet with built-in voice recorder and pigeonholes for records. There were about three dozen film spools there—his personal memoirs of the great expedition, a segment of his life and of history. He might add that to the ship's official log and its collections of scientific data, as a report to whatever powers might be on Earth now—if such powers were still interested. Llud selected a spool from among the earliest. It was one he had made shortly after leaving Procyon, end of the first leg of the trip. He slid it onto the reproducer. His own voice came from the speaker, fresher, more vibrant and confident than he knew it was now. "One light-day out from Procyon, the thirty-third day by ship's time since leaving Earth. "Our visit to Procyon drew a blank. There is only one huge planet, twice the size of Jupiter, and like Jupiter utterly unfit to support a colony. "Our hopes were dashed—and I think all of us, even remembering the Centaurus Expedition's failure, hoped more than we cared to admit. If Procyon had possessed a habitable planet, we could have returned after an absence of not much over twenty years Earth time. "It is cheering to note that the crew seems only more resolute. We go on to Capella; its spectrum, so like our own Sun's, beckons. If success comes there, a century will have passed before we can return to Earth; friends, relatives, all the generation that launched the Quest ships will be long since dead. Nevertheless we go on. Our generation's dream, humanity's dream, lives in us and in the ship forever...." Presently Knof Llud switched off that younger voice of his and leaned back, an ironic smile touching his lips. That fervent idealism seemed remote and foreign to him now. The fanfares of departure must still have been ringing in his ears. He rose, slipped the record back in its niche and picked out another, later, one. "One week since we passed close enough to Aldebaran to ascertain that that system, too, is devoid of planets. "We face the unpleasant realization that what was feared is probably true—that worlds such as the Sun's are a rare accident, and that we may complete our search without finding even one new Earth. "It makes no difference, of course; we cannot betray the plan.... This may be man's last chance of escaping his pitiful limitation to one world in all the Universe. Certainly the building of this ship and its two sisters, the immense expenditure of time and labor and energy stores that went into them, left Earth's economy drained and exhausted. Only once in a long age does mankind rise to such a selfless and transcendent effort—the effort of Egypt that built the pyramids, or the war efforts of the nations in the last great conflicts of the twentieth century. "Looked at historically, such super-human outbursts of energy are the result of a population's outgrowing its room and resources, and therefore signalize the beginning of the end. Population can be limited, but the price is a deadly frustration, because growth alone is life.... In our day the end of man's room for growth on the Earth was in sight—so we launched the Quests . Perhaps our effort will prove as futile as pyramid-building, less practical than orgies of slaughter to reduce pressure.... In any case, it would be impossible to transport very many people to other stars; but Earth could at least go into its decline with the knowledge that its race went onward and upward, expanding limitlessly into the Universe.... "Hopeless, unless we find planets!" Knof Llud shook his head sorrowfully and took off the spool. That was from the time when he had grown philosophical after the first disappointments. He frowned thoughtfully, choosing one more spool that was only four years old. The recorded voice sounded weary, yet alive with a strange longing.... "We are in the heart of Pleiades; a hundred stars show brilliant on the screens, each star encircled by a misty halo like lights glowing through fog, for we are traversing a vast diffuse nebula. "According to plan, the Quest III has reached its furthest point from Earth. Now we turn back along a curve that will take us past many more stars and stellar systems—but hope is small that any of those will prove a home for man, as have none of the thousands of stars examined already. "But what are a few thousand stars in a galaxy of billions? We have only, as it were, visited a handful of the outlying villages of the Universe, while the lights of its great cities still blaze far ahead along the Milky Way. "On flimsy excuses I have had Zost Relyul make observations of the globular cluster Omega Centauri. There are a hundred thousand stars there in a volume of space where one finds a few dozen in the Sun's neighborhood; there if anywhere must circle the planets we seek! But Omega Centauri is twenty thousand light years away.... "Even so—by expending its remaining fuel freely, the Quest III could achieve a velocity that would take us there without dying of senility of aging too greatly. It would be a one-way journey—even if enough fuel remained, there would be little point in returning to Earth after more than forty thousand years. By then our civilization certainly, and perhaps the human race itself, would have perished from memory. "That was why the planners limited our voyage, and those of the other Quests , to less than a thousand years Earth time. Even now, according to the sociodynamic predictions made then, our civilization—if the other expeditions failed also—will have reached a dangerously unstable phase, and before we can get back it may have collapsed completely from overpopulation. "Why go back, then with the news of our failure? Why not forget about Earth and go on to Omega Centauri? What use is quixotic loyalty to a decree five thousand years old, whose makers are dead and which may be forgotten back there? "Would the crew be willing? I don't know—some of them still show signs of homesickness, though they know with their minds that everything that was once 'home' has probably been swept away.... "It doesn't matter. Today I gave orders to swing the ship." Savagely Knof Llud stabbed the button that shut off the speaker. Then he sat for a time with head resting in his hands, staring into nothing. The memory of that fierce impulse to go on still had power to shake him. A couple of lines of poetry came into his head, as he read them once in translation from the ancient English.... ... for my purpose holds To sail beyond the sunset, and the baths Of all the western stars, until I die. Llud sighed. He still couldn't say just why he had given the order to turn back. The stars had claimed his heart—but he was still a part of Earth, and not even nine hundred years of space and time had been able to alter that. He wondered if there would still be a quiet stream and a green shady place beside it where a death-weary man, relieved at last of responsibility, could rest and dream no more.... Those things went on, if men didn't change them. And a pine forest where he and young Knof could go camping, and lie on their backs at night and gaze at the glittering constellations, far away, out of reach.... He wasn't sure he would want to do that, though. Suddenly a faint cushioned jar went through the great ship; it seemed to falter one moment in flight. The captain was on his feet instantly, but then his movements became unhurried. Whatever it had been was past, and he had a good idea what it had been—a meteoroid, nothing unusual in the vicinity of the Sun, though in interstellar space and around planetless stars such collisions were rare to the vanishing point. No harm could have been done. The Quest III's collision armor was nonmaterial and for practical purposes invulnerable. Just as he took his finger off the button that opened the door, the intercommunication phone shrilled imperatively. Knof Llud wheeled, frowning—surely a meteoroid impact wasn't that serious. Coincidence, maybe—it might be Zost Relyul calling as instructed. He reached the phone at the moment when another, heavier jolt shook the vessel. Llud snatched up the receiver with the speed of a scalded cat. "Captain?" It was Gwar Den's voice, stammering a little. "Captain, we're being attacked!" "Sound the alarm. Emergency stations." He had said it automatically, then felt a curious detached relief at the knowledge that after all these years he could still respond quickly and smoothly to a crisis. There was a moment's silence, and he heard the alarm start—three short buzzes and repeat, ringing through all the great length of the interstellar ship. Knowing that Gwar Den was still there, he said, "Now—attacked by what?" "Ships," said Gwar Den helplessly. "Five of them so far. No, there's a sixth now." Repeated blows quivered the Quest III's framework. The navigator said, obviously striving for calm, "They're light craft, not fifty feet long, but they move fast. The detectors hardly had time to show them before they opened up. Can't get a telescope beam on them long enough to tell much." "If they're that small," said Knof Llud deliberately, "they can't carry anything heavy enough to hurt us. Hold to course. I'll be right up." In the open doorway he almost fell over his son. Young Knof's eyes were big; he had heard his father's words. "Something's happened," he judged with deadly twelve-year-old seriousness and, without wasting time on questions, "Can I go with you, huh, Dad?" Llud hesitated, said, "All right. Come along and keep out of the way." He headed for the bridge with strides that the boy could not match. There were people running in the corridors, heading for their posts. Their faces were set, scared, uncomprehending. The Quest III shuddered, again and again, under blows that must have had millions of horsepower behind them; but it plunged on toward Earth, its mighty engines still steadily braking its interstellar velocity. To a man, the ship's responsible officers were already on the bridge, most of them breathless. To a man they looked appeal at Captain Knof Llud. "Well?" he snapped. "What are they doing?" Gwar Den spoke. "There are thirteen of them out there now, sir, and they're all banging away at us." The captain stared into the black star-strewn depths of a vision screen where occasional blue points of light winked ominously, never twice from the same position. Knof Jr. flattened himself against the metal wall and watched silently. His young face was less anxious than his elders'; he had confidence in his father. "If they had anything heavier," surmised the captain, "they'd have unlimbered it by now. They're out to get us. But at this rate, they can't touch us as long as our power lasts—or until they bring up some bigger stuff." The mild shocks went on—whether from projectiles or energy-charges, would be hard to find out and it didn't matter; whatever was hitting the Quest III's shell was doing it at velocities where the distinction between matter and radiation practically ceases to exist. But that shell was tough. It was an extension of the gravitic drive field which transmitted the engines' power equally to every atom of the ship; forces impinging on the outside of the field were similarly transmitted and rendered harmless. The effect was as if the vessel and all space inside its field were a single perfectly elastic body. A meteoroid, for example, on striking it rebounded—usually vaporized by the impact—and the ship, in obedience to the law of equal and opposite forces, rebounded too, but since its mass was so much greater, its deflection was negligible. The people in the Quest III would have felt nothing at all of the vicious onslaught being hurled against them, save that their inertialess drive, at its normal thrust of two hundred gravities, was intentionally operated at one half of one per cent efficiency to provide the illusion of Earthly gravitation. One of the officers said shakily, "It's as if they've been lying in wait for us. But why on Earth—" "That," said the captain grimly, "is what we have to find out. Why—on Earth. At least, I suspect the answer's there." The Quest III bored steadily on through space, decelerating. Even if one were no fatalist, there seemed no reason to stop decelerating or change course. There was nowhere else to go and too little fuel left if there had been; come what might, this was journey's end—perhaps in a more violent and final way than had been anticipated. All around wheeled the pigmy enemies, circling, maneuvering, and attacking, always attacking, with the senseless fury of maddened hornets. The interstellar ship bore no offensive weapons—but suddenly on one of the vision screens a speck of light flared into nova-brilliance, dazzling the watchers for the brief moment in which its very atoms were torn apart. Knof Jr. whooped ecstatically and then subsided warily, but no one was paying attention to him. The men on the Quest III's bridge looked questions at each other, as the thought of help from outside flashed into many minds at once. But Captain Llud said soberly, "It must have caught one of their own shots, reflected. Maybe its own, if it scored too direct a hit." He studied the data so far gathered. A few blurred pictures had been got, which showed cylindrical space ships much like the Quest III , except that they were rocket-propelled and of far lesser size. Their size was hard to ascertain, because you needed to know their distance and speed—but detector-beam echoes gave the distance, and likewise, by the Doppler method, the velocity of directly receding or approaching ships. It was apparent that the enemy vessels were even smaller than Gwar Den had at first supposed—not large enough to hold even one man. Tiny, deadly hornets with a colossal sting. "Robot craft, no doubt," said Knof Llud, but a chill ran down his spine as it occurred to him that perhaps the attackers weren't of human origin. They had seen no recognizable life in the part of the galaxy they had explored, but one of the other Quests might have encountered and been traced home by some unhuman race that was greedy and able to conquer. It became evident, too, that the bombardment was being kept up by a constant arrival of fresh attackers, while others raced away into space, presumably returning to base to replenish their ammunition. That argued a planned and prepared interception with virulent hatred behind it. Elsuz Llug, the gravitic engineer, calculated dismally, "At the rate we're having to shed energy, the fuel will be gone in six or eight hours." "We'll have reached Earth before then," Gwar Den said hopefully. "If they don't bring out the heavy artillery first." "We're under the psychological disadvantage," said the captain, "of not knowing why we're being attacked." Knof Jr. burst out, spluttering slightly with the violence of a thought too important to suppress, "But we're under a ps-psychological advantage, too!" His father raised an eyebrow. "What's that? I don't seem to have noticed it." "They're mad and we aren't, yet," said the boy. Then, seeing that he hadn't made himself clear, "In a fight, if a guy gets mad he starts swinging wild and then you nail him." Smiles splintered the ice of tension. Captain Llud said, "Maybe you've got something there. They seem to be mad, all right. But we're not in a position to throw any punches." He turned back to the others. "As I was going to say—I think we'd better try to parley with the enemy. At least we may find out who he is and why he's determined to smash us." And now instead of tight-beam detectors the ship was broadcasting on an audio carrier wave that shifted through a wide range of frequencies, repeating on each the same brief recorded message: "Who are you? What do you want? We are the interstellar expedition Quest III ...." And so on, identifying themselves and protesting that they were unarmed and peaceful, that there must be some mistake, and querying again, "Who are you ?" There was no answer. The ship drove on, its fuel trickling away under multiplied demands. Those outside were squandering vastly greater amounts of energy in the effort to batter down its defenses, but converting that energy into harmless gravitic impulses was costing the Quest III too. Once more Knof Llud had the insidious sense of his own nerves and muscles and will weakening along with the power-sinews of his ship. Zost Relyul approached him apologetically. "If you have time, Captain—I've got some data on Earth now." Eagerly Llud took the sheaf of photographs made with the telescope. But they told him nothing; only the continental outlines were clear, and those were as they had been nine hundred years ago.... He looked up inquiringly at Zost Relyul. "There are some strange features," said the astronomer carefully. "First of all—there are no lights on the night side. And on the daylight face, our highest magnification should already reveal traces of cities, canals, and the like—but it does not. "The prevailing color of the land masses, you see, is the normal green vegetation. But the diffraction spectrum is queer. It indicates reflecting surfaces less than one-tenth millimeter wide—so the vegetation there can't be trees or grass, but must be more like a fine moss or even a coarse mold." "Is that all?" demanded Llud. "Isn't it enough?" said Zost Relyul blankly. "Well—we tried photography by invisible light, of course. The infra-red shows nothing and likewise the ultraviolet up to the point where the atmosphere is opaque to it." The captain sighed wearily. "Good work," he said. "Keep it up; perhaps you can answer some of these riddles before—" " We know who you are ," interrupted a harshly crackling voice with a strange accent, " and pleading will do you no good. " Knof Llud whirled to the radio apparatus, his weariness dropping from him once more. He snapped, "But who are you?" and the words blended absurdly with the same words in his own voice on the still repeating tape. He snapped off the record; as he did so the speaker, still crackling with space static, said, "It may interest you to know that you are the last. The two other interstellar expeditions that went out have already returned and been destroyed, as you will soon be—the sooner, if you continue toward Earth." Knof Llud's mind was clicking again. The voice—which must be coming from Earth, relayed by one of the midget ships—was not very smart; it had already involuntarily told him a couple of things—that it was not as sure of itself as it sounded he deduced from the fact it had deigned to speak at all, and from its last remark he gathered that the Quest III's ponderous and unswerving progress toward Earth had somehow frightened it. So it was trying to frighten them. He shoved those facts back for future use. Just now he had to know something, so vitally that he asked it as a bald question, " Are you human? " The voice chuckled sourly. "We are human," it answered, "but you are not." The captain was momentarily silent, groping for an adequate reply. Behind him somebody made a choked noise, the only sound in the stunned hush, and the ship jarred slightly as a thunderbolt slammed vengefully into its field. "Suppose we settle this argument about humanity," said Knof Llud woodenly. He named a vision frequency. "Very well." The tone was like a shrug. The voice went on in its language that was quite intelligible, but alien-sounding with the changes that nine hundred years had wrought. "Perhaps, if you realize your position, you will follow the intelligent example of the Quest I's commander." Knof Llud stiffened. The Quest I , launched toward Arcturus and the star cloud called Berenice's Hair, had been after the Quest III the most hopeful of the expeditions—and its captain had been a good friend of Llud's, nine hundred years ago.... He growled, "What happened to him?" "He fought off our interceptors, which are around you now, for some time," said the voice lightly. "When he saw that it was hopeless, he preferred suicide to defeat, and took his ship into the Sun." A short pause. "The vision connection is ready." Knof Llud switched on the screen at the named wavelength, and a picture formed there. The face and figure that appeared were ugly, but undeniably a man's. His features and his light-brown skin showed the same racial characteristics possessed by those aboard the Quest III , but he had an elusive look of deformity. Most obviously, his head seemed too big for his body, and his eyes in turn too big for his head. He grinned nastily at Knof Llud. "Have you any other last wishes?" "Yes," said Llud with icy control. "You haven't answered one question. Why do you want to kill us? You can see we're as human as you are." The big-headed man eyed him with a speculative look in his great eyes, behind which the captain glimpsed the flickering raw fire of a poisonous hatred. "It is enough for you to know that you must die."
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D. Maybe nobody
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Who is the least lovable character in The Thin Red Line?
A. Private Bell
B. Lieutenant Colonel Tall
C. Captain Staros
D. Seargant Welsh
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War and Pieces No movie in the last decade has succeeded in psyching out critics and audiences as fully as the powerful, rambling war epic The Thin Red Line , Terrence Malick's return to cinema after 20 years. I've sat through it twice and am still trying to sort out my responses, which run from awe to mockery and back. Like Saving Private Ryan , the picture wallops you in the gut with brilliant, splattery battle montages and Goyaesque images of hell on earth. But Malick, a certified intellectual and the Pynchonesque figure who directed Badlands and Days of Heaven in the 1970s and then disappeared, is in a different philosophical universe from Steven Spielberg. Post-carnage, his sundry characters philosophize about their experiences in drowsy, runic voice-overs that come at you like slow bean balls: "Why does nature vie with itself? ... Is there an avenging power in nature, not one power but two?" Or "This great evil: Where's it come from? What seed, what root did it grow from? Who's doin' this? Who's killin' us, robbin' us of life and light?" First you get walloped with viscera, then you get beaned by blather. Those existential speculations don't derive from the screenplay's source, an archetypal but otherwise down-to-earth 1962 novel by James Jones (who also wrote From Here to Eternity ) about the American invasion of the South Pacific island of Guadalcanal. They're central to Malick's vision of the story, however, and not specious. In the combat genre, the phrase "war is hell" usually means nothing more than that it's a bummer to lose a limb or two, or to see your buddy get his head blown off. A true work of art owes us more than literal horrors, and Malick obliges by making his theater of war the setting for nothing less than a meditation on the existence of God. He tells the story solemnly, in three parts, with a big-deal cast (Sean Penn, Nick Nolte, John Cusack) and a few other major stars (John Travolta, Woody Harrelson, George Clooney) dropping by for cameos. After an Edenic prelude, in which a boyishly idealistic absent without leave soldier, Pvt. Witt (Jim Caviezel), swims with native youths to the accompaniment of a heavenly children's choir, the first part sees the arrival of the Allied forces on the island, introduces the principal characters (none of whom amounts to a genuine protagonist), and lays out the movie's geographical and philosophical terrain. The centerpiece--the fighting--goes on for over an hour and features the most frantic and harrowing sequences, chiefly the company's initially unsuccessful frontal assault on a Japanese hilltop bunker. The coda lasts nearly 40 minutes and is mostly talk and cleanup, the rhythms growing more relaxed until a final, incongruous spasm of violence--whereupon the surviving soldiers pack their gear and motor off to another South Pacific battle. In the final shot, a twisted tree grows on the waterline of the beach, the cycle of life beginning anew. The Thin Red Line has a curious sound-scape, as the noise of battle frequently recedes to make room for interior monologues and Hans Zimmer's bump-bump, minimalist New Age music. Pvt. Bell (Ben Chaplin) talks to his curvy, redheaded wife, viewed in deliriously sensual flashbacks. ("Love: Where does it come from? Who lit this flame in us?") Lt. Col. Tall (Nolte), a borderline lunatic passed over one too many times for promotion and itching to win a battle no matter what the human cost, worries groggily about how his men perceive him. The dreamer Witt poses folksy questions about whether we're all a part of one big soul. If the movie has a spine, it's his off-and-on dialogue with Sgt. Welsh (Penn), who's increasingly irritated by the private's beatific, almost Billy Budd-like optimism. Says Welsh, "In this world, a man himself is nothin', and there ain't no world but this one." Replies Witt, high cheekbones glinting, "I seen another world." At first it seems as if Witt will indeed be Billy Budd to Welsh's vindictive Claggart. But if Witt is ultimately an ethereal martyr, Welsh turns out to be a Bogart-like romantic who can't stop feeling pain in the face of an absent God. He speaks the movie's epitaph, "Darkness and light, strife and love: Are they the workings of one mind, the feature of the same face? O my soul, let me be in you now. Look out through my eyes. Look out at the things you made, all things shining." Malick puts a lot of shining things on the screen: soldiers, natives, parrots, bats, rodents, visions of Eden by way of National Geographic and of the Fall by way of Alpo. Malick's conception of consciousness distributes it among the animate and inanimate alike; almost every object is held up for rapturous contemplation. I could cite hundreds of images: A soldier in a rocking boat hovers over a letter he's writing, which is crammed from top to bottom and side to side with script. (You don't know the man, but you can feel in an instant his need to cram everything in.) A small, white-bearded Melanesian man strolls nonchalantly past a platoon of tensely trudging grunts who can't believe they're encountering this instead of a hail of Japanese bullets. Two shots bring down the first pair of soldiers to advance on the hill; a second later, the sun plays mystically over the tall, yellow grass that has swallowed their bodies. John Toll's camera rushes in on a captured Japanese garrison: One Japanese soldier shrieks; another, skeletal, laughs and laughs; a third weeps over a dying comrade. The face of a Japanese soldier encased in earth speaks from the dead, "Are you righteous? Know that I was, too." Whether or not these pearllike epiphanies are strung is another matter. Malick throws out his overarching theme--is nature two-sided, at war with itself?--in the first few minutes but, for all his startling juxtapositions, he never dramatizes it with anything approaching the clarity of, say, Brian De Palma's Casualties of War (1989). Besides the dialogue between Welsh and Witt, The Thin Red Line 's other organizing story involves a wrenching tug of war between Nolte's ambition-crazed Tall and Capt. Staros (Elias Koteas), who refuses an order to send his men on what will surely be a suicidal--and futile--assault on a bunker. But matters of cause and effect don't really interest Malick. Individual acts of conscience can and do save lives, and heroism can win a war or a battle, he acknowledges. But Staros is ultimately sent packing, and Malick never bothers to trace the effect of his action on the Guadalcanal operation. In fact, the entire battle seems to take place in a crazed void. Tall quotes Homer's "rosy-fingered dawn" and orders a meaningless bombardment to "buck the men up--it'll look like the Japs are catching hell." Soldiers shoot at hazy figures, unsure whether they're Japanese or American. Men collide, blow themselves in half with their own mishandled grenades, stab themselves frantically with morphine needles, shove cigarettes up their noses to keep the stench of the dying and the dead at bay. A tiny bird, mortally wounded, flutters in the grass. Malick is convincing--at times overwhelming--on the subject of chaos. It's when he tries to ruminate on order that he gets gummed up, retreating to one of his gaseous multiple mouthpieces: "Where is it that we were together? Who is it that I lived with? Walked with? The brother. ... The friend. ... One mind." I think I'd have an easier time with Malick's metaphysical speculations if I had a sense of some concomitant geopolitical ones--central to any larger musings on forces of nature as viewed through the prism of war. Couldn't it be that the German and Japanese fascist orders were profoundly anti-natural, and that the Allies' cause was part of a violent but natural correction? You don't have to buy into Spielberg's Lincolnesque pieties in Saving Private Ryan to believe that there's a difference between World War II and Vietnam (or, for that matter, World War II and the invasion of Grenada or our spats with Iraq). While he was at Harvard, Malick might have peeled himself off the lap of his pointy-headed mentor, Stanley Cavell, the philosopher and film theorist, and checked out a few of Michael Waltzer's lectures on just and unjust wars. Maybe then he'd view Guadalcanal not in an absurdist vacuum (the soldiers come, they kill and are killed, they leave) but in the larger context of a war that was among the most rational (in its aims, if not its methods) fought in the last several centuries. For all his visionary filmmaking, Malick's Zen neutrality sometimes seems like a cultivated--and pretentious--brand of fatuousness. John Travolta's empty nightclub impersonation of Bill Clinton in Primary Colors (1998) had one positive result: It gave him a jump-start on Jan Schlichtmann, the reckless personal injury lawyer at the center of A Civil Action . Travolta's Schlichtmann is much more redolent of Clinton: slick and selfish and corrupt in lots of ways but basically on the side of the angels, too proud and arrogant to change tactics when all is certainly lost. Schlichtmann pursued--and more or less blew--a civil liability case against the corporate giants Beatrice and W.R. Grace over the allegedly carcinogenic water supply of Woburn, Mass. Boston writer Jonathan Harr, in the book the movie is based on, went beyond the poison in the Woburn wells to evoke (stopping just short of libel) the poison of the civil courts, where platoons of overpaid corporate lawyers can drive opponents with pockets less deep and psyches less stable into bankruptcy and hysteria. Director Steven Zaillian's version doesn't capture the mounting rage that one experiences while reading Harr's book, or even the juicy legal machinations that Francis Ford Coppola giddily manipulated in his underrated adaptation of John Grisham's The Rainmaker (1997). But A Civil Action is a sturdy piece of work, an old-fashioned conversion narrative with some high-tech zip. Schlichtmann doesn't take this "orphan" case--brought by the parents of several children who died of leukemia--because he wants to do good but because he figures that Grace and Beatrice will fork over huge sums of money to keep the parents from testifying publicly about their children's last days. He might succeed, too, if it weren't for Jerome Facher (Robert Duvall), the Beatrice lawyer who knows how to keep Schlichtmann shadowboxing while his small firm's financial resources dwindle to nothing. Zaillian is at his most assured when he cuts back and forth between Facher's Harvard Law School lectures on what not to do in court and Schlichtmann's fumbling prosecution. The sequence has the extra dimension of good journalism: It dramatizes and comments simultaneously. Plus, it gives Duvall a splendid platform for impish understatement. (Duvall has become more fun to watch than just about anyone in movies.) Elsewhere, Zaillian takes a more surface approach, sticking to legal minutiae and rarely digging for the deeper evil. As in his Searching for Bobby Fischer (1993), the outcome of every scene is predictable, but how Zaillian gets from beat to beat is surprisingly fresh. He also gets sterling bit performances from Sydney Pollack as the spookily sanguine Grace CEO, William H. Macy as Schlichtmann's rabbity accountant, and Kathleen Quinlan as the mother of one of the victims. Quinlan knows that when you're playing a woman who has lost a child you don't need to emote--you reveal the emotion by trying not to emote. To the families involved in the Woburn tragedy, the real climax of this story isn't the downbeat ending of the book or the sleight of hand, "let's call the Environmental Protection Agency," upbeat ending of the movie. The climax is the publication of a book that takes the plaintiffs' side and that remains on the best-seller list in hardcover and paperback for years. The climax is the movie starring John Travolta. Beatrice and Grace made out OK legally, but some of us will never use their products again without thinking about Travolta losing his shirt in the name of those wasted-away little kids.
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B. Lieutenant Colonel Tall
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How were the feature representations evaluated?
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### Introduction
Neural networks for language processing have advanced rapidly in recent years. A key breakthrough was the introduction of transformer architectures BIBREF0 . One recent system based on this idea, BERT BIBREF1 , has proven to be extremely flexible: a single pretrained model can be fine-tuned to achieve state-of-the-art performance on a wide variety of NLP applications. This suggests the model is extracting a set of generally useful features from raw text. It is natural to ask, which features are extracted? And how is this information represented internally? Similar questions have arisen with other types of neural nets. Investigations of convolutional neural networks BIBREF2 , BIBREF3 have shown how representations change from layer to layer BIBREF4 ; how individual units in a network may have meaning BIBREF5 ; and that “meaningful” directions exist in the space of internal activation BIBREF6 . These explorations have led to a broader understanding of network behavior. Analyses on language-processing models (e.g., BIBREF7 , BIBREF8 , BIBREF9 , BIBREF10 , BIBREF11 ) point to the existence of similarly rich internal representations of linguistic structure. Syntactic features seem to be extracted by RNNs (e.g., BIBREF7 , BIBREF9 ) as well as in BERT BIBREF11 , BIBREF12 , BIBREF13 , BIBREF10 . Inspirational work from Hewitt and Manning BIBREF8 found evidence of a geometric representation of entire parse trees in BERT's activation space. Our work extends these explorations of the geometry of internal representations. Investigating how BERT represents syntax, we describe evidence that attention matrices contain grammatical representations. We also provide mathematical arguments that may explain the particular form of the parse tree embeddings described in BIBREF8 . Turning to semantics, using visualizations of the activations created by different pieces of text, we show suggestive evidence that BERT distinguishes word senses at a very fine level. Moreover, much of this semantic information appears to be encoded in a relatively low-dimensional subspace. ### Context and related work
Our object of study is the BERT model introduced in BIBREF1 . To set context and terminology, we briefly describe the model's architecture. The input to BERT is based on a sequence of tokens (words or pieces of words). The output is a sequence of vectors, one for each input token. We will often refer to these vectors as context embeddings because they include information about a token's context. BERT's internals consist of two parts. First, an initial embedding for each token is created by combining a pre-trained wordpiece embedding with position and segment information. Next, this initial sequence of embeddings is run through multiple transformer layers, producing a new sequence of context embeddings at each step. (BERT comes in two versions, a 12-layer BERT-base model and a 24-layer BERT-large model.) Implicit in each transformer layer is a set of attention matrices, one for each attention head, each of which contains a scalar value for each ordered pair $(token_i, token_j)$ . ### Language representation by neural networks
Sentences are sequences of discrete symbols, yet neural networks operate on continuous data–vectors in high-dimensional space. Clearly a successful network translates discrete input into some kind of geometric representation–but in what form? And which linguistic features are represented? The influential Word2Vec system BIBREF14 , for example, has been shown to place related words near each other in space, with certain directions in space correspond to semantic distinctions. Grammatical information such as number and tense are also represented via directions in space. Analyses of the internal states of RNN-based models have shown that they represent information about soft hierarchical syntax in a form that can be extracted by a one-hidden-layer network BIBREF9 . One investigation of full-sentence embeddings found a wide variety of syntactic properties could be extracted not just by an MLP, but by logistic regression BIBREF15 . Several investigations have focused on transformer architectures. Experiments suggest context embeddings in BERT and related models contain enough information to perform many tasks in the traditional “NLP pipeline” BIBREF12 –tagging part-of-speech, co-reference resolution, dependency labeling, etc.–with simple classifiers (linear or small MLP models) BIBREF11 , BIBREF10 . Qualitative, visualization-based work BIBREF16 suggests attention matrices may encode important relations between words. A recent and fascinating discovery by Hewitt and Manning BIBREF8 , which motivates much of our work, is that BERT seems to create a direct representation of an entire dependency parse tree. The authors find that (after a single global linear transformation, which they term a “structural probe”) the square of the distance between context embeddings is roughly proportional to tree distance in the dependency parse. They ask why squaring distance is necessary; we address this question in the next section. The work cited above suggests that language-processing networks create a rich set of intermediate representations of both semantic and syntactic information. These results lead to two motivating questions for our research. Can we find other examples of intermediate representations? And, from a geometric perspective, how do all these different types of information coexist in a single vector? ### Geometry of syntax
We begin by exploring BERT's internal representation of syntactic information. This line of inquiry builds on the work by Hewitt and Manning in two ways. First, we look beyond context embeddings to investigate whether attention matrices encode syntactic features. Second, we provide a simple mathematical analysis of the tree embeddings that they found. ### Attention probes and dependency representations
As in BIBREF8 , we are interested in finding representations of dependency grammar relations BIBREF17 . While BIBREF8 analyzed context embeddings, another natural place to look for encodings is in the attention matrices. After all, attention matrices are explicitly built on the relations between pairs of words. To formalize what it means for attention matrices to encode linguistic features, we use an attention probe, an analog of edge probing BIBREF11 . An attention probe is a task for a pair of tokens, $(token_i, token_j)$ where the input is a model-wide attention vector formed by concatenating the entries $a_{ij}$ in every attention matrix from every attention head in every layer. The goal is to classify a given relation between the two tokens. If a linear model achieves reliable accuracy, it seems reasonable to say that the model-wide attention vector encodes that relation. We apply attention probes to the task of identifying the existence and type of dependency relation between two words. The data for our first experiment is a corpus of parsed sentences from the Penn Treebank BIBREF18 . This dataset has the constituency grammar for the sentences, which was translated to a dependency grammar using the PyStanfordDependencies library BIBREF19 . The entirety of the Penn Treebank consists of 3.1 million dependency relations; we filtered this by using only examples of the 30 dependency relations with more than 5,000 examples in the data set. We then ran each sentence through BERT-base, and obtained the model-wide attention vector (see Figure 1 ) between every pair of tokens in the sentence, excluding the $[SEP]$ and $[CLS]$ tokens. This and subsequent experiments were conducted using PyTorch on MacBook machines. With these labeled embeddings, we trained two L2 regularized linear classifiers via stochastic gradient descent, using BIBREF20 . The first of these probes was a simple linear binary classifier to predict whether or not an attention vector corresponds to the existence of a dependency relation between two tokens. This was trained with a balanced class split, and 30% train/test split. The second probe was a multiclass classifier to predict which type of dependency relation exists between two tokens, given the dependency relation’s existence. This probe was trained with distributions outlined in table 2 . The binary probe achieved an accuracy of 85.8%, and the multiclass probe achieved an accuracy of 71.9%. Our real aim, again, is not to create a state-of-the-art parser, but to gauge whether model-wide attention vectors contain a relatively simple representation of syntactic features. The success of this simple linear probe suggests that syntactic information is in fact encoded in the attention vectors. ### Geometry of parse tree embeddings
Hewitt and Manning's result that context embeddings represent dependency parse trees geometrically raises several questions. Is there a reason for the particular mathematical representation they found? Can we learn anything by visualizing these representations? Hewitt and Manning ask why parse tree distance seems to correspond specifically to the square of Euclidean distance, and whether some other metric might do better BIBREF8 . We describe mathematical reasons why squared Euclidean distance may be natural. First, one cannot generally embed a tree, with its tree metric $d$ , isometrically into Euclidean space (Appendix "Embedding trees in Euclidean space" ). Since an isometric embedding is impossible, motivated by the results of BIBREF8 we might ask about other possible representations. Definition 1 (power- $p$ embedding) Let $M$ be a metric space, with metric $d$ . We say $f: M \rightarrow \mathbb {R}^n$ is a power- $p$ embedding if for all $x, y \in M$ , we have $||f(x) - f(y)||^p = d(x, y)$ In these terms, we can say BIBREF8 found evidence of a power-2 embedding for parse trees. It turns out that power-2 embeddings are an especially elegant mapping. For one thing, it is easy to write down an explicit model–a mathematical idealization–for a power-2 embedding for any tree. Theorem 1 Any tree with $n$ nodes has a power-2 embedding into $\mathbb {R}^{n-1}$ . Let the nodes of the tree be $t_0, ..., t_{n-1}$ , with $t_0$ being the root node. Let $\lbrace e_1, ..., e_{n-1}\rbrace $ be orthogonal unit basis vectors for $\mathbb {R}^{n-1}$ . Inductively, define an embedding $f$ such that: $f(t_0) = 0$ $f(t_i) = e_i + f(parent(t_i))$ Given two distinct tree nodes $x$ and $y$ , where $m$ is the tree distance $d(x, y)$ , it follows that we can move from $f(x)$ to $f(y)$ using $m$ mutually perpendicular unit steps. Thus $||f(x) - f(y)||^2 = m = d(x, y)$ Remark 1 This embedding has a simple informal description: at each embedded vertex of the graph, all line segments to neighboring embedded vertices are unit-distance segments, orthogonal to each other and to every other edge segment. (It's even easy to write down a set of coordinates for each node.) By definition any two power-2 embeddings of the same tree are isometric; with that in mind, we refer to this as the canonical power-2 embedding. In the proof of Theorem 1, instead of choosing basis vectors in advance, one can choose random unit vectors. Because two random vectors will be nearly orthogonal in high-dimensional space, the power-2 embedding condition will approximately hold. This means that in space that is sufficiently high-dimensional (compared to the size of the tree) it is possible to construct an approximate power-2 embedding with essentially “local” information, where a tree node is connected to its children via random unit-length branches. We refer to this type of embedding as a random branch embedding. (See Appendix "Ideal vs. actual parse tree embeddings" for a visualization of these various embeddings.) In addition to these appealing aspects of power-2 embeddings, it is worth noting that power- $p$ embeddings will not necessarily even exist when $p < 2$ . (See Appendix "Embedding trees in Euclidean space" for the proof.) Theorem 2 For any $p < 2$ , there is a tree which has no power- $p$ embedding. Remark 2 On the other hand, the existence result for power-2 embeddings, coupled with results of BIBREF22 , implies that power- $p$ tree embeddings do exist for any $p > 2$ . The simplicity of power-2 tree embeddings, as well as the fact that they may be approximated by a simple random model, suggests they may be a generally useful alternative to approaches to tree embeddings that require hyperbolic geometry BIBREF23 . How do parse tree embeddings in BERT compare to exact power-2 embeddings? To explore this question, we created a simple visualization tool. The input to each visualization is a sentence from the Penn Treebank with associated dependency parse trees (see Section "Geometry of word senses" ). We then extracted the token embeddings produced by BERT-large in layer 16 (following BIBREF8 ), transformed by the Hewitt and Manning’s “structural probe” matrix $B$ , yielding a set of points in 1024-dimensional space. We used PCA to project to two dimensions. (Other dimensionality-reduction methods, such as t-SNE and UMAP BIBREF24 , were harder to interpret.) To visualize the tree structure, we connected pairs of points representing words with a dependency relation. The color of each edge indicates the deviation from true tree distance. We also connected, with dotted line, pairs of words without a dependency relation but whose positions (before PCA) were far closer than expected. The resulting image lets us see both the overall shape of the tree embedding, and fine-grained information on deviation from a true power-2 embedding. Two example visualizations are shown in Figure 2 , next to traditional diagrams of their underlying parse trees. These are typical cases, illustrating some common patterns; for instance, prepositions are embedded unexpectedly close to words they relate to. (Figure 7 shows additional examples.) A natural question is whether the difference between these projected trees and the canonical ones is merely noise, or a more interesting pattern. By looking at the average embedding distances of each dependency relation (see Figure 3 ) , we can see that they vary widely from around 1.2 ( $compound:prt$ , $advcl$ ) to 2.5 ( $mwe$ , $parataxis$ , $auxpass$ ). Such systematic differences suggest that BERT's syntactic representation has an additional quantitative aspect beyond traditional dependency grammar. ### Geometry of word senses
BERT seems to have several ways of representing syntactic information. What about semantic features? Since embeddings produced by transformer models depend on context, it is natural to speculate that they capture the particular shade of meaning of a word as used in a particular sentence. (E.g., is “bark” an animal noise or part of a tree?) We explored geometric representations of word sense both qualitatively and quantitatively. ### Visualization of word senses
Our first experiment is an exploratory visualization of how word sense affects context embeddings. For data on different word senses, we collected all sentences used in the introductions to English-language Wikipedia articles. (Text outside of introductions was frequently fragmentary.) We created an interactive application, which we plan to make public. A user enters a word, and the system retrieves 1,000 sentences containing that word. It sends these sentences to BERT-base as input, and for each one it retrieves the context embedding for the word from a layer of the user's choosing. The system visualizes these 1,000 context embeddings using UMAP BIBREF24 , generally showing clear clusters relating to word senses. Different senses of a word are typically spatially separated, and within the clusters there is often further structure related to fine shades of meaning. In Figure 4 , for example, we not only see crisp, well-separated clusters for three meanings of the word “die,” but within one of these clusters there is a kind of quantitative scale, related to the number of people dying. See Appendix "Additional word sense visualizations" for further examples. The apparent detail in the clusters we visualized raises two immediate questions. First, is it possible to find quantitative corroboration that word senses are well-represented? Second, how can we resolve a seeming contradiction: in the previous section, we saw how position represented syntax; yet here we see position representing semantics. ### Measurement of word sense disambiguation capability
The crisp clusters seen in visualizations such as Figure 4 suggest that BERT may create simple, effective internal representations of word senses, putting different meanings in different locations. To test this hypothesis quantitatively, we test whether a simple classifier on these internal representations can perform well at word-sense disambiguation (WSD). We follow the procedure described in BIBREF10 , which performed a similar experiment with the ELMo model. For a given word with $n$ senses, we make a nearest-neighbor classifier where each neighbor is the centroid of a given word sense's BERT-base embeddings in the training data. To classify a new word we find the closest of these centroids, defaulting to the most commonly used sense if the word was not present in the training data. We used the data and evaluation from BIBREF25 : the training data was SemCor BIBREF26 (33,362 senses), and the testing data was the suite described in BIBREF25 (3,669 senses). The simple nearest-neighbor classifier achieves an F1 score of 71.1, higher than the current state of the art (Table 1 ), with the accuracy monotonically increasing through the layers. This is a strong signal that context embeddings are representing word-sense information. Additionally, an even higher score of 71.5 was obtained using the technique described in the following section. We hypothesized that there might also exist a linear transformation under which distances between embeddings would better reflect their semantic relationships–that is, words of the same sense would be closer together and words of different senses would be further apart. To explore this hypothesis, we trained a probe following Hewitt and Manning's methodology. We initialized a random matrix $B\in {R}^{k\times m}$ , testing different values for $m$ . Loss is, roughly, defined as the difference between the average cosine similarity between embeddings of words with different senses, and that between embeddings of the same sense. However, we clamped the cosine similarity terms to within $\pm 0.1$ of the pre-training averages for same and different senses. (Without clamping, the trained matrix simply ended up taking well-separated clusters and separating them further. We tested values between $0.05$ and $0.2$ for the clamping range and $0.1$ had the best performance.) Our training corpus was the same dataset from 4.1.2., filtered to include only words with at least two senses, each with at least two occurrences (for 8,542 out of the original 33,362 senses). Embeddings came from BERT-base (12 layers, 768-dimensional embeddings). We evaluate our trained probes on the same dataset and WSD task used in 4.1.2 (Table 1 ). As a control, we compare each trained probe against a random probe of the same shape. As mentioned in 4.1.2, untransformed BERT embeddings achieve a state-of-the-art accuracy rate of 71.1%. We find that our trained probes are able to achieve slightly improved accuracy down to $m=128$ . Though our probe achieves only a modest improvement in accuracy for final-layer embeddings, we note that we were able to more dramatically improve the performance of embeddings at earlier layers (see Appendix for details: Figure 10 ). This suggests there is more semantic information in the geometry of earlier-layer embeddings than a first glance might reveal. Our results also support the idea that word sense information may be contained in a lower-dimensional space. This suggests a resolution to the seeming contradiction mentioned above: a vector encodes both syntax and semantics, but in separate complementary subspaces. ### Embedding distance and context: a concatenation experiment
If word sense is affected by context, and encoded by location in space, then we should be able to influence context embedding positions by systematically varying their context. To test this hypothesis, we performed an experiment based on a simple and controllable context change: concatenating sentences where the same word is used in different senses. We picked 25,096 sentence pairs from SemCor, using the same keyword in different senses. E.g.: A: "He thereupon went to London and spent the winter talking to men of wealth." went: to move from one place to another. B: "He went prone on his stomach, the better to pursue his examination." went: to enter into a specified state. We define a matching and an opposing sense centroid for each keyword. For sentence A, the matching sense centroid is the average embedding for all occurrences of “went” used with sense A. A's opposing sense centroid is the average embedding for all occurrences of “went” used with sense B. We gave each individual sentence in the pair to BERT-base and recorded the cosine similarity between the keyword embeddings and their matching sense centroids. We also recorded the similarity between the keyword embeddings and their opposing sense centroids. We call the ratio between the two similarities the individual similarity ratio. Generally this ratio is greater than one, meaning that the context embedding for the keyword is closer to the matching centroid than the opposing one. We joined each sentence pair with the word "and" to create a single new sentence. We gave these concatenations to BERT and recorded the similarities between the keyword embeddings and their matching/opposing sense centroids. Their ratio is the concatenated similarity ratio. Our hypothesis was that the keyword embeddings in the concatenated sentence would move towards their opposing sense centroids. Indeed, we found that the average individual similarity ratio was higher than the average concatenated similarity ratio at every layer (see Figure 5 ). Concatenating a random sentence did not change the individual similarity ratios. If the ratio is less than one for any sentence, that means BERT has misclassified its keyword sense. We found that the misclassification rate was significantly higher for final-layer embeddings in the concatenated sentences compared to the individual sentences: 8.23% versus 2.43% respectively. We also measured the effect of projecting the final-layer keyword embeddings into the semantic subspace discussed in 4.1.3. After multiplying each embedding by our trained semantic probe, we obtained an average concatenated similarity ratio of 1.578 and individual similarity ratio of 1.875, which suggests that the transformed embeddings are closer to their matching sense centroids than the original embeddings (the original concatenated similarity ratio is 1.284 and the individual similarity ratio is 1.430). We also measured lower average misclassification rates for the transformed embeddings: 7.31% for concatenated sentences and 2.27% for individual sentences. ### Conclusion and future work
We have presented a series of experiments that shed light on BERT's internal representations of linguistic information. We have found evidence of syntactic representation in attention matrices, with certain directions in space representing particular dependency relations. We have also provided a mathematical justification for the squared-distance tree embedding found by Hewitt and Manning. Meanwhile, we have shown that just as there are specific syntactic subspaces, there is evidence for subspaces that represent semantic information. We also have shown how mistakes in word sense disambiguation may correspond to changes in internal geometric representation of word meaning. Our experiments also suggest an answer to the question of how all these different representations fit together. We conjecture that the internal geometry of BERT may be broken into multiple linear subspaces, with separate spaces for different syntactic and semantic information. Investigating this kind of decomposition is a natural direction for future research. What other meaningful subspaces exist? After all, there are many types of linguistic information that we have not looked for. A second important avenue of exploration is what the internal geometry can tell us about the specifics of the transformer architecture. Can an understanding of the geometry of internal representations help us find areas for improvement, or refine BERT's architecture? Acknowledgments: We would like to thank David Belanger, Tolga Bolukbasi, Jasper Snoek, and Ian Tenney for helpful feedback and discussions. ### Embedding trees in Euclidean space
Here we provide additional detail on the existence of various forms of tree embeddings. Isometric embeddings of a tree (with its intrinsic tree metric) into Euclidean space are rare. Indeed, such an embedding is impossible even a four-point tree $T$ , consisting of a root node $R$ with three children $C_1, C_2, C_3$ . If $f:T \rightarrow \mathbb {R}^n$ is a tree isometry then $||f(R) - f(C_1)) || = ||f(R) - f(C_2)) || = 1$ , and $||f(C_1) - f(C_2)) || = 2$ . It follows that $f(R)$ , $f(C_1)$ , $f(C_2)$ are collinear. The same can be said of $f(R)$ , $R$0 , and $R$1 , meaning that $R$2 . Since this four-point tree cannot be embedded, it follows the only trees that can be embedded are simply chains. Not only are isometric embeddings generally impossible, but power- $p$ embeddings may also be unavailable when $p < 2$ , as the following argument shows. Proof of Theorem "Theorem 2" We covered the case of $p = 1$ above. When $p < 1$ , even a tree of three points is impossible to embed without violating the triangle inequality. To handle the case when $1 < p < 2$ , consider a “star-shaped” tree of one root node with $k$ children; without loss of generality, assume the root node is embedded at the origin. Then in any power- $p$ embedding the other vertices will be sent to unit vectors, and for each pair of these unit vectors we have $||v_i - v_j||^p = 2$ . On the other hand, a well-known folk theorem (e.g., see BIBREF27 ) says that given $k$ unit vectors $v_1, ..., v_k$ at least one pair of distinct vectors has $v_i \cdot v_j \ge -1/(k - 1)$ . By the law of cosines, it follows that $||v_i - v_j|| \le \sqrt{2 + \frac{2}{k-1}}$ . For any $p < 2$ , there is a sufficiently large $k$ such that $||v_i - v_j||^p \le (\sqrt{2 + \frac{2}{k-1}})^p = (2 + \frac{2}{k-1})^{p/2} < 2$ . Thus for any $p < 2$ a large enough star-shaped tree cannot have a power- $p$ embedding. ### Ideal vs. actual parse tree embeddings
Figure 2 shows (left) a visualization of a BERT parse tree embedding (as defined by the context embeddings for individual words in a sentence). We compare with PCA projections of the canonical power-2 embedding of the same tree structure, as well as a random branch embedding. Finally, we display a completely randomly embedded tree as a control. The visualizations show a clear visual similarity between the BERT embedding and the two mathematical idealizations. ### Additional BERT parse tree visualizations
Figure 7 shows four additional examples of PCA projections of BERT parse tree embeddings. ### Additional word sense visualizations
We provide two additional examples of word sense visualizations, hand-annotated to show key clusters. See Figure 8 and Figure 9 . Figure 1: A model-wide attention vector for an ordered pair of tokens contains the scalar attention values for that pair in all attention heads and layers. Shown: BERT-base. Figure 2: Visualizing embeddings of two sentences after applying the Hewitt-Manning probe. We compare the parse tree (left images) with a PCA projection of context embeddings (right images). Figure 3: The average squared edge length between two words with a given dependency. Figure 4: Embeddings for the word "die" in different contexts, visualized with UMAP. Sample points are annotated with corresponding sentences. Overall annotations (blue text) are added as a guide. Table 1: [Left] F1 scores for WSD task. [Right] Semantic probe % accuracy on final-layer BERT-base embeddings Figure 5: Average ratio of similarity to sense A vs. similarity to sense B. Figure 6: PCA projection of the context embeddings for the sentence “The field has reserves of 21 million barrels.” transformed by Hewitt and Manning’s “structural probe” matrix, compared to the canonical power-2 embedding, a random branch embedding, and a completely random embedding. Figure 7: Additional examples of BERT parse trees. In each pair, at left is a drawing of the abstract tree; at right is a PCA view of the embeddings. Colors are the same as in Figure 6. Figure 8: Context embeddings for “lie” as used in different sentences. Figure 9: Context embeddings for “lie” as used in different sentences. Table 2: Per-dependency results of multiclass linear classifier trained on attention vectors, with 300,000 training examples and 150,000 test examples. Figure 10: Change in classification accuracy by layer for different probe dimensionalities.
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attention probes, using visualizations of the activations created by different pieces of text
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What would have happened if Allen's blaster had not run out of charge?
A. He would still have hit the switch, ending the story the same way.
B. He would have been able to shoot the switch from where he stood instead of having to make a run for it.
C. He would have accidentally cut off communication with other ships.
D. He would have been able to shoot down the robots and not need to hit the switch.
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SURVIVAL TACTICS By AL SEVCIK ILLUSTRATOR NOVICK The robots were built to serve Man; to do his work, see to his comforts, make smooth his way. Then the robots figured out an additional service—putting Man out of his misery. There was a sudden crash that hung sharply in the air, as if a tree had been hit by lightning some distance away. Then another. Alan stopped, puzzled. Two more blasts, quickly together, and the sound of a scream faintly. Frowning, worrying about the sounds, Alan momentarily forgot to watch his step until his foot suddenly plunged into an ant hill, throwing him to the jungle floor. "Damn!" He cursed again, for the tenth time, and stood uncertainly in the dimness. From tall, moss-shrouded trees, wrist-thick vines hung quietly, scraping the spongy ground like the tentacles of some monstrous tree-bound octopus. Fitful little plants grew straggly in the shadows of the mossy trunks, forming a dense underbrush that made walking difficult. At midday some few of the blue sun's rays filtered through to the jungle floor, but now, late afternoon on the planet, the shadows were long and gloomy. Alan peered around him at the vine-draped shadows, listening to the soft rustlings and faint twig-snappings of life in the jungle. Two short, popping sounds echoed across the stillness, drowned out almost immediately and silenced by an explosive crash. Alan started, "Blaster fighting! But it can't be!" Suddenly anxious, he slashed a hurried X in one of the trees to mark his position then turned to follow a line of similar marks back through the jungle. He tried to run, but vines blocked his way and woody shrubs caught at his legs, tripping him and holding him back. Then, through the trees he saw the clearing of the camp site, the temporary home for the scout ship and the eleven men who, with Alan, were the only humans on the jungle planet, Waiamea. Stepping through the low shrubbery at the edge of the site, he looked across the open area to the two temporary structures, the camp headquarters where the power supplies and the computer were; and the sleeping quarters. Beyond, nose high, stood the silver scout ship that had brought the advance exploratory party of scientists and technicians to Waiamea three days before. Except for a few of the killer robots rolling slowly around the camp site on their quiet treads, there was no one about. "So, they've finally got those things working." Alan smiled slightly. "Guess that means I owe Pete a bourbon-and-soda for sure. Anybody who can build a robot that hunts by homing in on animals' mind impulses ..." He stepped forward just as a roar of blue flame dissolved the branches of a tree, barely above his head. Without pausing to think, Alan leaped back, and fell sprawling over a bush just as one of the robots rolled silently up from the right, lowering its blaster barrel to aim directly at his head. Alan froze. "My God, Pete built those things wrong!" Suddenly a screeching whirlwind of claws and teeth hurled itself from the smoldering branches and crashed against the robot, clawing insanely at the antenna and blaster barrel. With an awkward jerk the robot swung around and fired its blaster, completely dissolving the lower half of the cat creature which had clung across the barrel. But the back pressure of the cat's body overloaded the discharge circuits. The robot started to shake, then clicked sharply as an overload relay snapped and shorted the blaster cells. The killer turned and rolled back towards the camp, leaving Alan alone. Shakily, Alan crawled a few feet back into the undergrowth where he could lie and watch the camp, but not himself be seen. Though visibility didn't make any difference to the robots, he felt safer, somehow, hidden. He knew now what the shooting sounds had been and why there hadn't been anyone around the camp site. A charred blob lying in the grass of the clearing confirmed his hypothesis. His stomach felt sick. "I suppose," he muttered to himself, "that Pete assembled these robots in a batch and then activated them all at once, probably never living to realize that they're tuned to pick up human brain waves, too. Damn! Damn!" His eyes blurred and he slammed his fist into the soft earth. When he raised his eyes again the jungle was perceptibly darker. Stealthy rustlings in the shadows grew louder with the setting sun. Branches snapped unaccountably in the trees overhead and every now and then leaves or a twig fell softly to the ground, close to where he lay. Reaching into his jacket, Alan fingered his pocket blaster. He pulled it out and held it in his right hand. "This pop gun wouldn't even singe a robot, but it just might stop one of those pumas." They said the blast with your name on it would find you anywhere. This looked like Alan's blast. Slowly Alan looked around, sizing up his situation. Behind him the dark jungle rustled forbiddingly. He shuddered. "Not a very healthy spot to spend the night. On the other hand, I certainly can't get to the camp with a pack of mind-activated mechanical killers running around. If I can just hold out until morning, when the big ship arrives ... The big ship! Good Lord, Peggy!" He turned white; oily sweat punctuated his forehead. Peggy, arriving tomorrow with the other colonists, the wives and kids! The metal killers, tuned to blast any living flesh, would murder them the instant they stepped from the ship! A pretty girl, Peggy, the girl he'd married just three weeks ago. He still couldn't believe it. It was crazy, he supposed, to marry a girl and then take off for an unknown planet, with her to follow, to try to create a home in a jungle clearing. Crazy maybe, but Peggy and her green eyes that changed color with the light, with her soft brown hair, and her happy smile, had ended thirty years of loneliness and had, at last, given him a reason for living. "Not to be killed!" Alan unclenched his fists and wiped his palms, bloody where his fingernails had dug into the flesh. There was a slight creak above him like the protesting of a branch too heavily laden. Blaster ready, Alan rolled over onto his back. In the movement, his elbow struck the top of a small earthy mound and he was instantly engulfed in a swarm of locust-like insects that beat disgustingly against his eyes and mouth. "Fagh!" Waving his arms before his face he jumped up and backwards, away from the bugs. As he did so, a dark shapeless thing plopped from the trees onto the spot where he had been lying stretched out. Then, like an ambient fungus, it slithered off into the jungle undergrowth. For a split second the jungle stood frozen in a brilliant blue flash, followed by the sharp report of a blaster. Then another. Alan whirled, startled. The planet's double moon had risen and he could see a robot rolling slowly across the clearing in his general direction, blasting indiscriminately at whatever mind impulses came within its pickup range, birds, insects, anything. Six or seven others also left the camp headquarters area and headed for the jungle, each to a slightly different spot. Apparently the robot hadn't sensed him yet, but Alan didn't know what the effective range of its pickup devices was. He began to slide back into the jungle. Minutes later, looking back he saw that the machine, though several hundred yards away, had altered its course and was now headed directly for him. His stomach tightened. Panic. The dank, musty smell of the jungle seemed for an instant to thicken and choke in his throat. Then he thought of the big ship landing in the morning, settling down slowly after a lonely two-week voyage. He thought of a brown-haired girl crowding with the others to the gangway, eager to embrace the new planet, and the next instant a charred nothing, unrecognizable, the victim of a design error or a misplaced wire in a machine. "I have to try," he said aloud. "I have to try." He moved into the blackness. Powerful as a small tank, the killer robot was equipped to crush, slash, and burn its way through undergrowth. Nevertheless, it was slowed by the larger trees and the thick, clinging vines, and Alan found that he could manage to keep ahead of it, barely out of blaster range. Only, the robot didn't get tired. Alan did. The twin moons cast pale, deceptive shadows that wavered and danced across the jungle floor, hiding debris that tripped him and often sent him sprawling into the dark. Sharp-edged growths tore at his face and clothes, and insects attracted by the blood matted against his pants and shirt. Behind, the robot crashed imperturbably after him, lighting the night with fitful blaster flashes as some winged or legged life came within its range. There was movement also, in the darkness beside him, scrapings and rustlings and an occasional low, throaty sound like an angry cat. Alan's fingers tensed on his pocket blaster. Swift shadowy forms moved quickly in the shrubs and the growling became suddenly louder. He fired twice, blindly, into the undergrowth. Sharp screams punctuated the electric blue discharge as a pack of small feline creatures leaped snarling and clawing back into the night. Mentally, Alan tried to figure the charge remaining in his blaster. There wouldn't be much. "Enough for a few more shots, maybe. Why the devil didn't I load in fresh cells this morning!" The robot crashed on, louder now, gaining on the tired human. Legs aching and bruised, stinging from insect bites, Alan tried to force himself to run holding his hands in front of him like a child in the dark. His foot tripped on a barely visible insect hill and a winged swarm exploded around him. Startled, Alan jerked sideways, crashing his head against a tree. He clutched at the bark for a second, dazed, then his knees buckled. His blaster fell into the shadows. The robot crashed loudly behind him now. Without stopping to think, Alan fumbled along the ground after his gun, straining his eyes in the darkness. He found it just a couple of feet to one side, against the base of a small bush. Just as his fingers closed upon the barrel his other hand slipped into something sticky that splashed over his forearm. He screamed in pain and leaped back, trying frantically to wipe the clinging, burning blackness off his arm. Patches of black scraped off onto branches and vines, but the rest spread slowly over his arm as agonizing as hot acid, or as flesh being ripped away layer by layer. Almost blinded by pain, whimpering, Alan stumbled forward. Sharp muscle spasms shot from his shoulder across his back and chest. Tears streamed across his cheeks. A blue arc slashed at the trees a mere hundred yards behind. He screamed at the blast. "Damn you, Pete! Damn your robots! Damn, damn ... Oh, Peggy!" He stepped into emptiness. Coolness. Wet. Slowly, washed by the water, the pain began to fall away. He wanted to lie there forever in the dark, cool, wetness. For ever, and ever, and ... The air thundered. In the dim light he could see the banks of the stream, higher than a man, muddy and loose. Growing right to the edge of the banks, the jungle reached out with hairy, disjointed arms as if to snag even the dirty little stream that passed so timidly through its domain. Alan, lying in the mud of the stream bed, felt the earth shake as the heavy little robot rolled slowly and inexorably towards him. "The Lord High Executioner," he thought, "in battle dress." He tried to stand but his legs were almost too weak and his arm felt numb. "I'll drown him," he said aloud. "I'll drown the Lord High Executioner." He laughed. Then his mind cleared. He remembered where he was. Alan trembled. For the first time in his life he understood what it was to live, because for the first time he realized that he would sometime die. In other times and circumstances he might put it off for a while, for months or years, but eventually, as now, he would have to watch, still and helpless, while death came creeping. Then, at thirty, Alan became a man. "Dammit, no law says I have to flame-out now !" He forced himself to rise, forced his legs to stand, struggling painfully in the shin-deep ooze. He worked his way to the bank and began to dig frenziedly, chest high, about two feet below the edge. His arm where the black thing had been was swollen and tender, but he forced his hands to dig, dig, dig, cursing and crying to hide the pain, and biting his lips, ignoring the salty taste of blood. The soft earth crumbled under his hands until he had a small cave about three feet deep in the bank. Beyond that the soil was held too tightly by the roots from above and he had to stop. The air crackled blue and a tree crashed heavily past Alan into the stream. Above him on the bank, silhouetting against the moons, the killer robot stopped and its blaster swivelled slowly down. Frantically, Alan hugged the bank as a shaft of pure electricity arced over him, sliced into the water, and exploded in a cloud of steam. The robot shook for a second, its blaster muzzle lifted erratically and for an instant it seemed almost out of control, then it quieted and the muzzle again pointed down. Pressing with all his might, Alan slid slowly along the bank inches at a time, away from the machine above. Its muzzle turned to follow him but the edge of the bank blocked its aim. Grinding forward a couple of feet, slightly overhanging the bank, the robot fired again. For a split second Alan seemed engulfed in flame; the heat of hell singed his head and back, and mud boiled in the bank by his arm. Again the robot trembled. It jerked forward a foot and its blaster swung slightly away. But only for a moment. Then the gun swung back again. Suddenly, as if sensing something wrong, its tracks slammed into reverse. It stood poised for a second, its treads spinning crazily as the earth collapsed underneath it, where Alan had dug, then it fell with a heavy splash into the mud, ten feet from where Alan stood. Without hesitation Alan threw himself across the blaster housing, frantically locking his arms around the barrel as the robot's treads churned furiously in the sticky mud, causing it to buck and plunge like a Brahma bull. The treads stopped and the blaster jerked upwards wrenching Alan's arms, then slammed down. Then the whole housing whirled around and around, tilting alternately up and down like a steel-skinned water monster trying to dislodge a tenacious crab, while Alan, arms and legs wrapped tightly around the blaster barrel and housing, pressed fiercely against the robot's metal skin. Slowly, trying to anticipate and shift his weight with the spinning plunges, Alan worked his hand down to his right hip. He fumbled for the sheath clipped to his belt, found it, and extracted a stubby hunting knife. Sweat and blood in his eyes, hardly able to move on the wildly swinging turret, he felt down the sides to the thin crack between the revolving housing and the stationary portion of the robot. With a quick prayer he jammed in the knife blade—and was whipped headlong into the mud as the turret literally snapped to a stop. The earth, jungle and moons spun in a pinwheeled blur, slowed, and settled to their proper places. Standing in the sticky, sweet-smelling ooze, Alan eyed the robot apprehensively. Half buried in mud, it stood quiet in the shadowy light except for an occasional, almost spasmodic jerk of its blaster barrel. For the first time that night Alan allowed himself a slight smile. "A blade in the old gear box, eh? How does that feel, boy?" He turned. "Well, I'd better get out of here before the knife slips or the monster cooks up some more tricks with whatever it's got for a brain." Digging little footholds in the soft bank, he climbed up and stood once again in the rustling jungle darkness. "I wonder," he thought, "how Pete could cram enough brain into one of those things to make it hunt and track so perfectly." He tried to visualize the computing circuits needed for the operation of its tracking mechanism alone. "There just isn't room for the electronics. You'd need a computer as big as the one at camp headquarters." In the distance the sky blazed as a blaster roared in the jungle. Then Alan heard the approaching robot, crunching and snapping its way through the undergrowth like an onrushing forest fire. He froze. "Good Lord! They communicate with each other! The one I jammed must be calling others to help." He began to move along the bank, away from the crashing sounds. Suddenly he stopped, his eyes widened. "Of course! Radio! I'll bet anything they're automatically controlled by the camp computer. That's where their brain is!" He paused. "Then, if that were put out of commission ..." He jerked away from the bank and half ran, half pulled himself through the undergrowth towards the camp. Trees exploded to his left as another robot fired in his direction, too far away to be effective but churning towards him through the blackness. Alan changed direction slightly to follow a line between the two robots coming up from either side, behind him. His eyes were well accustomed to the dark now, and he managed to dodge most of the shadowy vines and branches before they could snag or trip him. Even so, he stumbled in the wiry underbrush and his legs were a mass of stinging slashes from ankle to thigh. The crashing rumble of the killer robots shook the night behind him, nearer sometimes, then falling slightly back, but following constantly, more unshakable than bloodhounds because a man can sometimes cover a scent, but no man can stop his thoughts. Intermittently, like photographers' strobes, blue flashes would light the jungle about him. Then, for seconds afterwards his eyes would see dancing streaks of yellow and sharp multi-colored pinwheels that alternately shrunk and expanded as if in a surrealist's nightmare. Alan would have to pause and squeeze his eyelids tight shut before he could see again, and the robots would move a little closer. To his right the trees silhouetted briefly against brilliance as a third robot slowly moved up in the distance. Without thinking, Alan turned slightly to the left, then froze in momentary panic. "I should be at the camp now. Damn, what direction am I going?" He tried to think back, to visualize the twists and turns he'd taken in the jungle. "All I need is to get lost." He pictured the camp computer with no one to stop it, automatically sending its robots in wider and wider forays, slowly wiping every trace of life from the planet. Technologically advanced machines doing the job for which they were built, completely, thoroughly, without feeling, and without human masters to separate sense from futility. Finally parts would wear out, circuits would short, and one by one the killers would crunch to a halt. A few birds would still fly then, but a unique animal life, rare in the universe, would exist no more. And the bones of children, eager girls, and their men would also lie, beside a rusty hulk, beneath the alien sun. "Peggy!" As if in answer, a tree beside him breathed fire, then exploded. In the brief flash of the blaster shot, Alan saw the steel glint of a robot only a hundred yards away, much nearer than he had thought. "Thank heaven for trees!" He stepped back, felt his foot catch in something, clutched futilely at some leaves and fell heavily. Pain danced up his leg as he grabbed his ankle. Quickly he felt the throbbing flesh. "Damn the rotten luck, anyway!" He blinked the pain tears from his eyes and looked up—into a robot's blaster, jutting out of the foliage, thirty yards away. Instinctively, in one motion Alan grabbed his pocket blaster and fired. To his amazement the robot jerked back, its gun wobbled and started to tilt away. Then, getting itself under control, it swung back again to face Alan. He fired again, and again the robot reacted. It seemed familiar somehow. Then he remembered the robot on the river bank, jiggling and swaying for seconds after each shot. "Of course!" He cursed himself for missing the obvious. "The blaster static blanks out radio transmission from the computer for a few seconds. They even do it to themselves!" Firing intermittently, he pulled himself upright and hobbled ahead through the bush. The robot shook spasmodically with each shot, its gun tilted upward at an awkward angle. Then, unexpectedly, Alan saw stars, real stars brilliant in the night sky, and half dragging his swelling leg he stumbled out of the jungle into the camp clearing. Ahead, across fifty yards of grass stood the headquarters building, housing the robot-controlling computer. Still firing at short intervals he started across the clearing, gritting his teeth at every step. Straining every muscle in spite of the agonizing pain, Alan forced himself to a limping run across the uneven ground, carefully avoiding the insect hills that jutted up through the grass. From the corner of his eye he saw another of the robots standing shakily in the dark edge of the jungle waiting, it seemed, for his small blaster to run dry. "Be damned! You can't win now!" Alan yelled between blaster shots, almost irrational from the pain that ripped jaggedly through his leg. Then it happened. A few feet from the building's door his blaster quit. A click. A faint hiss when he frantically jerked the trigger again and again, and the spent cells released themselves from the device, falling in the grass at his feet. He dropped the useless gun. "No!" He threw himself on the ground as a new robot suddenly appeared around the edge of the building a few feet away, aimed, and fired. Air burned over Alan's back and ozone tingled in his nostrils. Blinding itself for a few seconds with its own blaster static, the robot paused momentarily, jiggling in place. In this instant, Alan jammed his hands into an insect hill and hurled the pile of dirt and insects directly at the robot's antenna. In a flash, hundreds of the winged things erupted angrily from the hole in a swarming cloud, each part of which was a speck of life transmitting mental energy to the robot's pickup devices. Confused by the sudden dispersion of mind impulses, the robot fired erratically as Alan crouched and raced painfully for the door. It fired again, closer, as he fumbled with the lock release. Jagged bits of plastic and stone ripped past him, torn loose by the blast. Frantically, Alan slammed open the door as the robot, sensing him strongly now, aimed point blank. He saw nothing, his mind thought of nothing but the red-clad safety switch mounted beside the computer. Time stopped. There was nothing else in the world. He half-jumped, half-fell towards it, slowly, in tenths of seconds that seemed measured out in years. The universe went black. Later. Brilliance pressed upon his eyes. Then pain returned, a multi-hurting thing that crawled through his body and dragged ragged tentacles across his brain. He moaned. A voice spoke hollowly in the distance. "He's waking. Call his wife." Alan opened his eyes in a white room; a white light hung over his head. Beside him, looking down with a rueful smile, stood a young man wearing space medical insignia. "Yes," he acknowledged the question in Alan's eyes, "you hit the switch. That was three days ago. When you're up again we'd all like to thank you." Suddenly a sobbing-laughing green-eyed girl was pressed tightly against him. Neither of them spoke. They couldn't. There was too much to say. THE END Transcriber's Note: This etext was produced from Amazing Science Fiction Stories October 1958. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note.
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A. He would still have hit the switch, ending the story the same way.
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What does the data cleaning and filtering process consist of?
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### Introduction
The goal of text summarization is to condense a piece of text into a shorter version that contains the salient information. Due to the prevalence of news articles and the need to provide succinct summaries for readers, a majority of existing datasets for summarization come from the news domain BIBREF0, BIBREF1, BIBREF2. However, according to journalistic conventions, the most important information in a news report usually appears near the beginning of the article BIBREF3. While it facilitates faster and easier understanding of the news for readers, this lead bias causes undesirable consequences for summarization models. The output of these models is inevitably affected by the positional information of sentences. Furthermore, the simple baseline of using the top few sentences as summary can achieve a stronger performance than many sophisticated models BIBREF4. It can take a lot of effort for models to overcome the lead bias BIBREF3. Additionally, most existing summarization models are fully supervised and require time and labor-intensive annotations to feed their insatiable appetite for labeled data. For example, the New York Times Annotated Corpus BIBREF1 contains 1.8 million news articles, with 650,000 summaries written by library scientists. Therefore, some recent work BIBREF5 explores the effect of domain transfer to utilize datasets other than the target one. But this method may be affected by the domain drift problem and still suffers from the lack of labelled data. The recent promising trend of pretraining models BIBREF6, BIBREF7 proves that a large quantity of data can be used to boost NLP models' performance. Therefore, we put forward a novel method to leverage the lead bias of news articles in our favor to conduct large-scale pretraining of summarization models. The idea is to leverage the top few sentences of a news article as the target summary and use the rest as the content. The goal of our pretrained model is to generate an abstractive summary given the content. Coupled with careful data filtering and cleaning, the lead bias can provide a delegate summary of sufficiently good quality, and it immediately renders the large quantity of unlabeled news articles corpus available for training news summarization models. We employ this pretraining idea on a three-year collection of online news articles. We conduct thorough data cleaning and filtering. For example, to maintain a quality assurance bar for using leading sentences as the summary, we compute the ratio of overlapping non-stopping words between the top 3 sentences and the rest of the article. As a higher ratio implies a closer semantic connection, we only keep articles for which this ratio is higher than a threshold. We end up with 21.4M articles based on which we pretrain a transformer-based encoder-decoder summarization model. We conduct thorough evaluation of our models on five benchmark news summarization datasets. Our pretrained model achieves a remarkable performance on various target datasets without any finetuning. This shows the effectiveness of leveraging the lead bias to pretrain on large-scale news data. We further finetune the model on target datasets and achieve better results than a number of strong baseline models. For example, the pretrained model without finetuning obtains state-of-the-art results on DUC-2003 and DUC-2004. The finetuned model obtains 3.2% higher ROUGE-1, 1.6% higher ROUGE-2 and 2.1% higher ROUGE-L scores than the best baseline model on XSum dataset BIBREF2. Human evaluation results also show that our models outperform existing baselines like pointer-generator network. The rest of paper is organized as follows. We introduce related work in news summarization and pretraining in Sec:rw. We describe the details of pretraining using lead bias in Sec:pre. We introduce the transformer-based summarization model in Sec:model. We show the experimental results in Sec:exp and conclude the paper in Sec:conclusion. ### Related work ::: Document Summarization
End-to-end abstractive text summarization has been intensively studied in recent literature. To generate summary tokens, most architectures take the encoder-decoder approach BIBREF8. BIBREF9 first introduces an attention-based seq2seq model to the abstractive sentence summarization task. However, its output summary degenerates as document length increases, and out-of-vocabulary (OOV) words cannot be efficiently handled. To tackle these challenges, BIBREF4 proposes a pointer-generator network that can both produce words from the vocabulary via a generator and copy words from the source article via a pointer. BIBREF10 utilizes reinforcement learning to improve the result. BIBREF11 uses a content selector to over-determine phrases in source documents that helps constrain the model to likely phrases. BIBREF12 adds Gaussian focal bias and a salience-selection network to the transformer encoder-decoder structure BIBREF13 for abstractive summarization. BIBREF14 randomly reshuffles the sentences in news articles to reduce the effect of lead bias in extractive summarization. ### Related work ::: Pretraining
In recent years, pretraining language models have proved to be quite helpful in NLP tasks. The state-of-the-art pretrained models include ELMo BIBREF15, GPT BIBREF7, BERT BIBREF6 and UniLM BIBREF16. Built upon large-scale corpora, these pretrained models learn effective representations for various semantic structures and linguistic relationships. As a result, pretrained models have been widely used with considerable success in applications such as question answering BIBREF17, sentiment analysis BIBREF15 and passage reranking BIBREF18. Furthermore, UniLM BIBREF16 leverages its sequence-to-sequence capability for abstractive summarization; the BERT model has been employed as an encoder in BERTSUM BIBREF19 for extractive/abstractive summarization. Compared to our work, UniLM BIBREF16 is a general language model framework and does not take advantage of the special semantic structure of news articles. Similarly, BERTSUM BIBREF19 directly copies the pretrained BERT structure into its encoder and finetunes on labelled data instead of pretraining with the large quantity of unlabeled news corpus available. Recently, PEGASUS BIBREF20 leverages a similar idea of summarization pretraining, but they require finetuning with data from target domains, whereas our model has a remarkable performance without any finetuning. ### Pretraining with Leading Sentences
News articles usually follow the convention of placing the most important information early in the content, forming an inverted pyramid structure. This lead bias has been discovered in a number of studies BIBREF3, BIBREF14. One of the consequences is that the lead baseline, which simply takes the top few sentences as the summary, can achieve a rather strong performance in news summarization. For instance, in the CNN/Daily Mail dataset BIBREF0, using the top three sentences as summaries can get a higher ROUGE score than many deep learning based models. This positional bias brings lots of difficulty for models to extract salient information from the article and generate high-quality summaries. For instance, BIBREF14 discovers that most models' performances drop significantly when a random sentence is inserted in the leading position, or when the sentences in a news article are shuffled. On the other hand, news summarization, just like many other supervised learning tasks, suffers from the scarcity of labelled training data. Abstractive summarization is especially data-hungry since the efficacy of models depends on high-quality handcrafted summaries. We propose that the lead bias in news articles can be leveraged in our favor to train an abstractive summarization model without human labels. Given a news article, we treat the top three sentences, denoted by Lead-3, as the target summary, and use the rest of the article as news content. The goal of the summarization model is to produce Lead-3 using the following content, as illustrated in fig:top3. The benefit of this approach is that the model can leverage the large number of unlabeled news articles for pretraining. In the experiment, we find that the pretrained model alone can have a strong performance on various news summarization datasets, without any further training. We also finetune the pretrained model on downstream datasets with labelled summaries. The model can quickly adapt to the target domain and further increase its performance. It is worth noting that this idea of utilizing structural bias for large-scale summarization pretraining is not limited to specific types of models, and it can be applied to other types of text as well: academic papers with abstracts, novels with editor's notes, books with tables of contents. However, one should carefully examine and clean the source data to take advantage of lead bias, as the top three sentences may not always form a good summary. We provide more details in the experiments about the data filtering and cleaning mechanism we apply. ### Model
In this section, we introduce our abstractive summarization model, which has a transformer-based encoder-decoder structure. We first formulate the supervised summarization problem and then present the network architecture. ### Model ::: Problem formulation
We formalize the problem of supervised abstractive summarization as follows. The input consists of $a$ pairs of articles and summaries: $\lbrace (X_1, Y_1), (X_2, Y_2), ..., (X_a, Y_a)\rbrace $. Each article and summary are tokenized: $X_i=(x_1,...,x_{L_i})$ and $Y_i=(y_1,...,y_{N_i})$. In abstractive summarization, the summary tokens need not be from the article. For simplicity, we will drop the data index subscript. The goal of the system is to generate summary $Y=(y_1,...,y_m)$ given the transcript $X=\lbrace x_1, ..., x_n\rbrace $. ### Model ::: Network Structure
We utilize a transformer-based encoder-decoder structure that maximizes the conditional probability of the summary: $P(Y|X, \theta )$, where $\theta $ represents the parameters. ### Model ::: Network Structure ::: Encoder
The encoder maps each token into a fixed-length vector using a trainable dictionary $\mathcal {D}$ randomly initialized using a normal distribution with zero mean and a standard deviation of 0.02. Each transformer block conducts multi-head self-attention. And we use sinusoidal positional embedding in order to process arbitrarily long input. In the end, the output of the encoder is a set of contextualized vectors: ### Model ::: Network Structure ::: Decoder
The decoder is a transformer that generates the summary tokens one at a time, based on the input and previously generated summary tokens. Each token is projected onto a vector using the same dictionary $\mathcal {D}$ as the encoder. The decoder transformer block includes an additional cross-attention layer to fuse in information from the encoder. The output of the decoder transformer is denoted as: To predict the next token $w_{k}$, we reuse the weights of dictionary $\mathcal {D}$ as the final linear layer to decode $u^D_{k-1}$ into a probability distribution over the vocabulary: $P(w_k|w_{<k},u^E_{1:m})=( \mathcal {D}u^D_{k-1})$. Training. During training, we seek to minimize the cross-entropy loss: We use teacher-forcing in decoder training, i.e. the decoder takes ground-truth summary tokens as input. The model has 10 layers of 8-headed transformer blocks in both its encoder and decoder, with 154.4M parameters. Inference. During inference, we employ beam search to select the best candidate. The search starts with the special token $\langle \mbox{BEGIN}\rangle $. We ignore any candidate word which results in duplicate trigrams. We select the summary with the highest average log-likelihood per token. ### Experiments ::: Datasets
We evaluate our model on five benchmark summarization datasets: the New York Times Annotated Corpus (NYT) BIBREF1, XSum BIBREF2, the CNN/DailyMail dataset BIBREF0, DUC-2003 and DUC-2004 BIBREF21. These datasets contain 104K, 227K, 312K, 624 and 500 news articles and human-edited summaries respectively, covering different topics and various summarization styles. For NYT dataset, we use the same train/val/test split and filtering methods following BIBREF22. As DUC-2003/2004 datasets are very small, we follow BIBREF23 to employ them as test set only. ### Experiments ::: Implementation Details
We use SentencePiece BIBREF24 for tokenization, which segments any sentence into subwords. We train the SentencePiece model on pretrained data to generate a vocabulary of size 32K and of dimension 720. The vocabulary stays fixed during pretraining and finetuning. Pretraining. We collect three years of online news articles from June 2016 to June 2019. We filter out articles overlapping with the evaluation data on media domain and time range. We then conduct several data cleaning strategies. First, many news articles begin with reporter names, media agencies, dates or other contents irrelevant to the content, e.g. “New York (CNN) –”, “Jones Smith, May 10th, 2018:”. We therefore apply simple regular expressions to remove these prefixes. Second, to ensure that the summary is concise and the article contains enough salient information, we only keep articles with 10-150 words in the top three sentences and 150-1200 words in the rest, and that contain at least 6 sentences in total. In this way, we filter out i) articles with excessively long content to reduce memory consumption; ii) very short leading sentences with little information which are unlikely to be a good summary. To encourage the model to generate abstrative summaries, we also remove articles where any of the top three sentences is exactly repeated in the rest of the article. Third, we try to remove articles whose top three sentences may not form a relevant summary. For this purpose, we utilize a simple metric: overlapping words. We compute the portion of non-stopping words in the top three sentences that are also in the rest of an article. A higher portion implies that the summary is representative and has a higher chance of being inferred by the model using the rest of the article. To verify, we compute the overlapping ratio of non-stopping words between human-edited summary and the article in CNN/DailyMail dataset, which has a median value of 0.87. Therefore, in pretraining, we keep articles with an overlapping word ratio higher than 0.65. These filters rule out around 95% of the raw data and we end up with 21.4M news articles, 12,000 of which are randomly sampled for validation. We pretrain the model for 10 epochs and evaluate its performance on the validation set at the end of each epoch. The model with the highest ROUGE-L score is selected. During pretraining, we use a dropout rate of 0.3 for all inputs to transformer layers. The batch size is 1,920. We use RAdam BIBREF25 as the optimizer, with a learning rate of $10^{-4}$. Also, due to the different numerical scales of the positional embedding and initialized sentence piece embeddings, we divide the positional embedding by 100 before feeding it into the transformer. The beam width is set to 5 during inference. Finetuning. During finetuning, we keep the optimizer, learning rate and dropout rate unchanged as in pretraining. The batch size is 32 for all datasets. We pick the model with the highest ROUGE-L score on the validation set and report its performance on the test set. Our strategy of Pretraining with unlabeled Lead-3 summaries is called PL. We denote the pretrained model with finetuning on target datasets as PL-FT. The model with only pretraining and no finetuning is denoted as PL-NoFT, which is the same model for all datasets. ### Experiments ::: Baseline
To compare with our model, we select a number of strong summarization models as baseline systems. $\textsc {Lead-X}$ uses the top $X$ sentences as a summary BIBREF19. The value of $X$ is 3 for NYT and CNN/DailyMail and 1 for XSum to accommodate the nature of summary length. $\textsc {PTGen}$ BIBREF4 is the pointer-generator network. $\textsc {DRM}$ BIBREF10 leverages deep reinforcement learning for summarization. $\textsc {TConvS2S}$ BIBREF2 is based on convolutional neural networks. $\textsc {BottomUp}$ BIBREF11 uses a bottom-up approach to generate summarization. ABS BIBREF26 uses neural attention for summary generation. DRGD BIBREF27 is based on a deep recurrent generative decoder. To compare with our pretrain-only model, we include several unsupervised abstractive baselines: SEQ$^3$ BIBREF28 employs the reconstruction loss and topic loss for summarization. BottleSum BIBREF23 leverages unsupervised extractive and self-supervised abstractive methods. GPT-2 BIBREF7 is a large-scaled pretrained language model which can be directly used to generate summaries. ### Experiments ::: Metrics
We employ the standard ROUGE-1, ROUGE-2 and ROUGE-L metrics BIBREF29 to evaluate all summarization models. These three metrics respectively evaluate the accuracy on unigrams, bigrams and longest common subsequence. ROUGE metrics have been shown to highly correlate with the human judgment BIBREF29. Following BIBREF22, BIBREF23, we use F-measure ROUGE on XSUM and CNN/DailyMail, and use limited-length recall-measure ROUGE on NYT and DUC. In NYT, the prediction is truncated to the length of the ground-truth summaries; in DUC, the prediction is truncated to 75 characters. ### Experiments ::: Results
The results are displayed in tab:nyt, tab:xsumresults, tab:cnndaily and tab:duc. As shown, on both NYT and XSum dataset, PL-FT outperforms all baseline models by a large margin. For instance, PL-FT obtains 3.2% higher ROUGE-1, 1.6% higher ROUGE-2 and 2.1% higher ROUGE-L scores than the best baseline model on XSum dataset. We conduct statistical test and found that the results are all significant with p-value smaller than 0.05 (marked by *) or 0.01 (marked by **), compared with previous best scores. On CNN/DailyMail dataset, PL-FT outperforms all baseline models except BottomUp BIBREF11. PL-NoFT, the pretrained model without any finetuning, also gets remarkable results. On XSum dataset, PL-NoFT is almost 8% higher than Lead-1 in ROUGE-1 and ROUGE-L. On CNN/DailyMail dataset, PL-NoFT significantly outperforms unsupervised models SEQ$^3$ and GPT-2, and even surpasses the supervised pointer-generator network. PL-NoFT also achieves state-of-the-art results on DUC-2003 and DUC-2004 among unsupervised models (except ROUGE-1 on DUC-2004), outperforming other carefully designed unsupervised summarization models. It's worth noting that PL-NoFT is the same model for all experiments, which proves that our pretrain strategy is effective across different news corpus. ### Experiments ::: Abstractiveness Analysis
We measure the abstractiveness of our model via the ratio of novel n-grams in summaries, i.e. the percentage of n-grams in the summary that are not present in the article. fig:novel shows this ratio in summaries from reference and generated by PL-NoFT and PL-FT in NYT dataset. Both PL-NoFT and PL-FT yield more novel 1-grams in summary than the reference. And PL-NoFT has similar novelty ratio with the reference in other n-gram categories. Also, we observe that the novelty ratio drops after finetuning. We attribute this to the strong lead bias in the NYT dataset which affects models trained on it. ### Experiments ::: Human Evaluation
We conduct human evaluation of the generated summaries from our models and the pointer generator network with coverage. We randomly sample 100 articles from the CNN/DailyMail test set and ask 3 human labelers from Amazon Mechanical Turk to assess the quality of summaries with a score from 1 to 5 (5 means perfect quality. The labelers need to judge whether the summary can express the salient information from the article in a concise form of fluent language. The evaluation guidelines are given in Table TABREF23. To reduce bias, we randomly shuffle summaries from different sources for each article. As shown in Table TABREF23, both of our models PL-NoFT and PL-FT outperform the pointer generator network (PTGen+Cov), and PL-FT's advantage over PTGen+Cov is statistically significant. This shows the effectiveness of both our pretraining and finetuning strategy. To evaluate the inter-annotator agreement, we compute the kappa statistics among the labels and the score is 0.34. ### Conclusions
In this paper, we propose a simple and effective pretraining method for news summarization. By employing the leading sentences from a news article as its target summary, we turn the problematic lead bias for news summarization in our favor. Based on this strategy, we conduct pretraining for abstractive summarization in a large-scale news corpus. We conduct thorough empirical tests on five benchmark news summarization datasets, including both automatic and human evaluations. Results show that the same pretrained model without any finetuning can achieve state-of-the-art results among unsupervised methods over various news summarization datasets. And finetuning on target domains can further improve the model's performance. We argue that this pretraining method can be applied in more scenarios where structural bias exists. Figure 1: Using Lead-3 summary as target in pretraining. Figure 2: Ratio of novel n-grams in summaries from reference, PL-NoFT and PL-FT models in NYT test set. Table 1: ROUGE recall scores on NYT test set. Table 2: ROUGE F1 results on XSum test set. Table 3: ROUGE F1 results on CNN/DailyMail test set. Table 4: Scoring criteria for human evaluation of summaries. Table 5: Average and standard deviations of human evaluation scores for summaries on CNN/DailyMail test set. Scores range from 1 to 5 with 5 being perfect. Each summary is judged by 3 human evaluators. PL-FT’s result is statistically significant compared with pointer-generator network with coverage with a p-value less than 10−7.
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many news articles begin with reporter names, media agencies, dates or other contents irrelevant to the content, to ensure that the summary is concise and the article contains enough salient information, we only keep articles with 10-150 words in the top three sentences and 150-1200 words in the rest, and that contain at least 6 sentences in total, we try to remove articles whose top three sentences may not form a relevant summary
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Which category and description best describes the type of story “The Recruit” is using as its base?
A. Coming of age: Wayne must kill one person during the break out test in order to become a functioning member of society. Breaking out is a rite of passage.
B. Boy Meets Girl: When Wayne chases Red and attempts to kill her, he realizes that killing isn’t for him and that the rest of his life should
C. Animal Rights: The story is an exploration of Wayne’s realization that cats and mice should not be subject to violence.
D. Man vs. Nature: The entire story is dedicated to exploring how a society can kill the animalistic natures within a human body and soul.
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THE RECRUIT BY BRYCE WALTON It was dirty work, but it would make him a man. And kids had a right to grow up—some of them! [Transcriber's Note: This etext was produced from Worlds of If Science Fiction, July 1962. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Wayne, unseen, sneered down from the head of the stairs. The old man with his thick neck, thick cigar, evening highball, potgut and bald head without a brain in it. His slim mother with nervously polite smiles and voice fluttering, assuring the old man by her frailty that he was big in the world. They were squareheads one and all, marking moron time in a gray dream. Man, was he glad to break out. The old man said, "He'll be okay. Let him alone." "But he won't eat. Just lies there all the time." "Hell," the old man said. "Sixteen's a bad time. School over, waiting for the draft and all. He's in between. It's rough." Mother clasped her forearms and shook her head once slowly. "We got to let him go, Eva. It's a dangerous time. You got to remember about all these dangerous repressed impulses piling up with nowhere to go, like they say. You read the books." "But he's unhappy." "Are we specialists? That's the Youth Board's headache, ain't it? What do we know about adolescent trauma and like that? Now get dressed or we'll be late." Wayne watched the ritual, grinning. He listened to their purposeless noises, their blabbing and yakking as if they had something to say. Blab-blab about the same old bones, and end up chewing them in the same old ways. Then they begin all over again. A freak sideshow all the way to nowhere. Squareheads going around either unconscious or with eyes looking dead from the millennium in the office waiting to retire into limbo. How come he'd been stuck with parental images like that? One thing—when he was jockeying a rocket to Mars or maybe firing the pants off Asiatic reds in some steamy gone jungle paradise, he'd forget his punkie origins in teeveeland. But the old man was right on for once about the dangerous repressed impulses. Wayne had heard about it often enough. Anyway there was no doubt about it when every move he made was a restrained explosion. So he'd waited in his room, and it wasn't easy sweating it out alone waiting for the breakout call from HQ. "Well, dear, if you say so," Mother said, with the old resigned sigh that must make the old man feel like Superman with a beerbelly. They heard Wayne slouching loosely down the stairs and looked up. "Relax," Wayne said. "You're not going anywhere tonight." "What, son?" his old man said uneasily. "Sure we are. We're going to the movies." He could feel them watching him, waiting; and yet still he didn't answer. Somewhere out in suburban grayness a dog barked, then was silent. "Okay, go," Wayne said. "If you wanta walk. I'm taking the family boltbucket." "But we promised the Clemons, dear," his mother said. "Hell," Wayne said, grinning straight into the old man. "I just got my draft call." He saw the old man's Adam's apple move. "Oh, my dear boy," Mother cried out. "So gimme the keys," Wayne said. The old man handed the keys over. His understanding smile was strained, and fear flicked in his sagging eyes. "Do be careful, dear," his mother said. She ran toward him as he laughed and shut the door on her. He was still laughing as he whoomed the Olds between the pale dead glow of houses and roared up the ramp onto the Freeway. Ahead was the promising glitter of adventure-calling neon, and he looked up at the high skies of night and his eyes sailed the glaring wonders of escape. He burned off some rubber finding a slot in the park-lot. He strode under a sign reading Public Youth Center No. 947 and walked casually to the reception desk, where a thin man with sergeant's stripes and a pansy haircut looked out of a pile of paperwork. "Where you think you're going, my pretty lad?" Wayne grinned down. "Higher I hope than a typewriter jockey." "Well," the sergeant said. "How tough we are this evening. You have a pass, killer?" "Wayne Seton. Draft call." "Oh." The sergeant checked his name off a roster and nodded. He wrote on a slip of paper, handed the pass to Wayne. "Go to the Armory and check out whatever your lusting little heart desires. Then report to Captain Jack, room 307." "Thanks, sarge dear," Wayne said and took the elevator up to the Armory. A tired fat corporal with a naked head blinked up at tall Wayne. Finally he said, "So make up your mind, bud. Think you're the only kid breaking out tonight?" "Hold your teeth, pop," Wayne said, coolly and slowly lighting a cigarette. "I've decided." The corporal's little eyes studied Wayne with malicious amusement. "Take it from a vet, bud. Sooner you go the better. It's a big city and you're starting late. You can get a cat, not a mouse, and some babes are clever hellcats in a dark alley." "You must be a genius," Wayne said. "A corporal with no hair and still a counterboy. I'm impressed. I'm all ears, Dad." The corporal sighed wearily. "You can get that balloon head ventilated, bud, and good." Wayne's mouth twitched. He leaned across the counter toward the shelves and racks of weapons. "I'll remember that crack when I get my commission." He blew smoke in the corporal's face. "Bring me a Smith and Wesson .38, shoulder holster with spring-clip. And throw in a Skelly switchblade for kicks—the six-inch disguised job with the double springs." The corporal waddled back with the revolver and the switchblade disguised in a leather comb case. He checked them on a receipt ledger, while Wayne examined the weapons, broke open the revolver, twirled the cylinder and pushed cartridges into the waiting chamber. He slipped the knife from the comb case, flicked open the blade and stared at its gleam in the buttery light as his mouth went dry and the refracted incandescence of it trickled on his brain like melted ice, exciting and scary. He removed his leather jacket. He slung the holster under his left armpit and tested the spring clip release several times, feeling the way the serrated butt dropped into his wet palm. He put his jacket back on and the switchblade case in his pocket. He walked toward the elevator and didn't look back as the corporal said, "Good luck, tiger." Captain Jack moved massively. The big stone-walled office, alive with stuffed lion and tiger and gunracks, seemed to grow smaller. Captain Jack crossed black-booted legs and whacked a cane at the floor. It had a head shaped like a grinning bear. Wayne felt the assured smile die on his face. Something seemed to shrink him. If he didn't watch himself he'd begin feeling like a pea among bowling balls. Contemptuously amused little eyes glittered at Wayne from a shaggy head. Shoulders hunched like stuffed sea-bags. "Wayne Seton," said Captain Jack as if he were discussing something in a bug collection. "Well, well, you're really fired up aren't you? Really going out to eat 'em. Right, punk?" "Yes, sir," Wayne said. He ran wet hands down the sides of his chinos. His legs seemed sheathed in lead as he bit inwardly at shrinking fear the way a dog snaps at a wound. You big overblown son, he thought, I'll show you but good who is a punk. They made a guy wait and sweat until he screamed. They kept a guy on the fire until desire leaped in him, ran and billowed and roared until his brain was filled with it. But that wasn't enough. If this muscle-bound creep was such a big boy, what was he doing holding down a desk? "Well, this is it, punk. You go the distance or start a butterfly collection." The cane darted up. A blade snicked from the end and stopped an inch from Wayne's nose. He jerked up a shaky hand involuntarily and clamped a knuckle-ridged gag to his gasping mouth. Captain Jack chuckled. "All right, superboy." He handed Wayne his passcard. "Curfew's off, punk, for 6 hours. You got 6 hours to make out." "Yes, sir." "Your beast is primed and waiting at the Four Aces Club on the West Side. Know where that is, punk?" "No, sir, but I'll find it fast." "Sure you will, punk," smiled Captain Jack. "She'll be wearing yellow slacks and a red shirt. Black hair, a cute trick. She's with a hefty psycho who eats punks for breakfast. He's butchered five people. They're both on top of the Undesirable list, Seton. They got to go and they're your key to the stars." "Yes, sir," Wayne said. "So run along and make out, punk," grinned Captain Jack. A copcar stopped Wayne as he started over the bridge, out of bright respectable neon into the murky westside slum over the river. Wayne waved the pass card, signed by Captain Jack, under the cop's quivering nose. The cop shivered and stepped back and waved him on. The Olds roared over the bridge as the night's rain blew away. The air through the open window was chill and damp coming from Slumville, but Wayne felt a cold that wasn't of the night or the wind. He turned off into a rat's warren of the inferiors. Lights turned pale, secretive and sparse, the uncared-for streets became rough with pitted potholes, narrow and winding and humid with wet unpleasant smells. Wayne's fearful exhilaration increased as he cruised with bated breath through the dark mazes of streets and rickety tenements crawling with the shadows of mysterious promise. He found the alley, dark, a gloom-dripping tunnel. He drove cautiously into it and rolled along, watching. His belly ached with expectancy as he spotted the sick-looking dab of neon wanly sparkling. FOUR ACES CLUB He parked across the alley. He got out and stood in shadows, digging the sultry beat of a combo, the wild pulse of drums and spinning brass filtering through windows painted black. He breathed deep, started over, ducked back. A stewbum weaved out of a bank of garbage cans, humming to himself, pulling at a rainsoaked shirt clinging to a pale stick body. He reminded Wayne of a slim grub balanced on one end. The stewbum stumbled. His bearded face in dim breaking moonlight had a dirty, greenish tinge as he sensed Wayne there. He turned in a grotesque uncoordinated jiggling and his eyes were wide with terror and doom. "I gotta hide, kid. They're on me." Wayne's chest rose and his hands curled. The bum's fingers drew at the air like white talons. "Help me, kid." He turned with a scratchy cry and retreated before the sudden blast of headlights from a Cad bulleting into the alley. The Cad rushed past Wayne and he felt the engine-hot fumes against his legs. Tires squealed. The Cad stopped and a teener in black jacket jumped out and crouched as he began stalking the old rummy. "This is him! This is him all right," the teener yelled, and one hand came up swinging a baseball bat. A head bobbed out of the Cad window and giggled. The fumble-footed rummy tried to run and plopped on wet pavement. The teener moved in, while a faint odor of burnt rubber hovered in the air as the Cad cruised in a slow follow-up. Wayne's breath quickened as he watched, feeling somehow blank wonder at finding himself there, free and breaking out at last with no curfew and no law but his own. He felt as though he couldn't stop anything. Living seemed directionless, but he still would go with it regardless, until something dropped off or blew to hell like a hot light-bulb. He held his breath, waiting. His body was tensed and rigid as he moved in spirit with the hunting teener, an omniscient shadow with a hunting license and a ghetto jungle twenty miles deep. The crawling stewbum screamed as the baseball bat whacked. The teener laughed. Wayne wanted to shout. He opened his mouth, but the yell clogged up somewhere, so that he remained soundless yet with his mouth still open as he heard the payoff thuds where the useless wino curled up with stick arms over his rheumy face. The teener laughed, tossed the bat away and began jumping up and down with his hobnailed, mail-order air force boots. Then he ran into the Cad. A hootch bottle soared out, made a brittle tink-tink of falling glass. "Go, man!" The Cad wooshed by. It made a sort of hollow sucking noise as it bounced over the old man twice. Then the finlights diminished like bright wind-blown sparks. Wayne walked over and sneered down at the human garbage lying in scummed rain pools. The smell of raw violence, the scent of blood, made his heart thump like a trapped rubber ball in a cage. He hurried into the Four Aces, drawn by an exhilarating vision ... and pursued by the hollow haunting fears of his own desires. He walked through the wavering haze of smoke and liquored dizziness and stood until his eyes learned the dark. He spotted her red shirt and yellow legs over in the corner above a murky lighted table. He walked toward her, watching her little subhuman pixie face lift. The eyes widened with exciting terror, turned even paler behind a red slash of sensuous mouth. Briefed and waiting, primed and eager for running, she recognized her pursuer at once. He sat at a table near her, watching and grinning and seeing her squirm. She sat in that slightly baffled, fearful and uncomprehending attitude of being motionless, as though they were all actors performing in a weirdo drama being staged in that smoky thick-aired dive. Wayne smiled with wry superiority at the redheaded psycho in a dirty T-shirt, a big bruiser with a gorilla face. He was tussling his mouse heavy. "What's yours, teener?" the slug-faced waiter asked. "Bring me a Crusher, buddyroo," Wayne said, and flashed his pass card. "Sure, teener." Red nuzzled the mouse's neck and made drooly noises. Wayne watched and fed on the promising terror and helplessness of her hunted face. She sat rigid, eyes fixed on Wayne like balls of frozen glass. Red looked up and stared straight at Wayne with eyes like black buttons imbedded in the waxlike skin of his face. Then he grinned all on one side. One huge hand scratched across the wet table top like a furious cat's. Wayne returned the challenging move but felt a nervous twitch jerk at his lips. A numbness covered his brain like a film as he concentrated on staring down Red the psycho. But Red kept looking, his eyes bright but dead. Then he began struggling it up again with the scared little mouse. The waiter sat the Crusher down. Wayne signed a chit; tonight he was in the pay of the state. "What else, teener?" "One thing. Fade." "Sure, teener," the waiter said, his breathy words dripping like syrup. Wayne drank. Liquored heat dripped into his stomach. Fire tickled his veins, became hot wire twisting in his head. He drank again and forced out a shaky breath. The jazz beat thumped fast and muted brass moaned. Drumpulse, stabbing trumpet raped the air. Tension mounted as Wayne watched her pale throat convulsing, the white eyelids fluttering. Red fingered at her legs and salivated at her throat, glancing now and then at Wayne, baiting him good. "Okay, you creep," Wayne said. He stood up and started through the haze. The psycho leaped and a table crashed. Wayne's .38 dropped from its spring-clip holster and the blast filled the room. The psycho screamed and stumbled toward the door holding something in. The mouse darted by, eluded Wayne's grasp and was out the door. Wayne went out after her in a laughing frenzy of release. He felt the cold strange breath of moist air on his sweating skin as he sprinted down the alley into a wind full of blowing wet. He ran laughing under the crazy starlight and glimpsed her now and then, fading in and out of shadows, jumping, crawling, running with the life-or-death animation of a wild deer. Up and down alleys, a rat's maze. A rabbit run. Across vacant lots. Through shattered tenement ruins. Over a fence. There she was, falling, sliding down a brick shute. He gained. He moved up. His labored breath pumped more fire. And her scream was a rejuvenation hypo in his blood. She quivered above him on the stoop, panting, her eyes afire with terror. "You, baby," Wayne gasped. "I gotcha." She backed into darkness, up there against the sagging tenement wall, her arms out and poised like crippled wings. Wayne crept up. She gave a squeaking sob, turned, ran. Wayne leaped into gloom. Wood cracked. He clambered over rotten lumber. The doorway sagged and he hesitated in the musty dark. A few feet away was the sound of loose trickling plaster, a whimpering whine. "No use running," Wayne said. "Go loose. Give, baby. Give now." She scurried up sagging stairs. Wayne laughed and dug up after her, feeling his way through debris. Dim moonlight filtered through a sagging stairway from a shattered skylight three floors up. The mouse's shadow floated ahead. He started up. The entire stair structure canted sickeningly. A railing ripped and he nearly went with it back down to the first floor. He heard a scream as rotten boards crumbled and dust exploded from cracks. A rat ran past Wayne and fell into space. He burst into the third-floor hallway and saw her half-falling through a door under the jagged skylight. Wayne took his time. He knew how she felt waiting in there, listening to his creeping, implacable footfalls. Then he yelled and slammed open the door. Dust and stench, filth so awful it made nothing of the dust. In the corner he saw something hardly to be called a bed. More like a nest. A dirty, lumpy pile of torn mattress, felt, excelsior, shredded newspapers and rags. It seemed to crawl a little under the moon-streaming skylight. She crouched in the corner panting. He took his time moving in. He snickered as he flashed the switchblade and circled it like a serpent's tongue. He watched what was left of her nerves go to pieces like rotten cloth. "Do it quick, hunter," she whispered. "Please do it quick." "What's that, baby?" "I'm tired running. Kill me first. Beat me after. They won't know the difference." "I'm gonna bruise and beat you," he said. "Kill me first," she begged. "I don't want—" She began to cry. She cried right up in his face, her wide eyes unblinking, and her mouth open. "You got bad blood, baby," he snarled. He laughed but it didn't sound like him and something was wrong with his belly. It was knotting up. "Bad, I know! So get it over with, please. Hurry, hurry." She was small and white and quivering. She moaned but kept staring up at him. He ripped off his rivet-studded belt and swung once, then groaned and shuffled away from her. He kept backing toward the door. She crawled after him, begging and clutching with both arms as she wriggled forward on her knees. "Don't run. Please. Kill me! It'll be someone else if you don't. Oh, God, I'm so tired waiting and running!" "I can't," he said, and sickness soured in his throat. "Please." "I can't, I can't!" He turned and ran blindly, half-fell down the cracking stairs. Doctor Burns, head of the readjustment staff at the Youth Center, studied Wayne with abstract interest. "You enjoyed the hunt, Seton? You got your kicks?" "Yes, sir." "But you couldn't execute them?" "No, sir." "They're undesirables. Incurables. You know that, Seton?" "Yes, sir." "The psycho you only wounded. He's a five-times murderer. And that girl killed her father when she was twelve. You realize there's nothing can be done for them? That they have to be executed?" "I know." "Too bad," the doctor said. "We all have aggressive impulses, primitive needs that must be expressed early, purged. There's murder in all of us, Seton. The impulse shouldn't be denied or suppressed, but educated . The state used to kill them. Isn't it better all around, Seton, for us to do it, as part of growing up? What was the matter, Seton?" "I—felt sorry for her." "Is that all you can say about it?" "Yes, sir." The doctor pressed a buzzer. Two men in white coats entered. "You should have got it out of your system, Seton, but now it's still in there. I can't turn you out and have it erupt later—and maybe shed clean innocent blood, can I?" "No, sir," Wayne mumbled. He didn't look up. "I'm sorry I punked out." "Give him the treatment," the doctor said wearily. "And send him back to his mother." Wayne nodded and they led him away. His mind screamed still to split open some prison of bone and lay bare and breathing wide. But there was no way out for the trapped. Now he knew about the old man and his poker-playing pals. They had all punked out. Like him.
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A. Coming of age: Wayne must kill one person during the break out test in order to become a functioning member of society. Breaking out is a rite of passage.
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Which medication was added to Mr. Hurley's treatment in 02/2021?
Choose the correct answer from the following options:
A. Azacitidine
B. Levofloxacin
C. Rifampicin
D. Ethambutol
E. Pyrazinamide
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### Patient Report 0
**Dear colleague, **
We are reporting on Mr. Bruno Hurley, born on 12/24/1965, who has been
under our outpatient treatment since 02/11/2020.
**Diagnoses:**
- Refractory tuberculosis
- Manifestations: Open pulmonary tuberculosis, lymph node tuberculosis
(cervical, hilar, mediastinal), liver tuberculosis
**Imaging:**
- 11/01/19 Chest CT: Mediastinal lymph node conglomerate centrally
with poststenotic infiltrates on both sides. Splenomegaly.
- 11/04/19 Bronchoscopy: Large mediastinal and right hilar lymphomas.
Subcritical constriction of right segmental bronchi. EBUS-TBNA LK4R
and 10/11R.
**Microbiology:**
- 11/04/19 Tracheobronchial Secretions: Microscopic detection of
acid-fast rods, cultural detection of Mycobacterium tuberculosis,
phenotypically no evidence of resistance.
**Therapy:**
- Initial omission of pyrazinamide due to pancytopenia.
- Moxifloxacin: 11/10/19-11/20/19
- Pyrazinamide: 11/20/19-02/11/20
- Ethambutol: 11/08/19-02/11/20
- Rifampicin since: 11/08/19
- Isoniazid since: 11/08/19
- Levofloxacin since: 02/11/20
- Immunomodulatory therapy for low basal interferon / interferon
levels (ACTIMMUNE®)
**Microbiology:**
- 01/20/20 Sputum: Cultural detection of Mycobacterium tuberculosis:
Phenotypically no evidence of resistance.
- 01/02/20 Sputum: Last cultural detection of Mycobacterium
tuberculosis.
- 06/15/20 BAL: Occasional acid-fast rods, 16S-rRNA-PCR: M.
tuberculosis complex, no cultural evidence of Mycobacteria.
- 06/15/20 Lung biopsy: Occasional acid-fast rods, no cultural
evidence of Mycobacteria.
- 03/12/21 Sputum: first sputum without acid-fast rods, consistently
microscopically negative sputum samples since then.
**Histology:**
- 07/16/21: Mediastinal lymph node biopsy: Histologically no evidence
of malignancy/lymphoma.
**Other Diagnoses: **
- Secondary Acute Myeloid Leukemia with Myelodysplastic Syndrome
- Blood count at initial diagnosis: 15% blasts, erythrocyte
substitution required.
**Therapy:**
- 12/20-03/21 TB therapy
- 02/20-01/21 TB therapy: RMP + INH + FQ
- 01/21-04/21 RMP + INH + FQ + Actimmune® 04/22 CT: Regressive
findings of pulmonary TB changes, regressive cervical lymph nodes,
mediastinal LAP, and liver lesions size-stable; Sputum: No acid-fast
rods detected for the first time since 03/21.
- BM aspiration: Secondary AML.
**Current Presentation:** Admission for allogeneic stem cell
transplantation
Pathogen Location / Material of Detection or Infection Month/Year or
Last Detection
- HIV Serology: Negative - 11/19
- Mycobacterium tuberculosis Complex: Bronchoalveolar Lavage,
Tracheobronchial Secretion, Sputum - 11/19
**Medical History:** We took over Mr. Hurley for the continuation of TB
therapy on 11/02/20. His hospital admission took place at the end of
October 2019 due to neutropenic fever. The patient reported temperatures
up to 39°C for the past 3 days. Since 08/19, the patient has been
receiving hematological-oncological treatment for MDS. The colleagues
from hematology performed a repeat bone marrow aspiration before
transferring to Station 12. The blast percentage was significantly
reduced. HLA typing of the brother for allogeneic stem cell
transplantation planning had already been done in the summer of 2019.
After a chest CT revealed extensive mediastinal lymphomas with
compression of the bronchial tree bilaterally and post-stenotic
infiltrates, a bronchoscopy was performed. M. tuberculosis was cultured
from sputum and TBS. An EBUS-guided lymph node biopsy was histologically
processed, revealing granulomatous inflammation and molecular evidence
of the M. tuberculosis complex. On 11/08/19, a four-drug
anti-tuberculosis therapy was initiated, initially with Moxifloxacin
instead of Pyrazinamide due to pancytopenia. Moxifloxacin was replaced
by Pyrazinamide on 11/20/19. The four-drug therapy was continued for a
total of 3 months due to prolonged microscopic evidence of acid-fast
rods in follow-up sputum samples. Isoniazid dosage was adjusted after
peak level control (450 mg q24h), as was Rifampicin dose (900 mg q24h).
On 01/02/20, Mycobacterium tuberculosis was last cultured in a sputum
sample. Nevertheless, acid-fast rods continued to be detected in the
sputum. Due to the lack of culturability of mycobacteria, Mr. Hurley was
discharged to home care after consultation with the Tuberculosis Welfare
Office.
**Allergies**: None known. Toxic Substances: Smoking: Non-smoker;
Alcohol: No; Drugs: No
**Social History:** Originally from Brazil, has been living in the US
for 8 years. Lives with his partner.
**Current lab results:**
**Parameter** **Results** **Reference Range**
---------------------------------------- -------------- ---------------------
ConA-Induced Cytokines (Th1/Th2)
Interleukin 10 10 pg/mL \< 364 pg/mL
Interferon Gamma 265-6781 pg/mL
Interleukin 2 74 pg/mL 43-374 pg/mL
Interleukin 4 13 pg/mL \< 34 pg/mL
Interleukin 5 3 pg/mL \< 55 pg/mL
Naive CD45RA+CCR7+ (% of CD8+) 6.35 % 8.22-59.58 %
TEMRA CD45RA+CCR7- (% of CD8+) 50.44 % 7.32-55.99 %
Central Memory CD45RA-CCR7+ (% of CD) 2.60 % 1.67-5.84 %
Effector Memory CD45RA-CCR7- (% of CD) 40.60 % 22.52-62.25 %
Naive CD45RA+ (% of CD4+) 26.26 % 17.46-60.24 %
TEMRA CD45RA+ CCR7- (% of CD4+) 1.26 % 2.74-15.54 %
Central Memory CD45RA-CCR7+ (% of CD) 34.21 % 16.40-33.41 %
Effector Memory CD45RA-CCR7- (% of CD) 38.28 % 17.38-40.38 %
Granulocytes 0.60 abs./nL 3.00-6.50 abs./nL
Granulocytes (relative) 45 % 50-80 %
Lymphocytes 0.57 abs./nL 1.50-3.00 abs./nL
Lymphocytes (relative) 43 % 20-40 %
Monocytes 0.13 abs./nL \<0.50 abs./nL
Monocytes (relative) 10 % 2-10 %
NK Cells 0.16 abs./nL 0.10-0.40 abs./nL
NK Cells (% of Lymphocytes) 29 5-25
γ/δ TCR+ T-Cells (relative) 2 % \< 10 %
α/β TCR+ T-Cells (relative) 98 % \>90 %
CD19+ B-Cells (% of Lymphocytes) 3 % 5-25 %
CD4/CD8 Ratio 0.9 % 1.1-3.0 %
CD8-CD4-T-Cells (% of T-Cells) 5.86 % \< 15.00 %
CD8+CD4+-T-Cells (% of T-Cells) 0.74 % \< 10.00 %
CD3+ T-Cells 0.38 abs./nL 0.90-2.20 abs./nL
**Parameter** **Results** **Reference Range**
-------------------------------------------------- ---------------- ---------------------
Complete Blood Count (EDTA)
Hemoglobin 6.6 g/dL 13.5-17.0 g/dL
Hematocrit 19.0 % 39.5-50.5 %
Erythrocytes 2.3 x 10\^6/uL 4.3-5.8 x 10\^6/uL
Platelets 61 x 10\^3/uL 150-370 x 10\^3/uL
MCV (Mean Corpuscular Volume) 81.5 fL 80.0-99.0 fL
MCH (Mean Corpuscular Hemoglobin) 28.3 pg 27.0-33.5 pg
MCHC (Mean Corpuscular Hemoglobin Concentration) 34.7 g/dL 31.5-36.0 g/dL
MPV (Mean Platelet Volume) 10.4 fL 7.0-12.0 fL
RDW-CV (Red Cell Distribution Width-CV) 12.7 % 11.5-15.0 %
**Parameter** **Results** **Reference Range**
-------------------------- ------------- ---------------------
Other Investigations
QFT-TB Gold plus TB1 0.11 IU/mL \<0.35 IU/mL
QFT-TB Gold plus TB2 0.07 IU/mL \<0.35 IU/mL
QFT-TB Gold plus Mitogen 3.38 IU/mL \>0.50 IU/mL
QFT-TB Gold plus Result Negative
**Lung Aspiration from 06/15/20:** Examination Request: Acid-fast rods
(Microscopy + Culture) **Microscopic Findings:**
- Auramine stain: Occasionally, acid-fast rods Result: No growth of
Mycobacterium sp. after 12 weeks of incubation.
2. Forceps Biopsy Exophytic Trachea: One piece of tissue. Microscopy:
HE, PAS, Giemsa, Diagnosis:
3. Predominantly blood clot and necrotic material alongside sparsely
altered lymphatic tissue due to sampling (EBUS-TBNA LK 7 as
indicated).
4. Components of a granulation tissue polyp (Forceps Biopsy Exophytic
Trachea as indicated). Comment: The finding in 1. continues to be
suspicious of a mycobacterial infection. We are conducting molecular
pathological examinations in this regard and will report again.
> [Comment]{.underline}: Detection of mycobacterial DNA of the M.
> tuberculosis complex type. No evidence of atypical mycobacteria. No
> evidence of malignancy.
**Current Medication:**
**Medication** **Dosage** **Frequency**
------------------------- ------------ ---------------
Rifampin (Rifadin) 600 mg 1-0-0
Isoniazid (Nydrazid) 500 mg 1-0-0
Levofloxacin (Levaquin) 450 mg 1-0-1
**\
**
### Patient Report 1
**Dear colleague, **
We report to you about our patient Mr. Bruno Hurley, born on 12/24/1965.
Who has received inpatient treatment from 07/17/2021 to 09/03/2021.
**Diagnoses**:
- Acute Myeloid Leukemia with Myelodysplasia-Related Changes (AML-MRC)
<!-- -->
- Myelodysplastic Syndrome EB-2, diagnosed in July 2010. Blood count
at initial diagnosis: 15% blasts, erythrocyte transfusion-dependent.
Cytogenetics: 46,XY \[1\]; 47,XY,+Y,i(21)(q10)\[15\];
47,XY,+Y,trp(21)(q11q22)\[4\]. Molecular genetics: Mutations in
RUNX1, SF3B1. IPSS-R: 7 (very high risk).
- In 08/2020, diagnosed with Myelodysplastic Syndrome with ring
sideroblasts.
- Received transfusions of 2 units of red blood cells every 3-4 weeks
to maintain hemoglobin between 4-6 g/dL.
- Bone marrow biopsy showed MDS-EB2 with 14.5% blasts.
- Initiated Azacitidine treatment (2x 75 mg subcutaneously, days 1-5 +
8-9 every 4 weeks) as an outpatient.
- 10/23/2019: Hospitalized for fever during neutropenia.
- 12/06/2019: Diagnosed with tuberculosis - positive Tbc-PCR in
tracheobronchial secretions, acid-fast bacilli in tracheobronchial
secretions, histological confirmation from EBUS biopsy of a
conglomerate of melted lymph nodes from 11/03/2019.
- 01/2021: Bone marrow biopsy showed secondary AML with 26% blasts.
- 03/2021: Started Venetoclax/Vidaza.
- 05/2021: Bone marrow biopsy showed 0.8% myeloid blasts coexpressing
CD117 and CD7. Cytology showed 6% blasts.
- 05/2021: Started the 4th cycle of Vidaza/Venetoclax.
- 06/17/2022: Started the 5th cycle of Vidaza/Venetoclax.
- 07/29/2021: Underwent allogeneic stem cell transplantation from a
HLA-identical unrelated donor (10/10 antigen match) for AML-MRC in
first complete remission (CR). Conditioning regimen included
Treosulfan 12g/m2, Fludarabin 5x 30 mg/m2, ATG 3x 10 mg/kg.
**Other Diagnoses:**
- Persistent tuberculosis with lymph node swelling since June 2020.
- Open lung tuberculosis diagnosed in November 2019.
- Location: CT of the chest showed central mediastinal lymph node
conglomerate with post-stenotic infiltrates bilaterally,
splenomegaly.
- Bronchoscopy on December 5, 2020, showed large mediastinal and
right hilar lymph nodes, subcritical narrowing of right
segmental bronchi. EBUS-TBNA
- CT Chest/Neck on 02/05/2020: Regression of pulmonary
infiltrates, enlargement of necrotic lymph nodes in the upper
mediastinum and infraclavicular on the right (compressing the
internal jugular vein/esophagus).
- Culture confirmation of Mycobacterium tuberculosis,
pansensitive: Tracheobronchial secretion
- Initiated antituberculous combination therapy
**Current Presentation:** Admission for allogeneic stem cell
transplantation from a HLA-identical unrelated donor (10/10 antigen
match) for AML-MRC in first complete remission.
**Medical History:** In 2019, Mr. Hurley was diagnosed with
Myelodysplastic Syndrome EB-2. Starting from September 2019, he received
Azacitidine therapy. In December 2020, he was diagnosed with open lung
tuberculosis, which was challenging to treat due to his dysfunctional
immune system. In January 2021, his MDS progressed to AML-MRC with 26%
blasts. After treatment with Venetoclax/Vidaza, he achieved remission in
May 2021. Tuberculosis remained largely under control.
Due to AML-MRC, he was recommended for allogeneic stem cell
transplantation from a HLA-identical unrelated donor. At the time of
admission for transplantation, he was largely asymptomatic. He
occasionally experienced mild dry cough but denied fever, night sweats,
or weight loss. The admission and counseling were conducted with
translation assistance from his life partner due to limited proficiency
in English.
**Allergies**: None
**Transfusion History**: Currently requires transfusions every 14 days.
Both red blood cell and platelet transfusions have been tolerated
without problems.
**Abdominal CT from 01/20/2021:**
**Findings**: Significant peripancreatic fluid accumulation in the upper
abdominal area with a somewhat indistinct border between the pancreatic
tissue, particularly in the pancreatic head region. Evidence of
inflammation affecting the stomach and duodenum. No presence of free air
or indications of hollow organ perforation. No conclusive signs of a
well-defined abscess. Moreover, the other parenchymal abdominal organs,
especially those lacking focal abnormalities suggestive of neoplastic or
inflammatory conditions, displayed normal appearances. The gallbladder
showed no notable issues, and there were no radiopaque concretions
observed. Both the intra- and extrahepatic bile ducts appeared
adequately dilated. Abdominal hollow organs exhibited unremarkable and
normal appearances without corresponding contrast and dilation. The
appendix appeared within normal parameters. Abdominal lymph nodes showed
no unusual findings. Some degree of aortic vasosclerosis was noted. The
depiction of the included lung portions revealed no abnormalities.
**Results**: Findings indicative of acute pancreatitis, most likely of
an exudative nature. No signs of hollow organ perforation were detected,
and there was no definitive evidence of an abscess (as far as could be
determined from native imaging).
**Summary**: The patient was admitted to our hospital through the
emergency department with the symptoms described above. With typical
upper abdominal pain and significantly elevated serum lipase levels, we
diagnosed acute pancreatitis. This diagnosis was corroborated by
peripancreatic fluid and ill-defined organ involvement in the abdominal
CT scan. There were no laboratory or anamnestic indications of a biliary
origin. The patient denied excessive alcohol consumption.
**Medication upon Admission:**
**Medication** **Dosage** **Frequency**
------------------------- ------------ ---------------
Rifampin (Rifadin) 600 mg 1-0-0
Isoniazid (Nydrazid) 500 mg 1-0-0
Levofloxacin (Levaquin) 450 mg 1-0-1
**Physical Examination:** General: Oriented in all qualities, in good
general condition with normal body weight (75 kg, 187 cm) Vital signs at
admission: Heart rate 63/min, Blood pressure 110/78 mmHg. Temperature at
admission 36.8 °C, Oxygen saturation 100% on room air. Skin and mucous
membranes: Dry skin, normal skin color, normal skin turgor. No scleral
icterus, non-irritated conjunctiva. Normal oral mucosa, moist tongue
without coating, no ulcers or thrush. Heart: Normal heart sounds,
rhythmic, regular rate, no pathological heart murmurs heard on
auscultation. Lungs: Resonant percussion sound, clear breath sounds
bilaterally, no wheezing, no prolonged expiration. Abdomen: Unremarkable
scar tissue, normal bowel sounds in all quadrants, soft, non-tender, no
guarding, liver and spleen not enlarged. Vascular: Central and
peripheral pulses palpable, no jugular vein distention, no peripheral
edema, extremities warm with no significant difference in size. Lymph
nodes: Palpable cervical swelling, inguinal and axillary lymph nodes
unremarkable. Neurology: Grossly neurologically unremarkable.
On 08/22/2021, a four-lumen central venous catheter was placed in the
right internal jugular vein without complications. During the
conditioning regimen, the patient received the following:
**Medication** **Dosage** **Frequency**
---------------------------------------------- ---------------------- -------------------------
Fludarabine (Fludara) 30 mg/m² (5x 57 mg) 07/23/2023 - 07/27/2023
Treosulfan (Ovastat) 12 g/m² (3x 22.9 g) 07/23/2023 - 07/25/2023
Anti-Thymocyte Globulin (ATG, Thymoglobulin) 10 mg/kg (3x 700 mg) 07/23/2023 - 07/28/2023
**Antiemetic Therapy:**
The antiemetic therapy included Ondansetron, Aprepitant, and
Dexamethasone, and the conditioning regimen was well tolerated.
**Prophylaxis of Graft-Versus-Host Disease (GvHD):**
**Substances** **Start Date** **Day -2** **Day 1**
---------------- ---------------- ------------ -----------
Cyclosporine 08/28/2022
Mycophenolate 07/30/2021
**Stem Cell Source** **Date** **CD34/kg KG** **CD45/kg KG** **CD3/kg KG** **Volume**
---------------------- ------------ ---------------- ---------------- --------------- ------------
PBSCT 07/29/2021 7.39 x10\^6 8.56 x10\^8 260.7 x10\^6 194 ml
**Summary:** Mr. Hurley was admitted for allogeneic stem cell
transplantation from a HLA-identical unrelated donor for AML-MRC. The
conditioning regimen with Treosulfan, Fludarabin, and ATG was well
tolerated, and the transplantation proceeded without complications.
**Toxicities:** There was an adverse event-related increase in bilirubin
levels, reaching a maximum of 2.68 mg/dL. Elevated ALT levels, up to a
maximum of 53 U/L, were observed.
**Acute Graft-Versus-Host Disease (GvHD):** Signs of GvHD were not
observed until the time of discharge.
**Medication upon Discharge:**Formularbeginn
**Medication ** **Dosage** **Frequency**
---------------------------------- ------------ ------------------------------------------------
Acyclovir (Zovirax) 500 mg 1-0-1-0
Entecavir (Baraclude) 0.5 mg 1-0-0-0
Rifampin (Rifadin) 600 mg 1.5-0-0-0
Isoniazid/Pyridoxine (Nydrazid) 300 mg 2-0-0-0
Levofloxacin (Levaquin) 500 mg 1-0-1-0
Mycophenolate Mofetil (CellCept) 500 mg 2-0-2-0
Folic Acid 5 mg 1-0-0-0
Magnesium \-- 3-3-3-0
Pantoprazole (Protonix) 40 mg 1-0-0-0 (before a meal)
Ursodeoxycholic Acid (Actigall) 250 mg 1-1-1-0
Cyclosporine (Sandimmune) 100 mg 100 mg 4-0-4-0
Cyclosporine (Sandimmune) 50 mg 50 mg 4-0-4-0 (based on TDM, last dose 400 mg 1-0-1)
Cyclosporine (Sandimmune) 10 mg 10 mg 4-0-4-0 (based on TDM, last dose 400 mg 1-0-1)
**Current Recommendations: **
1. Bone marrow puncture on Day +60, +120, and +360 post-transplantation
(including MRD and chimerism) and Day +180 depending on MRD and
chimerism progression.
2. Continuation of immunosuppressive therapy with ciclosporin adjusted
to achieve target levels of around 150 ng/ml, for a minimum of 3
months post-transplantation. Immunosuppression with mycophenolate
mofetil will be continued until Day +40.
3. Prophylaxis with Aciclovir must continue for 6 weeks after
discontinuation of immunosuppression at a dosage of 15-20 mg/kg/day
(divided into 2 doses). Dose adjustment based on renal function may
be necessary.
4. Pneumocystis pneumonia prophylaxis through monthly Pentamidine
inhalation or administration of Cotrim forte 960mg must continue at
least until immunosuppression is discontinued or until an absolute
CD4+ T-cell count exceeds \>200/µL in peripheral blood. Cotrim forte
960mg has not been started when leukocytes are \<2/nL.
5. Weekly monitoring of CMV and EBV viral loads through quantitative
PCR from EDTA blood.
6. Timing of antituberculous medication intake:
- Take Rifampicin and Isoniazid in the morning on an empty stomach, 30
minutes before breakfast.
- Take levofloxacin with a 2-hour gap from divalent cations (Mg2+,
strongly calcium-rich foods).
**Lab results upon Discharge:**
**Parameter** **Result** **Reference Range**
------------------------------ -------------------- ---------------------
Cyclosporine 127.00 ng/mL \--
Sodium 141 mEq/L 136-145 mEq/L
Potassium 4.1 mEq/L 3.5-4.5 mEq/L
Glucose 108 mg/dL 60-110 mg/dL
Creatinine 0.65 mg/dL 0.70-1.20 mg/dL
Estimated GFR (eGFR CKD-EPI) 111 mL/min/1.73 m² \--
Urea 26 mg/dL 17-48 mg/dL
Total Bilirubin 0.35 mg/dL \<1.20 mg/dL
**Complete Blood Count **
**Parameter** **Results** **Reference Range**
--------------- ----------------- -----------------------
Hemoglobin 9.5 g/dL 13.5-17.0 g/dL
Hematocrit 28.2% 39.5-50.5%
Erythrocytes 3.2 x 10\^6/µL 4.3-5.8 x 10\^6/µL
Leukocytes 1.47 x 10\^3/µL 3.90-10.50 x 10\^3/µL
Platelets 193 x 10\^3/µL 150-370 x 10\^3/µL
MCV 88.7 fL 80.0-99.0 fL
MCH 29.9 pg 27.0-33.5 pg
MCHC 33.7 g/dL 31.5-36.0 g/dL
MPV 9.8 fL 7.0-12.0 fL
RDW-CV 18.9% 11.5-15.0%
### Patient Report 2
**Dear colleague, **
We report on Mr. Bruno Hurley, born on 12/24/1965, who was under our
inpatient care from 2/20/2022, to 02/24/2022.
**Diagnoses:**
- Acute Pancreatitis, possibly medication-related under antitubercular
therapy.
- Current medications include Entecavir, Rifampicin, and
Isoniazid/Pyridoxin, which have been paused after consultation with
the infectious disease team.
**Other Diagnoses:**
- Acute Myeloid Leukemia with Myelodysplasia-Related Changes (AML-MRC)
- Myelodysplastic Syndrome EB-2
- Allogeneic stem cell transplantation
- EBV Reactivation (Treated with immunoglobulins for 3 days)
- Persistent Tuberculosis with lymph node swelling
- Open Lung Tuberculosis - Initial Diagnosis
- Antitubercular combination therapy since (Moxifloxacin, Pyrazinamid,
Ethambutol, Rifampicin, Isoniazid).
- Rectal colonization with 4-MRGN.
**Medical History:** The patient presented via ambulance from his
workplace. The patient reported sudden onset upper abdominal pain,
mainly in the epigastric region, accompanied by nausea and vomiting. He
also experienced watery diarrhea once today. He had lunch around noon,
consisting noodles. There was no fever, cough, sputum production,
dyspnea, or urinary abnormalities. He has been taking daily
antitubercular combination therapy, including Rifampicin, for open
tuberculosis. The patient denied alcohol consumption and weight loss.
**Medication** **Dosage** **Frequency**
----------------------------------------- ------------ ----------------------------
Acyclovir (Zovirax) 400 mg 1-0-1
Entecavir (Baraclude) 0.5 mg 1-0-0
Rifampin (Rifadin) 600 mg 1.5-0-0
Isoniazid/Pyridoxine (Nydrazid) 300 mg 1-0-1
Pantoprazole (Protonix) 40 mg 1-0-0
Trimethoprim/Sulfamethoxazole (Bactrim) 960 mg 1 tablet, on Mon, Wed, Fri
Methylprednisolone (Medrol) 0.79 mg As needed
Prednisolone 4 mg As needed
**Allergies:** None
**Physical Exam:**
Vital Signs: Blood Pressure 178/90 mmHg, Pulse 85/min, SpO2 89%,
Temperature 36.7°C, Respiratory Rate 20/min.
Clinical Status: Upon initial examination, a reduced general condition.
Cardiovascular: Heart sounds were normal, rhythm was regular, and no
murmurs were heard.
Respiratory: Vesicular breath sounds, sonorous percussion.
Abdominal: Sluggish peristalsis, soft abdominal walls, guarding and
tenderness in the epigastrium, liver and spleen not palpable, no free
fluid.
Extremities: Minimal edema.
**ECG Findings:** ECG on admission showed normal sinus rhythm (69/min),
normal ST intervals, R/S transition in V3/V4, and no significant
abnormalities.
´
**Medication upon Discharge:**
**Medication ** **Dosage** **Frequency**
----------------------------------------- ------------ ----------------------------
Acyclovir (Zovirax) 400 mg 1-0-1
Entecavir (Baraclude) 0.5 mg PAUSED
Rifampin (Rifadin) 600 mg PAUSED
Isoniazid/Pyridoxine (Nydrazid) 300 mg PAUSED
Pantoprazole (Protonix) 40 mg 1-0-0
Trimethoprim/Sulfamethoxazole (Bactrim) 960 mg 1 tablet, on Mon, Wed, Fri
Methylprednisolone (Medrol) 0.79 mg As needed (as needed)
Prednisolone 4 mg As needed (as needed)
Tramadol (Ultram) 50 mg 1 tablet, every 6 hours
**Parameter** **Results** **Reference Range**
------------------------- ----------------- -----------------------
White Blood Cells (WBC) 5.0 x 10\^9/L 3.7 - 9.9 x 10\^9/L
Hemoglobin 14.0 g/dL 13.6 - 17.5 g/dL
Hematocrit 40% 40 - 53%
Red Blood Cells (RBC) 4.00 x 10\^12/L 4.4 - 5.9 x 10\^12/L
MCV 99 fL 80 - 96 fL
MCH 32.8 pg 28.3 - 33.5 pg
MCHC 33.1 g/dL 31.5 - 34.5 g/dL
Platelets 161 x 10\^9/L 146 - 328 x 10\^9/L
Absolute Neutrophils 3.7 x 10\^9/L 1.8 - 6.2 x 10\^9/L
Absolute Monocytes 0.31 x 10\^9/L 0.25 - 0.85 x 10\^9/L
Absolute Eosinophils 0.03 x 10\^9/L 0.03 - 0.44 x 10\^9/L
Absolute Basophils 0.01 x 10\^9/L 0.01 - 0.08 x 10\^9/L
Absolute Lymphocytes 0.9 x 10\^9/L 1.1 - 3.2 x 10\^9/L
Immature Granulocytes 0.0 x 10\^9/L 0.0 x 10\^9/L
### Patient Report 3
**Dear colleague, **
We are writing to inform you on our patient, Mr. Hurley, who presented
to our outpatient clinic on 07/12/2022.
**Diagnoses:**
- Acute Pancreatitis, possibly medication-related under antitubercular
therapy.
- Current medications include Entecavir, Rifampicin, and
Isoniazid/Pyridoxin, which have been paused after consultation with
the infectious disease team.
**Other Diagnoses:**
- Acute Myeloid Leukemia with Myelodysplasia-Related Changes (AML-MRC)
- Myelodysplastic Syndrome EB-2
- Allogeneic stem cell transplantation
- EBV Reactivation (Treated with immunoglobulins for 3 days)
- Persistent Tuberculosis with lymph node swelling
- Open Lung Tuberculosis - Initial Diagnosis
- Antitubercular combination therapy since (Moxifloxacin, Pyrazinamid,
Ethambutol, Rifampicin, Isoniazid).
- Rectal colonization with 4-MRGN.
**Current Presentation:** Presented with a referral from outpatient
oncologist for suspected recurrent AML, with DD GvHD ITP in the setting
of progressive pancytopenia, primarily thrombocytopenia. The patient is
in good general condition, denying acute symptoms, particularly no rash,
diarrhea, dyspnea, or fever.
**Physical Examination:** Alert, oriented, no signs of respiratory
distress, heart sounds regular, abdomen soft, no tenderness, no skin
rashes, especially no signs of GvHD, no edema.
- Heart Rate (HR): 130/85
- Temperature (Temp): 36.7°C
- Oxygen Saturation (SpO2): 97
- Respiratory Rate (AF): 12
- Pupillary Response: 15
**Imaging (CT):**
- [11/04/19 CT Chest/Abdomen/Pelvis ]{.underline}
- [01/04/20 Chest CT:]{.underline} Marked necrotic lymph nodes hilar
right with bronchus and vascular stenosis. Significant increasing
pneumonic infiltrates predominantly on the right.
- [02/05/20 Neck/Chest CT]{.underline}: Regression of pulmonary
infiltrates, but increased size of necrotic lymph nodes, especially
in the upper mediastinum and right infraclavicular with slit-like
compression of the right internal jugular vein and the esophagus.
- [06/07/20 Neck/Chest CT]{.underline}: Size-stable necrotic lymph
node conglomerate infraclavicular right, dimensioned axially up to
about 6 x 2 cm, with ongoing slit-shaped compression of the right
internal jugular vein. Hypoplastic mastoid cells left, idem.
Progressive, partly new and large-volume consolidations with
adjacent ground glass infiltrates on the right in the anterior, less
posterior upper lobe and perihilar. Inhomogeneous, partially reduced
contrast of consolidated lung parenchyma, broncho pneumogram
preserved dorsally only.
- [10/02/20 Neck/Chest/Abdomen/Pelvis CT:]{.underline} Size-regressive
consolidating infiltrate in the right upper lobe and adjacent
central lower lobe with increasing signs of liquefaction.
Progressive right pleural effusion and progressive signs of
pulmonary volume load. Regressive cervical, mediastinal, and right
hilar lymphadenopathy. Ongoing central hilar conglomerates that
compress the central hilar structures. Partly constant, partly
regressive presentation of known tuberculosis-suspected liver
lesions.
- [12/02/20 CT Chest/Abdomen/Pelvis]{.underline}.
- [01/20/2021 Abdominal CT.]{.underline}
- [02/23/21 Neck/Chest CT:]{.underline} Slightly regressive/nodular
fibrosing infiltrate in the right upper lobe and adjacent central
lower lobe with continuing significant residual findings. Within the
infiltrate, larger poorly perfused areas with cavitations and
scarred bronchiectasis. Increasing, partly patchy densities on the
left basal region, differential diagnoses include infiltrates and
ventilation disorders. Essentially constant cervical, mediastinal,
and hilar lymphadenopathy. Constant liver lesions in the upper
abdomen, differential diagnoses include TB manifestations and cystic
changes.
- [06/12/21 Neck/Chest/Abdomen/Pelvis CT:]{.underline} Improved
ventilation with regressive necrotic TB manifestations perihilar,
now only subtotal lobar atelectasis. Essentially constant necrotic
lymph node manifestations cervical, mediastinal, and right hilar,
exemplarily suprasternal right or right paratracheal. Narrow right
pleural effusion. Medium-term constant hypodense liver lesions
(regressive).
**Patient History:** Known to have AML with myelodysplastic changes,
first diagnosed 01/2021, myelodysplastic syndrome EB-2, fist diagnoses
07/2019, and history of allogeneic stem cell transplantation.
**Treatment and Progression:** Patient is hemodynamically stable, vital
signs within normal limits, afebrile. In good general condition,
clinical examination unremarkable, especially no skin GvHD signs. Venous
blood gas: Acid-base status balanced, electrolytes within normal range.
Laboratory findings show pancytopenia, Hb 11.3 g/dL, thrombocytopenia
29/nL, leukopenia 1.8/nL, atypical lymphocytes described as \"resembling
CLL,\" no blasts noted. Consultation with Hemato/Oncology confirmed no
acute need for hospitalization. Follow-up in the Hemato-Oncological
Clinic in September.
**Imaging:**
**CT Chest/Abdomen/Pelvis on 11/04/19:**
**Assessment:** In comparison with 10/23/19: In today\'s
contrast-enhanced examination, a newly unmasked large tumor is noted in
the right pulmonary hilum with encasement of the conduits of the right
lung lobe. Differential diagnosis includes a lymph node conglomerate,
central bronchial carcinoma, or, less likely, an inflammatory lesion.
Multiple suspicious malignant enlarged mediastinal lymph nodes,
particularly on the right paratracheal and infracarinal regions.
Short-term progression of peribronchovascular consolidation in the right
upper lobe and multiple new subsolid micronodules bilaterally.
Differential diagnosis includes inflammatory lesions, especially in the
presence of known neutropenia, which could raise suspicion of fungal
infection.
Intraabdominally, there is an image suggestive of small bowel subileus
without a clearly defined mechanical obstruction.
Density-elevated and ill-defined cystic lesion in the left upper pole of
the kidney. Primary consideration is a hemorrhaged or thickened cyst,
but ultimately, the nature of the lesion remains uncertain.
**CT Chest on 01/04/20:** Significant necrotic hilar lymph nodes on the
right with bronchial and vascular stenosis. Marked progression of
pulmonary infiltrates, particularly on the right, still compatible with
superinfection in the context of known active tuberculosis
**CT Chest from 02/05/20**: Marked necrotic lymph nodes hilar right with
bronchial and vascular stenosis. Significantly increasing pneumonia-like
infiltrates, particularly on the right, still compatible with
superinfection in the context of known open tuberculosis.
**Neck/Chest CT from 06/07/20:** Size-stable necrotic lymph node
conglomerate infraclavicular right, dimensioned axially up to about 6 x
2 cm, with ongoing slit-shaped compression of the right internal jugular
vein. Hypoplastic mastoid cells left, idem. Progressive, partly new and
large-volume consolidations with adjacent ground glass infiltrates on
the right in the anterior, less posterior upper lobe and perihilar.
Inhomogeneous, partially reduced contrast of consolidated lung
parenchyma, broncho pneumogram preserved dorsally only.
**Neck Ultrasound from 08/14/2020:** Clinical History, Question,
Justifying Indication: Follow-up of cervical lymph nodes in
tuberculosis.
**Findings/Assessment:** Neck Lymph Node Ultrasound from 05/20/2020 for
comparison. As in the previous examination, evidence of two
significantly enlarged supraclavicular lymph nodes on the right, both
showing a decrease in size compared to the previous examination: The
more medial node measures 2.9 x 1.6 cm compared to the previous 3.7 x
1.7 cm, while the more laterally located lymph node measures 3.3 x 1.4
cm compared to the previous 4.2 x 1.5 cm. The more medial lymph node
appears centrally hypoechoic, indicative of partial liquefaction, while
the more lateral lymph node has a rather solid appearance. No other
pathologically enlarged lymph nodes detected in the cervical region.
**CT Neck/Chest/Abdomen/Pelvis from 10/02/2020:** Assessment: Compared
to the previous examination from 06/07/2020, there is evidence of
regression in findings: Size regression of consolidating infiltrate in
the right upper lobe and the adjacent central lower lobe, albeit with
increasing signs of cavitation. Progressive right pleural effusion and
progressive signs of pulmonary volume overload. Regression of cervical,
mediastinal, and right hilar lymphadenopathy. Persistent centrally
liquefying lymph node conglomerates in the right hilar region,
compressing central hilar structures. Some findings remain stable, while
others have regressed. No evidence of new manifestations.
**CT Chest/Abdomen/Pelvis from 12/02/20:** Assessment: Compared to
10/02/20: In today\'s contrast examination, a newly unmasked large tumor
is located right pulmonary hilar, encasing the conduits of the right
lung lobe; Differential diagnosis includes lymph node conglomerate,
central bronchial carcinoma, and a distant possibility of inflammatory
lesions. Multiple suspiciously enlarged mediastinal lymph nodes,
especially right paratracheal and infracarinal. In a short time,
progressive peribronchovascular consolidations in the right upper lobe
and multiple new subsolid micronodules bilaterally; Differential
diagnosis includes inflammatory lesions, potentially fungal in the
context of known neutropenia. Intra-abdominally, there is a picture of
small bowel subileus without discernible mechanical obstruction.
Corresponding symptoms? Densely elevated and ill-defined cystic lesion
in the upper pole of the left kidney; Differential diagnosis primarily
includes a hemorrhaged/thickened cyst, ultimately with uncertain
malignancy.
**Chest in two planes on 04/23/2021:** **Findings/Assessment:** In
comparison with the corresponding prior images, most recently on
08/14/2020. Also refer to CT Neck and Chest on 01/23/2021. The heart is
enlarged with a leftward emphasis, but there are no signs of acute
congestion. Extensive consolidation projecting onto the right mid-field,
with a long-term trend toward regression but still clearly demarcated.
No pneumothorax. No pleural effusion. Known lymph nodes in the
mediastinum/hilum. Degenerative spinal changes.
**Neck/Chest CT on 02/23/21:** Slightly regressive/nodular fibrosing
infiltrate in the right upper lobe and adjacent central lower lobe with
continuing significant residual findings. Within the infiltrate, larger
poorly perfused areas with cavitations and scarred bronchiectasis.
Increasing, partly patchy densities on the left basal region,
differential diagnoses include infiltrates and ventilation disorders.
Essentially constant cervical, mediastinal, and hilar lymphadenopathy.
Constant liver lesions in the upper abdomen, differential diagnoses
include TB manifestations and cystic changes.
**CT Neck/Chest/Abdomen/Pelvis from 06/12/2021**: CT from 02/23/2021
available for comparison. Neck/Chest: Improved right upper lobe (ROL)
ventilation with regressive necrotic TB manifestations peri-hilar, now
only with subtotal lobar atelectasis. Essentially stable necrotic lymph
node manifestations in the cervical, mediastinal, and right hilar
regions, for example, supraclavicular on the right (18 mm, previously
30.1 Im 21.2) or right paratracheal (18 mm, previously 30.1 Im 33.8).
Narrow right pleural effusion, same as before. No pneumothorax. Heart
size normal. No pericardial effusion. Abdomen: Mid-term stable hypodense
liver lesions (regressing since 07/2021).
**Treatment and Progression:** Due to the extensive findings and the
untreatable immunocompromising underlying condition, we decided to
switch from a four-drug TB therapy to a three-drug therapy after nearly
3 months. In addition to rifampicin and isoniazid, levofloxacin was
initiated. Despite very good therapy adherence, acid-fast bacilli
continued to be detected microscopically in sputum samples without
culture confirmation of mycobacteria, even after discharge. Furthermore,
the radiological findings worsened. In April 2020, liver lesions were
identified in the CT that had not been described up to that point, and
pulmonary and mediastinal changes increased. Clinically, right cervical
lymphadenopathy also progressed in size. Due to a possible immune
reaction, a therapy with prednisolone was attempted for several weeks,
which did not lead to improvement. In June 2020, Mr. Hurley was
readmitted for bronchoscopy with BAL and EBUS-guided biopsy to rule out
differential diagnoses. An NTM-NGS-PCR was performed on the BAL, which
did not detect DNA from nontuberculous mycobacteria. Histologically,
predominantly necrotic material was found in the lymph node tissue, and
molecular pathological analysis detected DNA from the M. tuberculosis
complex. There were no indications of malignancy. In addition,
whole-genome sequencing of the most recently cultured mycobacteria was
performed, and latent resistance genes were also ruled out. Other
pathogens, including fungi, were likewise not detected. Aspergillus
antigen in BAL and serum was also negative. We continued the three-drug
therapy with Rifampicin, Isoniazid, and Levofloxacin. Mr. Hurley
developed an increasing need for red blood cell transfusions due to
myelodysplastic syndrome and began receiving regular transfusions from
his outpatient hematologist-oncologist in the summer of 2020. In a
repeat CT control in October 2020, increasing necrotic breakdown of the
right upper and middle lobes was observed, as well as progressive
ipsilateral pleural effusion and persistent mediastinal lymphadenopathy
and liver lesions. Mr. Hurley was referred to the immunology colleagues
to discuss additional immunological treatment options. After extensive
immune deficiency assessment, a low basal interferon-gamma level was
noted in the setting of lymphopenia due to MDS. In an immunological
conference, the patient was thoroughly discussed, and a trial of
interferon-gamma therapy in addition to antituberculous therapy was
discussed due to a low basal interferon-gamma level and a negative
Quantiferon test. After approval of an off-label application, we began
Actimmune® injections in January 2021 after extensive patient education.
Mr. Hurley learned to self-administer the subcutaneous injections and
initially tolerated the treatment well. Due to continuous worsening of
the blood count, a bone marrow puncture was performed again on an
outpatient basis by the attending hematologist-oncologist, and secondary
AML was diagnosed. Since February 2021, Mr. Hurley has received
Azacitidine and regular red blood cell and platelet concentrates. After
3 months of Actimmune® therapy, sputum no longer showed acid-fast
bacilli in March 2021, and radiologically, the left pleural effusion had
completely regressed, and the infiltrates had decreased. Actimmune® was
discontinued after 3 months. Towards the end of Actimmune® therapy, Mr.
Hurley developed pronounced shoulder arthralgia and pain in the upper
thoracic spine. Fractures were ruled out. With pain therapy, the pain
became tolerable and gradually improved. Arthralgia and myalgia are
common side effects of interferon-gamma. Due to the demonstrable
therapeutic response, we presented Mr. Hurley, along with an
interpreter, at the Department of Hematology and Oncology to discuss
further therapeutic options for AML in the context of the hematological
and infectious disease situation. After extensive explanation of the
disease situation, the risks of aggressive AML therapy in the presence
of unresolved tuberculosis, and the consequences of palliative AML
therapy. Mr. Hurley agreed to allogeneic stem cell transplantation after
some consideration. On an outpatient basis, the cytostatic therapy with
Azacitidine was expanded to include Venetoclax. Antituberculous therapy
with rifampicin, isoniazid, and levofloxacin was continued. Regular
sputum checks remained consistently microscopically negative until
complete AML remission was achieved. Mr. will be admitted for allogeneic
stem cell transplantation in July 2021. A repeat CT in June 2021
confirmed continued regression of the tuberculosis findings.
Antituberculous therapy will be continued indefinitely.
**CT Neck/Chest/Abdomen/Pelvis on 06/12/2022:** CT for comparison.
Neck/Chest: Improved right lung upper lobe ventilation with regressing
necrotic tuberculosis manifestations, now with only subtotal lobar
atelectasis. Essentially constant necrotic lymph node manifestations in
the cervical, mediastinal, and right hilar regions, as exemplified by
the right supraclavicular (18 mm, SE 301 HU 212) or right paratracheal
(18 mm, SE 301 HU 338) nodes. Narrow pleural effusion on the right,
likewise. No pneumothorax. The heart is not enlarged. No pericardial
effusion. Abdomen: Medium-term constant hypodense liver lesions
(regressing)
**Current Recommendations:** Continue antituberculous therapy without a
defined endpoint. Sputum checks during allogeneic stem cell
transplantation every 1-2 weeks. In case of clinical signs of persistent
infection, perform early CT scans of the neck, chest, and abdomen.
Follow-up appointment in our infectious diseases outpatient clinic after
allogeneic stem cell transplantation.
|
Azacitidine
|
Why didn’t David awaken the woman first?
A. He had amnesia and forgot.
B. She was important to the mission.
C. He stumbled and hurt himself.
D. He found her beautiful and didn’t want to harm her.
|
CAPTAIN CHAOS By D. ALLEN MORRISSEY Science equipped David Corbin with borrowed time; sent him winging out in a state of suspension to future centuries ... to a dark blue world whose only defense was to seal tight the prying minds of foolish interlopers. [Transcriber's Note: This etext was produced from Planet Stories November 1952. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] I heard the voice as I opened my eyes. I was lying down, still not aware of where I was, waiting for the voice. "Your name is David Corbin. Do you understand?" I looked in the direction of the sound. Above my feet a bulkhead loomed. There were round dials set in a row above a speaker. Over the mesh-covered speaker, two knobs glowed red. I ran the words over in my sluggish mind, thinking about an answer. The muscles in my throat tightened up in reflex as I tried to bring some unity into the jumble of thoughts and ideas that kept forming. One word formed out of the rush of anxiety. "No." I shouted a protest against the strangeness of the room. I looked to the right, my eyes following the curving ceiling that started at the cot. The curve met another straight bulkhead on the left. I was in a small room, gray in color, like dull metal. Overhead a bright light burned into my vision. I wondered where in the universe I was. "Your name is David Corbin. If you understand, press button A on your right." I stared at the speaker in the wall. The mesh-covered hole and the two lights looked like a caricature of a face, set in a panel of dials. I twisted my head to look for the button. I pushed away from the close wall but I couldn't move. I reached down to the tightness that held my body, found the wide strap that held me and fumbled with the buckle. I threw it off and pushed myself up from the hard cot. I heard myself yell in surprise as I floated up towards the light overhead. I was weightless. How do you describe being weightless when you are born into a world bound by gravity. I twisted and shut my eyes in terror. There was no sensation of place, no feeling of up or down, no direction. My back bumped against the ceiling and I opened my eyes to stare at the cot and floor. I was concentrating too hard on remembering to be frightened for long. I pushed away from the warm metal and the floor moved up to meet me. "If you understand, press button A on your right." What should I understand? That I was floating in a room that had a curved wall ... that nothing was right in this hostile room? When I reached the cot I held it and drew myself down. I glanced at the planes of the room, trying to place it with other rooms I could see in my mind. Gray walls with a crazy curved ceiling ... a door to my left that appeared to be air tight. I stared at my familiar hands. I rubbed them across my face, feeling the solidity of flesh and bone, afraid to think too hard about myself. "My name ... my name is...." "Your name is David Corbin." I stared at the speaker. How long did this go on? The name meant nothing to me, but I thought about it, watching the relentless lights that shone below the dials. I stood up slowly and looked at myself. I was naked except for heavy shorts, and there was no clue to my name in the pockets. The room was warm and the air I had been breathing was good but it seemed wrong to be dressed like this. I didn't know why. I thought about insanity, and the room seemed to fit my thoughts. When the voice repeated the message again I had to act. Walking was like treading water that couldn't be seen or felt. I floated against the door, twisting the handle in fear that it wouldn't turn. The handle clanged as I pushed it down and I stared at the opposite wall of a narrow gray passageway. I pushed out into it and grasped the metal rail that ran along the wall. I reasoned it was there to propel yourself through the passageway in this weightless atmosphere. It was effortless to move. I turned on my side like a swimmer and went hand over hand, shooting down the corridor. I braced against forward motion and stopped against a door at the end. Behind me I could see the opened door I had left, and the thought of that questioning voice made me want to move. I swung the door open, catching a glimpse of a room crowded with equipment and.... I will always remember the scream of terror, the paralyzing fright of what I saw through the portholes in the wall of the room. I saw the blackest night, pierced by brilliance that blinded me. There was no depth to the searing brightness of countless stars. They seemed to press against the glass, blobs of fire against a black curtain burning into my eyes and brain. It was space. I looked out at deep space, star systems in clusters. I shut my eyes. When I looked again I knew where I was. Why the little room had been shaped like quarter round. Why I drifted weightlessly. Why I was.... David Corbin. I knew more of the puzzle. Something was wrong. After the first shock of looking out, I accepted the fact that I was in a space ship, yet I couldn't read the maps that were fastened to a table, nor understand the function or design of the compact machinery. WHY, Why, Why? The thought kept pounding at me. I was afraid to touch anything in the room. I pressed against the clear window, wondering if the stars were familiar. I had a brief vivid picture of a night sky on Earth. This was not the same sky. Back in the room where I had awakened, I touched the panel with the glowing eyes. It had asked me if I understood. Now it must tell me why I didn't. It had to help me, that flat metallic voice that repeated the same words. It must tell me.... "Your name is David Corbin. If you understand, press button A on your right." I pressed the button by the cot. The red lights blinked out as I stood in patient attention, trying to outguess the voice. I recalled a phrase ... some words about precaution. Precaution against forgetting. It was crazy, but I trusted the panel. It was the only thing I saw that could help me, guard me against another shock like seeing outside of the clear portholes. "It is assumed the experiment is a success," the voice said. What experiment? "You have been removed from suspension. Assume manual control of this ship." Control of a ship? Going where? "Do not begin operations until the others are removed from suspension." What others? Tell me what to do. "Rely on instructions for factoring when you check the coordinates. Your maximum deviation from schedule cannot exceed two degrees. Adopt emergency procedures as you see fit. Good luck." The voice snapped off and I laughed hysterically. None of it had made sense, and I cursed whatever madness had put me here. "Tell me what to do," I shouted wildly. I hammered the hard metal until the pain in my hands made me stop. "I can't remember what to do." I held my bruised hands to my mouth, and I knew that was all the message there was. In blind panic I pushed away from the panel. Something tripped me and I fell back in a graceless arc. I pushed away from the floor, barely feeling the pain in my leg, and went into the hall. Pain burned along my leg but I couldn't stop. In the first panic of waking up in strangeness I had missed the other doors in the passage. The first swung back to reveal a deep closet holding five bulky suits. The second room was like my own. A dark haired, deep chested man lay on the cot. His muscular body was secured by a wide belt. He was as still as death, motionless without warmth or breath as I hovered over him. I couldn't remember his face. The next room held another man. He was young and wiry, like an athlete cast in marble, dark haired and big jawed. A glassy eye stared up when I rolled back his eyelid. The eyelid remained open until I closed it and went on. Another room ... another man ... another stranger. This man was tall and raw boned, light of skin and hair, as dead as the others. A flat, illogical voice had instructed me to revive these men. I shivered in spite of the warmth of the room, studying the black box that squatted on a shelf by his head. My hand shook when I touched the metal. I dared not try to operate anything. Revive the others ... instructions without knowledge were useless to me. I stopped looking into the doors in the passageway and went back to the room with the portholes. Everything lay in readiness, fastened down star charts, instruments, glittering equipment. There was no feeling of disorder or use in the room. It waited for human hands to make it operate. Not mine. Not now. I went past the room into another, where the curves were more sharp. I could visualize the tapering hull leading to the nose of the ship. This room was filled with equipment that formed a room out of the bordered area I stood in. I sat in the deep chair facing the panel of dials and instruments, in easy reach. I ran my hands over the dials, the rows of smooth colored buttons, wondering. The ports on the side were shielded and I stared out at static energy, hung motionless in a world of searing light. There was no distortion, no movement outside and I glanced back at the dials. What speeds were they recording? What speeds and perhaps, what distance? It was useless to translate the markings. They stood for anything I might guess, and something kept pricking my mind, telling me I had no time to guess. I thought of time again. I was supposed to act according to ... plan. Did that mean ... in time ... in time. I went back down the passageway. The fourth small room was the same. Except for the woman. She lay on a cot, young and beautiful, even in the death-like immobility I had come to accept. Her beauty was graceful lines of face and her figure—smooth tapering legs, soft curves that were carved out of flesh colored stone. Yet not stone. I held her small hand, then put it back on the cot. Her attire was brief like the rest of us, shorts and a man's shirt. Golden hair curled up around her lovely face. I wondered if she would ever smile or move that graceful head. I rolled back her eyelid and looked at a deep blue eye that stared back in glassy surprise. Four people in all, depending on a blind helpless fool who didn't know their names or the reason for that dependence. I sat beside her on the cot until I could stand it no longer. Searching the ship made me forget my fear. I hoped I would find some answers. I went from the nose to the last bulkhead in a frenzy of floating motion, looking behind each door until I went as far as I could. There were two levels to the ship. They both ended in the lead shield that was set where the swell of the curve was biggest. It meant the engine or engines took up half the ship, cut off from the forward half by the instrument studded shield. I retraced my steps and took a rough estimate of size. The ship, as I called it, was at least four hundred feet long, fifty feet in diameter on the inside. The silence was a force in itself, pressing down from the metal walls, driving me back to the comforting smallness of the room where I had been reborn. I laughed bitterly, thinking about the aptness of that. I had literally been reborn in this room, equipped with half ideas, and no point to start from, no premise to seek. I sensed the place to start from was back in the room. I searched it carefully. Minutes later I realized the apparatus by the cot was different. It was the same type of black box, but out from it was a metal arm, bent in a funny angle. At the tip of the arm, a needle gleamed dully and I rubbed the deep gash on my leg. I bent the arm back until the angle looked right. It was then I realized the needle came to a spot where it could have hit my neck when I lay down. My shout of excitement rang out in the room, as I pictured the action of the extended arm. I lost my sudden elation in the cabin where the girl lay. The box behind her head was completely closed, and it didn't yield to the pressure I applied. It had a cover, but no other opening where an arm could extend. I ran my fingers over the unbroken surface, prying over the thin crack at the base helplessly. If some sort of antidote was to be administered manually I was lost. I had no knowledge of what to inject or where to look for it. The chamber of the needle that had awakened me was empty. That meant a measured amount. In the laboratory on the lower level I went over the rows of cans and tubes fastened to the shelves. There were earths and minerals, seeds and chemicals, testing equipment in compact drawers, but nothing marked for me. I wondered if I was an engineer or a pilot, or perhaps a doctor sent along to safeguard the others. Complete amnesia would have been terrible enough but this half knowledge, part awareness and association with the ship was a frightening force that seemed ready to break out of me. I went back to the cabin where the powerful man lay. I had to risk failure with one of them. I didn't want it to be the girl. I fought down the thought that he might be the key man, remembering the voice that had given the message. It was up to me, and soon. The metal in the box would have withstood a bullet. It couldn't be pried apart, and I searched again and again for a release mechanism. I found it. I swung the massive cover off and set it down. The equipment waited for the touch of a button and it went into operation. I stepped back as the tubes glowed to life and the arm swung down with the gleaming needle. The needle went into the corded neck of the man. The fluid chamber drained under pressure and the arm moved back. I stood by the man for long minutes. Finally it came. He stirred restlessly, closing his hands into fists. The deep chest rose and fell unevenly as he breathed. Finally the eyes opened and he looked at me. I watched him adjust to the room. It was in his eyes, wide at first, moving about the confines of the room back to me. "It looks like we made it," he said. "Yes." He unfastened the belt and sat up. I pushed him back as he floated up finding little humor in the comic expression on his face. "No gravity," he grunted and sat back. "You get used to it fast," I answered. I thought of what to say as he watched me. "How do you feel?" He shrugged at the question. "Fine, I guess. Funny, I can't remember." He saw it in my face, making him stop. "I can't remember dropping off to sleep," he finished. I held his hard arm. "What else? How much do you remember?" "I'm all right," he answered. "There aren't supposed to be any effects from this." "Who is in charge of this ship?" I asked. He tensed suddenly. "You are, sir. Why?" I moved away from the cot. "Listen, I can't remember. I don't know your name or anything about this ship." "What do you mean? What can't you remember?" he asked. He stood up slowly, edging around towards the door. I didn't want to fight him. I wanted him to understand. "Look, I'm in trouble. Nothing fits, except my name." "You don't know me?" "No." "Are you serious?" "Yes, yes. I don't know why but it's happened." He let his breath out in a whistle. "For God's sake. Any bump on your head?" "I feel all right physically. I just can't place enough." "The others. What about the others?" he blurted. "I don't know. You're the first besides myself. I don't know how I stumbled on the way to revive you." He shook his head, watching me like I was a freak. "Let's check the rest right away." "Yes. I've got to know if they are like me. I'm afraid to think they might be." "Maybe it's temporary. We can figure something out." II The second man, the dark haired one, opened his eyes and recognized us. He asked questions in rapid fire excitement. The third man, the tall Viking, was all right until he moved. The weightless sensation made him violently sick. We put him back on the cot, securing him again with the belt, but the sight of us floating made him shake. He was retching without results when we drifted out. I followed him to the girl's quarters. "What about her. Why is she here?" I asked my companion. He lifted the cover from the apparatus. "She's the chemist in the crew." "A girl?" "Dr. Thiesen is an expert, trained for this," he said. I looked at her. She looked anything but like a chemist. "There must be men who could have been sent. I've been wondering why a girl." "I don't know why, Captain. You tried to stop her before. Age and experience were all that mattered to the brass." "It's a bad thing to do." "I suppose. The mission stated one chemist." "What is the mission of this ship?" I asked. He held up his hand. "We'd better wait, sir. Everything was supposed to be all right on this end. First you, then Carl, sick to his stomach." "Okay. I'll hold the questions until we see about her." We were out of luck with the girl. She woke up and she was frightened. We questioned her and she was coherent but she couldn't remember. I tried to smile as I sat on the cot, wondering what she was thinking. "How do you feel?" I asked. Her face was a mask of wide-eyed fear as she shook her head. "Can you remember?" "I don't know." Blue eyes stared at me in fear. Her voice was low. "Do you know my name?" The question frightened her. "Should I? I feel so strange. Give me a minute to think." I let her sit up slowly. "Do you know your name?" She tightened up in my arms. "Yes. It's...." She looked at us for help, frightened by the lack of clothing we wore, by the bleak room. Her eyes circled the room. "I'm afraid," she cried. I held her and she shook uncontrollably. "What's happened to me?" she asked. The dark haired man came into the room, silent and watchful. My companion motioned to him. "Get Carl and meet us in Control." The man looked at me and I nodded. "We'll be there in a moment. I'm afraid we've got trouble." He nodded and pushed away from us. The girl screamed and covered her face with her hands. I turned to the other man. "What's your name?" "Croft. John Croft." "John, what are your duties if any?" "Automatic control. I helped to install it." "Can you run this ship? How about the other two?" He hit his hands together. "You fly it, sir. Can't you think?" "I'm trying. I know the ship is familiar, but I've looked it over. Maybe I'm trying too hard." "You flew her from earth until we went into suspension," he said. "I can't remember when," I said. I held the trembling girl against me, shaking my head. He glanced at the girl. "If the calculations are right it was more than a hundred years ago." We assembled in the control room for a council. We were all a little better for being together. John Croft named the others for me. I searched each face without recognition. The blond man was Carl Herrick, a metallurgist. His lean face was white from his spell but he was better. Paul Sample was a biologist, John said. He was lithe and restless, with dark eyes that studied the rest of us. I looked at the girl. She was staring out of the ports, her hands pressed against the transparent break in the smooth wall. Karen Thiesen was a chemist, now frightened and trying to remember. I wasn't in much better condition. "Look, if it comes too fast for me, for any of us, we'll stop. John, you can lead off." "You ask the questions," he said. I indicated the ship. "Where in creation are we going?" "We set out from Earth for a single star in the direction of the center of our Galaxy." "From Earth? How could we?" "Let's move slowly, sir," he said. "We're moving fast. I don't know if you can picture it, but we're going about one hundred thousand miles an hour." "Through space?" "Yes." "What direction?" Paul cut in. "It's a G type star, like our own sun in mass and luminosity. We hope to find a planetary system capable of supporting life." "I can't grasp it. How can we go very far in a lifetime?" "It can be done in two lifetimes," John said quietly. "You said I had flown this ship. You meant before this suspension." "Yes. That's why we can cross space to a near star." "How long ago was it?" "It was set at about a hundred years, sir. Doesn't that fit at all?" "I can't believe it's possible." Carl caught my eye. "Captain, we save this time without aging at all. It puts us near a calculated destination." "We've lost our lifetime." It was Karen. She had been crying silently while we talked. "Don't think about it," Paul said. "We can still pull this out all right if you don't lose your nerve." "What are we to do?" she asked. John answered for me. "First we've got to find out where we are. I know this ship but I can't fly it." "Can I?" I asked. We set up a temporary plan of action. Paul took Karen to the laboratory in an effort to help her remember her job. Carl went back to divide the rations. I was to study the charts and manuals. It was better than doing nothing, and I went into the navigation room and sat down. Earth was an infinitesimal point somewhere behind us on the galactic plane, and no one else was trained to navigate. The ship thundered to life as I sat there. The blast roared once ... twice, then settled into a muted crescendo of sound that hummed through the walls. I went into the control room and watched John at the panel. "I wish I knew what you were doing," I said savagely. "Give it time." "We can't spare any, can we?" I asked. "I wish we knew. What about her—Dr. Thiesen?" "She's in the lab. I don't think that will do much good. She's got to be shocked out of a mental state like that." "I guess you're right," he said slowly. "She's trained to administer the suspension on the return trip." I let my breath out slowly. "I didn't think about that." "We couldn't even get part way back in a lifetime," he said. "How old are you, John?" "Twenty-eight." "What about me?" "Thirty." He stared at the panel in thought for a minutes. "What about shock treatment? It sounds risky." "I know. It's the only thing I could think of. Why didn't everyone react the same?" "That had me wondering for a while. I don't know. Anyway how could you go about making her remember?" "Throw a crisis, some situation at her, I guess." He shrugged, letting his sure hands rest on the panel of dials. I headed back towards the lab. If I could help her I might help myself. I was past the rooms when the horn blasted through the corridor. I turned automatically with the sound, pushing against the rail, towards the control room. Deep in my mind I could see danger, and without questioning why I knew I had to be at Control when the sound knifed through the stillness. John was shouting as I thrust my way into the room. "Turn the ship. There's something dead ahead." I had a glimpse of his contorted face as I dove at the control board. My hands hit buttons, thumbed a switch and then a sudden force threw me to the right. I slammed into the panel on the right, as the pressure of the change dimmed my vision. Reflex made me look up at the radar control screen. It wasn't operating. John let go of the padded chair, grinning weakly. I was busy for a few seconds, feeding compensation into the gyros. Relief flooded through me like warm liquid. I hung on the intercom for support, drawing air into my heaving lungs. "What—made you—think of that," I asked weakly. "Shock treatment." "I must have acted on instinct." "You did. Even for a sick man that was pretty fast," he laughed. "I can think again, John. I know who I am," I shouted. I threw my arms around his massive shoulders. "You did it." "You gave me the idea, Mister, talking about Dr. Thiesen." "It worked. I'm okay," I said in giddy relief. "I don't have to tell you I was scared as hell. I wish you could have seen your face, the look in your eyes when I woke up." "I wouldn't want to wake up like that again." "You're all right now?" he asked. I grinned and nodded an answer. I saw John as he was at the base, big and competent, sweating in the blazing sun. I thought about the rest of the crew too. "We're heading right for a star...." "It's been dead ahead for hours," he grunted. I leaned over and threw the intercom to open. "This is control. Listen ... everyone. I'm over it. Disregard the warning siren ... we were testing the ship." The lab light blinked on as Paul cut in. "What was it ... hey, you said you're all right." "John did it. He hit the alarm figuring I would react. Listen, Paul. Is any one hurt?" "No. Carl is here too. His stomach flopped again but he's okay. What about food. We're supposed to be checked before we eat." "We'll have to go ahead without it. Any change?" "No, I put her to bed. Shall I bring food?" I glanced at John. He rubbed his stomach. "Yes," I answered. "Bring it when you can. I've got to find out where we are." We had to get off course before we ran into the yellow-white star that had been picked for us. Food was set down by me, grew cold and was carried away and I was still rechecking the figures. We were on a line ten degrees above the galactic plane. The parallactic baseline from Earth to the single star could be in error several degrees, or we could be right on the calculated position of the star. The radar confirmed my findings ... and my worst fears. When we set it for direction and distance, the screen glowed to life and recorded the star dead ahead. In all the distant star clusters, only this G type star was thought to have a planetary system like our own. We were out on a gamble to find a planet capable of supporting life. The idea had intrigued scientists before I had first looked up at the night sky. When I was sure the electronically recorded course was accurate for time, I checked direction and speed from the readings and plotted our position. If I was right we were much closer than we wanted to be. The bright pips on the screen gave us the distance and size of the star while we fed the figures into the calculator for our rate of approach. Spectroscopic tests were run on the sun and checked against the figures that had been calculated on Earth. We analyzed temperature, magnetic fields, radial motion, density and luminosity, checking against the standards the scientists had constructed. It was a G type star like our own. It had more density and temperature and suitable planets or not, we had to change course in a hurry. Carl analyzed the findings while we came to a decision. Somewhere along an orbit that might be two hundred miles across, our hypothetical planet circled this star. That distance was selected when the planets in Earth's solar system had proved to be barren. If the observations on this star were correct, we could expect to find a planet in a state of fertility ... if it existed ... if it were suitable for colonization ... if we could find it.
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D. He found her beautiful and didn’t want to harm her.
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What is a major theme of the story?
A. Placebos can be just as powerful as engineered medications and cures
B. Not every illness should be cured through a western, pathology-focused approach to healing
C. The more people believe there is something 'wrong' with them, the greater lengths they will go to hide or repair their 'flaws'
D. Sometimes a 'cure' can end up causing more distress and pain than living with an affliction
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Name Your Symptom By JIM HARMON Illustrated by WEISS [Transcriber's Note: This etext was produced from Galaxy Science Fiction May 1956. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Anybody who shunned a Cure needed his head examined—assuming he had one left! Henry Infield placed the insulated circlet on his head gently. The gleaming rod extended above his head about a foot, the wires from it leading down into his collar, along his spine and finally out his pants leg to a short metallic strap that dragged on the floor. Clyde Morgan regarded his partner. "Suppose—just suppose—you were serious about this, why not just the shoes?" Infield turned his soft blue eyes to the black and tan oxfords with the very thick rubber soles. "They might get soaked through." Morgan took his foot off the chair behind the desk and sat down. "Suppose they were soaked through and you were standing on a metal plate—steps or a manhole cover—what good would your lightning rod do you then?" Infield shrugged slightly. "I suppose a man must take some chances." Morgan said, "You can't do it, Henry. You're crossing the line. The people we treat are on one side of the line and we're on the other. If you cross that line, you won't be able to treat people again." The small man looked out the large window, blinking myopically at the brassy sunlight. "That's just it, Clyde. There is a line between us, a wall. How can we really understand the people who come to us, if we hide on our side of the wall?" Morgan shook his thick head, ruffling his thinning red hair. "I dunno, Henry, but staying on our side is a pretty good way to keep sane and that's quite an accomplishment these days." Infield whirled and stalked to the desk. "That's the answer! The whole world is going mad and we are just sitting back watching it hike along. Do you know that what we are doing is really the most primitive medicine in the world? We are treating the symptoms and not the disease. One cannibal walking another with sleeping sickness doesn't cure anything. Eventually the savage dies—just as all those sick savages out in the street will die unless we can cure the disease, not only the indications." Morgan shifted his ponderous weight uneasily. "Now, Henry, it's no good to talk like that. We psychiatrists can't turn back the clock. There just aren't enough of us or enough time to give that old-fashioned therapy to all the sick people." Infield leaned on the desk and glared. "I called myself a psychiatrist once. But now I know we're semi-mechanics, semi-engineers, semi-inventors, semi lots of other things, but certainly not even semi-psychiatrists. A psychiatrist wouldn't give a foetic gyro to a man with claustrophobia." His mind went back to the first gyro ball he had ever issued; the remembrance of his pride in the thing sickened him. Floating before him in memory was the vertical hoop and the horizontal hoop, both of shining steel-impervium alloy. Transfixed in the twin circles was the face of the patient, slack with smiles and sweat. But his memory was exaggerating the human element. The gyro actually passed over a man's shoulder, through his legs, under his arms. Any time he felt the walls creeping in to crush him, he could withdraw his head and limbs into the circle and feel safe. Steel-impervium alloy could resist even a nuclear explosion. The foetic gyro ball was worn day and night, for life. The sickness overcame him. He sat down on Morgan's desk. "That's just one thing, the gyro ball. There are so many others, so many." Morgan smiled. "You know, Henry, not all of our Cures are so—so—not all are like that. Those Cures for mother complexes aren't even obvious. If anybody does see that button in a patient's ear, it looks like a hearing aid. Yet for a nominal sum, the patient is equipped to hear the soothing recorded voice of his mother saying, 'It's all right, everything's all right, Mommy loves you, it's all right....'" "But is everything all right?" Infield asked intensely. "Suppose the patient is driving over one hundred on an icy road. He thinks about slowing down, but there's the voice in his ear. Or suppose he's walking down a railroad track and hears a train whistle—if he can hear anything over that verbal pablum gushing in his ear." Morgan's face stiffened. "You know as well as I do that those voices are nearly subsonic. They don't cut a sense efficiency more than 23 per cent." "At first, Clyde—only at first. But what about the severe case where we have to burn a three-dimensional smiling mother-image on the eyes of the patient with radiation? With that image over everything he sees and with that insidious voice drumming in his head night and day, do you mean to say that man's senses will only be impaired 23 per cent? Why, he'll turn violently schizophrenic sooner or later—and you know it. The only cure we have for that is still a strait jacket, a padded cell or one of those inhuman lobotomies." Morgan shrugged helplessly. "You're an idealist." "You're damned right!" Infield slammed the door behind him. The cool air of the street was a relief. Infield stepped into the main stream of human traffic and tried to adjust to the second change in the air. People didn't bathe very often these days. He walked along, buffeted by the crowd, carried along in this direction, shoved back in that direction. Most people in the crowd seemed to be Normals, but you couldn't tell. Many "Cures" were not readily apparent. A young man with black glasses and a radar headset (a photophobe) was unable to keep from being pushed against Infield. He sounded out the lightning rod, his face changing when he realized it must be some kind of Cure. "Pardon me," he said warmly. "Quite all right." It was the first time in years that anyone had apologized to Infield for anything. He had been one of those condemned Normals, more to be scorned than pitied. Perhaps he could really get to understand these people, now that he had taken down the wall. Suddenly something else was pushing against Infield, forcing the air from his lungs. He stared down at the magnetic suction dart clinging leechlike to his chest. Model Acrophobe 101-X, he catalogued immediately. Description: safety belt. But his emotions didn't behave so well. He was thoroughly terrified, heart racing, sweat glands pumping. The impervium cable undulated vulgarly. Some primitive fear of snake symbols? his mind wondered while panic crushed him. "Uncouple that cable!" the shout rang out. It was not his own. A clean-cut young man with mouse-colored hair was moving toward the stubble-chinned, heavy-shouldered man quivering in the center of a web of impervium cables stuck secure to the walls and windows of buildings facing the street, the sidewalk, a mailbox, the lamp post and Infield. Mouse-hair yelled hoarsely, "Uncouple it, Davies! Can't you see the guy's got a lightning rod? You're grounding him! "I can't," Davies groaned. "I'm scared!" Halfway down the twenty feet of cable, Mouse-hair grabbed on. "I'm holding it. Release it, you hear?" Davies fumbled for the broad belt around his thickening middle. He jabbed the button that sent a negative current through the cable. The magnetic suction dart dropped away from Infield like a thing that had been alive and now was killed. He felt an overwhelming sense of relief. After breathing deeply for a few moments, he looked up to see Davies releasing and drawing all his darts into his belt, making it resemble a Hydra-sized spiked dog collar. Mouse-hair stood by tensely as the crowd disassembled. "This isn't the first time you've pulled something like this, Davies," he said. "You weren't too scared to release that cable. You just don't care about other people's feelings. This is official ." Mouse-hair drove a fast, hard right into the soft blue flesh of Davies' chin. The big man fell silently. The other turned to Infield. "He was unconscious on his feet," he explained. "He never knew he fell." "What did you mean by that punch being official?" Infield asked while trying to arrange his feelings into the comfortable, familiar patterns. The young man's eyes almost seemed to narrow, although his face didn't move; he merely radiated narrowed eyes. "How long have you been Cured?" "Not—not long," Infield evaded. The other glanced around the street. He moistened his lips and spoke slowly. "Do you think you might be interested in joining a fraternal organization of the Cured?" Infield's pulse raced, trying to get ahead of his thoughts, and losing out. A chance to study a pseudo-culture of the "Cured" developed in isolation! "Yes, I think I might. I owe you a drink for helping me out. How about it?" The man's face paled so fast, Infield thought for an instant that he was going to faint. "All right. I'll risk it." He touched the side of his face away from the psychiatrist. Infield shifted around, trying to see that side of his benefactor, but couldn't manage it in good grace. He wondered if the fellow was sporting a Mom-voice hearing aid and was afraid of raising her ire. He cleared his throat, noticing the affectation of it. "My name's Infield." "Price," the other answered absently. "George Price. I suppose they have liquor at the Club. We can have a drink there, I guess." Price set the direction and Infield fell in at his side. "Look, if you don't drink, I'll buy you a cup of coffee. It was just a suggestion." Under the mousy hair, Price's strong features were beginning to gleam moistly. "You are lucky in one way, Mr. Infield. People take one look at your Cure and don't ask you to go walking in the rain. But even after seeing this , some people still ask me to have a drink." This was revealed, as he turned his head, to be a small metal cube above his left ear. Infield supposed it was a Cure, although he had never issued one like it. He didn't know if it would be good form to inquire what kind it was. "It's a cure for alcoholism," Price told him. "It runs a constant blood check to see that the alcohol level doesn't go over the sobriety limit." "What happens if you take one too many?" Price looked off as if at something not particularly interesting, but more interesting than what he was saying. "It drives a needle into my temple and kills me." The psychiatrist felt cold fury rising in him. The Cures were supposed to save lives, not endanger them. "What kind of irresponsible idiot could have issued such a device?" he demanded angrily. "I did," Price said. "I used to be a psychiatrist. I was always good in shop. This is a pretty effective mechanism, if I say so myself. It can't be removed without causing my death and it's indestructible. Impervium-shielded, you see." Price probably would never get crazed enough for liquor to kill himself, Infield knew. The threat of death would keep him constantly shocked sane. Men hide in the comforts of insanity, but when faced with death, they are often forced back to reality. A man can't move his legs; in a fire, though, he may run. His legs were definitely paralyzed before and may be again, but for one moment he would forget the moral defeat of his life and his withdrawal from life and live an enforced sanity. But sometimes the withdrawal was—or could become—too complete. "We're here." Infield looked up self-consciously and noticed that they had crossed two streets from his building and were standing in front of what appeared to be a small, dingy cafe. He followed Price through the screeching screen door. They seated themselves at a small table with a red-checked cloth. Infield wondered why cheap bars and restaurants always used red-checked cloths. Then he looked closer and discovered the reason. They did a remarkably good job of camouflaging the spots of grease and alcohol. A fat man who smelled of the grease and alcohol of the tablecloths shuffled up to them with a towel on his arm, staring ahead of him at some point in time rather than space. Price lit a cigarette with unsteady hands. "Reggie is studying biblical text. Cute gadget. His contact lenses are made up of a lot of layers of polarized glass. Every time he blinks, the amount of polarization changes and a new page appears. His father once told him that if he didn't study his Bible and pray for him, his old dad would die." The psychiatrist knew the threat on the father's part couldn't create such a fixation by itself. His eyebrows faintly inquired. Price nodded jerkily. "Twenty years ago, at least." "What'll you have, Georgie?" Reggie asked. The young man snubbed out his cigarette viciously. "Bourbon. Straight." Reggie smiled—a toothy, vacant, comedy-relief smile. "Fine. The Good Book says a little wine is good for a man, or something like that. I don't remember exactly." Of course he didn't, Infield knew. Why should he? It was useless to learn his Bible lessons to save his father, because it was obvious his father was dead. He would never succeed because there was no reason to succeed. But he had to try, didn't he, for his father's sake? He didn't hate his father for making him study. He didn't want him to die. He had to prove that. Infield sighed. At least this device kept the man on his feet, doing some kind of useful work instead of rotting in a padded cell with a probably imaginary Bible. A man could cut his wrists with the edge of a sheet of paper if he tried long enough, so of course the Bible would be imaginary. "But, Georgie," the waiter complained, "you know you won't drink it. You ask me to bring you drinks and then you just look at them. Boy, do you look funny when you're looking at drinks. Honest, Georgie, I want to laugh when I think of the way you look at a glass with a drink in it." He did laugh. Price fumbled with the cigarette stub in the black iron ashtray, examining it with the skill of scientific observation. "Mr. Infield is buying me the drink and that makes it different." Reggie went away. Price kept dissecting the tobacco and paper. Infield cleared his throat and again reminded himself against such obvious affectations. "You were telling me about some organization of the Cured," he said as a reminder. Price looked up, no longer interested in the relic of a cigarette. He was suddenly intensely interested and intensely observant of the rest of the cafe. "Was I? I was? Well, suppose you tell me something. What do you really think of the Incompletes?" The psychiatrist felt his face frown. "Who?" "I forgot. You haven't been one of us long. The Incompletes is a truer name for the so-called Normals. Have you ever thought of just how dangerous these people are, Mr. Infield?" "Frankly, no," Infield said, realizing it was not the right thing to say but tiring of constant pretense. "You don't understand. Everyone has some little phobia or fixation. Maybe everyone didn't have one once, but after being told they did have them for generations, everyone who didn't have one developed a defense mechanism and an aberration so they would be normal. If that phobia isn't brought to the surface and Cured, it may arise any time and endanger other people. The only safe, good sound citizens are Cured. Those lacking Cures—the Incompletes— must be dealt with ." Infield's throat went dry. "And you're the one to deal with them?" "It's my Destiny." Price quickly added, "And yours, too, of course." Infield nodded. Price was a demagogue, young, handsome, dynamic, likable, impassioned with his cause, and convinced that it was his divine destiny. He was a psychopathic egotist and a dangerous man. Doubly dangerous to Infield because, even though he was one of the few people who still read books from the old days of therapy to recognize Price for what he was, he nevertheless still liked the young man for the intelligence behind the egotism and the courage behind the fanaticism. "How are we going to deal with the Incompletes?" Infield asked. Price started to glance around the cafe, then half-shrugged, almost visibly thinking that he shouldn't run that routine into the ground. "We'll Cure them whether they want to be Cured or not—for their own good." Infield felt cold inside. After a time, he found that the roaring was not just in his head. It was thundering outside. He was getting sick. Price was the type of man who could spread his ideas throughout the ranks of the Cured—if indeed the plot was not already universal, imposed upon many ill minds. He could picture an entirely Cured world and he didn't like the view. Every Cure cut down on the mental and physical abilities of the patient as it was, whether Morgan and the others admitted it or not. But if everyone had a crutch to lean on for one phobia, he would develop secondary symptoms. People would start needing two Cures—perhaps a foetic gyro and a safety belt—then another and another. There would always be a crutch to lean on for one thing and then room enough to develop something else—until everyone would be loaded down with too many Cures to operate. A Cure was a last resort, dope for a malignancy case, euthanasia for the hopeless. Enforced Cures would be a curse for the individual and the race. But Infield let himself relax. How could anyone force a mechanical relief for neurotic or psychopathic symptoms on someone who didn't want or need it? "Perhaps you don't see how it could be done," Price said. "I'll explain." Reggie's heavy hand sat a straight bourbon down before Price and another before Infield. Price stared at the drink almost without comprehension of how it came to be. He started to sweat. "George, drink it." The voice belonged to a young woman, a blonde girl with pink skin and suave, draped clothes. In this den of the Cured, Infield thought half-humorously, it was surprising to see a Normal—an "Incomplete." But then he noticed something about the baby she carried. The Cure had been very simple. It wasn't even a mechanized half-human robot, just a rag doll. She sat down at the table. "George," she said, "drink it. One drink won't raise your alcohol index to the danger point. You've got to get over this fear of even the sight or smell of liquor." The girl turned to Infield. "You're one of us, but you're new, so you don't know about George. Maybe you can help if you do. It's all silly. He's not an alcoholic. He didn't need to put that Cure on his head. It's just an excuse for not drinking. All of this is just because a while back something happened to the baby here—" she adjusted the doll's blanket—"when he was drinking. Just drinking, not drunk. "I don't remember what happened to the baby—it wasn't important. But George has been brooding about it ever since. I guess he thinks something else bad will happen because of liquor. That's silly. Why don't you tell him it's silly?" "Maybe it is," Infield said softly. "You could take the shock if he downed that drink and the shock might do you good." Price laughed shortly. "I feel like doing something very melodramatic, like throwing my drink—and yours—across the room, but I haven't got the guts to touch those glasses. Do it for me, will you? Cauterizing the bite might do me good if I'd been bitten by a rabid dog, but I don't have the nerve to do it." Before Infield could move, Reggie came and set both drinks on a little circular tray. He moved away. "I knew it. That's all he did, just look at the drink. Makes me laugh." Price wiped the sweat off his palms. Infield sat and thought. Mrs. Price cooed to the rag doll, unmindful of either of them now. "You were explaining," the psychiatrist said. "You were going to tell me how you were going to Cure the Incompletes." "I said we were going to do it. Actually you will play a greater part than I, Doctor Infield." The psychiatrist sat rigidly. "You didn't think you could give me your right name in front of your own office building and that I wouldn't recognize you? I know some psychiatrists are sensitive about wearing Cures themselves, but it is a mark of honor of the completely sane man. You should be proud of your Cure and eager to Cure others. Very eager." "Just what do you mean?" He already suspected Price's meaning. Price leaned forward. "There is one phobia that is so wide-spread, a Cure is not even thought of—hypochondria. Hundreds of people come to your office for a Cure and you turn them away. Suppose you and the other Cured psychiatrists give everybody who comes to you a Cure?" Infield gestured vaguely. "A psychiatrist wouldn't hand out Cures unless they were absolutely necessary." "You'll feel differently after you've been Cured for a while yourself. Other psychiatrists have." Before Infield could speak, a stubble-faced, barrel-chested man moved past their table. He wore a safety belt. It was the man Price had called Davies, the one who had fastened one of his safety lines to Infield in the street. Davies went to the bar in the back. "Gimme a bottle," he demanded of a vacant-eyed Reggie. He came back toward them, carrying the bottle in one hand, brushing off rain drops with the other. He stopped beside Price and glared. Price leaned back. The chair creaked. Mrs. Price kept cooing to the doll. "You made me fall," Davies accused. Price shrugged. "You were unconscious. You never knew it." Sweat broke out on Davies' forehead. "You broke the Code. Don't you think I can imagine how it was to fall? You louse!" Suddenly, Davies triggered his safety belt. At close range, before the lines could fan out in a radius, all the lines in front attached themselves to Price, the ones at each side clung to their table and the floor, and all the others to the table behind Infield. Davies released all lines except those on Price, and then threw himself backward, dragging Price out of his chair and onto the floor. Davies didn't mind making others fall. They were always trying to make him fall just so they could laugh at him or pounce on him; why shouldn't he like to make them fall first? Expertly, Davies moved forward and looped the loose lines around Price's head and shoulders and then around his feet. He crouched beside Price and shoved the bottle into the gasping mouth and poured. Price twisted against the binding lines in blind terror, gagging and spouting whiskey. Davies laughed and tilted the bottle more. Mrs. Price screamed. "The Cure! If you get that much liquor in his system, it will kill him!" She rocked the rag doll in her arms, trying to soothe it, and stared in horror. Infield hit the big man behind the ear. He dropped the bottle and fell over sideways on the floor. Fear and hate mingled in his eyes as he looked up at Infield. Nonsense, Infield told himself. Eyes can't register emotion. Davies released his lines and drew them in. He got up precariously. "I'm going to kill you," he said, glaring at Infield. "You made me fall worse than Georgie did. I'm really going to kill you." Infield wasn't a large man, but he had pressed two hundred and fifty many times in gym. He grabbed Davies' belt with both hands and lifted him about six inches off the floor. "I could drop you," the psychiatrist said. "No!" Davies begged weakly. "Please!" "I'll do it if you cause more trouble." Infield sat down and rubbed his aching forearms. Davies backed off in terror, right into the arms of Reggie. The waiter closed his huge hands on the acrophobe's shoulders. " You broke the Code all the way," Reggie said. "The Good Book says 'Thou shouldn't kill' or something like that, and so does the Code." "Let him go, Reggie," Price choked out, getting to his feet. "I'm not dead." He wiped his hand across his mouth. "No. No, you aren't." Infield felt an excitement pounding through him, same as when he had diagnosed his first case. No, better than that. "That taste of liquor didn't kill you, Price. Nothing terrible happened. You could find some way to get rid of that Cure." Price stared at him as if he were a padded-cell case. "That's different. I'd be a hopeless drunk without the Cure. Besides, no one ever gets rid of a Cure." They were all looking at Infield. Somehow he felt this represented a critical point in history. It was up to him which turn the world took, the world as represented by these four Cured people. "I'm afraid I'm for less Cures instead of more, Price. Look, if I can show you that someone can discard a Cure, would you get rid of that—if I may use the word— monstrous thing on your head?" Price grinned. Infield didn't recognize its smugness at the time. "I'll show you." He took off the circlet with the lightning rod and yanked at the wire running down into his collar. The new-old excitement within was running high. He felt the wire snap and come up easily. He threw the Cure on the floor. "Now," he said, "I am going out in that rain storm. There's thunder and lightning out there. I'm afraid, but I can get along without a Cure and so can you." "You can't! Nobody can!" Price screamed after him. He turned to the others. "If he reveals us, the Cause is lost. We've got to stop him for good . We've got to go after him." "It's slippery," Davies whimpered. "I might fall." Mrs. Price cuddled her rag doll. "I can't leave the baby and she mustn't get wet." "Well, there's no liquor out there and you can study your text in the lightning flashes, Reggie. Come on." Running down the streets that were tunnels of shining tar, running into the knifing ice bristles of the rain, Henry Infield realized that he was very frightened of the lightning. There is no action without a reason, he knew from the old neglected books. He had had a latent fear of lightning when he chose the lightning rod Cure. He could have picked a safety belt or foetic gyro just as well. He sneezed. He was soaked through, but he kept on running. He didn't know what Price and Reggie planned to do when they caught him. He slipped and fell. He would soon find out what they wanted. The excitement was all gone now and it left an empty space into which fear rushed. Reggie said, "We shall make a sacrifice." Infield looked up and saw the lightning reflected on the blade of a thin knife. Infield reached toward it more in fascination than fear. He managed to get all his fingers around two of Reggie's. He jerked and the knife fell into Infield's palm. The psychiatrist pulled himself erect by holding to Reggie's arm. Staggering to his feet, he remembered what he must do and slashed at the waiter's head. A gash streaked across the man's brow and blood poured into his eyes. He screamed. "I can't see the words!" It was his problem. Infield usually solved other people's problems, but now he ran away—he couldn't even solve his own. Infield realized that he had gone mad as he held the thin blade high overhead, but he did need some kind of lightning rod. Price (who was right behind him, gaining) had been right. No one could discard a Cure. He watched the lightning play its light on the blade of his Cure and he knew that Price was going to kill him in the next moment. He was wrong. The lightning hit him first. Reggie squinted under the bandage at the lettering on the door that said INFIELD & MORGAN and opened the door. He ran across the room to the man sitting at the desk, reading by the swivel light. "Mr. Morgan, your partner, Mr. Infield, he—" "Just a moment." Morgan switched on the room lights. "What were you saying?" "Mr. Infield went out without his Cure in a storm and was struck by lightning. We took him to the morgue. He must have been crazy to go out without his Cure." Morgan stared into his bright desk light without blinking. "This is quite a shock to me. Would you mind leaving? I'll come over to your place and you can tell me about it later." Reggie went out. "Yes, sir. He was struck by lightning, struck dead. He must have been crazy to leave his Cure...." The door closed. Morgan exhaled. Poor Infield. But it wasn't the lightning that killed him, of course. Morgan adjusted the soundproofing plugs in his ears, thinking that you did have to have quite a bit of light to read lips. The thunder, naturally, was what had killed Infield. Loud noise—any noise—that would do it every time. Too bad Infield had never really stopped being one of the Incompletes. Dangerous people. He would have to deal with them.
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D. Sometimes a 'cure' can end up causing more distress and pain than living with an affliction
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After seeing Dr. Cobb, what isn't something Giles thought about doing?
A. volunteering to man the big ship
B. seeing another doctor for a second opinion
C. dating again
D. finding a new place to live
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The Dwindling Years He didn’t expect to be last—but neither did he anticipate the horror of being the first! By LESTER DEL REY Illustrated by JOHNS NEARLY TWO hundred years of habit carried the chairman of Exodus Corporation through the morning ritual of crossing the executive floor. Giles made the expected comments, smiled the proper smiles and greeted his staff by the right names, but it was purely automatic. Somehow, thinking had grown difficult in the mornings recently. Inside his private office, he dropped all pretense and slumped into the padding of his chair, gasping for breath and feeling his heart hammering in his chest. He’d been a fool to come to work, he realized. But with the Procyon shuttle arriving yesterday, there was no telling what might turn up. Besides, that fool of a medicist had sworn the shot would cure any allergy or asthma. Giles heard his secretary come in, but it wasn’t until the smell of the coffee reached his nose that he looked up. She handed him a filled cup and set the carafe down on the age-polished surface of the big desk. She watched solicitously as he drank. “That bad, Arthur?” she asked. “Just a little tired,” he told her, refilling the cup. She’d made the coffee stronger than usual and it seemed to cut through some of the thickness in his head. “I guess I’m getting old, Amanda.” She smiled dutifully at the time-worn joke, but he knew she wasn’t fooled. She’d cycled to middle age four times in her job and she probably knew him better than he knew himself—which wouldn’t be hard, he thought. He’d hardly recognized the stranger in the mirror as he tried to shave. His normal thinness had looked almost gaunt and there were hollows in his face and circles under his eyes. Even his hair had seemed thinner, though that, of course, was impossible. “Anything urgent on the Procyon shuttle?” he asked as she continue staring at him with worried eyes. SHE JERKED her gaze away guiltily and turned to the incoming basket. “Mostly drugs for experimenting. A personal letter for you, relayed from some place I never heard of. And one of the super-light missiles! They found it drifting half a light-year out and captured it. Jordan’s got a report on it and he’s going crazy. But if you don’t feel well—” “I’m all right!” he told her sharply. Then he steadied himself and managed to smile. “Thanks for the coffee, Amanda.” She accepted dismissal reluctantly. When she was gone, he sat gazing at the report from Jordan at Research. For eighty years now, they’d been sending out the little ships that vanished at greater than the speed of light, equipped with every conceivable device to make them return automatically after taking pictures of wherever they arrived. So far, none had ever returned or been located. This was the first hope they’d found that the century-long trips between stars in the ponderous shuttles might be ended and he should have been filled with excitement at Jordan’s hasty preliminary report. He leafed through it. The little ship apparently had been picked up by accident when it almost collided with a Sirius-local ship. Scientists there had puzzled over it, reset it and sent it back. The two white rats on it had still been alive. Giles dropped the report wearily and picked up the personal message that had come on the shuttle. He fingered the microstrip inside while he drank another coffee, and finally pulled out the microviewer. There were three frames to the message, he saw with some surprise. He didn’t need to see the signature on the first projection. Only his youngest son would have sent an elaborate tercentenary greeting verse—one that would arrive ninety years too late! Harry had been born just before Earth passed the drastic birth limitation act and his mother had spoiled him. He’d even tried to avoid the compulsory emigration draft and stay on with his mother. It had been the bitter quarrels over that which had finally broken Giles’ fifth marriage. Oddly enough, the message in the next frame showed none of that. Harry had nothing but praise for the solar system where he’d been sent. He barely mentioned being married on the way or his dozen children, but filled most of the frame with glowing description and a plea for his father to join him there! GILES SNORTED and turned to the third frame, which showed a group picture of the family in some sort of vehicle, against the background of an alien but attractive world. He had no desire to spend ninety years cooped up with a bunch of callow young emigrants, even in one of the improved Exodus shuttles. And even if Exodus ever got the super-light drive working, there was no reason he should give up his work. The discovery that men could live practically forever had put an end to most family ties; sentiment wore thin in half a century—which wasn’t much time now, though it had once seemed long enough. Strange how the years seemed to get shorter as their number increased. There’d been a song once—something about the years dwindling down. He groped for the lines and couldn’t remember. Drat it! Now he’d probably lie awake most of the night again, trying to recall them. The outside line buzzed musically, flashing Research’s number. Giles grunted in irritation. He wasn’t ready to face Jordan yet. But he shrugged and pressed the button. The intense face that looked from the screen was frowning as Jordan’s eyes seemed to sweep around the room. He was still young—one of the few under a hundred who’d escaped deportation because of special ability—and patience was still foreign to him. Then the frown vanished as an expression of shock replaced it, and Giles felt a sinking sensation. If he looked that bad— But Jordan wasn’t looking at him; the man’s interest lay in the projected picture from Harry, across the desk from the communicator. “Antigravity!” His voice was unbelieving as he turned his head to face the older man. “What world is that?” Giles forced his attention on the picture again and this time he noticed the vehicle shown. It was enough like an old model Earth conveyance to pass casual inspection, but it floated wheellessly above the ground. Faint blur lines indicated it had been moving when the picture was taken. “One of my sons—” Giles started to answer. “I could find the star’s designation....” Jordan cursed harshly. “So we can send a message on the shuttle, begging for their secret in a couple of hundred years! While a hundred other worlds make a thousand major discoveries they don’t bother reporting! Can’t the Council see anything ?” Giles had heard it all before. Earth was becoming a backwater world; no real progress had been made in two centuries; the young men were sent out as soon as their first fifty years of education were finished, and the older men were too conservative for really new thinking. There was a measure of truth in it, unfortunately. “They’ll slow up when their populations fill,” Giles repeated his old answers. “We’re still ahead in medicine and we’ll get the other discoveries eventually, without interrupting the work of making the Earth fit for our longevity. We can wait. We’ll have to.” THE YOUNGER man stared at him with the strange puzzled look Giles had seen too often lately. “Damn it, haven’t you read my report? We know the super-light drive works! That missile reached Sirius in less than ten days. We can have the secret of this antigravity in less than a year! We—” “Wait a minute.” Giles felt the thickness pushing back at his mind and tried to fight it off. He’d only skimmed the report, but this made no sense. “You mean you can calibrate your guiding devices accurately enough to get a missile where you want it and back?” “ What? ” Jordan’s voice rattled the speaker. “Of course not! It took two accidents to get the thing back to us—and with a half-light-year miss that delayed it about twenty years before the Procyon shuttle heard its signal. Pre-setting a course may take centuries, if we can ever master it. Even with Sirius expecting the missiles and ready to cooperate. I mean the big ship. We’ve had it drafted for building long enough; now we can finish it in three months. We know the drive works. We know it’s fast enough to reach Procyon in two weeks. We even know life can stand the trip. The rats were unharmed.” Giles shook his head at what the other was proposing, only partly believing it. “Rats don’t have minds that could show any real damage such as the loss of power to rejuvenate. We can’t put human pilots into a ship with our drive until we’ve tested it more thoroughly, Bill, even if they could correct for errors on arrival. Maybe if we put in stronger signaling transmitters....” “Yeah. Maybe in two centuries we’d have a through route charted to Sirius. And we still wouldn’t have proved it safe for human pilots. Mr. Giles, we’ve got to have the big ship. All we need is one volunteer!” It occurred to Giles then that the man had been too fired with the idea to think. He leaned back, shaking his head again wearily. “All right, Bill. Find me one volunteer. Or how about you? Do you really want to risk losing the rest of your life rather than waiting a couple more centuries until we know it’s safe? If you do, I’ll order the big ship.” Jordan opened his mouth and for a second Giles’ heart caught in a flux of emotions as the man’s offer hovered on his lips. Then the engineer shut his mouth slowly. The belligerence ran out of him. He looked sick, for he had no answer. NO SANE man would risk a chance for near eternity against such a relatively short wait. Heroism had belonged to those who knew their days were numbered, anyhow. “Forget it, Bill,” Giles advised. “It may take longer, but eventually we’ll find a way. With time enough, we’re bound to. And when we do, the ship will be ready.” The engineer nodded miserably and clicked off. Giles turned from the blank screen to stare out of the windows, while his hand came up to twist at the lock of hair over his forehead. Eternity! They had to plan and build for it. They couldn’t risk that plan for short-term benefits. Usually it was too easy to realize that, and the sight of the solid, time-enduring buildings outside should have given him a sense of security. Today, though, nothing seemed to help. He felt choked, imprisoned, somehow lost; the city beyond the window blurred as he studied it, and he swung the chair back so violently that his hand jerked painfully on the forelock he’d been twisting. Then he was staring unbelievingly at the single white hair that was twisted with the dark ones between his fingers. Like an automaton, he bent forward, his other hand groping for the mirror that should be in one of the drawers. The dull pain in his chest sharpened and his breath was hoarse in his throat, but he hardly noticed as he found the mirror and brought it up. His eyes focused reluctantly. There were other white strands in his dark hair. The mirror crashed to the floor as he staggered out of the office. It was only two blocks to Giles’ residence club, but he had to stop twice to catch his breath and fight against the pain that clawed at his chest. When he reached the wood-paneled lobby, he was barely able to stand. Dubbins was at his side almost at once, with a hand under his arm to guide him toward his suite. “Let me help you, sir,” Dubbins suggested, in the tones Giles hadn’t heard since the man had been his valet, back when it was still possible to find personal servants. Now he managed the club on a level of quasi-equality with the members. For the moment, though, he’d slipped back into the old ways. GILES FOUND himself lying on his couch, partially undressed, with the pillows just right and a long drink in his hand. The alcohol combined with the reaction from his panic to leave him almost himself again. After all, there was nothing to worry about; Earth’s doctors could cure anything. “I guess you’d better call Dr. Vincenti,” he decided. Vincenti was a member and would probably be the quickest to get. Dubbins shook his head. “Dr. Vincenti isn’t with us, sir. He left a year ago to visit a son in the Centauri system. There’s a Dr. Cobb whose reputation is very good, sir.” Giles puzzled over it doubtfully. Vincenti had been an oddly morose man the last few times he’d seen him, but that could hardly explain his taking a twenty-year shuttle trip for such a slim reason. It was no concern of his, though. “Dr. Cobb, then,” he said. Giles heard the other man’s voice on the study phone, too low for the words to be distinguishable. He finished the drink, feeling still better, and was sitting up when Dubbins came back. “Dr. Cobb wants you to come to his office at once, sir,” he said, dropping to his knee to help Giles with his shoes. “I’d be pleased to drive you there.” Giles frowned. He’d expected Cobb to come to him. Then he grimaced at his own thoughts. Dubbins’ manners must have carried him back into the past; doctors didn’t go in for home visits now—they preferred to see their patients in the laboratories that housed their offices. If this kept on, he’d be missing the old days when he’d had a mansion and counted his wealth in possessions, instead of the treasures he could build inside himself for the future ahead. He was getting positively childish! Yet he relished the feeling of having Dubbins drive his car. More than anything else, he’d loved being driven. Even after chauffeurs were a thing of the past, Harry had driven him around. Now he’d taken to walking, as so many others had, for even with modern safety measures so strict, there was always a small chance of some accident and nobody had any desire to spend the long future as a cripple. “I’ll wait for you, sir,” Dubbins offered as they stopped beside the low, massive medical building. It was almost too much consideration. Giles nodded, got out and headed down the hall uncertainly. Just how bad did he look? Well, he’d soon find out. He located the directory and finally found the right office, its reception room wall covered with all the degrees Dr. Cobb had picked up in some three hundred years of practice. Giles felt better, realizing it wouldn’t be one of the younger men. COBB APPEARED himself, before the nurse could take over, and led Giles into a room with an old-fashioned desk and chairs that almost concealed the cabinets of equipment beyond. He listened as Giles stumbled out his story. Halfway through, the nurse took a blood sample with one of the little mosquito needles and the machinery behind the doctor began working on it. “Your friend told me about the gray hair, of course,” Cobb said. At Giles’ look, he smiled faintly. “Surely you didn’t think people could miss that in this day and age? Let’s see it.” He inspected it and began making tests. Some were older than Giles could remember—knee reflex, blood pressure, pulse and fluoroscope. Others involved complicated little gadgets that ran over his body, while meters bobbed and wiggled. The blood check came through and Cobb studied it, to go back and make further inspections of his own. At last he nodded slowly. “Hyper-catabolism, of course. I thought it might be. How long since you had your last rejuvenation? And who gave it?” “About ten years ago,” Giles answered. He found his identity card and passed it over, while the doctor studied it. “My sixteenth.” It wasn’t going right. He could feel it. Some of the panic symptoms were returning; the pulse in his neck was pounding and his breath was growing difficult. Sweat ran down his sides from his armpit and he wiped his palms against his coat. “Any particular emotional strain when you were treated—some major upset in your life?” Cobb asked. Giles thought as carefully as he could, but he remembered nothing like that. “You mean—it didn’t take? But I never had any trouble, Doctor. I was one of the first million cases, when a lot of people couldn’t rejuvenate at all, and I had no trouble even then.” Cobb considered it, hesitated as if making up his mind to be frank against his better judgment. “I can’t see any other explanation. You’ve got a slight case of angina—nothing serious, but quite definite—as well as other signs of aging. I’m afraid the treatment didn’t take fully. It might have been some unconscious block on your part, some infection not diagnosed at the time, or even a fault in the treatment. That’s pretty rare, but we can’t neglect the possibility.” HE STUDIED his charts again and then smiled. “So we’ll give you another treatment. Any reason you can’t begin immediately?” Giles remembered that Dubbins was waiting for him, but this was more important. It hadn’t been a joke about his growing old, after all. But now, in a few days, he’d be his old—no, of course not—his young self again! They went down the hall to another office, where Giles waited outside while Cobb conferred with another doctor and technician, with much waving of charts. He resented every second of it. It was as if the almost forgotten specter of age stood beside him, counting the seconds. But at last they were through and he was led into the quiet rejuvenation room, where the clamps were adjusted about his head and the earpieces were fitted. The drugs were shot painlessly into his arm and the light-pulser was adjusted to his brain-wave pattern. It had been nothing like this his first time. Then it had required months of mental training, followed by crude mechanical and drug hypnosis for other months. Somewhere in every human brain lay the memory of what his cells had been like when he was young. Or perhaps it lay in the cells themselves, with the brain as only a linkage to it. They’d discovered that, and the fact that the mind could effect physical changes in the body. Even such things as cancer could be willed out of existence—provided the brain could be reached far below the conscious level and forced to operate. There had been impossible faith cures for millenia—cataracts removed from blinded eyes within minutes, even—but finding the mechanism in the brain that worked those miracles had taken an incredible amount of study and finding a means of bringing it under control had taken even longer. Now they did it with dozens of mechanical aids in addition to the hypnotic instructions—and did it usually in a single sitting, with the full transformation of the body taking less than a week after the treatment! But with all the equipment, it wasn’t impossible for a mistake to happen. It had been no fault of his ... he was sure of that ... his mind was easy to reach ... he could relax so easily.... He came out of it without even a headache, while they were removing the probes, but the fatigue on the operator’s face told him it had been a long and difficult job. He stretched experimentally, with the eternal unconscious expectation that he would find himself suddenly young again. But that, of course, was ridiculous. It took days for the mind to work on all the cells and to repair the damage of time. COBB LED him back to the first office, where he was given an injection of some kind and another sample of his blood was taken, while the earlier tests were repeated. But finally the doctor nodded. “That’s all for now, Mr. Giles. You might drop in tomorrow morning, after I’ve had a chance to complete my study of all this. We’ll know by then whether you’ll need more treatment. Ten o’clock okay?” “But I’ll be all right?” Cobb smiled the automatic reassurance of his profession. “We haven’t lost a patient in two hundred years, to my knowledge.” “Thanks,” said Giles. “Ten o’clock is fine.” Dubbins was still waiting, reading a paper whose headlined feature carried a glowing account of the discovery of the super-light missile and what it might mean. He took a quick look at Giles and pointed to it. “Great work, Mr. Giles. Maybe we’ll all get to see some of those other worlds yet.” Then he studied Giles more carefully. “Everything’s in good shape now, sir?” “The doctor says everything’s going to be fine,” Giles answered. It was then he realized for the first time that Cobb had said no such thing. A statement that lightning had never struck a house was no guarantee that it never would. It was an evasion meant to give such an impression. The worry nagged at him all the way back. Word had already gone around the club that he’d had some kind of attack and there were endless questions that kept it on his mind. And even when it had been covered and recovered, he could still sense the glances of the others, as if he were Vincenti in one of the man’s more morose moods. He found a single table in the dining room and picked his way through the meal, listening to the conversation about him only when it was necessary because someone called across to him. Ordinarily, he was quick to support the idea of clubs in place of private families. A man here could choose his group and grow into them. Yet he wasn’t swallowed by them, as he might be by a family. Giles had been living here for nearly a century now and he’d never regretted it. But tonight his own group irritated him. He puzzled over it, finding no real reason. Certainly they weren’t forcing themselves on him. He remembered once when he’d had a cold, before they finally licked that; Harry had been a complete nuisance, running around with various nostrums, giving him no peace. Constant questions about how he felt, constant little looks of worry—until he’d been ready to yell at the boy. In fact, he had. Funny, he couldn’t picture really losing his temper here. Families did odd things to a man. HE LISTENED to a few of the discussions after the dinner, but he’d heard them all before, except for one about the super-speed drive, and there he had no wish to talk until he could study the final report. He gave up at last and went to his own suite. What he needed was a good night’s sleep after a little relaxation. Even that failed him, though. He’d developed one of the finest chess collections in the world, but tonight it held no interest. And when he drew out his tools and tried working on the delicate, lovely jade for the set he was carving his hands seemed to be all thumbs. None of the other interests he’d developed through the years helped to add to the richness of living now. He gave it up and went to bed—to have the fragment of that song pop into his head. Now there was no escaping it. Something about the years—or was it days—dwindling down to something or other. Could they really dwindle down? Suppose he couldn’t rejuvenate all the way? He knew that there were some people who didn’t respond as well as others. Sol Graves, for instance. He’d been fifty when he finally learned how to work with the doctors and they could only bring him back to about thirty, instead of the normal early twenties. Would that reduce the slice of eternity that rejuvenation meant? And what had happened to Sol? Or suppose it wasn’t rejuvenation, after all; suppose something had gone wrong with him permanently? He fought that off, but he couldn’t escape the nagging doubts at the doctor’s words. He got up once to stare at himself in the mirror. Ten hours had gone by and there should have been some signs of improvement. He couldn’t be sure, though, whether there were or not. He looked no better the next morning when he finally dragged himself up from the little sleep he’d managed to get. The hollows were still there and the circles under his eyes. He searched for the gray in his hair, but the traitorous strands had been removed at the doctor’s office and he could find no new ones. He looked into the dining room and then went by hastily. He wanted no solicitous glances this morning. Drat it, maybe he should move out. Maybe trying family life again would give him some new interests. Amanda probably would be willing to marry him; she’d hinted at a date once. He stopped, shocked by the awareness that he hadn’t been out with a woman for.... He couldn’t remember how long it had been. Nor why. “In the spring, a young man’s fancy,” he quoted to himself, and then shuddered. It hadn’t been that kind of spring for him—not this rejuvenation nor the last, nor the one before that. GILES TRIED to stop scaring himself and partially succeeded, until he reached the doctor’s office. Then it was no longer necessary to frighten himself. The wrongness was too strong, no matter how professional Cobb’s smile! He didn’t hear the preliminary words. He watched the smile vanish as the stack of reports came out. There was no nurse here now. The machines were quiet—and all the doors were shut. Giles shook his head, interrupting the doctor’s technical jargon. Now that he knew there was reason for his fear, it seemed to vanish, leaving a coldness that numbed him. “I’d rather know the whole truth,” he said. His voice sounded dead in his ears. “The worst first. The rejuvenation...?” Cobb sighed and yet seemed relieved. “Failed.” He stopped, and his hands touched the reports on his desk. “Completely,” he added in a low, defeated tone. “But I thought that was impossible!” “So did I. I wouldn’t believe it even yet—but now I find it isn’t the first case. I spent the night at Medical Center going up the ranks until I found men who really know about it. And now I wish I hadn’t.” His voice ran down and he gathered himself together by an effort. “It’s a shock to me, too, Mr. Giles. But—well, to simplify it, no memory is perfect—even cellular memory. It loses a little each time. And the effect is cumulative. It’s like an asymptotic curve—the further it goes, the steeper the curve. And—well, you’ve passed too far.” He faced away from Giles, dropping the reports into a drawer and locking it. “I wasn’t supposed to tell you, of course. It’s going to be tough enough when they’re ready to let people know. But you aren’t the first and you won’t be the last, if that’s any consolation. We’ve got a longer time scale than we used to have—but it’s in centuries, not in eons. For everybody, not just you.” It was no consolation. Giles nodded mechanically. “I won’t talk, of course. How—how long?” Cobb spread his hands unhappily. “Thirty years, maybe. But we can make them better. Geriatric knowledge is still on record. We can fix the heart and all the rest. You’ll be in good physical condition, better than your grandfather—” “And then....” Giles couldn’t pronounce the words. He’d grown old and he’d grow older. And eventually he’d die! An immortal man had suddenly found death hovering on his trail. The years had dwindled and gone, and only a few were left. He stood up, holding out his hand. “Thank you, Doctor,” he said, and was surprised to find he meant it. The man had done all he could and had at least saved him the suspense of growing doubt and horrible eventual discovery. OUTSIDE ON the street, he looked up at the Sun and then at the buildings built to last for thousands of years. Their eternity was no longer a part of him. Even his car would outlast him. He climbed into it, still partly numbed, and began driving mechanically, no longer wondering about the dangers that might possibly arise. Those wouldn’t matter much now. For a man who had thought of living almost forever, thirty years was too short a time to count. He was passing near the club and started to slow. Then he went on without stopping. He wanted no chance to have them asking questions he couldn’t answer. It was none of their business. Dubbins had been kind—but now Giles wanted no kindness. The street led to the office and he drove on. What else was there for him? There, at least, he could still fill his time with work—work that might even be useful. In the future, men would need the super-light drive if they were to span much more of the Universe than now. And he could speed up the work in some ways still, even if he could never see its finish. It would be cold comfort but it was something. And he might keep busy enough to forget sometimes that the years were gone for him. Automatic habit carried him through the office again, to Amanda’s desk, where her worry was still riding her. He managed a grin and somehow the right words came to his lips. “I saw the doctor, Amanda, so you can stop figuring ways to get me there.” She smiled back suddenly, without feigning it. “Then you’re all right?” “As all right as I’ll ever be,” he told her. “They tell me I’m just growing old.” This time her laugh was heartier. He caught himself before he could echo her mirth in a different voice and went inside where she had the coffee waiting for him. Oddly, it still tasted good to him. The projection was off, he saw, wondering whether he’d left it on or not. He snapped the switch and saw the screen light up, with the people still in the odd, wheelless vehicle on the alien planet. FOR A long moment, he stared at the picture without thinking, and then bent closer. Harry’s face hadn’t changed much. Giles had almost forgotten it, but there was still the same grin there. And his grandchildren had a touch of it, too. And of their grandfather’s nose, he thought. Funny, he’d never seen even pictures of his other grandchildren. Family ties melted away too fast for interstellar travel. Yet there seemed to be no slackening of them in Harry’s case, and somehow it looked like a family, rather than a mere group. A very pleasant family in a very pleasant world. He read Harry’s note again, with its praise for the planet and its invitation. He wondered if Dr. Vincenti had received an invitation like that, before he left. Or had he even been one of those to whom the same report had been delivered by some doctor? It didn’t matter, but it would explain things, at least. Twenty years to Centaurus, while the years dwindled down— Then abruptly the line finished itself. “The years dwindle down to a precious few....” he remembered. “A precious few.” Those dwindling years had been precious once. He unexpectedly recalled his own grandfather holding him on an old knee and slipping him candy that was forbidden. The years seemed precious to the old man then. Amanda’s voice came abruptly over the intercom. “Jordan wants to talk to you,” she said, and the irritation was sharp in her voice. “He won’t take no!” Giles shrugged and reached for the projector, to cut it off. Then, on impulse, he set it back to the picture, studying the group again as he switched on Jordan’s wire. But he didn’t wait for the hot words about whatever was the trouble. “Bill,” he said, “start getting the big ship into production. I’ve found a volunteer.” He’d been driven to it, he knew, as he watched the man’s amazed face snap from the screen. From the first suspicion of his trouble, something inside him had been forcing him to make this decision. And maybe it would do no good. Maybe the ship would fail. But thirty years was a number a man could risk. If he made it, though.... Well, he’d see those grandchildren of his this year—and Harry. Maybe he’d even tell Harry the truth, once they got done celebrating the reunion. And there’d be other grandchildren. With the ship, he’d have time enough to look them up. Plenty of time! Thirty years was a long time, when he stopped to think of it. —LESTER DEL REY
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B. seeing another doctor for a second opinion
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What are three main machine translation tasks?
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### Introduction
In recent years, Transformer has been remarkably adept at sequence learning tasks like machine translation BIBREF0, BIBREF1, text classification BIBREF2, BIBREF3, language modeling BIBREF4, BIBREF5, etc. It is solely based on an attention mechanism that captures global dependencies between input tokens, dispensing with recurrence and convolutions entirely. The key idea of the self-attention mechanism is updating token representations based on a weighted sum of all input representations. However, recent research BIBREF6 has shown that the Transformer has surprising shortcomings in long sequence learning, exactly because of its use of self-attention. As shown in Figure 1 (a), in the task of machine translation, the performance of Transformer drops with the increase of the source sentence length, especially for long sequences. The reason is that the attention can be over-concentrated and disperse, as shown in Figure 1 (b), and only a small number of tokens are represented by attention. It may work fine for shorter sequences, but for longer sequences, it causes insufficient representation of information and brings difficulty for the model to comprehend the source information intactly. In recent work, local attention that constrains the attention to focus on only part of the sequences BIBREF7, BIBREF8 is used to address this problem. However, it costs self-attention the ability to capture long-range dependencies and also does not demonstrate effectiveness in sequence to sequence learning tasks. To build a module with both inductive bias of local and global context modelling in sequence to sequence learning, we hybrid self-attention with convolution and present Parallel multi-scale attention called MUSE. It encodes inputs into hidden representations and then applies self-attention and depth-separable convolution transformations in parallel. The convolution compensates for the insufficient use of local information while the self-attention focuses on capturing the dependencies. Moreover, this parallel structure is highly extensible, and new transformations can be easily introduced as new parallel branches, and is also favourable to parallel computation. The main contributions are summarized as follows: We find that the attention mechanism alone suffers from dispersed weights and is not suitable for long sequence representation learning. The proposed method tries to address this problem and achieves much better performance on generating long sequence. We propose a parallel multi-scale attention and explore a simple but efficient method to successfully combine convolution with self-attention all in one module. MUSE outperforms all previous models with same training data and the comparable model size, with state-of-the-art BLEU scores on three main machine translation tasks. MUSE-simple introduce parallel representation learning and brings expansibility and parallelism. Experiments show that the inference speed can be increased by 31% on GPUs. ### MUSE: Parallel Multi-Scale Attention
Like other sequence-to-sequence models, MUSE also adopts an encoder-decoder framework. The encoder takes a sequence of word embeddings $(x_1, \cdots , x_n)$ as input where $n$ is the length of input. It transfers word embeddings to a sequence of hidden representation ${z} = (z_1, \cdots , z_n)$. Given ${z}$, the decoder is responsible for generating a sequence of text $(y_1, \cdots , y_m)$ token by token. The encoder is a stack of $N$ MUSE modules. Residual mechanism and layer normalization are used to connect two adjacent layers. The decoder is similar to encoder, except that each MUSE module in the decoder not only captures features from the generated text representations but also performs attention over the output of the encoder stack through additional context attention. Residual mechanism and layer normalization are also used to connect two modules and two adjacent layers. The key part in the proposed model is the MUSE module, which contains three main parts: self-attention for capturing global features, depth-wise separable convolution for capturing local features, and a position-wise feed-forward network for capturing token features. The module takes the output of $(i-1)$ layer as input and generates the output representation in a fusion way: where “Attention” refers to self-attention, “Conv” refers to dynamic convolution, “Pointwise” refers to a position-wise feed-forward network. The followings list the details of each part. We also propose MUSE-simple, a simple version of MUSE, which generates the output representation similar to the MUSE model except for that it dose not the include convolution operation: ### MUSE: Parallel Multi-Scale Attention ::: Attention Mechanism for Global Context Representation
Self-attention is responsible for learning representations of global context. For a given input sequence $X$, it first projects $X$ into three representations, key $K$, query $Q$, and value $V$. Then, it uses a self-attention mechanism to get the output representation: Where $W^O$, $W^Q$, $W^K$, and $W^V$ are projection parameters. The self-attention operation $\sigma $ is the dot-production between key, query, and value pairs: Note that we conduct a projecting operation over the value in our self-attention mechanism $V_1=VW^V$ here. ### MUSE: Parallel Multi-Scale Attention ::: Convolution for Local Context Modeling
We introduce convolution operations into MUSE to capture local context. To learn contextual sequence representations in the same hidden space, we choose depth-wise convolution BIBREF9 (we denote it as DepthConv in the experiments) as the convolution operation because it includes two separate transformations, namely, point-wise projecting transformation and contextual transformation. It is because that original convolution operator is not separable, but DepthConv can share the same point-wise projecting transformation with self-attention mechanism. We choose dynamic convolution BIBREF10, the best variant of DepthConv, as our implementation. Each convolution sub-module contains multiple cells with different kernel sizes. They are used for capturing different-range features. The output of the convolution cell with kernel size $k$ is: where $W^{V}$ and $W^{out}$ are parameters, $W^{V}$ is a point-wise projecting transformation matrix. The $Depth\_conv$ refers to depth convolution in the work of BIBREF10. For an input sequence $X$, the output $O$ is computed as: where $d$ is the hidden size. Note that we conduct the same projecting operation over the input in our convolution mechanism $V_2=XW^V$ here with that in self-attention mechanism. Shared projection To learn contextual sequence representations in the same hidden space, the projection in the self-attention mechanism $V_1=VW_V$ and that in the convolution mechanism $V_2=XW^V$ is shared. Because the shared projection can project the input feature into the same hidden space. If we conduct two independent projection here: $V_1=VW_1^V$ and $V_2=XW^V_2$, where $W_1^V$ and $W_2^V$ are two parameter matrices, we call it as separate projection. We will analyze the necessity of applying shared projection here instead of separate projection. Dynamically Selected Convolution Kernels We introduce a gating mechanism to automatically select the weight of different convolution cells. ### MUSE: Parallel Multi-Scale Attention ::: Point-wise Feed-forward Network for Capturing Token Representations
To learn token level representations, MUSE concatenates an self-attention network with a position-wise feed-forward network at each layer. Since the linear transformations are the same across different positions, the position-wise feed-forward network can be seen as a token feature extractor. where $W_1$, $b_1$, $W_2$, and $b_2$ are projection parameters. ### Experiment
We evaluate MUSE on four machine translation tasks. This section describes the datasets, experimental settings, detailed results, and analysis. ### Experiment ::: Datasets
WMT14 En-Fr and En-De datasets The WMT 2014 English-French translation dataset, consisting of $36M$ sentence pairs, is adopted as a big dataset to test our model. We use the standard split of development set and test set. We use newstest2014 as the test set and use newstest2012 +newstest2013 as the development set. Following BIBREF11, we also adopt a joint source and target BPE factorization with the vocabulary size of $40K$. For medium dataset, we borrow the setup of BIBREF0 and adopt the WMT 2014 English-German translation dataset which consists of $4.5M$ sentence pairs, the BPE vocabulary size is set to $32K$. The test and validation datasets we used are the same as BIBREF0. IWSLT De-En and En-Vi datasets Besides, we perform experiments on two small IWSLT datasets to test the small version of MUSE with other comparable models. The IWSLT 2014 German-English translation dataset consists of $160k$ sentence pairs. We also adopt a joint source and target BPE factorization with the vocabulary size of $32K$. The IWSLT 2015 English-Vietnamese translation dataset consists of $133K$ training sentence pairs. For the En-Vi task, we build a dictionary including all source and target tokens. The vocabulary size for English is $17.2K$, and the vocabulary size for the Vietnamese is $6.8K$. ### Experiment ::: Experimental Settings ::: Model
For fair comparisons, we only compare models reported with the comparable model size and the same training data. We do not compare BIBREF12 because it is an ensemble method. We build MUSE-base and MUSE-large with the parameter size comparable to Transformer-base and Transformer-large. We adopt multi-head attention BIBREF0 as implementation of self-attention in MUSE module. The number of attention head is set to 4 for MUSE-base and 16 for MUSE-large. We also add the network architecture built by MUSE-simple in the similar way into the comparison. MUSE consists of 12 residual blocks for encoder and 12 residual blocks for decoder, the dimension is set to 384 for MUSE-base and 768 for MUSE-large. The hidden dimension of non linear transformation is set to 768 for MUSE-base and 3072 for MUSE-large. The MUSE-large is trained on 4 Titan RTX GPUs while the MUSE-base is trained on a single NVIDIA RTX 2080Ti GPU. The batch size is calculated at the token level, which is called dynamic batching BIBREF0. We adopt dynamic convolution as the variant of depth-wise separable convolution. We tune the kernel size on the validation set. For convolution with a single kernel, we use the kernel size of 7 for all layers. In case of dynamic selected kernels, the kernel size is 3 for small kernels and 15 for large kernels for all layers. ### Experiment ::: Experimental Settings ::: Training
The training hyper-parameters are tuned on the validation set. MUSE-large For training MUSE-large, following BIBREF13, parameters are updated every 32 steps. We train the model for $80K$ updates with a batch size of 5120 for En-Fr, and train the model for ${30K}$ updates with a batch size of 3584 for En-De. The dropout rate is set to $0.1$ for En-Fr and ${0.3}$ for En-De. We borrow the setup of optimizer from BIBREF10 and use the cosine learning rate schedule with 10000 warmup steps. The max learning rate is set to $0.001$ on En-De translation and ${0.0007}$ on En-Fr translation. For checkpoint averaging, following BIBREF10, we tune the average checkpoints for En-De translation tasks. For En-Fr translation, we do not average checkpoint but use the final single checkpoint. MUSE-base We train and test MUSE-base on two small datasets, IWSLT 2014 De-En translation and IWSLT2015 En-Vi translation. Following BIBREF0, we use Adam optimizer with a learning rate of $0.001$. We use the warmup mechanism and invert the learning rate decay with warmup updates of $4K$. For the De-En dataset, we train the model for $20K$ steps with a batch size of $4K$. The parameters are updated every 4 steps. The dropout rate is set to $0.4$. For the En-Vi dataset, we train the model for $10K$ steps with a batch size of $4K$. The parameters are also updated every 4 steps. The dropout rate is set to $0.3$. We save checkpoints every epoch and average the last 10 checkpoints for inference. ### Experiment ::: Experimental Settings ::: Evaluation
During inference, we adopt beam search with a beam size of 5 for De-En, En-Fr and En-Vi translation tasks. The length penalty is set to 0.8 for En-Fr according to the validation results, 1 for the two small datasets following the default setting of BIBREF14. We do not tune beam width and length penalty but use the setting reported in BIBREF0. The BLEU metric is adopted to evaluate the model performance during evaluation. ### Experiment ::: Results
As shown in Table TABREF24, MUSE outperforms all previously models on En-De and En-Fr translation, including both state-of-the-art models of stand alone self-attention BIBREF0, BIBREF13, and convolutional models BIBREF11, BIBREF15, BIBREF10. This result shows that either self-attention or convolution alone is not enough for sequence to sequence learning. The proposed parallel multi-scale attention improves over them both on En-De and En-Fr. Compared to Evolved Transformer BIBREF19 which is constructed by NAS and also mixes convolutions of different kernel size, MUSE achieves 2.2 BLEU gains in En-Fr translation. Relative position or local attention constraints bring improvements over origin self-attention model, but parallel multi-scale outperforms them. MUSE can also scale to small model and small datasets, as depicted in Table TABREF25, MUSE-base pushes the state-of-the-art from 35.7 to 36.3 on IWSLT De-En translation dataset. It is shown in Table TABREF24 and Table TABREF25 that MUSE-simple which contains the basic idea of parallel multi-scale attention achieves state-of-the-art performance on three major machine translation datasets. ### Experiment ::: How do we propose effective parallel multi-scale attention?
In this subsection we compare MUSE and its variants on IWSLT 2015 De-En translation to answer the question. Does concatenating self-attention with convolution certainly improve the model? To bridge the gap between point-wise transformation which learns token level representations and self-attention which learns representations of global context, we introduce convolution to enhance our multi-scale attention. As we can see from the first experiment group of Table TABREF27, convolution is important in the parallel multi-scale attention. However, it is not easy to combine convolution and self-attention in one module to build better representations on sequence to sequence tasks. As shown in the first line of both second and third group of Table TABREF27, simply learning local representations by using convolution or depth-wise separable convolution in parallel with self-attention harms the performance. Furthermore, combining depth-wise separable convolution (in this work we choose its best variant dynamic convolution as implementation) is even worse than combining convolution. Why do we choose DepthConv and what is the importance of sharing Projection of DepthConv and self-attention? We conjecture that convolution and self-attention both learn contextual sequence representations and they should share the point transformation and perform the contextual transformation in the same hidden space. We first project the input to a hidden representation and perform a variant of depth-wise convolution and self-attention transformations in parallel. The fist two experiments in third group of Table TABREF27 show that validating the utility of sharing Projection in parallel multi-scale attention, shared projection gain 1.4 BLEU scores over separate projection, and bring improvement of 0.5 BLEU scores over MUSE-simple (without DepthConv). How much is the kernel size? Comparative experiments show that the too large kernel harms performance both for DepthConv and convolution. Since there exists self-attention and point-wise transformations, simply applying the growing kernel size schedule proposed in SliceNet BIBREF15 doesn't work. Thus, we propose to use dynamically selected kernel size to let the learned network decide the kernel size for each layer. ### Experiment ::: Further Analysis ::: Parallel multi-scale attention brings time efficiency on GPUs
The underlying parallel structure (compared to the sequential structure in each block of Transformer) allows MUSE to be efficiently computed on GPUs. For example, we can combine small matrices into large matrices, and while it does not reduce the number of actual operations, it can be better paralleled by GPUs to speed up computation. Concretely, for each MUSE module, we first concentrate $W^Q,W^K,W^V$ of self-attention and $W_1$ of point feed-forward transformation into a single encoder matrix $W^{Enc}$, and then perform transformation such as self-attention, depth-separable convolution, and nonlinear transformation, in parallel, to learn multi-scale representations in the hidden layer. $W^O,W_2,W^{out}$ can also be combined a single decoder matrix $W^{Dec}$. The decoder of sequence to sequence architecture can be implemented similarly. In Table TABREF31, we conduct comparisons to show the speed gains with the aforementioned implementation, and the batch size is set to one sample per batch to simulate online inference environment. Under the settings, where the numbers of parameters are similar for MUSE and Transformer, about 31% increase in inference speed can be obtained. The experiments use MUSE with 6 MUSE-simple modules and Transformer with 6 base blocks. The hidden size is set to 512. Parallel multi-scale attention generates much better long sequence As demonstrated in Figure FIGREF32, MUSE generates better sequences of various length than self-attention, but it is remarkably adept at generate long sequence, e.g. for sequence longer than 100, MUSE is two times better. Lower layers prefer local context and higher layers prefer more contextual representations MUSE contains multiple dynamic convolution cells, whose streams are fused by a gated mechanism. The weight for each dynamic cell is a scalar. Here we analyze the weight of different dynamic convolution cells in different layers. Figure FIGREF32 shows that as the layer depth increases, the weight of dynamic convolution cells with small kernel sizes gradually decreases. It demonstrates that lower layers prefer local features while higher layers prefer global features. It is corresponding to the finding in BIBREF26. MUSE not only gains BLEU scores, but also generates more reasonable sentences and increases the translation quality. We conduct the case study on the De-En dataset and the cases are shown in Table TABREF34 in Appendix. In case 1, although the baseline transformer translates many correct words according to the source sentence, the translated sentence is not fluent at all. It indicates that Transformer does not capture the relationship between some words and their neighbors, such as “right” and “clap”. By contrast, MUSE captures them well by combining local convolution with global self-attention. In case 2, the cause adverbial clause is correctly translated by MUSE while transformer misses the word “why” and fails to translate it. ### Related Work
Sequence to sequence learning is an important task in machine learning. It evolves understanding and generating sequence. Machine translation is the touchstone of sequence to sequence learning. Traditional approaches usually adopt long-short term memory networks BIBREF27, BIBREF28 to learn the representation of sequences. However, these models either are built upon auto-regressive structures requiring longer encoding time or perform worse on real-world natural language processing tasks. Recent studies explore convolutional neural networks (CNN) BIBREF11 or self-attention BIBREF0 to support high-parallel sequence modeling and does not require auto-regressive structure during encoding, thus bringing large efficiency improvements. They are strong at capturing local or global dependencies. There are several studies on combining self-attention and convolution. However, they do not surpass both convectional and self-attention mechanisms. BIBREF4 propose to augment convolution with self attention by directly concentrating them in computer vision tasks. However, as demonstrated in Table TABREF27 there method does not work for sequence to sequence learning task. Since state-of-the-art models on question answering tasks still consist on self-attention and do no adopt ideas in QAnet BIBREF29. Both self-attention BIBREF13 and convolution BIBREF10 outperforms Evolved transformer by near 2 BLEU scores on En-Fr translation. It seems that learning global and local context through stacking self-attention and convolution layers does not beat either self-attention or convolution models. In contrast, the proposed parallel multi-scale attention outperforms previous convolution or self-attention based models on main translation tasks, showing its effectiveness for sequence to sequence learning. ### Conclusion and Future work
Although the self-attention mechanism has been prevalent in sequence modeling, we find that attention suffers from dispersed weights especially for long sequences, resulting from the insufficient local information. To address this problem, we present Parallel Multi-scale Attention (MUSE) and MUSE-simple. MUSE-simple introduces the idea of parallel multi-scale attention into sequence to sequence learning. And MUSE fuses self-attention, convolution, and point-wise transformation together to explicitly learn global, local and token level sequence representations. Especially, we find from empirical results that the shared projection plays important part in its success, and is essential for our multi-scale learning. Beyond the inspiring new state-of-the-art results on three major machine translation datasets, detailed analysis and model variants also verify the effectiveness of MUSE. For future work, the parallel structure is highly extensible and provide many opportunities to improve these models. In addition, given the success of shared projection, we would like to explore its detailed effects on contextual representation learning. Finally, we are exited about future of parallel multi-scale attention and plan to apply this simple but effective idea to other tasks including image and speech. ### Conclusion and Future work ::: Acknowledgments
This work was supported in part by National Natural Science Foundation of China (No. 61673028). Figure 1: The left figure shows that the performance drops largely with the increase of sentence length on the De-En dataset. The right figure shows the attention map from the 3-th encoder layer. As we can see, the attention map is too dispersed to capture sufficient information. For example, “[EOS]”, contributing little to word alignment, is surprisingly over attended. Figure 2: Multi-scale attention hybrids point-wise transformation, convolution, and self-attention to learn multi-scale sequence representations in parallel. We project convolution and self-attention into the same space to learn contextual representations. Table 1: MUSE-large outperforms all previous models under the standard training and evaluation setting on WMT14 En-De and WMT14 En-Fr datasets. Table 2: MUSE-base outperforms previous state-of-the-art models on IWSLT De-En translation datasets and outperforms previous models without BPE processing on IWSLT En-Vi. Table 3: Comparisons between MUSE and its variants on the IWSLT 2015 De-En translation task. Table 4: The comparison between the inference speed of MUSE and Transformer. Figure 3: BLEU scores of models on different groups with different source sentence lengths. The experiments are conducted on the De-En dataset. MUSE performs better than Transformer, especially on long sentences. Figure 4: Dynamically selected kernels at each layer: The blue bars represent the ratio between the percentage of the convolution with smaller kernel sizes and the percentage of the convolution with large kernel sizes. Table 5: Case study on the De-En dataset. The red bolded words denote the wrong translation and blue bolded words denote the correct translation. In case 1, transformer fails to capture the relationship between some words and their neighbors, such as “right” and “clap”. In case 2, the cause adverbial clause is correctly translated by MUSE while transformer misses the word “why” and fails to translate it.
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De-En, En-Fr and En-Vi translation tasks
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How did the Quest III crew feel as they first approached the Sun?
A. Satisfied that they had visited many wonderful planets.
B. Eager but anxious to be home after many disappointing false hopes.
C. Dizzy from the many colors displayed due to the Doppler Effect.
D. Disappointed that Earth was still there.
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THE GIANTS RETURN By ROBERT ABERNATHY Earth set itself grimly to meet them with corrosive fire, determined to blast them back to the stars. But they erred in thinking the Old Ones were too big to be clever. [Transcriber's Note: This etext was produced from Planet Stories Fall 1949. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] In the last hours the star ahead had grown brighter by many magnitudes, and had changed its color from a dazzling blue through white to the normal yellow, of a GO sun. That was the Doppler effect as the star's radial velocity changed relative to the Quest III , as for forty hours the ship had decelerated. They had seen many such stars come near out of the galaxy's glittering backdrop, and had seen them dwindle, turn red and go out as the Quest III drove on its way once more, lashed by despair toward the speed of light, leaving behind the mockery of yet another solitary and lifeless luminary unaccompanied by worlds where men might dwell. They had grown sated with the sight of wonders—of multiple systems of giant stars, of nebulae that sprawled in empty flame across light years. But now unwonted excitement possessed the hundred-odd members of the Quest III's crew. It was a subdued excitement; men and women, they came and stood quietly gazing into the big vision screens that showed the oncoming star, and there were wide-eyed children who had been born in the ship and had never seen a planet. The grownups talked in low voices, in tones of mingled eagerness and apprehension, of what might lie at the long journey's end. For the Quest III was coming home; the sun ahead was the Sun, whose rays had warmed their lives' beginning. Knof Llud, the Quest III's captain, came slowly down the narrow stair from the observatory, into the big rotunda that was now the main recreation room, where most of the people gathered. The great chamber, a full cross-section of the vessel, had been at first a fuel hold. At the voyage's beginning eighty per cent of the fifteen-hundred-foot cylinder had been engines and fuel; but as the immense stores were spent and the holds became radioactively safe, the crew had spread out from its original cramped quarters. Now the interstellar ship was little more than a hollow shell. Eyes lifted from the vision screens to interrogate Knof Llud; he met them with an impassive countenance, and announced quietly, "We've sighted Earth." A feverish buzz arose; the captain gestured for silence and went on, "It is still only a featureless disk to the telescope. Zost Relyul has identified it—no more." But this time the clamor was not to be settled. People pressed round the screens, peering into them as if with the naked eye they could pick out the atom of reflected light that was Earth, home. They wrung each other's hands, kissed, shouted, wept. For the present their fears were forgotten and exaltation prevailed. Knof Llud smiled wryly. The rest of the little speech he had been about to make didn't matter anyway, and it might have spoiled this moment. He turned to go, and was halted by the sight of his wife, standing at his elbow. His wry smile took on warmth; he asked, "How do you feel, Lesra?" She drew an uncertain breath and released it in a faint sigh. "I don't know. It's good that Earth's still there." She was thinking, he judged shrewdly, of Knof Jr. and Delza, who save from pictures could not remember sunlit skies or grassy fields or woods in summer.... He said, with a touch of tolerant amusement, "What did you think might have happened to Earth? After all, it's only been nine hundred years." "That's just it," said Lesra shakily. "Nine hundred years have gone by— there —and nothing will be the same. It won't be the same world we left, the world we knew and fitted in...." The captain put an arm round her with comforting pressure. "Don't worry. Things may have changed—but we'll manage." But his face had hardened against registering the gnawing of that same doubtful fear within him. He let his arm fall. "I'd better get up to the bridge. There's a new course to be set now—for Earth." He left her and began to climb the stairway again. Someone switched off the lights, and a charmed whisper ran through the big room as the people saw each other's faces by the pale golden light of Earth's own Sun, mirrored and multiplied by the screens. In that light Lesra's eyes gleamed with unshed tears. Captain Llud found Navigator Gwar Den looking as smug as the cat that ate the canary. Gwar Den was finding that the actual observed positions of the planets thus far located agreed quite closely with his extrapolations from long unused charts of the Solar System. He had already set up on the calculator a course that would carry them to Earth. Llud nodded curt approval, remarking, "Probably we'll be intercepted before we get that far." Den was jolted out of his happy abstraction. "Uh, Captain," he said hesitantly. "What kind of a reception do you suppose we'll get?" Llud shook his head slowly. "Who knows? We don't know whether any of the other Quests returned successful, or if they returned at all. And we don't know what changes have taken place on Earth. It's possible—not likely, though—that something has happened to break civilization's continuity to the point where our expedition has been forgotten altogether." He turned away grim-lipped and left the bridge. From his private office-cabin, he sent a message to Chief Astronomer Zost Relyul to notify him as soon as Earth's surface features became clear; then he sat idle, alone with his thoughts. The ship's automatic mechanisms had scant need of tending; Knof Llud found himself wishing that he could find some back-breaking task for everyone on board, himself included, to fill up the hours that remained. There was an extensive and well-chosen film library in the cabin, but he couldn't persuade himself to kill time that way. He could go down and watch the screens, or to the family apartment where he might find Lesra and the children—but somehow he didn't want to do that either. He felt empty, drained—like his ship. As the Quest III's fuel stores and the hope of success in man's mightiest venture had dwindled, so the strength had gone out of him. Now the last fuel compartment was almost empty and Captain Knof Llud felt tired and old. Perhaps, he thought, he was feeling the weight of his nine hundred Earth years—though physically he was only forty now, ten years older than when the voyage had begun. That was the foreshortening along the time axis of a space ship approaching the speed of light. Weeks and months had passed for the Quest III in interstellar flight while years and decades had raced by on the home world. Bemusedly Llud got to his feet and stood surveying a cabinet with built-in voice recorder and pigeonholes for records. There were about three dozen film spools there—his personal memoirs of the great expedition, a segment of his life and of history. He might add that to the ship's official log and its collections of scientific data, as a report to whatever powers might be on Earth now—if such powers were still interested. Llud selected a spool from among the earliest. It was one he had made shortly after leaving Procyon, end of the first leg of the trip. He slid it onto the reproducer. His own voice came from the speaker, fresher, more vibrant and confident than he knew it was now. "One light-day out from Procyon, the thirty-third day by ship's time since leaving Earth. "Our visit to Procyon drew a blank. There is only one huge planet, twice the size of Jupiter, and like Jupiter utterly unfit to support a colony. "Our hopes were dashed—and I think all of us, even remembering the Centaurus Expedition's failure, hoped more than we cared to admit. If Procyon had possessed a habitable planet, we could have returned after an absence of not much over twenty years Earth time. "It is cheering to note that the crew seems only more resolute. We go on to Capella; its spectrum, so like our own Sun's, beckons. If success comes there, a century will have passed before we can return to Earth; friends, relatives, all the generation that launched the Quest ships will be long since dead. Nevertheless we go on. Our generation's dream, humanity's dream, lives in us and in the ship forever...." Presently Knof Llud switched off that younger voice of his and leaned back, an ironic smile touching his lips. That fervent idealism seemed remote and foreign to him now. The fanfares of departure must still have been ringing in his ears. He rose, slipped the record back in its niche and picked out another, later, one. "One week since we passed close enough to Aldebaran to ascertain that that system, too, is devoid of planets. "We face the unpleasant realization that what was feared is probably true—that worlds such as the Sun's are a rare accident, and that we may complete our search without finding even one new Earth. "It makes no difference, of course; we cannot betray the plan.... This may be man's last chance of escaping his pitiful limitation to one world in all the Universe. Certainly the building of this ship and its two sisters, the immense expenditure of time and labor and energy stores that went into them, left Earth's economy drained and exhausted. Only once in a long age does mankind rise to such a selfless and transcendent effort—the effort of Egypt that built the pyramids, or the war efforts of the nations in the last great conflicts of the twentieth century. "Looked at historically, such super-human outbursts of energy are the result of a population's outgrowing its room and resources, and therefore signalize the beginning of the end. Population can be limited, but the price is a deadly frustration, because growth alone is life.... In our day the end of man's room for growth on the Earth was in sight—so we launched the Quests . Perhaps our effort will prove as futile as pyramid-building, less practical than orgies of slaughter to reduce pressure.... In any case, it would be impossible to transport very many people to other stars; but Earth could at least go into its decline with the knowledge that its race went onward and upward, expanding limitlessly into the Universe.... "Hopeless, unless we find planets!" Knof Llud shook his head sorrowfully and took off the spool. That was from the time when he had grown philosophical after the first disappointments. He frowned thoughtfully, choosing one more spool that was only four years old. The recorded voice sounded weary, yet alive with a strange longing.... "We are in the heart of Pleiades; a hundred stars show brilliant on the screens, each star encircled by a misty halo like lights glowing through fog, for we are traversing a vast diffuse nebula. "According to plan, the Quest III has reached its furthest point from Earth. Now we turn back along a curve that will take us past many more stars and stellar systems—but hope is small that any of those will prove a home for man, as have none of the thousands of stars examined already. "But what are a few thousand stars in a galaxy of billions? We have only, as it were, visited a handful of the outlying villages of the Universe, while the lights of its great cities still blaze far ahead along the Milky Way. "On flimsy excuses I have had Zost Relyul make observations of the globular cluster Omega Centauri. There are a hundred thousand stars there in a volume of space where one finds a few dozen in the Sun's neighborhood; there if anywhere must circle the planets we seek! But Omega Centauri is twenty thousand light years away.... "Even so—by expending its remaining fuel freely, the Quest III could achieve a velocity that would take us there without dying of senility of aging too greatly. It would be a one-way journey—even if enough fuel remained, there would be little point in returning to Earth after more than forty thousand years. By then our civilization certainly, and perhaps the human race itself, would have perished from memory. "That was why the planners limited our voyage, and those of the other Quests , to less than a thousand years Earth time. Even now, according to the sociodynamic predictions made then, our civilization—if the other expeditions failed also—will have reached a dangerously unstable phase, and before we can get back it may have collapsed completely from overpopulation. "Why go back, then with the news of our failure? Why not forget about Earth and go on to Omega Centauri? What use is quixotic loyalty to a decree five thousand years old, whose makers are dead and which may be forgotten back there? "Would the crew be willing? I don't know—some of them still show signs of homesickness, though they know with their minds that everything that was once 'home' has probably been swept away.... "It doesn't matter. Today I gave orders to swing the ship." Savagely Knof Llud stabbed the button that shut off the speaker. Then he sat for a time with head resting in his hands, staring into nothing. The memory of that fierce impulse to go on still had power to shake him. A couple of lines of poetry came into his head, as he read them once in translation from the ancient English.... ... for my purpose holds To sail beyond the sunset, and the baths Of all the western stars, until I die. Llud sighed. He still couldn't say just why he had given the order to turn back. The stars had claimed his heart—but he was still a part of Earth, and not even nine hundred years of space and time had been able to alter that. He wondered if there would still be a quiet stream and a green shady place beside it where a death-weary man, relieved at last of responsibility, could rest and dream no more.... Those things went on, if men didn't change them. And a pine forest where he and young Knof could go camping, and lie on their backs at night and gaze at the glittering constellations, far away, out of reach.... He wasn't sure he would want to do that, though. Suddenly a faint cushioned jar went through the great ship; it seemed to falter one moment in flight. The captain was on his feet instantly, but then his movements became unhurried. Whatever it had been was past, and he had a good idea what it had been—a meteoroid, nothing unusual in the vicinity of the Sun, though in interstellar space and around planetless stars such collisions were rare to the vanishing point. No harm could have been done. The Quest III's collision armor was nonmaterial and for practical purposes invulnerable. Just as he took his finger off the button that opened the door, the intercommunication phone shrilled imperatively. Knof Llud wheeled, frowning—surely a meteoroid impact wasn't that serious. Coincidence, maybe—it might be Zost Relyul calling as instructed. He reached the phone at the moment when another, heavier jolt shook the vessel. Llud snatched up the receiver with the speed of a scalded cat. "Captain?" It was Gwar Den's voice, stammering a little. "Captain, we're being attacked!" "Sound the alarm. Emergency stations." He had said it automatically, then felt a curious detached relief at the knowledge that after all these years he could still respond quickly and smoothly to a crisis. There was a moment's silence, and he heard the alarm start—three short buzzes and repeat, ringing through all the great length of the interstellar ship. Knowing that Gwar Den was still there, he said, "Now—attacked by what?" "Ships," said Gwar Den helplessly. "Five of them so far. No, there's a sixth now." Repeated blows quivered the Quest III's framework. The navigator said, obviously striving for calm, "They're light craft, not fifty feet long, but they move fast. The detectors hardly had time to show them before they opened up. Can't get a telescope beam on them long enough to tell much." "If they're that small," said Knof Llud deliberately, "they can't carry anything heavy enough to hurt us. Hold to course. I'll be right up." In the open doorway he almost fell over his son. Young Knof's eyes were big; he had heard his father's words. "Something's happened," he judged with deadly twelve-year-old seriousness and, without wasting time on questions, "Can I go with you, huh, Dad?" Llud hesitated, said, "All right. Come along and keep out of the way." He headed for the bridge with strides that the boy could not match. There were people running in the corridors, heading for their posts. Their faces were set, scared, uncomprehending. The Quest III shuddered, again and again, under blows that must have had millions of horsepower behind them; but it plunged on toward Earth, its mighty engines still steadily braking its interstellar velocity. To a man, the ship's responsible officers were already on the bridge, most of them breathless. To a man they looked appeal at Captain Knof Llud. "Well?" he snapped. "What are they doing?" Gwar Den spoke. "There are thirteen of them out there now, sir, and they're all banging away at us." The captain stared into the black star-strewn depths of a vision screen where occasional blue points of light winked ominously, never twice from the same position. Knof Jr. flattened himself against the metal wall and watched silently. His young face was less anxious than his elders'; he had confidence in his father. "If they had anything heavier," surmised the captain, "they'd have unlimbered it by now. They're out to get us. But at this rate, they can't touch us as long as our power lasts—or until they bring up some bigger stuff." The mild shocks went on—whether from projectiles or energy-charges, would be hard to find out and it didn't matter; whatever was hitting the Quest III's shell was doing it at velocities where the distinction between matter and radiation practically ceases to exist. But that shell was tough. It was an extension of the gravitic drive field which transmitted the engines' power equally to every atom of the ship; forces impinging on the outside of the field were similarly transmitted and rendered harmless. The effect was as if the vessel and all space inside its field were a single perfectly elastic body. A meteoroid, for example, on striking it rebounded—usually vaporized by the impact—and the ship, in obedience to the law of equal and opposite forces, rebounded too, but since its mass was so much greater, its deflection was negligible. The people in the Quest III would have felt nothing at all of the vicious onslaught being hurled against them, save that their inertialess drive, at its normal thrust of two hundred gravities, was intentionally operated at one half of one per cent efficiency to provide the illusion of Earthly gravitation. One of the officers said shakily, "It's as if they've been lying in wait for us. But why on Earth—" "That," said the captain grimly, "is what we have to find out. Why—on Earth. At least, I suspect the answer's there." The Quest III bored steadily on through space, decelerating. Even if one were no fatalist, there seemed no reason to stop decelerating or change course. There was nowhere else to go and too little fuel left if there had been; come what might, this was journey's end—perhaps in a more violent and final way than had been anticipated. All around wheeled the pigmy enemies, circling, maneuvering, and attacking, always attacking, with the senseless fury of maddened hornets. The interstellar ship bore no offensive weapons—but suddenly on one of the vision screens a speck of light flared into nova-brilliance, dazzling the watchers for the brief moment in which its very atoms were torn apart. Knof Jr. whooped ecstatically and then subsided warily, but no one was paying attention to him. The men on the Quest III's bridge looked questions at each other, as the thought of help from outside flashed into many minds at once. But Captain Llud said soberly, "It must have caught one of their own shots, reflected. Maybe its own, if it scored too direct a hit." He studied the data so far gathered. A few blurred pictures had been got, which showed cylindrical space ships much like the Quest III , except that they were rocket-propelled and of far lesser size. Their size was hard to ascertain, because you needed to know their distance and speed—but detector-beam echoes gave the distance, and likewise, by the Doppler method, the velocity of directly receding or approaching ships. It was apparent that the enemy vessels were even smaller than Gwar Den had at first supposed—not large enough to hold even one man. Tiny, deadly hornets with a colossal sting. "Robot craft, no doubt," said Knof Llud, but a chill ran down his spine as it occurred to him that perhaps the attackers weren't of human origin. They had seen no recognizable life in the part of the galaxy they had explored, but one of the other Quests might have encountered and been traced home by some unhuman race that was greedy and able to conquer. It became evident, too, that the bombardment was being kept up by a constant arrival of fresh attackers, while others raced away into space, presumably returning to base to replenish their ammunition. That argued a planned and prepared interception with virulent hatred behind it. Elsuz Llug, the gravitic engineer, calculated dismally, "At the rate we're having to shed energy, the fuel will be gone in six or eight hours." "We'll have reached Earth before then," Gwar Den said hopefully. "If they don't bring out the heavy artillery first." "We're under the psychological disadvantage," said the captain, "of not knowing why we're being attacked." Knof Jr. burst out, spluttering slightly with the violence of a thought too important to suppress, "But we're under a ps-psychological advantage, too!" His father raised an eyebrow. "What's that? I don't seem to have noticed it." "They're mad and we aren't, yet," said the boy. Then, seeing that he hadn't made himself clear, "In a fight, if a guy gets mad he starts swinging wild and then you nail him." Smiles splintered the ice of tension. Captain Llud said, "Maybe you've got something there. They seem to be mad, all right. But we're not in a position to throw any punches." He turned back to the others. "As I was going to say—I think we'd better try to parley with the enemy. At least we may find out who he is and why he's determined to smash us." And now instead of tight-beam detectors the ship was broadcasting on an audio carrier wave that shifted through a wide range of frequencies, repeating on each the same brief recorded message: "Who are you? What do you want? We are the interstellar expedition Quest III ...." And so on, identifying themselves and protesting that they were unarmed and peaceful, that there must be some mistake, and querying again, "Who are you ?" There was no answer. The ship drove on, its fuel trickling away under multiplied demands. Those outside were squandering vastly greater amounts of energy in the effort to batter down its defenses, but converting that energy into harmless gravitic impulses was costing the Quest III too. Once more Knof Llud had the insidious sense of his own nerves and muscles and will weakening along with the power-sinews of his ship. Zost Relyul approached him apologetically. "If you have time, Captain—I've got some data on Earth now." Eagerly Llud took the sheaf of photographs made with the telescope. But they told him nothing; only the continental outlines were clear, and those were as they had been nine hundred years ago.... He looked up inquiringly at Zost Relyul. "There are some strange features," said the astronomer carefully. "First of all—there are no lights on the night side. And on the daylight face, our highest magnification should already reveal traces of cities, canals, and the like—but it does not. "The prevailing color of the land masses, you see, is the normal green vegetation. But the diffraction spectrum is queer. It indicates reflecting surfaces less than one-tenth millimeter wide—so the vegetation there can't be trees or grass, but must be more like a fine moss or even a coarse mold." "Is that all?" demanded Llud. "Isn't it enough?" said Zost Relyul blankly. "Well—we tried photography by invisible light, of course. The infra-red shows nothing and likewise the ultraviolet up to the point where the atmosphere is opaque to it." The captain sighed wearily. "Good work," he said. "Keep it up; perhaps you can answer some of these riddles before—" " We know who you are ," interrupted a harshly crackling voice with a strange accent, " and pleading will do you no good. " Knof Llud whirled to the radio apparatus, his weariness dropping from him once more. He snapped, "But who are you?" and the words blended absurdly with the same words in his own voice on the still repeating tape. He snapped off the record; as he did so the speaker, still crackling with space static, said, "It may interest you to know that you are the last. The two other interstellar expeditions that went out have already returned and been destroyed, as you will soon be—the sooner, if you continue toward Earth." Knof Llud's mind was clicking again. The voice—which must be coming from Earth, relayed by one of the midget ships—was not very smart; it had already involuntarily told him a couple of things—that it was not as sure of itself as it sounded he deduced from the fact it had deigned to speak at all, and from its last remark he gathered that the Quest III's ponderous and unswerving progress toward Earth had somehow frightened it. So it was trying to frighten them. He shoved those facts back for future use. Just now he had to know something, so vitally that he asked it as a bald question, " Are you human? " The voice chuckled sourly. "We are human," it answered, "but you are not." The captain was momentarily silent, groping for an adequate reply. Behind him somebody made a choked noise, the only sound in the stunned hush, and the ship jarred slightly as a thunderbolt slammed vengefully into its field. "Suppose we settle this argument about humanity," said Knof Llud woodenly. He named a vision frequency. "Very well." The tone was like a shrug. The voice went on in its language that was quite intelligible, but alien-sounding with the changes that nine hundred years had wrought. "Perhaps, if you realize your position, you will follow the intelligent example of the Quest I's commander." Knof Llud stiffened. The Quest I , launched toward Arcturus and the star cloud called Berenice's Hair, had been after the Quest III the most hopeful of the expeditions—and its captain had been a good friend of Llud's, nine hundred years ago.... He growled, "What happened to him?" "He fought off our interceptors, which are around you now, for some time," said the voice lightly. "When he saw that it was hopeless, he preferred suicide to defeat, and took his ship into the Sun." A short pause. "The vision connection is ready." Knof Llud switched on the screen at the named wavelength, and a picture formed there. The face and figure that appeared were ugly, but undeniably a man's. His features and his light-brown skin showed the same racial characteristics possessed by those aboard the Quest III , but he had an elusive look of deformity. Most obviously, his head seemed too big for his body, and his eyes in turn too big for his head. He grinned nastily at Knof Llud. "Have you any other last wishes?" "Yes," said Llud with icy control. "You haven't answered one question. Why do you want to kill us? You can see we're as human as you are." The big-headed man eyed him with a speculative look in his great eyes, behind which the captain glimpsed the flickering raw fire of a poisonous hatred. "It is enough for you to know that you must die."
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B. Eager but anxious to be home after many disappointing false hopes.
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Why didn't the narrator provide the leprechauns with the correct equation?
A. He knows that the leprechauns are preventing humans from destroying the Earth
B. He wants to take credit for the equation and is concerned they will try to get credit first
C. In swearing their allegiance to him, they are bound to him for eternity
D. He believes humans need to believe in things like leprechauns in order to sustain their own race
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Every writer must seek his own Flowery Kingdom in imagination's wide demesne, and if that search can begin and end on Earth his problem has been greatly simplified. In post-war Japan Walt Sheldon has found not only serenity, but complete freedom to write undisturbed about the things he treasures most. A one-time Air Force officer, he has turned to fantasy in his lighter moments, to bring us such brightly sparkling little gems as this. houlihan's equation by ... Walt Sheldon The tiny spaceship had been built for a journey to a star. But its small, mischievous pilots had a rendezvous with destiny—on Earth. I must admit that at first I wasn't sure I was hearing those noises. It was in a park near the nuclear propulsion center—a cool, green spot, with the leaves all telling each other to hush, be quiet, and the soft breeze stirring them up again. I had known precisely such a secluded little green sanctuary just over the hill from Mr. Riordan's farm when I was a boy. Now it was a place I came to when I had a problem to thrash out. That morning I had been trying to work out an equation to give the coefficient of discharge for the matter in combustion. You may call it gas, if you wish, for we treated it like gas at the center for convenience—as it came from the rocket tubes in our engine. Without this coefficient to give us control, we would have lacked a workable equation when we set about putting the first moon rocket around those extraordinary engines of ours, which were still in the undeveloped blueprint stage. I see I shall have to explain this, although I had hoped to get right along with my story. When you start from scratch, matter discharged from any orifice has a velocity directly proportional to the square root of the pressure-head driving it. But when you actually put things together, contractions or expansions in the gas, surface roughness and other factors make the velocity a bit smaller. At the terrible discharge speed of nuclear explosion—which is what the drive amounts to despite the fact that it is simply water in which nuclear salts have been previously dissolved—this small factor makes quite a difference. I had to figure everything into it—diameter of the nozzle, sharpness of the edge, the velocity of approach to the point of discharge, atomic weight and structure— Oh, there is so much of this that if you're not a nuclear engineer yourself it's certain to weary you. Perhaps you had better take my word for it that without this equation—correctly stated, mind you—mankind would be well advised not to make a first trip to the moon. And all this talk of coefficients and equations sits strangely, you might say, upon the tongue of a man named Kevin Francis Houlihan. But I am, after all, a scientist. If I had not been a specialist in my field I would hardly have found myself engaged in vital research at the center. Anyway, I heard these little noises in the park. They sounded like small working sounds, blending in eerily mysterious fashion with a chorus of small voices. I thought at first it might be children at play, but then at the time I was a bit absent-minded. I tiptoed to the edge of the trees, not wanting to deprive any small scalawags of their pleasure, and peered out between the branches. And what do you suppose I saw? Not children, but a group of little people, hard at work. There was a leader, an older one with a crank face. He was beating the air with his arms and piping: "Over here, now! All right, bring those electrical connections over here—and see you're not slow as treacle about it!" There were perhaps fifty of the little people. I was more than startled by it, too. I had not seen little people in—oh, close to thirty years. I had seen them first as a boy of eight, and then, very briefly again, on my tenth birthday. And I had become convinced they could never be seen here in America. I had never seen them so busy, either. They were building something in the middle of the glade. It was long and shiny and upright and a little over five feet in height. "Come along now, people!" said this crotchety one, looking straight at me. "Stop starin' and get to work! You'll not be needin' to mind that man standin' there! You know he can't see nor hear us!" Oh, it was good to hear the rich old tongue again. I smiled, and the foreman of the leprechauns—if that's what he was—saw me smile and became stiff and alert for a moment, as though suspecting that perhaps I actually could see him. Then he shrugged and turned away, clearly deeming such a thing impossible. I said, "Just a minute, friend, and I'll beg your pardon. It so happens I can see you." He whirled to face me again, staring open-mouthed. Then he said, "What? What's that, now?" "I can see you," I said. "Ohhh!" he said and put his palms to his cheekbones. "Saints be with us! He's a believer! Run everybody—run for your lives!" And they all began running, in as many directions as there were little souls. They began to scurry behind the trees and bushes, and a sloping embankment nearby. "No, wait!" I said. "Don't go away! I'll not be hurting you!" They continued to scurry. I knew what it was they feared. "I don't intend catching one of you!" I said. "Come back, you daft little creatures!" But the glade was silent, and they had all disappeared. They thought I wanted their crock of gold, of course. I'd be entitled to it if I could catch one and keep him. Or so the legends affirmed, though I've wondered often about the truth of them. But I was after no gold. I only wanted to hear the music of an Irish tongue. I was lonely here in America, even if I had latched on to a fine job of work for almost shamefully generous pay. You see, in a place as full of science as the nuclear propulsion center there is not much time for the old things. I very much wanted to talk to the little people. I walked over to the center of the glade where the curious shiny object was standing. It was as smooth as glass and shaped like a huge cigar. There were a pair of triangular fins down at the bottom, and stubby wings amidships. Of course it was a spaceship, or a miniature replica of one. I looked at it more closely. Everything seemed almost miraculously complete and workable. I shook my head in wonder, then stepped back from the spaceship and looked about the glade. I knew they were all hiding nearby, watching me apprehensively. I lifted my head to them. "Listen to me now, little people!" I called out. "My name's Houlihan of the Roscommon Houlihans. I am descended from King Niall himself—or so at least my father used to say! Come on out now, and pass the time o' day!" Then I waited, but they didn't answer. The little people always had been shy. Yet without reaching a decision in so many words I knew suddenly that I had to talk to them. I'd come to the glen to work out a knotty problem, and I was up against a blank wall. Simply because I was so lonely that my mind had become clogged. I knew that if I could just once hear the old tongue again, and talk about the old things, I might be able to think the problem through to a satisfactory conclusion. So I stepped back to the tiny spaceship, and this time I struck it a resounding blow with my fist. "Hear me now, little people! If you don't show yourselves and come out and talk to me, I'll wreck this spaceship from stem to stern!" I heard only the leaves rustling softly. "Do you understand? I'll give you until I count three to make an appearance! One!" The glade remained deathly silent. "Two!" I thought I heard a stirring somewhere, as if a small, brittle twig had snapped in the underbrush. " Three! " And with that the little people suddenly appeared. The leader—he seemed more wizened and bent than before—approached me slowly and warily as I stood there. The others all followed at a safe distance. I smiled to reassure them and then waved my arm in a friendly gesture of greeting. "Good morning," I said. "Good morning," the foreman said with some caution. "My name is Keech." "And mine's Houlihan, as I've told you. Are you convinced now that I have no intention of doing you any injury?" "Mr. Houlihan," said Keech, drawing a kind of peppered dignity up about himself, "in such matters I am never fully convinced. After living for many centuries I am all too acutely aware of the perversity of human nature." "Yes," I said. "Well, as you will quickly see, all I want to do is talk." I nodded as I spoke, and sat down cross-legged upon the grass. "Any Irishman wants to talk, Mr. Houlihan." "And often that's all he wants," I said. "Sit down with me now, and stop staring as if I were a snake returned to the Island." He shook his head and remained standing. "Have your say, Mr. Houlihan. And afterward we'll appreciate it if you'll go away and leave us to our work." "Well, now, your work," I said, and glanced at the spaceship. "That's exactly what's got me curious." The others had edged in a bit now and were standing in a circle, intently staring at me. I took out my pipe. "Why," I asked, "would a group of little people be building a spaceship here in America—out in this lonely place?" Keech stared back without much expression, and said, "I've been wondering how you guessed it was a spaceship. I was surprised enough when you told me you could see us but not overwhelmingly so. I've run into believers before who could see the little people. It happens every so often, though not as frequently as it did a century ago. But knowing a spaceship at first glance! Well, I must confess that does astonish me." "And why wouldn't I know a spaceship when I see one?" I said. "It just so happens I'm a doctor of science." "A doctor of science, now," said Keech. "Invited by the American government to work on the first moon rocket here at the nuclear propulsion center. Since it's no secret I can advise you of it." "A scientist, is it," said Keech. "Well, now, that's very interesting." "I'll make no apologies for it," I said. "Oh, there's no need for apology," said Keech. "Though in truth we prefer poets to scientists. But it has just now crossed my mind, Mr. Houlihan that you, being a scientist, might be of help to us." "How?" I asked. "Well, I might try starting at the beginning," he replied. "You might," I said. "A man usually does." Keech took out his own pipe—a clay dudeen—and looked hopeful. I gave him a pinch of tobacco from my pouch. "Well, now," he said, "first of all you're no doubt surprised to find us here in America." "I am surprised from time to time to find myself here," I said. "But continue." "We had to come here," said Keech, "to learn how to make a spaceship." "A spaceship, now," I said, unconsciously adopting some of the old manner. "Leprechauns are not really mechanically inclined," said Keech. "Their major passions are music and laughter and mischief, as anyone knows." "Myself included," I agreed. "Then why do you need a spaceship?" "Well, if I may use an old expression, we've had a feelin' lately that we're not long for this world. Or let me put it this way. We feel the world isn't long for itself." I scratched my cheek. "How would a man unravel a statement such as that?" "It's very simple. With all the super weapons you mortals have developed, there's the distinct possibility you might be blowin' us all up in the process of destroying yourselves." "There is that possibility," I said. "Well, then, as I say," said Keech, "the little people have decided to leave the planet in a spaceship. Which we're buildin' here and now. We've spied upon you and learned how to do it. Well—almost how to do it. We haven't learned yet how to control the power—" "Hold on, now," I said. "Leaving the planet, you say. And where would you be going?" "There's another committee working on that. 'Tis not our concern. I was inclined to suggest the constellation Orion, which sounds as though it has a good Irish name, but I was hooted down. Be that as it may, my own job was to go into your nuclear center, learn how to make the ship, and proceed with its construction. Naturally, we didn't understand all of your high-flyin' science, but some of our people are pretty clever at gettin' up replicas of things." "You mean you've been spying on us at the center all this time? Do you know, we often had the feeling we were being watched, but we thought it was by the Russians. There's one thing which puzzles me, though. If you've been constantly around us—and I'm still able to see the little people—why did I never see you before?" "It may be we never crossed your path. It may be you can only see us when you're thinkin' of us, and of course truly believin' in us. I don't know—'tis a thing of the mind, and not important at the moment. What's important is for us to get our first ship to workin' properly and then we'll be on our way." "You're determined to go." "Truly we are, Mr. Houlihan. Now—to business. Just during these last few minutes a certain matter has crossed my mind. That's why I'm wastin' all this time with you, sir. You say you are a scientist." "A nuclear engineer." "Well, then, it may be that you can help us—now that you know we're here." "Help you?" "The power control, Mr. Houlihan. As I understand it, 'tis necessary to know at any instant exactly how much thrust is bein' delivered through the little holes in back. And on paper it looks simple enough—the square of somethin' or other. I've got the figures jotted in a book when I need 'em. But when you get to doin' it it doesn't come out exactly as it does on paper." "You're referring to the necessity for a coefficient of discharge." "Whatever it might be named," said Keech, shrugging. "'Tis the one thing we lack. I suppose eventually you people will be gettin' around to it. But meanwhile we need it right now, if we're to make our ship move." "And you want me to help you with this?" "That is exactly what crossed my mind." I nodded and looked grave and kneaded my chin for a moment softly. "Well, now, Keech," I said finally, "why should I help you?" "Ha!" said Keech, grinning, but not with humor, "the avarice of humans! I knew it! Well, Mr. Houlihan, I'll give you reason enough. The pot o' gold, Mr. Houlihan!" "The one at the end of the rainbow?" "It's not at the end of the rainbow. That's a grandmother's tale. Nor is it actually in an earthen crock. But there's gold, all right, enough to make you rich for the rest of your life. And I'll make you a proposition." "Go ahead." "We'll not be needin' gold where we're goin'. It's yours if you show us how to make our ship work." "Well, now, that's quite an offer," I said. Keech had the goodness to be quiet while I sat and thought for a while. My pipe had gone out and I lit it again. I finally said, "Let's have a look at your ship's drive and see what we can see." "You accept the proposition then?" "Let's have a look," I said, and that was all. Well, we had a look, and then several looks, and before the morning was out we had half the spaceship apart, and were deep in argument about the whole project. It was a most fascinating session. I had often wished for a true working model at the center, but no allowance had been inserted in the budget for it. Keech brought me paper and pencil and I talked with the aid of diagrams, as engineers are wont to do. Although the pencils were small and I had to hold them between thumb and forefinger, as you would a needle, I was able to make many sensible observations and even a few innovations. I came back again the next day—and every day for the following two weeks. It rained several times, but Keech and his people made a canopy of boughs and leaves and I was comfortable enough. Every once in a while someone from the town or the center itself would pass by, and stop to watch me. But of course they wouldn't see the leprechauns or anything the leprechauns had made, not being believers. I would halt work, pass the time of day, and then, in subtle fashion, send the intruder on his way. Keech and the little people just stood by and grinned all the while. At the end of sixteen days I had the entire problem all but whipped. It is not difficult to understand why. The working model and the fact that the small people with their quick eyes and clever fingers could spot all sorts of minute shortcomings was a great help. And I was hearing the old tongue and talking of the old things every day, and truly that went far to take the clutter out of my mind. I was no longer so lonely that I couldn't think properly. On the sixteenth day I covered a piece of paper with tiny mathematical symbols and handed it to Keech. "Here is your equation," I said. "It will enable you to know your thrust at any given moment, under any circumstances, in or out of gravity, and under all conditions of friction and combustion." "Thank you, Mr. Houlihan," said Keech. All his people had gathered in a loose circle, as though attending a rite. They were all looking at me quietly. "Mr. Houlihan," said Keech, "you will not be forgotten by the leprechauns. If we ever meet again, upon another world perchance, you'll find our friendship always eager and ready." "Thank you," I said. "And now, Mr. Houlihan," said Keech, "I'll see that a quantity of gold is delivered to your rooms tonight, and so keep my part of the bargain." "I'll not be needing the gold," I said. Keech's eyebrows popped upward. "What's this now?" "I'll not be needing it," I repeated. "I don't feel it would be right to take it for a service of this sort." "Well," said Keech in surprise, and in some awe, too, "well, now, musha Lord help us! 'Tis the first time I ever heard such a speech from a mortal." He turned to his people. "We'll have three cheers now, do you hear, for Mr. Houlihan—friend of the little people as long as he shall live!" And they cheered. And little tears crept into the corners of some of their turned-up eyes. We shook hands, all of us, and I left. I walked through the park, and back to the nuclear propulsion center. It was another cool, green morning with the leaves making only soft noises as the breezes came along. It smelled exactly like a wood I had known in Roscommon. And I lit my pipe and smoked it slowly and chuckled to myself at how I had gotten the best of the little people. Surely it was not every mortal who could accomplish that. I had given them the wrong equation, of course. They would never get their spaceship to work now, and later, if they tried to spy out the right information I would take special measures to prevent it, for I had the advantage of being able to see them. As for our own rocket ship, it should be well on its way by next St. Patrick's Day. For I had indeed determined the true coefficient of discharge, which I never could have done so quickly without those sessions in the glade with Keech and his working model. It would go down in scientific literature now, I suppose, as Houlihan's Equation, and that was honor and glory enough for me. I could do without Keech's pot of gold, though it would have been pleasant to be truly rich for a change. There was no sense in cheating him out of the gold to boot, for leprechauns are most clever in matters of this sort and he would have had it back soon enough—or else made it a burden in some way. Indeed, I had done a piece of work greatly to my advantage, and also to the advantage of humankind, and when a man can do the first and include the second as a fortunate byproduct it is a most happy accident. For if I had shown the little people how to make a spaceship they would have left our world. And this world, as long as it lasts—what would it be in that event? I ask you now, wouldn't we be even more likely to blow ourselves to Kingdom Come without the little people here for us to believe in every now and then? Transcriber's Note: This etext was produced from Fantastic Universe September 1955. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note.
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D. He believes humans need to believe in things like leprechauns in order to sustain their own race
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What two architectures are used?
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### Introduction
In recent years, word embeddings BIBREF0, BIBREF1, BIBREF2 have been proven to be very useful for training downstream natural language processing (NLP) tasks. Moreover, contextualized embeddings BIBREF3, BIBREF4 have been shown to further improve the performance of NLP tasks such as named entity recognition, question answering, or text classification when used as word features because they are able to resolve ambiguities of word representations when they appear in different contexts. Different deep learning architectures such as multilingual BERT BIBREF4, LASER BIBREF5 and XLM BIBREF6 have proved successful in the multilingual setting. All these architectures learn the semantic representations from unannotated text, making them cheap given the availability of texts in online multilingual resources such as Wikipedia. However, the evaluation of such resources is usually done for the high-resourced languages, where one has a smorgasbord of tasks and test sets to evaluate on. This is the best-case scenario, languages with tones of data for training that generate high-quality models. For low-resourced languages, the evaluation is more difficult and therefore normally ignored simply because of the lack of resources. In these cases, training data is scarce, and the assumption that the capability of deep learning architectures to learn (multilingual) representations in the high-resourced setting holds in the low-resourced one does not need to be true. In this work, we focus on two African languages, Yorùbá and Twi, and carry out several experiments to verify this claim. Just by a simple inspection of the word embeddings trained on Wikipedia by fastText, we see a high number of non-Yorùbá or non-Twi words in the vocabularies. For Twi, the vocabulary has only 935 words, and for Yorùbá we estimate that 135 k out of the 150 k words belong to other languages such as English, French and Arabic. In order to improve the semantic representations for these languages, we collect online texts and study the influence of the quality and quantity of the data in the final models. We also examine the most appropriate architecture depending on the characteristics of each language. Finally, we translate test sets and annotate corpora to evaluate the performance of both our models together with fastText and BERT pre-trained embeddings which could not be evaluated otherwise for Yorùbá and Twi. The evaluation is carried out in a word similarity and relatedness task using the wordsim-353 test set, and in a named entity recognition (NER) task where embeddings play a crucial role. Of course, the evaluation of the models in only two tasks is not exhaustive but it is an indication of the quality we can obtain for these two low-resourced languages as compared to others such as English where these evaluations are already available. The rest of the paper is organized as follows. Related works are reviewed in Section SECREF2 The two languages under study are described in Section SECREF3. We introduce the corpora and test sets in Section SECREF4. The fifth section explores the different training architectures we consider, and the experiments that are carried out. Finally, discussion and concluding remarks are given in Section SECREF6 ### Related Work
The large amount of freely available text in the internet for multiple languages is facilitating the massive and automatic creation of multilingual resources. The resource par excellence is Wikipedia, an online encyclopedia currently available in 307 languages. Other initiatives such as Common Crawl or the Jehovah’s Witnesses site are also repositories for multilingual data, usually assumed to be noisier than Wikipedia. Word and contextual embeddings have been pre-trained on these data, so that the resources are nowadays at hand for more than 100 languages. Some examples include fastText word embeddings BIBREF2, BIBREF7, MUSE embeddings BIBREF8, BERT multilingual embeddings BIBREF4 and LASER sentence embeddings BIBREF5. In all cases, embeddings are trained either simultaneously for multiple languages, joining high- and low-resource data, or following the same methodology. On the other hand, different approaches try to specifically design architectures to learn embeddings in a low-resourced setting. ChaudharyEtAl:2018 follow a transfer learning approach that uses phonemes, lemmas and morphological tags to transfer the knowledge from related high-resource language into the low-resource one. jiangEtal:2018 apply Positive-Unlabeled Learning for word embedding calculations, assuming that unobserved pairs of words in a corpus also convey information, and this is specially important for small corpora. In order to assess the quality of word embeddings, word similarity and relatedness tasks are usually used. wordsim-353 BIBREF9 is a collection of 353 pairs annotated with semantic similarity scores in a scale from 0 to 10. Even the problems detected in this dataset BIBREF10, it is widely used by the community. The test set was originally created for English, but the need for comparison with other languages has motivated several translations/adaptations. In hassanMihalcea:2009 the test was translated manually into Spanish, Romanian and Arabic and the scores were adapted to reflect similarities in the new language. The reported correlation between the English scores and the Spanish ones is 0.86. Later, JoubarneInkpen:2011 show indications that the measures of similarity highly correlate across languages. leviantReichart:2015 translated also wordsim-353 into German, Italian and Russian and used crowdsourcing to score the pairs. Finally, jiangEtal:2018 translated with Google Cloud the test set from English into Czech, Danish and Dutch. In our work, native speakers translate wordsim-353 into Yorùbá and Twi, and similarity scores are kept unless the discrepancy with English is big (see Section SECREF11 for details). A similar approach to our work is done for Gujarati in JoshiEtAl:2019. ### Languages under Study ::: Yorùbá
is a language in the West Africa with over 50 million speakers. It is spoken among other languages in Nigeria, republic of Togo, Benin Republic, Ghana and Sierra Leon. It is also a language of Òrìsà in Cuba, Brazil, and some Caribbean countries. It is one of the three major languages in Nigeria and it is regarded as the third most spoken native African language. There are different dialects of Yorùbá in Nigeria BIBREF11, BIBREF12, BIBREF13. However, in this paper our focus is the standard Yorùbá based upon a report from the 1974 Joint Consultative Committee on Education BIBREF14. Standard Yorùbá has 25 letters without the Latin characters c, q, v, x and z. There are 18 consonants (b, d, f, g, gb, j[dz], k, l, m, n, p[kp], r, s, ṣ, t, w y[j]), 7 oral vowels (a, e, ẹ, i, o, ọ, u), five nasal vowels, (an, $ \underaccent{\dot{}}{e}$n, in, $ \underaccent{\dot{}}{o}$n, un) and syllabic nasals (m̀, ḿ, ǹ, ń). Yorùbá is a tone language which makes heavy use of lexical tones which are indicated by the use of diacritics. There are three tones in Yorùbá namely low, mid and high which are represented as grave ($\setminus $), macron ($-$) and acute ($/$) symbols respectively. These tones are applied on vowels and syllabic nasals. Mid tone is usually left unmarked on vowels and every initial or first vowel in a word cannot have a high tone. It is important to note that tone information is needed for correct pronunciation and to have the meaning of a word BIBREF15, BIBREF12, BIBREF14. For example, owó (money), ọw (broom), òwò (business), w (honour), ọw (hand), and w (group) are different words with different dots and diacritic combinations. According to Asahiah2014, Standard Yorùbá uses 4 diacritics, 3 are for marking tones while the fourth which is the dot below is used to indicate the open phonetic variants of letter "e" and "o" and the long variant of "s". Also, there are 19 single diacritic letters, 3 are marked with dots below (ẹ, ọ, ṣ) while the rest are either having the grave or acute accent. The four double diacritics are divided between the grave and the acute accent as well. As noted in Asahiah2014, most of the Yorùbá texts found in websites or public domain repositories (i) either use the correct Yorùbá orthography or (ii) replace diacritized characters with un-diacritized ones. This happens as a result of many factors, but most especially to the unavailability of appropriate input devices for the accurate application of the diacritical marks BIBREF11. This has led to research on restoration models for diacritics BIBREF16, but the problem is not well solved and we find that most Yorùbá text in the public domain today is not well diacritized. Wikipedia is not an exception. ### Languages under Study ::: Twi
is an Akan language of the Central Tano Branch of the Niger Congo family of languages. It is the most widely spoken of the about 80 indigenous languages in Ghana BIBREF17. It has about 9 million native speakers and about a total of 17–18 million Ghanaians have it as either first or second language. There are two mutually intelligible dialects, Asante and Akuapem, and sub-dialectical variants which are mostly unknown to and unnoticed by non-native speakers. It is also mutually intelligible with Fante and to a large extent Bono, another of the Akan languages. It is one of, if not the, easiest to learn to speak of the indigenous Ghanaian languages. The same is however not true when it comes to reading and especially writing. This is due to a number of easily overlooked complexities in the structure of the language. First of all, similarly to Yorùbá, Twi is a tonal language but written without diacritics or accents. As a result, words which are pronounced differently and unambiguous in speech tend to be ambiguous in writing. Besides, most of such words fit interchangeably in the same context and some of them can have more than two meanings. A simple example is: Me papa aba nti na me ne wo redi no yie no. S wo ara wo nim s me papa ba a, me suban fofor adi. This sentence could be translated as (i) I'm only treating you nicely because I'm in a good mood. You already know I'm a completely different person when I'm in a good mood. (ii) I'm only treating you nicely because my dad is around. You already know I'm a completely different person when my dad comes around. Another characteristic of Twi is the fact that a good number of stop words have the same written form as content words. For instance, “na” or “na” could be the words “and, then”, the phrase “and then” or the word “mother”. This kind of ambiguity has consequences in several natural language applications where stop words are removed from text. Finally, we want to point out that words can also be written with or without prefixes. An example is this same na and na which happen to be the same word with an omissible prefix across its multiple senses. For some words, the prefix characters are mostly used when the word begins a sentence and omitted in the middle. This however depends on the author/speaker. For the word embeddings calculation, this implies that one would have different embeddings for the same word found in different contexts. ### Data
We collect clean and noisy corpora for Yorùbá and Twi in order to quantify the effect of noise on the quality of the embeddings, where noisy has a different meaning depending on the language as it will be explained in the next subsections. ### Data ::: Training Corpora
For Yorùbá, we use several corpora collected by the Niger-Volta Language Technologies Institute with texts from different sources, including the Lagos-NWU conversational speech corpus, fully-diacritized Yorùbá language websites and an online Bible. The largest source with clean data is the JW300 corpus. We also created our own small-sized corpus by web-crawling three Yorùbá language websites (Alàkwé, r Yorùbá and Èdè Yorùbá Rẹw in Table TABREF7), some Yoruba Tweets with full diacritics and also news corpora (BBC Yorùbá and VON Yorùbá) with poor diacritics which we use to introduce noise. By noisy corpus, we refer to texts with incorrect diacritics (e.g in BBC Yorùbá), removal of tonal symbols (e.g in VON Yorùbá) and removal of all diacritics/under-dots (e.g some articles in Yorùbá Wikipedia). Furthermore, we got two manually typed fully-diacritized Yorùbá literature (Ìrìnkèrindò nínú igbó elégbèje and Igbó Olódùmarè) both written by Daniel Orowole Olorunfemi Fagunwa a popular Yorùbá author. The number of tokens available from each source, the link to the original source and the quality of the data is summarised in Table TABREF7. The gathering of clean data in Twi is more difficult. We use as the base text as it has been shown that the Bible is the most available resource for low and endangered languages BIBREF18. This is the cleanest of all the text we could obtain. In addition, we use the available (and small) Wikipedia dumps which are quite noisy, i.e. Wikipedia contains a good number of English words, spelling errors and Twi sentences formulated in a non-natural way (formulated as L2 speakers would speak Twi as compared to native speakers). Lastly, we added text crawled from jw and the JW300 Twi corpus. Notice that the Bible text, is mainly written in the Asante dialect whilst the last, Jehovah's Witnesses, was written mainly in the Akuapem dialect. The Wikipedia text is a mixture of the two dialects. This introduces a lot of noise into the embeddings as the spelling of most words differs especially at the end of the words due to the mixture of dialects. The JW300 Twi corpus also contains mixed dialects but is mainly Akuampem. In this case, the noise comes also from spelling errors and the uncommon addition of diacritics which are not standardised on certain vowels. Figures for Twi corpora are summarised in the bottom block of Table TABREF7. ### Data ::: Evaluation Test Sets ::: Yorùbá.
One of the contribution of this work is the introduction of the wordsim-353 word pairs dataset for Yorùbá. All the 353 word pairs were translated from English to Yorùbá by 3 native speakers. The set is composed of 446 unique English words, 348 of which can be expressed as one-word translation in Yorùbá (e.g. book translates to ìwé). In 61 cases (most countries and locations but also other content words) translations are transliterations (e.g. Doctor is dókítà and cucumber kùkúmbà.). 98 words were translated by short phrases instead of single words. This mostly affects words from science and technology (e.g. keyboard translates to pátákó ìtwé —literally meaning typing board—, laboratory translates to ìyàrá ìṣèwádìí —research room—, and ecology translates to ìm nípa àyíká while psychology translates to ìm nípa dá). Finally, 6 terms have the same form in English and Yorùbá therefore they are retained like that in the dataset (e.g. Jazz, Rock and acronyms such as FBI or OPEC). We also annotate the Global Voices Yorùbá corpus to test the performance of our trained Yorùbá BERT embeddings on the named entity recognition task. The corpus consists of 25 k tokens which we annotate with four named entity types: DATE, location (LOC), organization (ORG) and personal names (PER). Any other token that does not belong to the four named entities is tagged with "O". The dataset is further split into training (70%), development (10%) and test (20%) partitions. Table TABREF12 shows the number of named entities per type and partition. ### Data ::: Evaluation Test Sets ::: Twi
Just like Yorùbá, the wordsim-353 word pairs dataset was translated for Twi. Out of the 353 word pairs, 274 were used in this case. The remaining 79 pairs contain words that translate into longer phrases. The number of words that can be translated by a single token is higher than for Yorùbá. Within the 274 pairs, there are 351 unique English words which translated to 310 unique Twi words. 298 of the 310 Twi words are single word translations, 4 transliterations and 16 are used as is. Even if JoubarneInkpen:2011 showed indications that semantic similarity has a high correlation across languages, different nuances between words are captured differently by languages. For instance, both money and currency in English translate into sika in Twi (and other 32 English words which translate to 14 Twi words belong to this category) and drink in English is translated as Nsa or nom depending on the part of speech (noun for the former, verb for the latter). 17 English words fall into this category. In translating these, we picked the translation that best suits the context (other word in the pair). In two cases, the correlation is not fulfilled at all: soap–opera and star–movies are not related in the Twi language and the score has been modified accordingly. ### Semantic Representations
In this section, we describe the architectures used for learning word embeddings for the Twi and Yorùbá languages. Also, we discuss the quality of the embeddings as measured by the correlation with human judgements on the translated wordSim-353 test sets and by the F1 score in a NER task. ### Semantic Representations ::: Word Embeddings Architectures
Modeling sub-word units has recently become a popular way to address out-of-vocabulary word problem in NLP especially in word representation learning BIBREF19, BIBREF2, BIBREF4. A sub-word unit can be a character, character $n$-grams, or heuristically learned Byte Pair Encodings (BPE) which work very well in practice especially for morphologically rich languages. Here, we consider two word embedding models that make use of character-level information together with word information: Character Word Embedding (CWE) BIBREF20 and fastText BIBREF2. Both of them are extensions of the Word2Vec architectures BIBREF0 that model sub-word units, character embeddings in the case of CWE and character $n$-grams for fastText. CWE was introduced in 2015 to model the embeddings of characters jointly with words in order to address the issues of character ambiguities and non-compositional words especially in the Chinese language. A word or character embedding is learned in CWE using either CBOW or skipgram architectures, and then the final word embedding is computed by adding the character embeddings to the word itself: where $w_j$ is the word embedding of $x_j$, $N_j$ is the number of characters in $x_j$, and $c_k$ is the embedding of the $k$-th character $c_k$ in $x_j$. Similarly, in 2017 fastText was introduced as an extension to skipgram in order to take into account morphology and improve the representation of rare words. In this case the embedding of a word also includes the embeddings of its character $n$-grams: where $w_j$ is the word embedding of $x_j$, $G_j$ is the number of character $n$-grams in $x_j$ and $g_k$ is the embedding of the $k$-th $n$-gram. cwe also proposed three alternatives to learn multiple embeddings per character and resolve ambiguities: (i) position-based character embeddings where each character has different embeddings depending on the position it appears in a word, i.e., beginning, middle or end (ii) cluster-based character embeddings where a character can have $K$ different cluster embeddings, and (iii) position-based cluster embeddings (CWE-LP) where for each position $K$ different embeddings are learned. We use the latter in our experiments with CWE but no positional embeddings are used with fastText. Finally, we consider a contextualized embedding architecture, BERT BIBREF4. BERT is a masked language model based on the highly efficient and parallelizable Transformer architecture BIBREF21 known to produce very rich contextualized representations for downstream NLP tasks. The architecture is trained by jointly conditioning on both left and right contexts in all the transformer layers using two unsupervised objectives: Masked LM and Next-sentence prediction. The representation of a word is therefore learned according to the context it is found in. Training contextual embeddings needs of huge amounts of corpora which are not available for low-resourced languages such as Yorùbá and Twi. However, Google provided pre-trained multilingual embeddings for 102 languages including Yorùbá (but not Twi). ### Semantic Representations ::: Experiments ::: FastText Training and Evaluation
As a first experiment, we compare the quality of fastText embeddings trained on (high-quality) curated data and (low-quality) massively extracted data for Twi and Yorùbá languages. Facebook released pre-trained word embeddings using fastText for 294 languages trained on Wikipedia BIBREF2 (F1 in tables) and for 157 languages trained on Wikipedia and Common Crawl BIBREF7 (F2). For Yorùbá, both versions are available but only embeddings trained on Wikipedia are available for Twi. We consider these embeddings the result of training on what we call massively-extracted corpora. Notice that training settings for both embeddings are not exactly the same, and differences in performance might come both from corpus size/quality but also from the background model. The 294-languages version is trained using skipgram, in dimension 300, with character $n$-grams of length 5, a window of size 5 and 5 negatives. The 157-languages version is trained using CBOW with position-weights, in dimension 300, with character $n$-grams of length 5, a window of size 5 and 10 negatives. We want to compare the performance of these embeddings with the equivalent models that can be obtained by training on the different sources verified by native speakers of Twi and Yorùbá; what we call curated corpora and has been described in Section SECREF4 For the comparison, we define 3 datasets according to the quality and quantity of textual data used for training: (i) Curated Small Dataset (clean), C1, about 1.6 million tokens for Yorùbá and over 735 k tokens for Twi. The clean text for Twi is the Bible and for Yoruba all texts marked under the C1 column in Table TABREF7. (ii) In Curated Small Dataset (clean + noisy), C2, we add noise to the clean corpus (Wikipedia articles for Twi, and BBC Yorùbá news articles for Yorùbá). This increases the number of training tokens for Twi to 742 k tokens and Yorùbá to about 2 million tokens. (iii) Curated Large Dataset, C3 consists of all available texts we are able to crawl and source out for, either clean or noisy. The addition of JW300 BIBREF22 texts increases the vocabulary to more than 10 k tokens in both languages. We train our fastText systems using a skipgram model with an embedding size of 300 dimensions, context window size of 5, 10 negatives and $n$-grams ranging from 3 to 6 characters similarly to the pre-trained models for both languages. Best results are obtained with minimum word count of 3. Table TABREF15 shows the Spearman correlation between human judgements and cosine similarity scores on the wordSim-353 test set. Notice that pre-trained embeddings on Wikipedia show a very low correlation with humans on the similarity task for both languages ($\rho $=$0.14$) and their performance is even lower when Common Crawl is also considered ($\rho $=$0.07$ for Yorùbá). An important reason for the low performance is the limited vocabulary. The pre-trained Twi model has only 935 tokens. For Yorùbá, things are apparently better with more than 150 k tokens when both Wikipedia and Common Crawl are used but correlation is even lower. An inspection of the pre-trained embeddings indicates that over 135 k words belong to other languages mostly English, French and Arabic. If we focus only on Wikipedia, we see that many texts are without diacritics in Yorùbá and often make use of mixed dialects and English sentences in Twi. The Spearman $\rho $ correlation for fastText models on the curated small dataset (clean), C1, improves the baselines by a large margin ($\rho =0.354$ for Twi and 0.322 for Yorùbá) even with a small dataset. The improvement could be justified just by the larger vocabulary in Twi, but in the case of Yorùbá the enhancement is there with almost half of the vocabulary size. We found out that adding some noisy texts (C2 dataset) slightly improves the correlation for Twi language but not for the Yorùbá language. The Twi language benefits from Wikipedia articles because its inclusion doubles the vocabulary and reduces the bias of the model towards religious texts. However, for Yorùbá, noisy texts often ignore diacritics or tonal marks which increases the vocabulary size at the cost of an increment in the ambiguity too. As a result, the correlation is slightly hurt. One would expect that training with more data would improve the quality of the embeddings, but we found out with the results obtained with the C3 dataset, that only high-quality data helps. The addition of JW300 boosts the vocabulary in both cases, but whereas for Twi the corpus mixes dialects and is noisy, for Yorùbá it is very clean and with full diacritics. Consequently, the best embeddings for Yorùbá are obtained when training with the C3 dataset, whereas for Twi, C2 is the best option. In both cases, the curated embeddings improve the correlation with human judgements on the similarity task a $\Delta \rho =+0.25$ or, equivalently, by an increment on $\rho $ of 170% (Twi) and 180% (Yorùbá). ### Semantic Representations ::: Experiments ::: CWE Training and Evaluation
The huge ambiguity in the written Twi language motivates the exploration of different approaches to word embedding estimations. In this work, we compare the standard fastText methodology to include sub-word information with the character-enhanced approach with position-based clustered embeddings (CWE-LP as introduced in Section SECREF17). With the latter, we expect to specifically address the ambiguity present in a language that does not translate the different oral tones on vowels into the written language. The character-enhanced word embeddings are trained using a skipgram architecture with cluster-based embeddings and an embedding size of 300 dimensions, context window-size of 5, and 5 negative samples. In this case, the best performance is obtained with a minimum word count of 1, and that increases the effective vocabulary that is used for training the embeddings with respect to the fastText experiments reported in Table TABREF15. We repeat the same experiments as with fastText and summarise them in Table TABREF16. If we compare the relative numbers for the three datasets (C1, C2 and C3) we observe the same trends as before: the performance of the embeddings in the similarity task improves with the vocabulary size when the training data can be considered clean, but the performance diminishes when the data is noisy. According to the results, CWE is specially beneficial for Twi but not always for Yorùbá. Clean Yorùbá text, does not have the ambiguity issues at character-level, therefore the $n$-gram approximation works better when enough clean data is used ($\rho ^{C3}_{CWE}=0.354$ vs. $\rho ^{C3}_{fastText}=0.391$) but it does not when too much noisy data (no diacritics, therefore character-level information would be needed) is used ($\rho ^{C2}_{CWE}=0.345$ vs. $\rho ^{C2}_{fastText}=0.302$). For Twi, the character-level information reinforces the benefits of clean data and the best correlation with human judgements is reached with CWE embeddings ($\rho ^{C2}_{CWE}=0.437$ vs. $\rho ^{C2}_{fastText}=0.388$). ### Semantic Representations ::: Experiments ::: BERT Evaluation on NER Task
In order to go beyond the similarity task using static word vectors, we also investigate the quality of the multilingual BERT embeddings by fine-tuning a named entity recognition task on the Yorùbá Global Voices corpus. One of the major advantages of pre-trained BERT embeddings is that fine-tuning of the model on downstream NLP tasks is typically computationally inexpensive, often with few number of epochs. However, the data the embeddings are trained on has the same limitations as that used in massive word embeddings. Fine-tuning involves replacing the last layer of BERT used optimizing the masked LM with a task-dependent linear classifier or any other deep learning architecture, and training all the model parameters end-to-end. For the NER task, we obtain the token-level representation from BERT and train a linear classifier for sequence tagging. Similar to our observations with non-contextualized embeddings, we find out that fine-tuning the pre-trained multilingual-uncased BERT for 4 epochs on the NER task gives an F1 score of 0. If we do the same experiment in English, F1 is 58.1 after 4 epochs. That shows how pre-trained embeddings by themselves do not perform well in downstream tasks on low-resource languages. To address this problem for Yorùbá, we fine-tune BERT representations on the Yorùbá corpus in two ways: (i) using the multilingual vocabulary, and (ii) using only Yorùbá vocabulary. In both cases diacritics are ignored to be consistent with the base model training. As expected, the fine-tuning of the pre-trained BERT on the Yorùbá corpus in the two configurations generates better representations than the base model. These models are able to achieve a better performance on the NER task with an average F1 score of over 47% (see Table TABREF26 for the comparative). The fine-tuned BERT model with only Yorùbá vocabulary further increases by more than 4% in F1 score obtained with the tuning that uses the multilingual vocabulary. Although we do not have enough data to train BERT from scratch, we observe that fine-tuning BERT on a limited amount of monolingual data of a low-resource language helps to improve the quality of the embeddings. The same observation holds true for high-resource languages like German and French BIBREF23. ### Summary and Discussion
In this paper, we present curated word and contextual embeddings for Yorùbá and Twi. For this purpose, we gather and select corpora and study the most appropriate techniques for the languages. We also create test sets for the evaluation of the word embeddings within a word similarity task (wordsim353) and the contextual embeddings within a NER task. Corpora, embeddings and test sets are available in github. In our analysis, we show how massively generated embeddings perform poorly for low-resourced languages as compared to the performance for high-resourced ones. This is due both to the quantity but also the quality of the data used. While the Pearson $\rho $ correlation for English obtained with fastText embeddings trained on Wikipedia (WP) and Common Crawl (CC) are $\rho _{WP}$=$0.67$ and $\rho _{WP+CC}$=$0.78$, the equivalent ones for Yorùbá are $\rho _{WP}$=$0.14$ and $\rho _{WP+CC}$=$0.07$. For Twi, only embeddings with Wikipedia are available ($\rho _{WP}$=$0.14$). By carefully gathering high-quality data and optimising the models to the characteristics of each language, we deliver embeddings with correlations of $\rho $=$0.39$ (Yorùbá) and $\rho $=$0.44$ (Twi) on the same test set, still far from the high-resourced models, but representing an improvement over $170\%$ on the task. In a low-resourced setting, the data quality, processing and model selection is more critical than in a high-resourced scenario. We show how the characteristics of a language (such as diacritization in our case) should be taken into account in order to choose the relevant data and model to use. As an example, Twi word embeddings are significantly better when training on 742 k selected tokens than on 16 million noisy tokens, and when using a model that takes into account single character information (CWE-LP) instead of $n$-gram information (fastText). Finally, we want to note that, even within a corpus, the quality of the data might depend on the language. Wikipedia is usually used as a high-quality freely available multilingual corpus as compared to noisier data such as Common Crawl. However, for the two languages under study, Wikipedia resulted to have too much noise: interference from other languages, text clearly written by non-native speakers, lack of diacritics and mixture of dialects. The JW300 corpus on the other hand, has been rated as high-quality by our native Yorùbá speakers, but as noisy by our native Twi speakers. In both cases, experiments confirm the conclusions. ### Acknowledgements
The authors thank Dr. Clement Odoje of the Department of Linguistics and African Languages, University of Ibadan, Nigeria and Olóyè Gbémisóyè Àrdèó for helping us with the Yorùbá translation of the WordSim-353 word pairs and Dr. Felix Y. Adu-Gyamfi and Ps. Isaac Sarfo for helping with the Twi translation. We also thank the members of the Niger-Volta Language Technologies Institute for providing us with clean Yorùbá corpus The project on which this paper is based was partially funded by the German Federal Ministry of Education and Research under the funding code 01IW17001 (Deeplee). Responsibility for the content of this publication is with the authors. Table 1: Summary of the corpora used in the analysis. The last 3 columns indicate in which dataset (C1, C2 or C3) are the different sources included (see text, Section 5.2.). Table 2: Number of tokens per named entity type in the Global Voices Yorùbá corpus. Table 3: FastText embeddings: Spearman ρ correlation between human judgements and similarity scores on the wordSim353 for the three datasets analysed (C1, C2 and C3). The comparison with massive fastText embeddings is shown in the top rows. Table 4: CWE embeddings: Spearman ρ correlation between human evaluation and embedding similarities for the three datasets analysed (C1, C2 and C3). Table 5: NER F1 score on Global Voices Yorùbá corpus.
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fastText, CWE-LP
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How does KANE capture both high-order structural and attribute information of KGs in an efficient, explicit and unified manner?
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### Introduction
In the past decade, many large-scale Knowledge Graphs (KGs), such as Freebase BIBREF0, DBpedia BIBREF1 and YAGO BIBREF2 have been built to represent human complex knowledge about the real-world in the machine-readable format. The facts in KGs are usually encoded in the form of triples $(\textit {head entity}, relation, \textit {tail entity})$ (denoted $(h, r, t)$ in this study) through the Resource Description Framework, e.g.,$(\textit {Donald Trump}, Born In, \textit {New York City})$. Figure FIGREF2 shows the subgraph of knowledge graph about the family of Donald Trump. In many KGs, we can observe that some relations indicate attributes of entities, such as the $\textit {Born}$ and $\textit {Abstract}$ in Figure FIGREF2, and others indicates the relations between entities (the head entity and tail entity are real world entity). Hence, the relationship in KG can be divided into relations and attributes, and correspondingly two types of triples, namely relation triples and attribute triples BIBREF3. A relation triples in KGs represents relationship between entities, e.g.,$(\textit {Donald Trump},Father of, \textit {Ivanka Trump})$, while attribute triples denote a literal attribute value of an entity, e.g.,$(\textit {Donald Trump},Born, \textit {"June 14, 1946"})$. Knowledge graphs have became important basis for many artificial intelligence applications, such as recommendation system BIBREF4, question answering BIBREF5 and information retrieval BIBREF6, which is attracting growing interests in both academia and industry communities. A common approach to apply KGs in these artificial intelligence applications is through embedding, which provide a simple method to encode both entities and relations into a continuous low-dimensional embedding spaces. Hence, learning distributional representation of knowledge graph has attracted many research attentions in recent years. TransE BIBREF7 is a seminal work in representation learning low-dimensional vectors for both entities and relations. The basic idea behind TransE is that the embedding $\textbf {t}$ of tail entity should be close to the head entity's embedding $\textbf {r}$ plus the relation vector $\textbf {t}$ if $(h, r, t)$ holds, which indicates $\textbf {h}+\textbf {r}\approx \textbf {t}$. This model provide a flexible way to improve the ability in completing the KGs, such as predicating the missing items in knowledge graph. Since then, several methods like TransH BIBREF8 and TransR BIBREF9, which represent the relational translation in other effective forms, have been proposed. Recent attempts focused on either incorporating extra information beyond KG triples BIBREF10, BIBREF11, BIBREF12, BIBREF13, or designing more complicated strategies BIBREF14, BIBREF15, BIBREF16. While these methods have achieved promising results in KG completion and link predication, existing knowledge graph embedding methods still have room for improvement. First, TransE and its most extensions only take direct relations between entities into consideration. We argue that the high-order structural relationship between entities also contain rich semantic relationships and incorporating these information can improve model performance. For example the fact $\textit {Donald Trump}\stackrel{Father of}{\longrightarrow }\textit {Ivanka Trump}\stackrel{Spouse}{\longrightarrow }\textit {Jared Kushner} $ indicates the relationship between entity Donald Trump and entity Jared Kushner. Several path-based methods have attempted to take multiple-step relation paths into consideration for learning high-order structural information of KGs BIBREF17, BIBREF18. But note that huge number of paths posed a critical complexity challenge on these methods. In order to enable efficient path modeling, these methods have to make approximations by sampling or applying path selection algorithm. We argue that making approximations has a large impact on the final performance. Second, to the best of our knowledge, most existing knowledge graph embedding methods just leverage relation triples of KGs while ignoring a large number of attribute triples. Therefore, these methods easily suffer from sparseness and incompleteness of knowledge graph. Even worse, structure information usually cannot distinguish the different meanings of relations and entities in different triples. We believe that these rich information encoded in attribute triples can help explore rich semantic information and further improve the performance of knowledge graph. For example, we can learn date of birth and abstraction from values of Born and Abstract about Donald Trump in Figure FIGREF2. There are a huge number of attribute triples in real KGs, for example the statistical results in BIBREF3 shows attribute triples are three times as many as relationship triples in English DBpedia (2016-04). Recent a few attempts try to incorporate attribute triples BIBREF11, BIBREF12. However, these are two limitations existing in these methods. One is that only a part of attribute triples are used in the existing methods, such as only entity description is used in BIBREF12. The other is some attempts try to jointly model the attribute triples and relation triples in one unified optimization problem. The loss of two kinds triples has to be carefully balanced during optimization. For example, BIBREF3 use hyper-parameters to weight the loss of two kinds triples in their models. Considering limitations of existing knowledge graph embedding methods, we believe it is of critical importance to develop a model that can capture both high-order structural and attribute information of KGs in an efficient, explicit and unified manner. Towards this end, inspired by the recent developments of graph convolutional networks (GCN) BIBREF19, which have the potential of achieving the goal but have not been explored much for knowledge graph embedding, we propose Knowledge Graph Attention Networks for Enhancing Knowledge Graph Embedding (KANE). The key ideal of KANE is to aggregate all attribute triples with bias and perform embedding propagation based on relation triples when calculating the representations of given entity. Specifically, two carefully designs are equipped in KANE to correspondingly address the above two challenges: 1) recursive embedding propagation based on relation triples, which updates a entity embedding. Through performing such recursively embedding propagation, the high-order structural information of kGs can be successfully captured in a linear time complexity; and 2) multi-head attention-based aggregation. The weight of each attribute triples can be learned through applying the neural attention mechanism BIBREF20. In experiments, we evaluate our model on two KGs tasks including knowledge graph completion and entity classification. Experimental results on three datasets shows that our method can significantly outperforms state-of-arts methods. The main contributions of this study are as follows: 1) We highlight the importance of explicitly modeling the high-order structural and attribution information of KGs to provide better knowledge graph embedding. 2) We proposed a new method KANE, which achieves can capture both high-order structural and attribute information of KGs in an efficient, explicit and unified manner under the graph convolutional networks framework. 3) We conduct experiments on three datasets, demonstrating the effectiveness of KANE and its interpretability in understanding the importance of high-order relations. ### Related Work
In recent years, there are many efforts in Knowledge Graph Embeddings for KGs aiming to encode entities and relations into a continuous low-dimensional embedding spaces. Knowledge Graph Embedding provides a very simply and effective methods to apply KGs in various artificial intelligence applications. Hence, Knowledge Graph Embeddings has attracted many research attentions in recent years. The general methodology is to define a score function for the triples and finally learn the representations of entities and relations by minimizing the loss function $f_r(h,t)$, which implies some types of transformations on $\textbf {h}$ and $\textbf {t}$. TransE BIBREF7 is a seminal work in knowledge graph embedding, which assumes the embedding $\textbf {t}$ of tail entity should be close to the head entity's embedding $\textbf {r}$ plus the relation vector $\textbf {t}$ when $(h, r, t)$ holds as mentioned in section “Introduction". Hence, TransE defines the following loss function: TransE regarding the relation as a translation between head entity and tail entity is inspired by the word2vec BIBREF21, where relationships between words often correspond to translations in latent feature space. This model achieves a good trade-off between computational efficiency and accuracy in KGs with thousands of relations. but this model has flaws in dealing with one-to-many, many-to-one and many-to-many relations. In order to address this issue, TransH BIBREF8 models a relation as a relation-specific hyperplane together with a translation on it, allowing entities to have distinct representation in different relations. TransR BIBREF9 models entities and relations in separate spaces, i.e., entity space and relation spaces, and performs translation from entity spaces to relation spaces. TransD BIBREF22 captures the diversity of relations and entities simultaneously by defining dynamic mapping matrix. Recent attempts can be divided into two categories: (i) those which tries to incorporate additional information to further improve the performance of knowledge graph embedding, e.g., entity types or concepts BIBREF13, relations paths BIBREF17, textual descriptions BIBREF11, BIBREF12 and logical rules BIBREF23; (ii) those which tries to design more complicated strategies, e.g., deep neural network models BIBREF24. Except for TransE and its extensions, some efforts measure plausibility by matching latent semantics of entities and relations. The basic idea behind these models is that the plausible triples of a KG is assigned low energies. For examples, Distant Model BIBREF25 defines two different projections for head and tail entity in a specific relation, i.e., $\textbf {M}_{r,1}$ and $\textbf {M}_{r,2}$. It represents the vectors of head and tail entity can be transformed by these two projections. The loss function is $f_r(h,t)=||\textbf {M}_{r,1}\textbf {h}-\textbf {M}_{r,2}\textbf {t}||_{1}$. Our KANE is conceptually advantageous to existing methods in that: 1) it directly factors high-order relations into the predictive model in linear time which avoids the labor intensive process of materializing paths, thus is more efficient and convenient to use; 2) it directly encodes all attribute triples in learning representation of entities which can capture rich semantic information and further improve the performance of knowledge graph embedding, and 3) KANE can directly factors high-order relations and attribute information into the predictive model in an efficient, explicit and unified manner, thus all related parameters are tailored for optimizing the embedding objective. ### Problem Formulation
In this study, wo consider two kinds of triples existing in KGs: relation triples and attribute triples. Relation triples denote the relation between entities, while attribute triples describe attributes of entities. Both relation and attribute triples denotes important information about entity, we will take both of them into consideration in the task of learning representation of entities. We let $I $ denote the set of IRIs (Internationalized Resource Identifier), $B $ are the set of blank nodes, and $L $ are the set of literals (denoted by quoted strings). The relation triples and attribute triples can be formalized as follows: Definition 1. Relation and Attribute Triples: A set of Relation triples $ T_{R} $ can be represented by $ T_{R} \subset E \times R \times E $, where $E \subset I \cup B $ is set of entities, $R \subset I$ is set of relations between entities. Similarly, $ T_{A} \subset E \times R \times A $ is the set of attribute triples, where $ A \subset I \cup B \cup L $ is the set of attribute values. Definition 2. Knowledge Graph: A KG consists of a combination of relation triples in the form of $ (h, r, t)\in T_{R} $, and attribute triples in form of $ (h, r, a)\in T_{A} $. Formally, we represent a KG as $G=(E,R,A,T_{R},T_{A})$, where $E=\lbrace h,t|(h,r,t)\in T_{R} \cup (h,r,a)\in T_{A}\rbrace $ is set of entities, $R =\lbrace r|(h,r,t)\in T_{R} \cup (h,r,a)\in T_{A}\rbrace $ is set of relations, $A=\lbrace a|(h,r,a)\in T_{A}\rbrace $, respectively. The purpose of this study is try to use embedding-based model which can capture both high-order structural and attribute information of KGs that assigns a continuous representations for each element of triples in the form $ (\textbf {h}, \textbf {r}, \textbf {t})$ and $ (\textbf {h}, \textbf {r}, \textbf {a})$, where Boldfaced $\textbf {h}\in \mathbb {R}^{k}$, $\textbf {r}\in \mathbb {R}^{k}$, $\textbf {t}\in \mathbb {R}^{k}$ and $\textbf {a}\in \mathbb {R}^{k}$ denote the embedding vector of head entity $h$, relation $r$, tail entity $t$ and attribute $a$ respectively. Next, we detail our proposed model which models both high-order structural and attribute information of KGs in an efficient, explicit and unified manner under the graph convolutional networks framework. ### Proposed Model
In this section, we present the proposed model in detail. We first introduce the overall framework of KANE, then discuss the input embedding of entities, relations and values in KGs, the design of embedding propagation layers based on graph attention network and the loss functions for link predication and entity classification task, respectively. ### Proposed Model ::: Overall Architecture
The process of KANE is illustrated in Figure FIGREF2. We introduce the architecture of KANE from left to right. As shown in Figure FIGREF2, the whole triples of knowledge graph as input. The task of attribute embedding lays is embedding every value in attribute triples into a continuous vector space while preserving the semantic information. To capture both high-order structural information of KGs, we used an attention-based embedding propagation method. This method can recursively propagate the embeddings of entities from an entity's neighbors, and aggregate the neighbors with different weights. The final embedding of entities, relations and values are feed into two different deep neural network for two different tasks including link predication and entity classification. ### Proposed Model ::: Attribute Embedding Layer
The value in attribute triples usually is sentence or a word. To encode the representation of value from its sentence or word, we need to encode the variable-length sentences to a fixed-length vector. In this study, we adopt two different encoders to model the attribute value. Bag-of-Words Encoder. The representation of attribute value can be generated by a summation of all words embeddings of values. We denote the attribute value $a$ as a word sequence $a = w_{1},...,w_{n}$, where $w_{i}$ is the word at position $i$. The embedding of $\textbf {a}$ can be defined as follows. where $\textbf {w}_{i}\in \mathbb {R}^{k}$ is the word embedding of $w_{i}$. Bag-of-Words Encoder is a simple and intuitive method, which can capture the relative importance of words. But this method suffers in that two strings that contains the same words with different order will have the same representation. LSTM Encoder. In order to overcome the limitation of Bag-of-Word encoder, we consider using LSTM networks to encoder a sequence of words in attribute value into a single vector. The final hidden state of the LSTM networks is selected as a representation of the attribute value. where $f_{lstm}$ is the LSTM network. ### Proposed Model ::: Embedding Propagation Layer
Next we describe the details of recursively embedding propagation method building upon the architecture of graph convolution network. Moreover, by exploiting the idea of graph attention network, out method learn to assign varying levels of importance to entity in every entity's neighborhood and can generate attentive weights of cascaded embedding propagation. In this study, embedding propagation layer consists of two mainly components: attentive embedding propagation and embedding aggregation. Here, we start by describing the attentive embedding propagation. Attentive Embedding Propagation: Considering an KG $G$, the input to our layer is a set of entities, relations and attribute values embedding. We use $\textbf {h}\in \mathbb {R}^{k}$ to denote the embedding of entity $h$. The neighborhood of entity $h$ can be described by $\mathcal {N}_{h} = \lbrace t,a|(h,r,t)\in T_{R} \cup (h,r,a)\in T_{A}\rbrace $. The purpose of attentive embedding propagation is encode $\mathcal {N}_{h}$ and output a vector $\vec{\textbf {h}}$ as the new embedding of entity $h$. In order to obtain sufficient expressive power, one learnable linear transformation $\textbf {W}\in \mathbb {R}^{k^{^{\prime }} \times k}$ is adopted to transform the input embeddings into higher level feature space. In this study, we take a triple $(h,r,t)$ as example and the output a vector $\vec{\textbf {h}}$ can be formulated as follows: where $\pi (h,r,t)$ is attention coefficients which indicates the importance of entity's $t$ to entities $h$ . In this study, the attention coefficients also control how many information being propagated from its neighborhood through the relation. To make attention coefficients easily comparable between different entities, the attention coefficient $\pi (h,r,t)$ can be computed using a softmax function over all the triples connected with $h$. The softmax function can be formulated as follows: Hereafter, we implement the attention coefficients $\pi (h,r,t)$ through a single-layer feedforward neural network, which is formulated as follows: where the leakyRelu is selected as activation function. As shown in Equation DISPLAY_FORM13, the attention coefficient score is depend on the distance head entity $h$ and the tail entity $t$ plus the relation $r$, which follows the idea behind TransE that the embedding $\textbf {t}$ of head entity should be close to the tail entity's embedding $\textbf {r}$ plus the relation vector $\textbf {t}$ if $(h, r, t)$ holds. Embedding Aggregation. To stabilize the learning process of attention, we perform multi-head attention on final layer. Specifically, we use $m$ attention mechanism to execute the transformation of Equation DISPLAY_FORM11. A aggregators is needed to combine all embeddings of multi-head graph attention layer. In this study, we adapt two types of aggregators: Concatenation Aggregator concatenates all embeddings of multi-head graph attention, followed by a nonlinear transformation: where $\mathop {\Big |\Big |}$ represents concatenation, $ \pi (h,r,t)^{i}$ are normalized attention coefficient computed by the $i$-th attentive embedding propagation, and $\textbf {W}^{i}$ denotes the linear transformation of input embedding. Averaging Aggregator sums all embeddings of multi-head graph attention and the output embedding in the final is calculated applying averaging: In order to encode the high-order connectivity information in KGs, we use multiple embedding propagation layers to gathering the deep information propagated from the neighbors. More formally, the embedding of entity $h$ in $l$-th layers can be defined as follows: After performing $L$ embedding propagation layers, we can get the final embedding of entities, relations and attribute values, which include both high-order structural and attribute information of KGs. Next, we discuss the loss functions of KANE for two different tasks and introduce the learning and optimization detail. ### Proposed Model ::: Output Layer and Training Details
Here, we introduce the learning and optimization details for our method. Two different loss functions are carefully designed fro two different tasks of KG, which include knowledge graph completion and entity classification. Next details of these two loss functions are discussed. knowledge graph completion. This task is a classical task in knowledge graph representation learning community. Specifically, two subtasks are included in knowledge graph completion: entity predication and link predication. Entity predication aims to infer the impossible head/tail entities in testing datasets when one of them is missing, while the link predication focus on complete a triple when relation is missing. In this study, we borrow the idea of translational scoring function from TransE, which the embedding $\textbf {t}$ of tail entity should be close to the head entity's embedding $\textbf {r}$ plus the relation vector $\textbf {t}$ if $(h, r, t)$ holds, which indicates $d(h+r,t)= ||\textbf {h}+\textbf {r}- \textbf {t}||$. Specifically, we train our model using hinge-loss function, given formally as where $\gamma >0$ is a margin hyper-parameter, $[x ]_{+}$ denotes the positive part of $x$, $T=T_{R} \cup T_{A}$ is the set of valid triples, and $T^{\prime }$ is set of corrupted triples which can be formulated as: Entity Classification. For the task of entity classification, we simple uses a fully connected layers and binary cross-entropy loss (BCE) over sigmoid activation on the output of last layer. We minimize the binary cross-entropy on all labeled entities, given formally as: where $E_{D}$ is the set of entities indicates have labels, $C$ is the dimension of the output features, which is equal to the number of classes, $y_{ej}$ is the label indicator of entity $e$ for $j$-th class, and $\sigma (x)$ is sigmoid function $\sigma (x) = \frac{1}{1+e^{-x}}$. We optimize these two loss functions using mini-batch stochastic gradient decent (SGD) over the possible $\textbf {h}$, $\textbf {r}$, $\textbf {t}$, with the chin rule that applying to update all parameters. At each step, we update the parameter $\textbf {h}^{\tau +1}\leftarrow \textbf {h}^{\tau }-\lambda \nabla _{\textbf {h}}\mathcal {L}$, where $\tau $ labels the iteration step and $\lambda $ is the learning rate. ### Experiments ::: Date sets
In this study, we evaluate our model on three real KG including two typical large-scale knowledge graph: Freebase BIBREF0, DBpedia BIBREF1 and a self-construction game knowledge graph. First, we adapt a dataset extracted from Freebase, i.e., FB24K, which used by BIBREF26. Then, we collect extra entities and relations that from DBpedia which that they should have at least 100 mentions BIBREF7 and they could link to the entities in the FB24K by the sameAs triples. Finally, we build a datasets named as DBP24K. In addition, we build a game datasets from our game knowledge graph, named as Game30K. The statistics of datasets are listed in Table TABREF24. ### Experiments ::: Experiments Setting
In evaluation, we compare our method with three types of models: 1) Typical Methods. Three typical knowledge graph embedding methods includes TransE, TransR and TransH are selected as baselines. For TransE, the dissimilarity measure is implemented with L1-norm, and relation as well as entity are replaced during negative sampling. For TransR, we directly use the source codes released in BIBREF9. In order for better performance, the replacement of relation in negative sampling is utilized according to the suggestion of author. 2) Path-based Methods. We compare our method with two typical path-based model include PTransE, and ALL-PATHS BIBREF18. PTransE is the first method to model relation path in KG embedding task, and ALL-PATHS improve the PTransE through a dynamic programming algorithm which can incorporate all relation paths of bounded length. 3) Attribute-incorporated Methods. Several state-of-art attribute-incorporated methods including R-GCN BIBREF24 and KR-EAR BIBREF26 are used to compare with our methods on three real datasets. In addition, four variants of KANE which each of which correspondingly defines its specific way of computing the attribute value embedding and embedding aggregation are used as baseline in evaluation. In this study, we name four three variants as KANE (BOW+Concatenation), KANE (BOW+Average), and KANE (LSTM+Concatenation), KANE (LSTM+Average). Our method is learned with mini-batch SGD. As for hyper-parameters, we select batch size among {16, 32, 64, 128}, learning rate $\lambda $ for SGD among {0.1, 0.01, 0.001}. For a fair comparison, we also set the vector dimensions of all entity and relation to the same $k \in ${128, 258, 512, 1024}, the same dissimilarity measure $l_{1}$ or $l_{2}$ distance in loss function, and the same number of negative examples $n$ among {1, 10, 20, 40}. The training time on both data sets is limited to at most 400 epochs. The best models are selected by a grid search and early stopping on validation sets. ### Experiments ::: Entity Classification ::: Evaluation Protocol.
In entity classification, the aim is to predicate the type of entity. For all baseline models, we first get the entity embedding in different datasets through default parameter settings as in their original papers or implementations.Then, Logistic Regression is used as classifier, which regards the entity's embeddings as feature of classifier. In evaluation, we random selected 10% of training set as validation set and accuracy as evaluation metric. ### Experiments ::: Entity Classification ::: Test Performance.
Experimental results of entity classification on the test sets of all the datasets is shown in Table TABREF25. The results is clearly demonstrate that our proposed method significantly outperforms state-of-art results on accuracy for three datasets. For more in-depth performance analysis, we note: (1) Among all baselines, Path-based methods and Attribute-incorporated methods outperform three typical methods. This indicates that incorporating extra information can improve the knowledge graph embedding performance; (2) Four variants of KANE always outperform baseline methods. The main reasons why KANE works well are two fold: 1) KANE can capture high-order structural information of KGs in an efficient, explicit manner and passe these information to their neighboring; 2) KANE leverages rich information encoded in attribute triples. These rich semantic information can further improve the performance of knowledge graph; (3) The variant of KANE that use LSTM Encoder and Concatenation aggregator outperform other variants. The main reasons is that LSTM encoder can distinguish the word order and concatenation aggregator combine all embedding of multi-head attention in a higher leaver feature space, which can obtain sufficient expressive power. ### Experiments ::: Entity Classification ::: Efficiency Evaluation.
Figure FIGREF30 shows the test accuracy with increasing epoch on DBP24K and Game30K. We can see that test accuracy first rapidly increased in the first ten iterations, but reaches a stable stages when epoch is larger than 40. Figure FIGREF31 shows test accuracy with different embedding size and training data proportions. We can note that too small embedding size or training data proportions can not generate sufficient global information. In order to further analysis the embeddings learned by our method, we use t-SNE tool BIBREF27 to visualize the learned embedding. Figure FIGREF32 shows the visualization of 256 dimensional entity's embedding on Game30K learned by KANE, R-GCN, PransE and TransE. We observe that our method can learn more discriminative entity's embedding than other other methods. ### Experiments ::: Knowledge Graph Completion
The purpose of knowledge graph completion is to complete a triple $(h, r, t)$ when one of $h, r, t$ is missing, which is used many literature BIBREF7. Two measures are considered as our evaluation metrics: (1) the mean rank of correct entities or relations (Mean Rank); (2) the proportion of correct entities or relations ranked in top1 (Hits@1, for relations) or top 10 (Hits@10, for entities). Following the setting in BIBREF7, we also adopt the two evaluation settings named "raw" and "filter" in order to avoid misleading behavior. The results of entity and relation predication on FB24K are shown in the Table TABREF33. This results indicates that KANE still outperforms other baselines significantly and consistently. This also verifies the necessity of modeling high-order structural and attribute information of KGs in Knowledge graph embedding models. ### Conclusion and Future Work
Many recent works have demonstrated the benefits of knowledge graph embedding in knowledge graph completion, such as relation extraction. However, We argue that knowledge graph embedding method still have room for improvement. First, TransE and its most extensions only take direct relations between entities into consideration. Second, most existing knowledge graph embedding methods just leverage relation triples of KGs while ignoring a large number of attribute triples. In order to overcome these limitation, inspired by the recent developments of graph convolutional networks, we propose a new knowledge graph embedding methods, named KANE. The key ideal of KANE is to aggregate all attribute triples with bias and perform embedding propagation based on relation triples when calculating the representations of given entity. Empirical results on three datasets show that KANE significantly outperforms seven state-of-arts methods. Figure 1: Subgraph of a knowledge graph contains entities, relations and attributes. Figure 2: Illustration of the KANE architecture. Table 1: The statistics of datasets. Table 2: Entity classification results in accuracy. We run all models 10 times and report mean ± standard deviation. KANE significantly outperforms baselines on FB24K, DBP24K and Game30K. Figure 3: Test accuracy with increasing epoch. Table 3: Results of knowledge graph completion (FB24K) Figure 4: Test accuracy by varying parameter. Figure 5: The t-SNE visualization of entity embeddings in Game30K.
|
To capture both high-order structural information of KGs, we used an attention-based embedding propagation method.
|
What change was noted in Mr. Davies' osteopenia status between 2018 and 2020?
Choose the correct answer from the following options:
A. Marked improvement
B. Slight improvement
C. No change
D. Slight deterioration
E. Significant deterioration
|
### Patient Report 0
**Dear colleague, **
We are reporting on the patient Mr. George Davies, born on 07/25/1979,
who was admitted to our inpatient care from 04/09/2009 to 04/23/2009.
**Diagnoses:**
- Bronchopneumonia
- Classic Galactosemia
**Medical History:** The patient has a known diagnosis of galactosemia
(dietetically managed). For the past week, he has been experiencing
daily fevers up to 39°C, especially in the evenings and at night. He has
been heavily congested with yellowish-tinged sputum. The patient also
had difficulty sleeping through the night due to coughing fits, along
with excessive nighttime sweating, as reported by the father. He has had
a decreased appetite, resulting in a weight loss of 5 kg. He has
experienced frequent nausea but no vomiting, and there has been no
diarrhea. He has also complained of occasional headaches and neck pain.
He visited the family doctor, where he was prescribed a mucolytic
medication.
**Physical Examination:** Good general condition, with a lean build.
Skin color rosy. Mucous membranes moist. No pathological skin
manifestations. Pupils isochoric and react to light. Oropharynx
unremarkable. Tympanic membranes bilaterally reflective. No cervical
lymphadenopathy. Heart: Regular and rhythmic. Lungs: Clear breath sounds
bilaterally, diminished breath sounds on the left base. Abdomen: Soft,
non-tender, no masses, no hepatosplenomegaly, active peristalsis, no
signs of meningeal irritation, no exacerbation of headaches with bending
forward. Weight: 67 kg.
**Chest X-ray (posteroanterior view) dated 04/09/2009:**
**Findings:** In the lower left lung, there is a patchy area of reduced
transparency with partial obscuration of the heart contour. Mildly
increased markings caudal to the right hilum: Left-sided
bronchopneumonia with accompanying effusion on the left. The mediastinum
is not widened. Heart size is within normal limits. Equal ventilation of
both lungs. No pneumothorax detected.
Please note that this translation is for informational purposes and
should not replace professional medical advice or interpretation.
**Treatment and Progression:** The patient was admitted due to
bronchopneumonia. He received intravenous therapy with Cefuroxime and
additional inhalation therapy with Sodium Chloride 0.9%. Oxygen
supplementation was never required. His fever subsided rapidly, and his
condition improved significantly, allowing for his discharge today in a
satisfactory state for outpatient follow-up care. We recommend
continuing the Cefuroxime therapy until 09/10/2009. Laboratory results
showed an elevated creatinine level, and we request an outpatient
follow-up for further evaluation.
**Current Recommendations:**
- Follow-up appointment in the metabolic clinic on 09/20/09.
- Outpatient creatinine level check.
**Medication upon Discharge:**
- Cefuroxime axetil 2 x 500 mg daily orally.
**Neuropsychological findings**
**Self-assessment**: Mr. Davies reported not noticing any significant
deterioration in his memory. His ability to concentrate remained
essentially unchanged. Additionally, he stated that previous occasional
word-finding difficulties had improved. Currently, after completing
twelve years of education, he works part-time as a nursing assistant. He
still resides with his parents.
[Behavioral Observation]{.underline}: During the neuropsychological
assessment, Mr. Davies was cooperative, communicative, and friendly. He
understood instructions well and executed them appropriately.
[Neuropsychological Assessment Performed Procedures:]{.underline} Test
battery for attention assessment, subtests Alertness and Divided
Attention;
Wechsler Memory Scale -- Revised Version, subtests Forward and Backward
Digit Span; Verbal Learning and Memory Test by Rey, Rey-Osterrieth
Complex Figure Test Form B; Multiple-Choice Vocabulary Intelligence Test
(MWT-A, by Lehrl).
Attention In testing simple visual reactions, Mr. Davies exhibited
borderline reaction times with poor stability (245 ms, reaction time
median for tonic alertness; 52 ms, standard deviation for tonic
alertness). However, when provided with a warning stimulus, he
demonstrated normative performance with appropriate stability (212 ms,
reaction time median for phasic alertness; 45 ms, standard deviation for
phasic alertness). In the Divided Attention subtest, the subject must
simultaneously attend to both a visual and an auditory stimulus and
respond to a defined critical stimulus constellation. Mr. Davies
responded moderately to the visual stimuli (825 ms) and as expected to
the auditory stimuli (575 ms). However, the qualitative performance was
inadequate, with 2 omissions and 13 incorrect responses.
[Memory Short-term/Working Memory:]{.underline} The retention of verbal
information in short-term memory (Forward Digit Span) was average (raw
score 6). Mental manipulation of these briefly held contents (Backward
Digit Span) fell below expectations (raw score 3). Verbal Learning and
Memory: In the VLMT, 15 unrelated words are learned over 5 learning
trials. Mr. Davies demonstrated consistent learning (words in trials 1
to 5: 7-9-12-15-15) with an adequate span (raw score 7). The overall
learning performance matched age-related expectations (raw score 58).
After interference (remembering 7 words from an interference list), he
recalled all 15 words, and after a 30-minute retention interval, he
could also recall all 15 items. Two intrusions occurred during the
learning trials. Recognition performance was maximal.
[Figural Memory Performance]{.underline}: Immediate reproduction of a
complex geometric figure following error-free copying was average (raw
score 22.5,). After an approximately 30-minute retention interval,
performance remained within the normal range (raw score 21.5).
[Orientation and Knowledge:]{.underline} Orientation was intact in all
aspects. The patient could correctly answer questions regarding
situation and person, time, and place. He could name well-known public
figures and correctly place important historical events in time. Level
of [Intelligence and Problem Solving:]{.underline}In the MWT-A, four
fictitious words and one correctly spelled word are presented in a row,
and the task is to identify the correct word. Since this assesses
crystalline intelligence, which typically remains intact even after
brain damage, this parameter is used to estimate the premorbid
intellectual level. Mr. Davies achieved an average result here (raw
score 22). In logical-analytical thinking (LPS, subtest 3), which can be
used as an estimate for current fluid intelligence, his performance also
matched age-related expectations (raw score 19). In the Color-Word
Interference Test, a highly automated response tendency must be
suppressed in favor of a new behavior. This demand was completed within
an appropriate time frame (143 seconds).
[Evaluation of Cognitive Status:]{.underline} The neuropsychological
assessment revealed a patient oriented in all aspects, with an education
level estimated as average and corresponding ability for
logical-analytical thinking. Information processing speed was slightly
reduced under monotonous conditions but could be improved with external
stimulation. During dual-task demands, numerous incorrect responses were
observed. Short-term retention of information and its mental
manipulation (working memory aspect) were below average. Learning new
verbal content was quite possible, and the long-term retention
performance for newly learned material exceeded age-related
expectations. Figural content was retained within the norm. Increased
vulnerability to interference was present. In summary, within an average
level of intelligence, the patient exhibited limited attention and
working memory capacity but otherwise demonstrated age-appropriate
performance. The degree of impairment was mild.
### Patient Report 1
**Dear colleague, **
We are reporting on the patient Mr. George Davies, born on 07/25/1979,
who presented at our outpatient clinic on 08/27/2016.
**Diagnoses:**
- Galactosemia
- Osteopenia
- Last bone density measurement
- Lumbar spine T-score: -0.8
- Left proximal femur T-score: -1.4
- Right proximal femur T-score: -1.5
<!-- -->
- Vitamin D deficiency
- Status post appendectomy
- Status post elbow fracture left arm
**Molecular Genetic Diagnosis:** The molecular genetic analysis of the
uridyltransferase gene with the detection of a homozygous mutation
confirms the diagnosis. The exact mutation is available in the
patient\'s file.
**Medical History:** The patient is the first child of
non-consanguineous parents. After an uneventful pregnancy, he was
delivered by secondary cesarean section due to prolonged labor. Birth
weight was 4030 g, Apgar scores were 9-9-10. Postnatally, there was an
amnion infection syndrome, followed by hyperbilirubinemia and
hepatopathy, leading to the diagnosis of classical galactosemia in the
newborn screening on the 7th day of life. Normalization of liver
function parameters was achieved after initiating a lactose-free and
galactose-restricted diet. Since diagnosis, the patient has been under
the care of the Metabolic Clinic. In the course of development, there
were delays in fine and gross motor skills and, notably, in speech
development. In childhood, there were recurrent upper respiratory
infections and gastroenteritis, with the surgical insertion of ear
tubes. In 2006, an age-appropriate alpha EEG was recorded. In 2009, the
HAWIK IV intelligence test showed a total IQ of 76 with normal language
comprehension (IQ 42), reduced perception-based logical thinking (IQ
84), and working memory (IQ 77), as well as significantly reduced
processing speed (IQ 68). Despite adherence to the dietary regimen,
metabolic control has remained stable. Osteopenia was detected in the
lumbar spine and both femurs. Abdominal sonography showed normal
findings. Neuropsychological testing revealed restricted attention and
working memory capacities despite average intelligence. The extent of
impairments was considered mild. Ophthalmologically, apart from mild
myopic astigmatism, there were no abnormalities, and glasses or contact
lenses were recommended. He has completed his intermediate examination
and intends to pursue training as a nurse.
**Therapy and Progression:** Mr. Davies has classical galactosemia with
complete loss of galactose-1-phosphate uridyltransferase activity,
confirmed both enzymatically and molecularly. Despite good metabolic
control and excellent compliance, developmental delays typical of
classical galactosemia have occurred, including speech development
disorder. The patient\'s general condition is good. He adheres to a
lactose-free and galactose-restricted diet, with disease-specific
laboratory parameters (galactose-1-phosphate and galactitol) within
target ranges. Additionally, there are no signs of liver dysfunction. A
bone density measurement revealed osteopenia in both femurs, with a
slight deterioration compared to the previous examination. To prevent
the development of overt osteoporosis, the importance of regular intake
of vitamin D (20.000 I.U. once a week) and sufficient calcium intake,
e.g., through calcium-rich mineral water, was discussed with the
patient. Supplementation was initiated for low folate levels, and the
result will be monitored during follow-up. The annual check-ups have
been discussed with the patient.
**Medication** **Dosage** **Frequency**
---------------------------- ------------------------------------------------ -------------------
Vitamin D3 (Drisdol) 20.000 IU 1 tablet per week
Calcium-rich mineral water Aim for a total of 1,500 mg calcium intake/day As needed
Folic Acid 15 mg 1-0-0
**Lab results:**
**Parameter** **Result** **Reference Range**
--------------------------------------- -------------- ---------------------
Neutrophils 76.2% 42.0-77.0%
Lymphocytes 22.2% 20.0-44.0%
Monocytes 9.8% 2.0-9.5%
Basophils 1.42% 0.0-1.8%
Eosinophils 5.4% 0.5-5.5%
Immature Granulocytes 0.2% 0.0-1.0%
Sodium 136 mEq/L 136-145 mEq/L
Potassium 4.1 mEq/L 3.5-4.5 mEq/L
Calcium 9.32 mg/dL 8.8-10.2 mg/dL
Chloride 104 mEq/L 98-107 mEq/L
Creatinine 1.22 mg/dL 0.70-1.20 mg/dL
BUN 45 mg/dL 17-48 mg/dL
Uric Acid 5.3 mg/dL 3.6-8.2 mg/dL
CRP 0.6 mg/L \< 5.0 mg/L
PSA 2.21 ng/mL \< 4.40 ng/mL
ALT 12 U/L \< 41 U/L
AST 37 U/L \< 50 U/L
Alkaline Phosphatase 114 U/L 40-130 U/L
Gamma-GT 20 U/L 8-61 U/L
LDH 244 U/L 135-250 U/L
Testosterone \<0.03 ng/mL 1.32-8.92 ng/mL
TSH 1.42 mIU/L 0.27-4.20 mIU/L
Hemoglobin 12.7 g/dL 12.5-17.2 g/dL
Hematocrit 28.5% 37.0-49.0%
Red Blood Cells 4.2 M/µL 4.0-5.6 M/µL
White Blood Cells 4.98 K/µL 3.90-10.50 K/µL
Platelets 281 K/µL 150-370 K/µL
MCV 85.6 fL 80.0-101.0 fL
MCH 30.3 pg 27.0-34.0 pg
MCHC 35.4 g/dL 31.5-36.0 g/dL
MPV 9.2 fL 7.0-12.0 fL
RDW 13.6% 11.5-15.0%
Neutrophils Absolute 3.53 K/µL 1.50-7.70 K/µL
Immature Granulocytes Absolute 0.010 K/µL \< 0.050 K/µL
Lymphocytes Absolute 0.44 K/µL 1.10-4.50 K/µL
Monocytes Absolute 0.58 K/µL 0.10-0.90 K/µL
Eosinophils Absolute 0.30 K/µL 0.02-0.50 K/µL
Basophils Absolute 0.07 K/µL 0.00-0.20 K/µL
Reticulocytes 31.3 K/µL 25.0-105.0 K/µL
Reticulocyte % 0.94% 0.50-2.00%
Reticulocyte Production Index 0.3 \-
Ret-Hb 33.9 pg 28.5-34.5 pg
Prothrombin Time 112% \> 78%
INR 0.95 \< 1.25
Activated Partial Thromboplastin Time 30.2 sec. 25.0-38.0 sec.
### Patient Report 2
**Dear colleague, **
We are reporting to you about our patient, Mr. George Davies, born on
07/25/1979, who was under our outpatient care on 05/01/2017.
**Diagnoses:**
- Galactosemia
- Osteopenia
- Last bone density measurement
- Lumbar spine T-score: -0.8
- Left proximal femur T-score: -1.4
- Right proximal femur T-score: -1.5
<!-- -->
- Vitamin D deficiency
- Status post appendectomy
- Status post elbow fracture left arm
**Molecular Genetic Diagnosis:** The molecular genetic analysis of the
uridyltransferase gene with evidence of a homozygous mutation confirms
the diagnosis. The exact mutation is on file.
**Medical History:** The patient is the first child of
non-consanguineous parents. After an uneventful pregnancy, he was born
via secondary cesarean section due to prolonged labor. Birth weight was
4030 g, Apgar scores were 9-9-10. Postnatally, there was amnion
infection syndrome, followed by hyperbilirubinemia and hepatopathy.
Classic galactosemia was detected in the newborn screening on the 7th
day of life. Normalization of liver function parameters occurred after
the initiation of a lactose-free and galactose-poor diet. Since the
diagnosis, the patient has been under the care of the Metabolic Clinic.
Subsequently, he experienced developmental delays in fine and gross
motor skills, particularly in speech development. In childhood, he had
recurrent upper respiratory tract infections and gastroenteritis, and
ear tubes were surgically inserted.
In 2006, there was an age-appropriate alpha EEG, and in 2009, in the
HAWIK IV intelligence test, he had an overall IQ of 76 with normal
language comprehension (IQ 42), reduced perception-based logical
thinking (IQ 84), reduced working memory (IQ 77), and significantly
reduced processing speed (IQ 68). He maintained stable metabolic control
with the diet. In 02/15, osteopenia was detected in the lumbar spine,
left femur, and right femur during diagnostics. Abdominal sonography
showed normal findings. Neuropsychological testing at an average
intelligence level revealed restricted attention and working memory
capacities but otherwise age-appropriate performance. The degree of
impairment was mild. On the ophthalmological side, apart from myopic
astigmatism in both eyes, there were regular ophthalmological findings.
The patient was recommended glasses or contact lenses. He has completed
his intermediate examination and aims to complete an apprenticeship as a
nurse.
Despite good metabolic control and excellent compliance, he experienced
typical developmental delays associated with classical galactosemia,
including speech development disorders. His general condition is good.
The patient adheres to a lactose-free and galactose-poor diet, and
currently, the disease-specific laboratory parameters of
galactose-1-phosphate and galactitol are within target ranges. There are
no signs of liver dysfunction. The remaining laboratory parameters were
unremarkable. To prevent overt osteoporosis, we discussed with the
patient the importance of regularly taking vitamin D (20,000 I.U. once a
week) and ensuring an adequate calcium intake, for example, through
calcium-rich mineral water. The annual check-ups have been discussed
with the patient.
**Current lab results:**
**Parameter** **Result** **Reference Range**
------------------------- -------------- ---------------------
Taurine EDTA 104.7 µmol/L 54.0-210.0 µmol/L
Aspartic Acid 4.3 µmol/L 1.0-25.0 µmol/L
Glutamic Acid 33.1 µmol/L 10.0-131.0 µmol/L
Hydroxyproline 14.2 µmol/L \<35.0 µmol/L
Threonine 154.5 µmol/L 60.0-255.0 µmol/L
Asparagine 52.3 µmol/L 35.0-74.0 µmol/L
Glutamine 577.3 µmol/L 205.0-756.0 µmol/L
Proline 244.6 µmol/L \<329.0 µmol/L
Glycine 239.1 µmol/L 151.0-490.0 µmol/L
Alanine 347.1 µmol/L 177.0-583.0 µmol/L
Citrulline 49.4 µmol/L 12.0-55.0 µmol/L
Alpha-Aminobutyric Acid 19.5 µmol/L 5.0-41.0 µmol/L
Cystine 16.8 µmol/L 5.0-82.0 µmol/L
Cystathionine 0.1 µmol/L \<3.0 µmol/L
Methionine 24.0 µmol/L 13.0-42.0 µmol/L
Tyrosine 68.5 µmol/L 34.0-112.0 µmol/L
Phenylalanine 57.8 µmol/L 35.0-85.0 µmol/L
Tryptophan 42.9 µmol/L 10.0-140.0 µmol/L
Histidine 81.4 µmol/L 72.0-142.0 µmol/L
3-Methylhistidine 3.9 µmol/L \<8.0 µmol/L
1-Methylhistidine 14.2 µmol/L \<39.0 µmol/L
Ornithine 69.7 µmol/L 48.0-195.0 µmol/L
Lysine 183.5 µmol/L 110.0-282.0 µmol/L
Arginine 87.2 µmol/L 15.0-128.0 µmol/L
Alanine/Lysine Ratio 1.9 \<3.0
Valine 210.4 µmol/L 119.0-336.0 µmol/L
Allo-Isoleucine 1.9 µmol/L \<5.0 µmol/L
Isoleucine 63.1 µmol/L 30.0-108.0 µmol/L
Leucine 117.9 µmol/L 72.0-201.0 µmol/L
Serine 147.4 µmol/L 68.0-181.0 µmol/L
**Parameter** **Results** **Reference Range**
---------------------- ------------- ---------------------
Sodium 143 mEq/L 136-145 mEq/L
Potassium 3.6 mEq/L 3.4-4.5 mEq/L
Calcium 2.40 mEq/L 2.15-2.50 mEq/L
Chloride 100 mEq/L 98-107 mEq/L
Inorganic Phosphate 0.94 mEq/L 0.87-1.45 mEq/L
Magnesium 0.84 mEq/L 0.66-1.07 mEq/L
Glucose in Fluoride 89 mg/dL 60-110 mg/dL
Creatinine (Jaffé) 1.07 mg/dL 0.70-1.20 mg/dL
ALT \< 41 U/L 12 U/L
AST \< 50 U/L 38 U/L
Alkaline Phosphatase 40-130 U/L 115 U/L
Gamma-GT 8-61 U/L 20 U/L
**Current Medication:**
**Medication ** **Dosage** **Frequency**
------------------------------------- ------------------------------------------------ ---------------------------
Vitamin D3 (Drisdol) 20.000 IU 1 tablet per week
Calcium supplements (e.g. Caltrate) Aim for a total of 1,500 mg calcium intake/day
Folic acid 15 mg Once daily in the morning
### Patient Report 3
**Dear colleague, **
We would like to report on our shared patient, Mr. George Davies, born
on 07/25/1979
He presented at our Center for Rare Metabolic Diseases on 07/05/2018.
**Diagnoses:**
- Galactosemia
- Osteopenia
- Last bone density measurement
- Lumbar spine T-score: -0.8
- Left proximal femur T-score: -1.4
- Right proximal femur T-score: -1.5
<!-- -->
- Vitamin D deficiency
- Status post appendectomy
- Status post elbow fracture left arm
**Molecular Genetic Diagnosis:** Molecular genetic analysis of the
uridyltransferase gene confirmed a homozygous mutation, confirming the
diagnosis. The exact mutation is documented in the patient\'s records.
**Medical History:** The patient is the first child of
non-consanguineous parents. He was born via secondary cesarean section
after a prolonged labor, with a birth weight of 4030 grams and Apgar
scores of 9-9-10. Postnatally, he had amnion infection syndrome,
followed by hyperbilirubinemia and hepatopathy. Classic galactosemia was
diagnosed through newborn screening on the 7th day of life.
Normalization of liver function parameters occurred after the initiation
of a lactose-free and low-galactose diet. Since diagnosis, the patient
has been monitored at the Metabolic Clinic. In the course of his
development, he experienced delays in fine and gross motor skills,
especially in language development. In childhood, he had recurrent upper
respiratory infections and gastroenteritis, requiring the insertion of
ear tubes. In 2006, he had an age-appropriate alpha EEG, and in 2009, he
scored an overall IQ of 76 in the HAWIK IV intelligence test. This
included normal language comprehension (IQ 42), reduced perception-based
logical thinking (IQ 84), reduced working memory (IQ 77), and
significantly reduced processing speed (IQ 68). Despite adhering to the
diet, his metabolic parameters remained stable. In February 2015, a
diagnosis of osteopenia was made for his lumbar spine and both femurs.
Abdominal sonography was normal. Neuropsychological testing revealed
slightly limited attention and working memory capacity, with otherwise
age-appropriate performance. Ophthalmological examination showed no
abnormalities except for mild myopic astigmatism, for which glasses or
contact lenses were recommended.
**Current Recommendations:** Mr. Davies has classic galactosemia with
complete loss of Galactose-1-Phosphate Uridyltransferase activity,
confirmed both enzymatically and molecularly. Despite good metabolic
control and excellent compliance, he has experienced developmental
delays, particularly in language development, characteristic of classic
galactosemia. His overall condition is currently good. He adheres to a
lactose-free and low-galactose diet, resulting in his disease-specific
laboratory parameters (Galactose-1-Phosphate and Galactitol) being
within the target range. Additionally, there are no signs of liver
dysfunction or ocular changes. However, there is a minimal deficiency in
folate and vitamin D. We recommend supplementation with a lactose-free
folate preparation. We also plan to monitor thyroid parameters due to
latent hypothyroidism. His 2018 bone density measurement revealed
osteopenia in both femurs, which has slightly worsened compared to the
previous assessment. To prevent the development of manifest
osteoporosis, we discussed the importance of regular vitamin D
supplementation (20.000 IU once a week) and adequate calcium intake,
such as through calcium-rich mineral water or mature cheese.
### Patient Report 4
**Dear colleague, **
We would like to report on our patient, Mr. George Davies, born on
07/25/1979. He presented at our Center for Rare Metabolic Diseases on
06/14/2019.
**Diagnoses:**
- Galactosemia
- Osteopenia
- Last bone density measurement
- Lumbar spine T-score: -0.8
- Left proximal femur T-score: -1.4
- Right proximal femur T-score: -1.5
<!-- -->
- Vitamin D deficiency
- Status post appendectomy
- Status post elbow fracture left arm
**Molecular Genetic Diagnosis:** Molecular genetic analysis of the
uridyltransferase gene confirmed a homozygous mutation, confirming the
diagnosis. The exact mutation is documented in the patient\'s records.
**Medical History**: The patient is the first child of
non-consanguineous parents. He was born via secondary cesarean section
after a prolonged labor, with a birth weight of 4030 grams and Apgar
scores of 9-9-10. Postnatally, he had amnion infection syndrome,
followed by hyperbilirubinemia and hepatopathy. Classic galactosemia was
diagnosed through newborn screening on the 7th day of life.
Normalization of liver function parameters occurred after the initiation
of a lactose-free and low-galactose diet. In the course of his
development, he experienced delays in fine and gross motor skills,
especially in language development. In childhood, he had recurrent upper
respiratory infections and gastroenteritis, requiring the insertion of
ear tubes. In 2006, he had an age-appropriate alpha EEG, and in 2009, he
scored an overall IQ of 76 in the HAWIK IV intelligence test. This
included normal language comprehension (IQ 42), reduced perception-based
logical thinking (IQ 84), reduced working memory (IQ 77), and
significantly reduced processing speed (IQ 68). Despite adhering to the
diet, his metabolic parameters remained stable. In January 2013, a
diagnosis of osteopenia was made for his lumbar spine and both femurs.
Abdominal sonography was normal. Neuropsychological testing revealed
slightly limited attention and working memory capacity, with otherwise
age-appropriate performance. Ophthalmological examination showed no
abnormalities except for mild myopic astigmatism, for which glasses or
contact lenses were recommended.
**Summary**: Mr. Davies has classic galactosemia with a loss of
Galactose-1-Phosphate Uridyltransferase activity, confirmed both
enzymatically and molecularly. Despite good metabolic control and
excellent compliance, he has experienced developmental delays,
particularly in language development. Currently, the patient reports
occasional back tension, but his overall condition is good. He follows a
lactose-free and low-galactose diet, which has kept disease-specific
laboratory parameters, especially free Galactose, within therapeutic
target ranges. The rest of the laboratory diagnostics were pleasingly
unremarkable. Osteodensitometry in 2018 revealed osteopenia in both
femurs. The findings have slightly worsened compared to previous bone
density measurements in the femur area. A repeat bone density
measurement is scheduled for 2020. To prevent manifest osteoporosis, we
discussed the importance of regular vitamin D supplementation (20.000 IU
once a week) and adequate calcium intake, such as through calcium-rich
mineral water or mature cheese. The annual check-ups have been discussed
with the patient.
**Current lab results:**
**Parameter** **Reference Range** **Result**
---------------------------------------------- --------------------- --------------
Neutrophils 42.0-77.0 % 72.2 %
Lymphocytes 20.0-44.0 % 20.2 %
Monocytes 2.0-9.5 % 9.8 %
Basophils 0.0-1.8 % 1.2 %
Eosinophils 0.5-5.5 % 6.0 %
Immature Granulocytes 0.0-1.0 % 0.2 %
Sodium 136-145 mEq/L 137 mEq/L
Potassium 3.5-4.5 mEq/L 4.2 mEq/L
Calcium 8.8-10.2 mg/dL 9.24 mg/dL
Chloride 98-107 mEq/L 100 mEq/L
Creatinine 0.70-1.20 mg/dL 1.10 mg/dL
BUN (Blood Urea Nitrogen) 17-48 mg/dL 45 mg/dL
Uric Acid 3.6-8.2 mg/dL 5.2 mg/dL
CRP \< 5.0 mg/L 0.8 mg/L
PSA \< 4.40 ng/mL 2.31 ng/mL
ALT \< 41 U/L 12 U/L
AST \< 50 U/L 38 U/L
Alkaline Phosphatase 40-130 U/L 115 U/L
Gamma-GT 8-61 U/L 20 U/L
LDH 135-250 U/L 335 U/L
Testosterone 1.32-8.92 ng/mL \<0.03 ng/mL
TSH 0.27-4.20 mIU/L 1.42 mIU/L
Hemoglobin 12.5-17.2 g/dL 10.1 g/dL
Hematocrit 37.0-49.0 % 28.5 %
Red Blood Cells 4.0-5.6 M/uL 3.3 M/uL
White Blood Cells 3.90-10.50 K/uL 4.98 K/uL
Platelets 150-370 K/uL 281 K/uL
MCV 80.0-101.0 fL 85.6 fL
MCH 27.0-34.0 pg 30.3 pg
MCHC 31.5-36.0 g/dL 35.4 g/dL
MPV 7.0-12.0 fL 9.2 fL
RDW 11.5-15.0 % 13.4 %
Neutrophils Absolute 1.50-7.70 K/uL 3.59 K/uL
Immature Granulocytes Absolute \< 0.050 K/uL 0.010 K/uL
Lymphocytes Absolute 1.10-4.50 K/uL 0.43 K/uL
Monocytes Absolute 0.10-0.90 K/uL 0.58 K/uL
Eosinophils Absolute 0.02-0.50 K/uL 0.30 K/uL
Basophils Absolute 0.00-0.20 K/uL 0.07 K/uL
Reticulocytes 25.0-105.0 K/uL 31.3 K/uL
Reticulocyte 0.50-2.00 % 0.94 %
Ret-Hb 28.5-34.5 pg 33.9 pg
PT \> 78 % 112 %
INR \< 1.25 0.95
aPTT (Activated Partial Thromboplastin Time) 25.0-38.0 sec. 30.2 sec.
**Current Medication:**
**Medication (Brand Name)** **Dosage** **Frequency**
------------------------------------- ------------------------------------------------ ---------------------------
Vitamin D3 (Drisdol) 20.000 IU 1 tablet per week
Calcium supplements (e.g. Caltrate) Aim for a total of 1,500 mg calcium intake/day
Folic acid 15 mg Once daily in the morning
### Patient Report 5
**Dear colleague, **
We would like to provide a summary of the clinical course of our
patient, Mr. George Davies, born on 07/25/1979. He presented at our
Center for Rare Metabolic Diseases on 01/26/2020.
**Diagnoses:**
- Galactosemia
- Osteopenia
- Last bone density measurement
- Lumbar spine T-score: -0.8
- Left proximal femur T-score: -1.4
- Right proximal femur T-score: -1.5
<!-- -->
- Vitamin D deficiency
- Status post appendectomy
- Status post elbow fracture left arm
**Molecular Genetic Diagnosis:** Molecular genetic analysis of the
uridyltransferase gene confirmed a homozygous mutation, confirming the
diagnosis. The exact mutation is documented in the patient\'s records.
**Medical History:** The patient is the first child of
non-consanguineous parents. He was born via secondary cesarean section
after a prolonged labor, with a birth weight of 4030 grams and Apgar
scores of 9-9-10. Postnatally, he had amnion infection syndrome,
followed by hyperbilirubinemia and hepatopathy. Classic galactosemia was
diagnosed through newborn screening on the 7th day of life.
Normalization of liver function parameters occurred after the initiation
of a lactose-free and low-galactose diet. Since diagnosis, the patient
has been monitored at the Metabolic Clinic. In the course of his
development, he experienced delays in fine and gross motor skills,
especially in language development. In childhood, he had recurrent upper
respiratory infections and gastroenteritis, requiring the insertion of
ear tubes. In 2006, he had an age-appropriate alpha EEG, and in 2009, he
scored an overall IQ of 76 in the HAWIK IV intelligence test. This
included normal language comprehension (IQ 42), reduced perception-based
logical thinking (IQ 84), reduced working memory (IQ 77), and
significantly reduced processing speed (IQ 68). Despite adhering to the
diet, his metabolic parameters remained stable. In January 2013, a
diagnosis of osteopenia was made for his lumbar spine and both femurs.
Abdominal sonography was normal. Neuropsychological testing revealed
slightly limited attention and working memory capacity, with otherwise
age-appropriate performance. Ophthalmological examination showed no
abnormalities except for mild myopic astigmatism, for which glasses or
contact lenses were recommended.
**Physical Examination on 02/12/2020:** Blood Pressure: 120/87 mmHg
Heart Rate: 68/min Height: 175 cm Weight: 84.6 kg
**Current Presentation**: Mr. Davies has classic galactosemia with a
loss of Galactose-1-Phosphate Uridyltransferase activity, confirmed both
enzymatically and molecularly. Despite good metabolic control and
excellent compliance, he has experienced developmental delays,
particularly in language development. Clinically, the patient reports a
stable overall condition, although he can become overwhelmed in
stressful situations. He follows a lactose-free and low-galactose diet,
which has kept disease-specific laboratory parameters, especially
Galactose-1 Phosphate and Galactitol, within therapeutic target ranges.
Laboratory chemistry shows no signs of liver dysfunction. A mild vitamin
D deficiency was noted. Abdominal sonography revealed a minimally
enlarged liver without signs of hepatic steatosis, otherwise
unremarkable. The current bone density measurement showed osteopenia in
both femurs, with slight improvement compared to the previous
measurement in 2018. To prevent manifest osteoporosis, we discussed the
importance of regular vitamin D supplementation (20,000 IU once a week)
and adequate calcium intake, such as through calcium-rich mineral water
or mature cheese.
**Eye Examination:**
- 03/09/2015: Known, unchanged myopia in both eyes. Otherwise, a
regular ophthalmological examination with no evidence of cataracts.
- 03/20/2017: During today\'s examination, the known and essentially
unchanged myopic astigmatism was observed, with an otherwise regular
ophthalmological examination.
- 2018: Not performed.
- 2020: Unremarkable ophthalmological examination with known myopia in
both eyes.
**Upper Abdominal Ultrasound:**
- 01/20/2015: Unremarkable sonographic findings of the abdomen.
- 04/16/2017: Unremarkable sonographic findings of the upper abdomen,
particularly no hepatomegaly, hepatic steatosis, space-occupying
lesions, or kidney stones.
- 04/16/2018: Unremarkable sonographic findings of the abdomen,
especially no relevant hepatosplenomegaly and no hepatic steatosis.
- 01/12/2018: Unremarkable sonographic findings of the abdomen, mild
hepatomegaly without signs of hepatic steatosis.
**Bone Density Measurement on 05/02/2016:**
**Results:** Previous examination data from 2013 are available.
- Lumbar Spine Bone Density: 1.148 g/cm2 (94% of age-appropriate
reference) with a T-score of -0.8
- Left Proximal Femur Bone Density: 0.911 g/cm2 (83% of
age-appropriate reference) with a T-score of -1.4
- Right Proximal Femur Bone Density: 0.890 g/cm2 (81% of
age-appropriate reference) with a T-score of -1.5
Definition by the World Health Organization for Osteoporosis and
Osteopenia in white women: Normal: T-score at or above -1.0 SD;
Osteopenia: T-score between -1.0 and -2.5 SD; Osteoporosis: T-score at
or below -2.5 SD (WHO definitions apply only when using a reference
database of healthy young white women for T-score determination).
[Changes compared to the previous examination:]{.underline}
- Lumbar Spine (LWS): +6.0%
- Left Proximal Femur: -2.5%
- Right Proximal Femur: -1.7% Assessment: Bone density in both
proximal femurs is below the age-appropriate norm, indicating
osteopenia according to T-score analysis. Bone density in the lumbar
spine is within the normal range according to T-score analysis.
Compared to the previous examination, bone density has increased in
the lumbar spine and decreased in the proximal femurs.
**Bone Density Measurement on 12/01/2020: **
[Clinical Background and Indication:]{.underline} Galactosemia. Known
osteopenia, requesting bone density measurement.
[Results: ]{.underline}
- Lumbar Spine (L1-L4) Bone Density: 1.190 g/cm2 (97% of
age-appropriate reference) with a T-score of -0.3
- Lumbar Spine (L2-L4) Bone Density: 1.216 g/cm2 (97% of
age-appropriate reference) with a T-score of -0.2
- Left Proximal Femur Bone Density: 0.915 g/cm2 (83% of
age-appropriate reference) with a T-score of -1.3
- Right Proximal Femur Bone Density: 0.907 g/cm2 (82% of
age-appropriate reference) with a T-score of -1.4
Definition by the World Health Organization for Osteoporosis and
Osteopenia in white men: Normal: T-score at or above -1.0 SD;
Osteopenia: T-score between -1.0 and -2.5 SD; Osteoporosis: T-score at
or below -2.5 SD (WHO definitions apply only when using a reference
database of healthy young white men for T-score determination).
Changes compared to the previous examination:
- Lumbar Spine: +6.2%
- Left Proximal Femur: +0.4%
- Right Proximal Femur: +1.9%
Trabecular Bone Score (TBS) T-score for Lumbar Spine (L1-L4): 1.454
(0.0)
[Assessment:]{.underline}
- Bone density in the proximal femora remains below the
age-appropriate norm, consistent with osteopenia according to
T-score analysis.
- Lumbar spine bone density remains within the normal range.
- Compared to the previous examination on 04.07.2018, there is an
increase in bone density in the lumbar
**Outpatient Sonography Report Assessment:**
[Assessment:]{.underline} The liver remains minimally enlarged without
hepatic steatosis. Gallbladder stones persist with concrements showing
no signs of irritation or cholestasis.
**Abdominal Sonography 12/02/2020:**
[Clinical Background and Indication]{.underline}: Galactosemia. Liver
size? Steatosis? Liver function? Kidney stones?
Results: Several previous examinations are available, most recently the
abdominal sonography from 01/12/2020.
Minimal liver enlargement with homogeneous parenchyma and no steatosis.
No suspicious focal lesions indicative of malignancy. Hepatic veins are
patent. Portal vein with antegrade flow. Gallbladder and bile ducts
continue to show sludge-like concrements with no signs of inflammation.
No intrahepatic or extrahepatic cholestasis, and the common bile duct
(DHC) is not dilated. Spleen measures 12 cm in pole-to-pole distance,
appears homogeneous. The pancreas is not adequately assessable due to
intestinal gas interference. Both kidneys are of normal size with no
evidence of concrements or suspicious solid masses. No evidence of
urinary obstruction. Retroperitoneum is difficult to assess due to
intestinal gas interference and constitutional factors. The urinary
bladder is properly configured and adequately filled. No ascites is
observed.
[Assessment:]{.underline} The liver remains minimally enlarged without
hepatic steatosis. Gallbladder stones persist with concrements showing
no signs of irritation or cholestasis.
**Current Medication:**
**Medication ** **Dosage** **Frequency**
------------------------------------- ------------------------------------------------ ---------------------------
Vitamin D3 (Drisdol) 20.000 IU 1 tablet per week
Calcium supplements (e.g. Caltrate) Aim for a total of 1,500 mg calcium intake/day
Folic acid 15 mg Once daily in the morning
|
Slight improvement
|
To what is the title of the story, “Silence is—Deadly” referring?
A. Androka’s zone of silence is used as a deadly tool against the Nazi war effort.
B. Androka’s zone of silence is used as a deadly tool against the Comerford’s crew.
C. Androka’s zone of silence is used as a deadly tool, made in the name of revenging the Czech war effort.
D. Androka’s zone of silence is used as a deadly tool, helping the Americans sneak up on a Nazi Islet.
|
SILENCE IS—DEADLY By Bertrand L. Shurtleff Radio is an absolute necessity in modern organization—and particularly in modern naval organization. If you could silence all radio—silence of that sort would be deadly! [Transcriber's Note: This etext was produced from Astounding Science-Fiction April 1942. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] The hurried rat-a-tat of knuckles hammered on the cabin door. Commander Bob Curtis roused himself from his doze, got up from his chair, stretched himself to his full, lanky height and yawned. That would be Nelson, his navigating officer. Nelson always knocked that way—like a man in an external state of jitters over nothing at all. Curtis didn't hurry. It pleased him to let Nelson wait. He moved slowly to the door, paused there, and flung a backward glance at the man in the cabin with him—Zukor Androka, the elderly Czech scientist, a guest of the United States navy, here aboard the cruiser Comerford . The wizened face of the older man was molded in intent lines of concentration, as his bushy gray head bent over his drawing board. Curtis got a glimpse of the design on which he was working, and his lips relaxed in a faint smile. Androka had arrived on board the Comerford the day before she sailed from Norfolk. With him came a boatload of scientific apparatus and equipment, including a number of things that looked like oxygen tanks, which were now stored in the forward hold. Androka had watched over his treasures with the jealous care of a mother hen, and spent hours daily in the room in the superstructure that had been assigned as his laboratory. Sometimes, Curtis thought old Androka was a bit wacky—a scientist whose mind had been turned by the horror that had come to his country under the domination of the Nazi gestapo . At other times, the man seemed a genius. Perhaps that was the answer—a mad genius! Curtis opened the door and looked out. Rain whipped against his face like a stinging wet lash. Overhead, the sky was a storm-racked mass of clouds, broken in one spot by a tiny patch of starlit blue. His eyes rested inquiringly on the face of the man who stood before him. It was Nelson, his shaggy blond brows drawn scowlingly down over his pale eyes; his thin face a mass of tense lines; his big hands fumbling at the neck of his slicker. Rain was coursing down his white cheeks, streaking them with glistening furrows. The fellow was a headache to Curtis. He was overfriendly with a black-browed bos'n's mate named Joe Bradford—the worst trouble maker on board. But there was no question of his ability. He was a good navigating officer—dependable, accurate, conscientious. Nevertheless, his taut face, restless, searching eyes, and eternally nervous manner got Curtis' goat. "Come in, Nelson!" he said. Nelson shouldered his way inside, and stood there in his dripping oilskins, blinking his eyes against the yellow light. Curtis closed the door and nodded toward the bent form of Zukor Androka, with a quizzical grin. "Old Czech-and-Double-Czech is working hard on his latest invention to pull Hitler's teeth and re-establish the Czech Republic!" Nelson had no answering smile, although there had been a great deal of good-natured joking aboard the Comerford ever since the navy department had sent the scientist on board the cruiser to carry on his experiments. "I'm worried, sir!" Nelson said. "I'm not sure about my dead reckoning. This storm—" Curtis threw his arm around Nelson's dripping shoulders. "Forget it! Don't let a little error get you down!" "But this storm, sir!" Nelson avoided Curtis' friendly eyes and slipped out from under his arm. "It's got me worried. Quartering wind of undetermined force, variable and gusty. There's a chop to the sea—as if from unestimated currents among the islets. No chance to check by observation, and now there is a chance—look at me!" He held out his hands. They were shaking as if he had the chills. "You say there is a chance?" Curtis asked. "Stars out?" "As if by providence, sir, there's a clear patch. I'm wondering—" His voice trailed off, but his eyes swung toward the gleaming sextant on the rack. Commander Curtis shrugged good-naturedly and reached for the instrument. "Not that I've lost confidence in you, Nels, but just because you asked for it!" Curtis donned his slicker and went outside, sextant in hand. In a few minutes he returned and handed Nelson a sheet of paper with figures underlined heavily. "Here's what I make it," the commander told his navigating officer. "Bet you're not off appreciably." Nelson stared at the computations with shaking head. Then he mutely held up his own. Curtis stared, frowned, grabbed his own sheet again. "Any time I'm that far off old Figure-'em Nelson's estimate, I'm checking back," he declared, frowning at the two papers and hastily rechecking his own figures. "Call up to the bridge to stop her," he told Nelson. "We can't afford to move in these waters with such a possibility of error!" Nelson complied, and the throbbing drive of the engines lessened at once. Nelson said: "I've been wondering, sir, if it wouldn't be advisable to try getting a radio cross-bearing. With all these rocks and islets—" "Radio?" repeated the little Czech, thrusting his face between the other two, in his independent fashion that ignored ship's discipline. "You're using your radio?" He broke into a knowing chuckle, his keen old eyes twinkling behind their thick lenses. "Go ahead and try it. See how much you can get! It will be no more than Hitler can get when Zukor Androka decrees silence over the German airways! Try it! Try it, I say!" Bob Curtis stared at him, as if questioning his sanity. Then he hastened to the radio room, with Nelson at his heels, and the Czech trotting along behind. The door burst open as they neared it. A frightened operator came out, still wearing his earphones, and stood staring upward incredulously at the aërial. "Get us a radio cross-bearing for location at once," Curtis said sharply, for the operator seemed in a daze. "Bearing, sir?" The man brought his eyes down with difficulty, as if still dissatisfied. "I'm sorry, sir, but the outfit's dead. Went out on me about five minutes ago. I was taking the weather report when the set conked. I was trying to see if something's wrong." The Czech inventor giggled. Curtis gave him another curious look and thrust himself into the radio room. "Try again!" he told the operator. "See what you can get!" The radio man leaped to his seat and tried frantically. Again and again, he sent off a request for a cross-bearing from shore stations that had recently been established to insure safety to naval vessels, but there was no answer on any of the bands—not even the blare of a high-powered commercial program in the higher reach, nor the chatter of ships or amateurs on the shorter. "Dead!" Androka muttered, with a bitter laugh. "Yet not dead, gentlemen! The set is uninjured. The waves are what have been upset. I have shattered them around your ship, just as I can eventually shatter them all over Central Europe! For the next two hours, no radio messages can enter or leave my zone of radio silence—of refracted radio waves, set up by my little station on one of the neighboring islets!" There was a long pause, while commander and navigator stared at him. Curtis was the first to speak. "Your secrecy might well cost the United States navy one of its best light cruisers—and us our lives!" he said angrily. "We need that check by radio at once! If you're not talking nonsense, call off your dogs till we learn just where we are!" Androka held out his palms helplessly. "I can do nothing. I have given orders to my assistant that he must keep two hours of radio silence! I can get no message to him, for our radio is dead!" As if to mock him, the ship's radio began to answer: "Station 297 calling U. S. Cruiser Comerford . Station 297 calling U. S. Cruiser Comerford —" "U. S. Cruiser Comerford calling Station 297!" the operator intoned, winking at the two officers over Androka's discomfiture, and asked for the bearings. The answer came back: "Bearings north east by a quarter east, U. S. Cruiser Comerford !" Curtis sighed with relief. He saw that Nelson was staring fiercely at the radio operator, as the man went on calling: "U. S. Cruiser Comerford calling Station 364. U. S. Cruiser Comerford calling Station 364—" Then the instrument rasped again: "Station 364 calling U. S. Cruiser Comerford . Bearings north west by three west. Bearings north west by three west, U. S. Cruiser Comerford from Cay 364." Commander and navigator had both scribbled verifications of the numbers. Ignoring the gibbering Androka, who was wailing his disappointment that messages had penetrated his veil of silence, they raced for the chart room. Quickly the parallels stepped off the bearing from the designated points. Light intersecting lines proclaimed a check on their position. Curtis frowned and shook his head. Slowly he forced a reluctant grin as he stuck out his hand. "Shake, Nels," he said. "It's my turn to eat crow. You and the radio must be right. Continue as you were!" "I'm relieved, sir, just the same," Nelson admitted, "to have the radio bearings. We'd have piled up sure if you'd been right." They went on through the night. The starlit gap in the clouds had closed. The sky was again a blanket of darkness pouring sheets of rain at them. Nelson went back to the bridge, and Androka returned to the commander's cabin. Curtis lingered in the wireless room with the radio operator. "It's a funny thing," the latter said, still dialing and grousing, "how I got that cross-bearing through and can't get another squeak out of her. I'm wondering if that old goat really has done something to the ether. The set seems O. K." He lingered over the apparatus, checking and rechecking. Tubes lighted; wires were alive to the touch and set him to shaking his head at the tingle they sent through his inquiring fingers. Curtis left him at it, and went to rejoin Androka in the cabin. He found the little inventor pacing up and down, shaking his fists in the air; pausing every now and then to run his bony fingers through his tangled mop of gray hair, or to claw nervously at his beard. "You have seen a miracle, commander!" he shouted at Curtis. " My miracle! My invention has shattered the ether waves hereabouts hopelessly." "Seems to me," Curtis said dryly, "this invention can harm your friends as much as your enemies." The scientist drew himself up to his full height—which was only a little over five feet. His voice grew shrill. "Wait! Just wait! There are other inventions to supplement this one. Put them together, and they will defeat the Nazi hordes which have ravaged my country!" Curtis was a little shocked by the hatred that gleamed in Androka's eyes, under their bushy brows. There was something of the wild animal in the man's expression, as his lips drew back from his yellowed teeth. "Those tanks you have below," Curtis said, "have they some connection with this radio silence?" A far-away look came into Androka's eyes. He did not seem to hear the question. He lowered his voice: "My daughter is still in Prague. So are my sister and her husband, and their two daughters. If the gestapo knew what I am doing, all of them would be better dead. You understand—better dead?" Curtis said: "I understand." "And if the Nazi agents in America knew of the islet from which my zone of silence is projected—" Androka paused, his head tilted to one side, as if he were listening to something— On deck, there was shouting and commotion. Curtis rushed out, pulling on his slicker as he went. The shout from the watch forward had been picked up, and was being relayed all over the ship. The words struck on Curtis' ears with a note of impending tragedy. "Breakers ahead!" He was beside Navigating Officer Nelson on the bridge, and saw the helmsman climbing the rapidly spinning wheel like a monkey as he put it hard aport. Then the ship struck. Everything movable shot ahead until it brought up at the end of a swing or smacked against something solid. Curtis felt Nelson's hand grip his shoulder, as he put his lips close to his ear and shouted: "You must have been right, sir, and the radio bearings and my reckoning wrong. We've hit that reef a terrific smack. I'm afraid we're gored!" "Get out the collision mat!" Curtis ordered. "We ought to be able to keep her up!" And then he became aware of a deadly stillness. A vast wall of silence enveloped the entire cruiser. Looking over the side, he could no longer see the waves that a few minutes before had beaten savagely against the ship. The Comerford was shrouded in a huge pall of yellowish-gray mist, and more of it was coming up from below—from ventilators and hatchways and skylights—as if the whole ship were flooded with some evil vapor. Somehow, Curtis' mind flashed to the stories he'd heard of the forts of the Maginot Line, and of other forts in Holland and Belgium that had fallen before the early Nazi blitzkrieg, when their defenders found themselves struck numb and helpless by a gas that had been flooded into the inner compartments of their strongholds. There were those who said it was the work of sappers who had tunneled under the foundations, while others laid the induction of the gas to Fifth Column traitors. There were a hundred more or less plausible explanations— The vapor clouds that enveloped the Comerford were becoming thicker. All about the deck lay the forms of unconscious seamen, suddenly stricken helpless. And then Curtis saw other forms flitting about the deck—forms that looked like creatures from another world, but he recognized them for what they were—men wearing gas masks. Nelson was nowhere in sight. The steersman lay in a limp heap beside the swinging wheel. Then a gas-masked figure appeared through the shroud of mist and steadied it, so that the cruiser would not be completely at the mercy of the wind and the waves. Curtis heard the anchor let down, as if by invisible hands, the chain screaming and flailing its clanking way through the hawse hole. Then he was completely walled in by the yellowish-gray mist. He felt his senses swimming. Voices droned all around him in mumbling confusion—guttural voices that ebbed and flowed in a tide of excited talk. He caught a word of English now and then, mixed in with a flood of Teuton phonetics. Two words, in particular, registered clearly on his mind. One was " Carethusia "; the other was "convoy." But gradually his eardrums began to throb, as if someone were pounding on them from the inside. He couldn't get his breath; a cloud seemed to be mounting within him until it swept over his brain— He felt something strike the side of his head, and realized that he had fallen in a heap on the bridge. And after that, he wasn't conscious of anything— The rain had abated to a foggy drizzle. The wash of the surf swung the Comerford in a lazy, rolling motion, as she lay with her bow nosing into the sandbar at the entrance of the inlet. From her bridge, Navigating Officer Nelson watched the gas-masked figures moving about the decks, descending companionways—like goblins from an ancient fairy tale or a modern horror story. Nelson looked like a goblin himself, with his face covered by a respirator. At his side, stood his fellow conspirator Bos'n's Mate Joe Bradford, also wearing a gas mask. Nelson spoke in a low tone, his lips close to Bradford's ear. "It worked, Joe!" "Yeah!" Bradford agreed. "It worked—fine!" The limp bodies of the Comerford's crew were being carried to the lowered accommodation ladder and transferred into waiting lifeboats. Nelson swore under his breath. "Reckon it'll take a couple of hours before the ship's rid of that damn gas!" Bradford shook his head in disagreement. "The old geezer claims he's got a neutralizing chemical in one of them tanks of his that'll clear everything up inside half an hour." "I'd rather get along without Androka, if we could!" Nelson muttered. "He's nothing but a crackpot!" "It was a crackpot who invented the gas we used to break up the Maginot Line," Bradford reminded him. "It saved a lot of lives for the Fuehrer —lives that'd have been lost if the forts had to be taken by our storm troopers!" Nelson grunted and turned away. A short, thick-set figure in the uniform of a German naval commander had ascended the accommodation ladder and was mounting to the bridge. He, too, was equipped with a respirator. He came up to Nelson, saluted, and held out his hand, introducing himself as Herr Kommander Brandt. He began to speak in German, but Nelson stopped him. "I don't speak any German," he explained. "I was born and educated in the United States—of German parents, who had been ruined in the First World War. My mother committed suicide when she learned that we were penniless. My father—" He paused and cleared his throat. " Ja! Your father?" the German officer prompted, dropping into accented English. "Your father?" "My father dedicated me to a career of revenge—to wipe out his wrongs," Nelson continued. "If America hadn't gone into the First World War, he wouldn't have lost his business; my mother would still be living. When he joined the Nazi party, the way became clear to use me—to educate me in a military prep school, then send me to Annapolis, for a career in the United States navy—and no one suspected me. No one—" "Sometimes," Bradford put in, "I think Curtis suspected you." "Maybe Curtis'll find out his suspicions were justified," Nelson said bitterly. "But it won't do Curtis any good—a commander who's lost his ship." He turned to Brandt. "You have plenty of men to work the Comerford ?" Brandt nodded his square head. "We have a full crew—two hundred men—officers, seamen, mechanics, radio men, technical experts, all German naval reservists living in the United States, who've been sent here secretly, a few at a time, during the past six weeks!" The three—Brandt, Nelson and Bradford—stood on the bridge and talked, while the efficient stretcher-bearers worked industriously to remove the limp bodies of the Comerford's unconscious crew and row them ashore. And when that task was completed, lifeboats began to come alongside with strange-looking radio equipment, and more gas tanks like those Androka had brought aboard the Comerford with him, and dynamos and batteries that looked like something out of a scientific nightmare. And bustling all over the place, barking excited commands in German, pushing and pulling and pointing to emphasize his directions, was the strange figure of Professor Zukor Androka! "The professor's in his glory!" Nelson remarked to Kommander Brandt. "Funny thing about him," Bradford put in, "is that his inventions work. That zone of silence cut us off completely." Kommander Brandt nodded. "Goodt! But you got your message giving your bearings—the wrong ones?" "Yes," Nelson said. "That came through all right. And won't Curtis have a time explaining it!" "Hereafter," Brandt said solemnly, "the zone of silence vill be projected from the Comerford ; and ve have another invention of Androka's vich vill be even more useful vhen ve come to cut the Carethusia out of her convoy." "The Carethusia ?" Nelson asked, in a puzzled tone. Brandt said: "She's a freighter in a convoy out of St. Johns—twelve thousand tons. The orders are to take her; not sink her." "What's the idea?" "Her cargo," Brandt explained. "It iss more precious than rubies. It includes a large shipment of boarts." "Boarts?" Nelson repeated. "What are they?" "Boarts," Brandt told him, "are industrial diamonds—black, imperfectly crystallized stones, but far more valuable to us than flawless diamonds from Tiffany's on Fift' Avenue. They are needed for making machine tools. They come from northern Brazil—and our supply is low." "I should think we could get a shipment of these boarts direct from Brazil—through the blockade," Nelson said, "without taking the risk of capturing a United States navy cruiser." "There are other things Germany needs desperately on board the Carethusia ," Brandt explained. "Vanadium and nickel and hundreds of barrels of lard oil for machine-tool lubrication. Our agents have been watching the convoys closely for weeks for just such a cargo as the Carethusia is taking over." "Can we trust Androka?" Nelson asked, with a sudden note of suspicion in his voice. "Yes," Brandt assured him. "Of all men—we can trust Androka!" "But he's a Czech," Nelson argued. "The gestapo takes care of Czechs and Poles and Frenchmen and other foreigners whom it chooses as its agents," Brandt pointed out. "Androka has a daughter and other relations in Prague. He knows that if anything misfires, if there is the slightest suspicion of treachery on his part, his daughter and the others will suffer. Androka's loyalty is assured!" Nelson turned to watch the forward fighting top of the Comerford . The masked German seamen were installing some sort of apparatus up there—a strange-looking object that looked something like an old-fashioned trench mortar, and which connected with cables to the room that served as Androka's laboratory and workshop. Another crew was installing radio apparatus in the mizzentop turret. Descending a companionway to see what was going on below, Nelson found that portholes were being opened, and men were spraying chemical around to rid the below-decks atmosphere of the lethal gas that had overcome the Comerford's American crew. Returning to the bridge, he found that the tide in the inlet had risen considerably, and that the cruiser was riding more easily at her anchor. Then, at Brandt's orders, the anchor was hauled in, and lifeboats and a motor launch were used as tugs to work the vessel entirely free of the sand bar. This was accomplished without difficulty. Brandt came over to where Nelson was standing on the bridge and held out his hand. "Congratulations, Herr Kommander Nelson!" he said. "Ve have stolen one of the United States navy's newest and fastest cruisers!" He made a gesture as if raising a beer stein to drink a toast. " Prosit! " he added. " Prosit! " Nelson repeated, and the two grinned at each other. Stars were twinkling in a patch of black-blue sky, and broken mountains of gray cloud were skudding before the east wind. Commander Bob Curtis found himself lying in wet sand, on a beach, somewhere, with the rain—now a light, driving mist—beating on his face. He was chilled; his limbs were stiff and numb. His nose and throat felt parched inside, as if a wave of searing heat had scorched them. According to his last calculations, the Comerford had been cruising off the Maine coast. This probably was one of the islets of that region, or it might be the mainland. It was hard work getting to his feet, and when he did manage to stand, he could only plant his heels in the sand and sway to and fro for fully a minute, like a child learning to walk. All around him in the nearly total darkness, he could make out the dim forms of men sprawled on the beach; and of other men moving about, exploring. He heard the murmur of voices and saw the glow of lighted cigarettes. A man with a flashlight was approaching him. Its white glare shone for a moment in Curtis' face, and the familiar voice of Ensign Jack Dillon spoke: "Commander Curtis! Are you O. K., sir?" "I think so!" Curtis' heart warmed at the eager expression in Dillon's face; at the heartfelt concern in his friendly brown eyes. The young ensign was red-headed, impetuous, thoroughly genuine in his emotions. "How about yourself, Jack?" Curtis added. "A bit of a headache from the gas, but that's all. Any orders, sir?" Curtis thought for a moment. "Muster the crew, as best you can. We'll try to make a roll call. Is there any sign of the ship?" There was a solemn note in Dillon's voice. "No, sir. She's been worked off the sandbar and put to sea!" The words struck Curtis with the numbing shock of a blow on some nerve center. For the first time, he realized fully the tragedy that had swept down on him. He had lost his ship—one of the United States navy's fastest and newest small light cruisers—under circumstances which smelled strongly of treachery and sabotage. As he thought back, he realized that he might have prevented the loss, if he had been more alert, more suspicious. For it was clear to him now that the Comerford had been deliberately steered to this place; that the men who had seized her had been waiting here for that very purpose. The pieces of the picture fitted together like a jigsaw puzzle—Androka's zone of silence; the bearings given by radio; Navigating Officer Nelson's queer conduct. They were all part of a carefully laid plan! All the suspicious circumstances surrounding Nelson came flooding into Curtis' mind. He had never liked the man; never trusted him. Nelson always acted as if he had some secret, something to hide. Curtis recalled that Nelson and Androka had long conversations together—conversations which they would end abruptly when anyone else came within earshot. And Nelson had always been chummy with the worst trouble maker in the crew—Bos'n's Mate Bradford. Curtis went around, finding the officers, issuing orders. There were still some unconscious men to be revived. In a sheltered cove among the rocks, an exploring group had found enough dry driftwood to make a fire— In another hour, the skies had cleared, and white moonlight flooded the scene with a ghostly radiance. The men of the Comerford had all regained consciousness and were drying out in front of the big driftwood bonfires in the cove. Curtis ordered a beacon kept burning on a high promontory. Then he got the men lined up, according to their respective classifications, for a check-up on the missing. When this was completed, it was found that the Comerford's entire complement of two hundred and twenty men were present—except Navigating Officer Nelson, and Bos'n's Mate Bradford! And Zukor Androka was also missing! With the coming of dawn, a little exploration revealed that the Comerford's crew was marooned on an islet, about a square mile in area; that they had been put ashore without food or extra clothing or equipment of any kind, and that no boats had been left for them. One searching party reported finding the remains of what had been a radio station on a high promontory on the north shore of the islet. Another had found the remains of tents and log cabins, recently demolished, in a small, timbered hollow—a well-hidden spot invisible from the air, unless one were flying very low; a place where two hundred or more men could have camped. There was a good water supply—a small creek fed by springs—but nothing in the way of food. Evidently food was a precious commodity which the recent inhabitants of the islet couldn't afford to leave behind. Curtis was studying the wreckage of the wireless station, wondering if this might have been the source of Androka's zone of silence, when Ensign Jack Dillon came up to him. "There's a coast-guard cutter heading for the island, sir," he announced.
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B. Androka’s zone of silence is used as a deadly tool against the Comerford’s crew.
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What is a likely explanation for Orison seeing Benjamin Franklin images in the Microfabridae tank?
A. The Microfabridae are killing people and the faces look like Benjamin franklin.
B. It was a play of the eyes.
C. The Microfabridae are being used to process $100 bills for illegal purposes.
D. Someone accidentally dropped $100 bills into the tanks.
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CINDERELLA STORY By ALLEN KIM LANG What a bank! The First Vice-President was a cool cat—the elevator and the money operators all wore earmuffs—was just as phony as a three-dollar bill! [Transcriber's Note: This etext was produced from Worlds of If Science Fiction, May 1961. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] I The First Vice-President of the William Howard Taft National Bank and Trust Company, the gentleman to whom Miss Orison McCall was applying for a job, was not at all the public picture of a banker. His suit of hound's-tooth checks, the scarlet vest peeping above the vee of his jacket, were enough to assure Orison that the Taft Bank was a curious bank indeed. "I gotta say, chick, these references of yours really swing," said the Vice-President, Mr. Wanji. "Your last boss says you come on real cool in the secretary-bit." "He was a very kind employer," Orison said. She tried to keep from staring at the most remarkable item of Mr. Wanji's costume, a pair of furry green earmuffs. It was not cold. Mr. Wanji returned to Orison her letters of reference. "What color bread you got eyes for taking down, baby?" he asked. "Beg pardon?" "What kinda salary you bucking for?" he translated, bouncing up and down on the toes of his rough-leather desert boots. "I was making one-twenty a week in my last position," Miss McCall said. "You're worth more'n that, just to jazz up the decor," Mr. Wanji said. "What you say we pass you a cee-and-a-half a week. Okay?" He caught Orison's look of bewilderment. "One each, a Franklin and a Grant," he explained further. She still looked blank. "Sister, you gonna work in a bank, you gotta know who's picture's on the paper. That's a hunnerd-fifty a week, doll." "That will be most satisfactory, Mr. Wanji," Orison said. It was indeed. "Crazy!" Mr. Wanji grabbed Orison's right hand and shook it with athletic vigor. "You just now joined up with our herd. I wanna tell you, chick, it's none too soon we got some decent scenery around this tomb, girlwise." He took her arm and led her toward the bank of elevators. The uniformed operator nodded to Mr. Wanji, bowed slightly to Orison. He, too, she observed, wore earmuffs. His were more formal than Mr. Wanji's, being midnight blue in color. "Lift us to five, Mac," Mr. Wanji said. As the elevator door shut he explained to Orison, "You can make the Taft Bank scene anywhere between the street floor and floor five. Basement and everything higher'n fifth floor is Iron Curtain Country far's you're concerned. Dig, baby?" "Yes, sir," Orison said. She was wondering if she'd be issued earmuffs, now that she'd become an employee of this most peculiar bank. The elevator opened on five to a tiny office, just large enough to hold a single desk and two chairs. On the desk were a telephone and a microphone. Beside them was a double-decked "In" and "Out" basket. "Here's where you'll do your nine-to-five, honey," Mr. Wanji said. "What will I be doing, Mr. Wanji?" Orison asked. The Vice-President pointed to the newspaper folded in the "In" basket. "Flip on the microphone and read the paper to it," he said. "When you get done reading the paper, someone will run you up something new to read. Okay?" "It seems a rather peculiar job," Orison said. "After all, I'm a secretary. Is reading the newspaper aloud supposed to familiarize me with the Bank's operation?" "Don't bug me, kid," Mr. Wanji said. "All you gotta do is read that there paper into this here microphone. Can do?" "Yes, sir," Orison said. "While you're here, Mr. Wanji, I'd like to ask you about my withholding tax, social security, credit union, coffee-breaks, union membership, lunch hour and the like. Shall we take care of these details now? Or would you—" "You just take care of that chicken-flickin' kinda stuff any way seems best to you, kid," Mr. Wanji said. "Yes, sir," Orison said. This laissez-faire policy of Taft Bank's might explain why she'd been selected from the Treasury Department's secretarial pool to apply for work here, she thought. Orison McCall, girl Government spy. She picked up the newspaper from the "In" basket, unfolded it to discover the day's Wall Street Journal , and began at the top of column one to read it aloud. Wanji stood before the desk, nodding his head as he listened. "You blowing real good, kid," he said. "The boss is gonna dig you the most." Orison nodded. Holding her newspaper and her microphone, she read the one into the other. Mr. Wanji flicked his fingers in a good-by, then took off upstairs in the elevator. By lunchtime Orison had finished the Wall Street Journal and had begun reading a book an earmuffed page had brought her. The book was a fantastic novel of some sort, named The Hobbit . Reading this peculiar fare into the microphone before her, Miss McCall was more certain than ever that the Taft Bank was, as her boss in Washington had told her, the front for some highly irregular goings-on. An odd business for a Federal Mata Hari, Orison thought, reading a nonsense story into a microphone for an invisible audience. Orison switched off her microphone at noon, marked her place in the book and took the elevator down to the ground floor. The operator was a new man, ears concealed behind scarlet earmuffs. In the car, coming down from the interdicted upper floors, were several gentlemen with briefcases. As though they were members of a ballet-troupe, these gentlemen whipped off their hats with a single motion as Orison stepped aboard the elevator. Each of the chivalrous men, hat pressed to his heart, wore a pair of earmuffs. Orison nodded bemused acknowledgment of their gesture, and got off in the lobby vowing never to put a penny into this curiousest of banks. Lunch at the stand-up counter down the street was a normal interlude. Girls from the ground-floor offices of Taft Bank chattered together, eyed Orison with the coolness due so attractive a competitor, and favored her with no gambit to enter their conversations. Orison sighed, finished her tuna salad on whole-wheat, then went back upstairs to her lonely desk and her microphone. By five, Orison had finished the book, reading rapidly and becoming despite herself engrossed in the saga of Bilbo Baggins, Hobbit. She switched off the microphone, put on her light coat, and rode downstairs in an elevator filled with earmuffed, silent, hat-clasping gentlemen. What I need, Orison thought, walking rapidly to the busline, is a double Scotch, followed by a double Scotch. And what the William Howard Taft National Bank and Trust Company needs is a joint raid by forces of the U.S. Treasury Department and the American Psychiatric Association. Earmuffs, indeed. Fairy-tales read into a microphone. A Vice-President with the vocabulary of a racetrack tout. And what goes on in those upper floors? Orison stopped in at the restaurant nearest her apartment house—the Windsor Arms—and ordered a meal and a single Martini. Her boss in Washington had told her that this job of hers, spying on Taft Bank from within, might prove dangerous. Indeed it was, she thought. She was in danger of becoming a solitary drinker. Home in her apartment, Orison set the notes of her first day's observations in order. Presumably Washington would call tonight for her initial report. Item: some of the men at the Bank wore earmuffs, several didn't. Item: the Vice-President's name was Mr. Wanji: Oriental? Item: the top eight floors of the Taft Bank Building seemed to be off-limits to all personnel not wearing earmuffs. Item: she was being employed at a very respectable salary to read newsprint and nonsense into a microphone. Let Washington make sense of that, she thought. In a gloomy mood, Orison McCall showered and dressed for bed. Eleven o'clock. Washington should be calling soon, inquiring after the results of her first day's spying. No call. Orison slipped between the sheets at eleven-thirty. The clock was set; the lights were out. Wasn't Washington going to call her? Perhaps, she thought, the Department had discovered that the Earmuffs had her phone tapped. "Testing," a baritone voice muttered. Orison sat up, clutching the sheet around her throat. "Beg pardon?" she said. "Testing," the male voice repeated. "One, two, three; three, two, one. Do you read me? Over." Orison reached under the bed for a shoe. Gripping it like a Scout-ax, she reached for the light cord with her free hand and tugged at it. The room was empty. "Testing," the voice repeated. "What you're testing," Orison said in a firm voice, "is my patience. Who are you?" "Department of Treasury Monitor J-12," the male voice said. "Do you have anything to report, Miss McCall?" "Where are you, Monitor?" she demanded. "That's classified information," the voice said. "Please speak directly to your pillow, Miss McCall." Orison lay down cautiously. "All right," she whispered to her pillow. "Over here," the voice instructed her, coming from the unruffled pillow beside her. Orison transferred her head to the pillow to her left. "A radio?" she asked. "Of a sort," Monitor J-12 agreed. "We have to maintain communications security. Have you anything to report?" "I got the job," Orison said. "Are you ... in that pillow ... all the time?" "No, Miss McCall," the voice said. "Only at report times. Shall we establish our rendezvous here at eleven-fifteen, Central Standard Time, every day?" "You make it sound so improper," Orison said. "I'm far enough away to do you no harm, Miss McCall," the monitor said. "Now, tell me what happened at the bank today." Orison briefed her pillow on the Earmuffs, on her task of reading to a microphone, and on the generally mimsy tone of the William Howard Taft National Bank and Trust Company. "That's about it, so far," she said. "Good report," J-12 said from the pillow. "Sounds like you've dropped into a real snakepit, beautiful." "How do you know ... why do you think I'm beautiful?" Orison asked. "Native optimism," the voice said. "Good night." J-12 signed off with a peculiar electronic pop that puzzled Orison for a moment. Then she placed the sound: J-12 had kissed his microphone. Orison flung the shoe and the pillow under her bed, and resolved to write Washington for permission to make her future reports by registered mail. II At ten o'clock the next morning, reading page four of the current Wall Street Journal , Orison was interrupted by the click of a pair of leather heels. The gentleman whose heels had just slammed together was bowing. And she saw with some gratification that he was not wearing earmuffs. "My name," the stranger said, "is Dink Gerding. I am President of this bank, and wish at this time to welcome you to our little family." "I'm Orison McCall," she said. A handsome man, she mused. Twenty-eight? So tall. Could he ever be interested in a girl just five-foot-three? Maybe higher heels? "We're pleased with your work, Miss McCall," Dink Gerding said. He took the chair to the right of her desk. "It's nothing," Orison said, switching off the microphone. "On the contrary, Miss McCall. Your duties are most important," he said. "Reading papers and fairy-tales into this microphone is nothing any reasonably astute sixth-grader couldn't do as well," Orison said. "You'll be reading silently before long," Mr. Gerding said. He smiled, as though this explained everything. "By the way, your official designation is Confidential Secretary. It's me whose confidences you're to keep secret. If I ever need a letter written, may I stop down here and dictate it?" "Please do," Orison said. This bank president, for all his grace and presence, was obviously as kookie as his bank. "Have you ever worked in a bank before, Miss McCall?" Mr. Gerding asked, as though following her train of thought. "No, sir," she said. "Though I've been associated with a rather large financial organization." "You may find some of our methods a little strange, but you'll get used to them," he said. "Meanwhile, I'd be most grateful if you'd dispense with calling me 'sir.' My name is Dink. It is ridiculous, but I'd enjoy your using it." "Dink?" she asked. "And I suppose you're to call me Orison?" "That's the drill," he said. "One more question, Orison. Dinner this evening?" Direct, she thought. Perhaps that's why he's president of a bank, and still so young. "We've hardly met," she said. "But we're on a first-name basis already," he pointed out. "Dance?" "I'd love to," Orison said, half expecting an orchestra to march, playing, from the elevator. "Then I'll pick you up at seven. Windsor Arms, if I remember your personnel form correctly." He stood, lean, all bone and muscle, and bowed slightly. West Point? Hardly. His manners were European. Sandhurst, perhaps, or Saint Cyr. Was she supposed to reply with a curtsy? Orison wondered. "Thank you," she said. He was a soldier, or had been: the way, when he turned, his shoulders stayed square. The crisp clicking of his steps, a military metronome, to the elevator. When the door slicked open Orison, staring after Dink, saw that each of the half-dozen men aboard snapped off their hats (but not their earmuffs) and bowed, the earmuffed operator bowing with them. Small bows, true; just head-and-neck. But not to her. To Dink Gerding. Orison finished the Wall Street Journal by early afternoon. A page came up a moment later with fresh reading-matter: a copy of yesterday's Congressional Record . She launched into the Record , thinking as she read of meeting again this evening that handsome madman, that splendid lunatic, that unlikely bank-president. "You read so well , darling," someone said across the desk. Orison looked up. "Oh, hello," she said. "I didn't hear you come up." "I walk ever so lightly," the woman said, standing hip-shot in front of the desk, "and pounce ever so hard." She smiled. Opulent, Orison thought. Built like a burlesque queen. No, she thought, I don't like her. Can't. Wouldn't if I could. Never cared for cats. "I'm Orison McCall," she said, and tried to smile back without showing teeth. "Delighted," the visitor said, handing over an undelighted palm. "I'm Auga Vingt. Auga, to my friends." "Won't you sit down, Miss Vingt?" "So kind of you, darling," Auga Vingt said, "but I shan't have time to visit. I just wanted to stop and welcome you as a Taft Bank co-worker. One for all, all for one. Yea, Team. You know." "Thanks," Orison said. "Common courtesy," Miss Vingt explained. "Also, darling, I'd like to draw your attention to one little point. Dink Gerding—you know, the shoulders and muscles and crewcut? Well, he's posted property. Should you throw your starveling charms at my Dink, you'd only get your little eyes scratched out. Word to the wise, n'est-ce pas ?" "Sorry you have to leave so suddenly," Orison said, rolling her Wall Street Journal into a club and standing. "Darling." "So remember, Tiny, Dink Gerding is mine. You're all alone up here. You could get broken nails, fall down the elevator shaft, all sorts of annoyance. Understand me, darling?" "You make it very clear," Orison said. "Now you'd best hurry back to your stanchion, Bossy, before the hay's all gone." "Isn't it lovely, the way you and I reached an understanding right off?" Auga asked. "Well, ta-ta." She turned and walked to the elevator, displaying, Orison thought, a disgraceful amount of ungirdled rhumba motion. The elevator stopped to pick up the odious Auga. A passenger, male, stepped off. "Good morning, Mr. Gerding," Miss Vingt said, bowing. "Carry on, Colonel," the stranger replied. As the elevator door closed, he stepped up to Orison's desk. "Good morning. Miss McCall," he said. "What is this?" Orison demanded. "Visiting-day at the zoo?" She paused and shook her head. "Excuse me, sir," she said. "It's just that ... Vingt thing...." "Auga is rather intense," the new Mr. Gerding said. "Yeah, intense," Orison said. "Like a kidney-stone." "I stopped by to welcome you to the William Howard Taft National Bank and Trust Company family, Miss McCall," he said. "I'm Kraft Gerding, Dink's elder brother. I understand you've met Dink already." "Yes, sir," Orison said. The hair of this new Mr. Gerding was cropped even closer than Dink's. His mustache was gray-tipped, like a patch of frosted furze; and his eyes, like Dink's, were cobalt blue. The head, Orison mused, would look quite at home in one of Kaiser Bill's spike-topped Pickelhauben ; but the ears were in evidence, and seemed normal. Mr. Kraft Gerding bowed—what continental manners these bankers had!—and Orison half expected him to free her hand from the rolled-up paper she still clutched and plant a kiss on it. Instead, Kraft Gerding smiled a smile as frosty as his mustache and said, "I understand that my younger brother has been talking with you, Miss McCall. Quite proper, I know. But I must warn you against mixing business with pleasure." Orison jumped up, tossing the paper into her wastebasket. "I quit!" she shouted. "You can take this crazy bank ... into bankruptcy, for all I care. I'm not going to perch up here, target for every uncaged idiot in finance, and listen to another word." "Dearest lady, my humblest pardon," Kraft Gerding said, bowing again, a bit lower. "Your work is splendid; your presence is Taft Bank's most charming asset; my only wish is to serve and protect you. To this end, dear lady, I feel it my duty to warn you against my brother. A word to the wise...." " N'est-ce pas? " Orison said. "Well, Buster, here's a word to the foolish. Get lost." Kraft Gerding bowed and flashed his gelid smile. "Until we meet again?" "I'll hold my breath," Orison promised. "The elevator is just behind you. Push a button, will you? And bon voyage ." Kraft Gerding called the elevator, marched aboard, favored Orison with a cold, quick bow, then disappeared into the mysterious heights above fifth floor. First the unspeakable Auga Vingt, then the obnoxious Kraft Gerding. Surely, Orison thought, recovering the Wall Street Journal from her wastebasket and smoothing it, no one would convert a major Midwestern bank into a lunatic asylum. How else, though, could the behavior of the Earmuffs be explained? Could madmen run a bank? Why not, she thought. History is rich in examples of madmen running nations, banks and all. She began again to read the paper into the microphone. If she finished early enough, she might get a chance to prowl those Off-Limits upper floors. Half an hour further into the paper, Orison jumped, startled by the sudden buzz of her telephone. She picked it up. " Wanji e-Kal, Datto. Dink ger-Dink d'summa. " Orison scribbled down this intelligence in bemused Gregg before replying, "I'm a local girl. Try me in English." "Oh. Hi, Miss McCall," the voice said. "Guess I goofed. I'm in kinda clutch. This is Wanji. I got a kite for Mr. Dink Gerding. If you see him, tell him the escudo green is pale. Got that, doll?" "Yes, Mr. Wanji. I'll tell Mr. Gerding." Orison clicked the phone down. What now, Mata Hari? she asked herself. What was the curious language Mr. Wanji had used? She'd have to report the message to Washington by tonight's pillow, and let the polyglots of Treasury Intelligence puzzle it out. Meanwhile, she thought, scooting her chair back from her desk, she had a vague excuse to prowl the upper floors. The Earmuffs could only fire her. Orison folded the paper and put it in the "Out" basket. Someone would be here in a moment with something new to read. She'd best get going. The elevator? No. The operators had surely been instructed to keep her off the upstairs floors. But the building had a stairway. III The door on the sixth floor was locked. Orison went on up the stairs to seven. The glass of the door there was painted black on the inside, and the landing was cellar-dark. Orison closed her eyes for a moment. There was a curious sound. The buzzing of a million bees, barely within the fringes of her hearing. Somehow, a very pleasant sound. She opened her eyes and tried the knob. The door opened. Orison was blinded by the lights, brilliant as noonday sun. The room extended through the entire seventh floor, its windows boarded shut, its ceiling a mass of fluorescent lamps. Set about the floor were galvanized steel tanks, rectangular and a little bigger than bathtubs. Orison counted the rows of tanks. Twelve rows, nine tiers. One hundred and eight tanks. She walked closer. The tubs were laced together by strands of angel-hair, delicate white lattices scintillating with pink. She walked to the nearest of the tubs and looked in. It was half full of a greenish fluid, seething with tiny pink bubbles. For a moment Orison thought she saw Benjamin Franklin winking up at her from the liquid. Then she screamed. The pink bubbles, the tiny flesh-colored flecks glinting light from the spun-sugar bridges between the tanks, were spiders. Millions upon millions of spiders, each the size of a mustard-seed; crawling, leaping, swinging, spinning webs, seething in the hundred tanks. Orison put her hands over her ears and screamed again, backing toward the stairway door. Into a pair of arms. "I had hoped you'd be happy here, Miss McCall," Kraft Gerding said. Orison struggled to release herself. She broke free only to have her wrists seized by two Earmuffs that had appeared with the elder Gerding. "It seems that our Pandora doesn't care for spiders," he said. "Really, Miss McCall, our little pets are quite harmless. Were we to toss you into one of these tanks...." Orison struggled against her two sumo -sized captors, whose combined weights exceeded hers by some quarter-ton, without doing more than lifting her feet from the floor. "... your flesh would be unharmed, though they spun and darted all around you. Our Microfabridae are petrovorous, Miss McCall. Of course, once they discovered your teeth, and through them a skeleton of calcium, a delicacy they find most toothsome, you'd be filleted within minutes." "Elder Compassion wouldn't like your harming the girl, Sire," one of the earmuffed sumo -wrestlers protested. "Elder Compassion has no rank," Kraft Gerding said. "Miss McCall, you must tell me what you were doing here, or I'll toss you to the spiders." "Dink ... Dink!" Orison shouted. "My beloved younger brother is otherwise engaged than in the rescue of damsels in distress," Kraft said. "Someone, after all, has to mind the bank." "I came to bring a message to Dink," Orison said. "Let me go, you acromegalic apes!" "The message?" Kraft Gerding demanded. "Something about escudo green. Put me down!" Suddenly she was dropped. Her mountainous keepers were on the floor as though struck by lightning, their arms thrown out before them, their faces abject against the floor. Kraft Gerding was slowly lowering himself to one knee. Dink had entered the spider-room. Without questions, he strode between the shiko-ing Earmuffs and put his arms around Orison. "They can't harm you," he said. She turned to press her face against his chest. "You're all right, child. Breathe deep, swallow, and turn your brain back on. All right, now?" "All right," she said, still trembling. "They were going to throw me to the spiders." "Kraft told you that?" Dink Gerding released her and turned to the kneeling man. "Stand up, Elder Brother." "I...." Dink brought his right fist up from hip-level, crashing it into Kraft's jaw. Kraft Gerding joined the Earmuffs on the floor. "If you'd care to stand again, Elder Brother, you may attempt to recover your dignity without regard for the difference in our rank." Kraft struggled to one knee and remained kneeling, gazing up at Dink through half-closed eyes. "No? Then get out of here, all of you. Samma! " Kraft Gerding arose, stared for a moment at Dink and Orison, then, with the merest hint of a bow, led his two giant Earmuffs to the elevator. "I wish you hadn't come up here, Orison," Dink said. "Why did you do it?" "Have you read the story of Bluebeard?" Orison asked. She stood close to Dink, keeping her eyes on the nearest spidertank. "I had to see what it was you kept up here so secretly, what it was that I was forbidden to see. My excuse was to have been that I was looking for you, to deliver a message from Mr. Wanji. He said I was to tell you that the escudo green is pale." "You're too curious, and Wanji is too careless," Dink said. "Now, what is this thing you have about spiders?" "I've always been terrified of them," Orison said. "When I was a little girl, I had to stay upstairs all day one Sunday because there was a spider hanging from his thread in the stairway. I waited until Dad came home and took it down with a broom. Even then, I didn't have appetite for supper." "Strange," Dink said. He walked over to the nearest tank and plucked one of the tiny pink creatures from a web-bridge. "This is no spider, Orison," he said. She backed away from Dink Gerding and the minuscule creature he cupped in the palm of his hand. "These are Microfabridae, more nearly related to shellfish than to spiders," he said. "They're stone-and-metal eaters. They literally couldn't harm a fly. Look at it, Orison." He extended his palm. Orison forced herself to look. The little creature, flesh-colored against his flesh, was nearly invisible, scuttling around the bowl of his hand. "Pretty little fellow, isn't he?" Dink asked. "Here. You hold him." "I'd rather not," she protested. "I'd be happier if you did," Dink said. Orison extended her hand as into a furnace. Dink brushed the Microfabridus from his palm to hers. It felt crisp and hard, like a legged grain of sand. Dink took a magnifier from his pocket and unfolded it, to hold it over Orison's palm. "He's like a baby crawdad," Orison said. "A sort of crustacean," Dink agreed. "We use them in a commercial process we're developing. That's why we keep this floor closed off and secret. We don't have a patent on the use of Microfabridae, you see." "What do they do?" Orison asked. "That's still a secret," Dink said, smiling. "I can't tell even you that, not yet, even though you're my most confidential secretary." "What's he doing now?" Orison asked, watching the Microfabridus, perched up on the rear four of his six microscopic legs, scratching against her high-school class-ring with his tiny chelae. "They like gold," Dink explained, peering across her shoulder, comfortably close. "They're attracted to it by a chemical tropism, as children are attracted to candy. Toss him back into his tank, Orison. We'd better get you down where you belong." Orison brushed the midget crustacean off her finger into the nearest tank, where he joined the busy boil of his fellows. She felt her ring. It was pitted where the Microfabridus had been nibbling. "Strange, using crawdads in a bank," she said. She stood silent for a moment. "I thought I heard music," she said. "I heard it when I came in. Something like the sighing of wind in winter trees." "That's the hymn of the Microfabridae," Dink said. "They all sing together while they work, a chorus of some twenty million voices." He took her arm. "If you listen very carefully, you'll find the song these little workers sing the most beautiful music in the world." Orison closed her eyes, leaning back into Dink's arms, listening to the music that seemed on the outermost edge of her hearing. Wildness, storm and danger were its theme, counterpointed by promises of peace and harbor. She heard the wash of giant waves in the song, the crash of breakers against granite, cold and insatiable. And behind this, the quiet of sheltered tide-pools, the soft lub of sea-arms landlocked. "It's an ancient song," Dink said. "The Microfabridae have been singing it for a million years." He released her, and opened a wood-covered wooden box. He scooped up a cupful of the sand inside. "Hold out your hands," he told Orison. He filled them with the sand. "Throw our singers some supper for their song," he said. Orison went with her cupped hands to the nearest tank and sprinkled the mineral fishfood around inside it. The Microfabridae leaped from the liquid like miniature porpoises, seizing the grains of sand in mid-air. "They're so very strange," Orison said. At the bottom of the tank she thought she saw Ben Franklin again, winking at her through the bubbling life. Nonsense, she thought, brushing her hands.
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C. The Microfabridae are being used to process $100 bills for illegal purposes.
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What is ironic about Eric's contempt for the glass edifice over New York City?
A. If the glass was penetrated, he and Nada and all of New York would immediately perish
B. Its invention was inspired by the author of one of Eric's favorite science fiction novels
C. Something similar might have protected him and Nada from the harsh Venusian elements
D. Similar inventions are main features in his science fiction novels
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Transcriber's Note: This etext was produced from Amazing Stories December 1961 and was first published in Amazing Stories November 1930. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note. A Classic Reprint from AMAZING STORIES, November, 1930 Copyright 1931, by Experimenter Publications Inc. The Cosmic Express By JACK WILLIAMSON Introduction by Sam Moskowitz The year 1928 was a great year of discovery for AMAZING STORIES . They were uncovering new talent at such a great rate, (Harl Vincent, David H. Keller, E. E. Smith, Philip Francis Nowlan, Fletcher Pratt and Miles J. Breuer), that Jack Williamson barely managed to become one of a distinguished group of discoveries by stealing the cover of the December issue for his first story The Metal Man. A disciple of A. Merritt, he attempted to imitate in style, mood and subject the magic of that late lamented master of fantasy. The imitation found great favor from the readership and almost instantly Jack Williamson became an important name on the contents page of AMAZING STORIES . He followed his initial success with two short novels , The Green Girl in AMAZING STORIES and The Alien Intelligence in SCIENCE WONDER STORIES , another Gernsback publication. Both of these stories were close copies of A. Merritt, whose style and method Jack Williamson parlayed into popularity for eight years. Yet the strange thing about it was that Jack Williamson was one of the most versatile science fiction authors ever to sit down at the typewriter. When the vogue for science-fantasy altered to super science, he created the memorable super lock-picker Giles Habilula as the major attraction in a rousing trio of space operas , The Legion of Space, The Cometeers and One Against the Legion. When grim realism was the order of the day, he produced Crucible of Power and when they wanted extrapolated theory in present tense, he assumed the disguise of Will Stewart and popularized the concept of contra terrene matter in science fiction with Seetee Ship and Seetee Shock. Finally, when only psychological studies of the future would do, he produced "With Folded Hands ..." "... And Searching Mind." The Cosmic Express is of special interest because it was written during Williamson's A. Merritt "kick," when he was writing little else but, and it gave the earliest indication of a more general capability. The lightness of the handling is especially modern, barely avoiding the farcical by the validity of the notion that wireless transmission of matter is the next big transportation frontier to be conquered. It is especially important because it stylistically forecast a later trend to accept the background for granted, regardless of the quantity of wonders, and proceed with the story. With only a few thousand scanning-disk television sets in existence at the time of the writing, the surmise that this media would be a natural for westerns was particularly astute. Jack Williamson was born in 1908 in the Arizona territory when covered wagons were the primary form of transportation and apaches still raided the settlers. His father was a cattle man, but for young Jack, the ranch was anything but glamorous. "My days were filled," he remembers, "with monotonous rounds of what seemed an endless, heart-breaking war with drought and frost and dust-storms, poison-weeds and hail, for the sake of survival on the Llano Estacado." The discovery of AMAZING STORIES was the escape he sought and his goal was to be a science fiction writer. He labored to this end and the first he knew that a story of his had been accepted was when he bought the December, 1929 issue of AMAZING STORIES . Since then, he has written millions of words of science fiction and has gone on record as follows: "I feel that science-fiction is the folklore of the new world of science, and the expression of man's reaction to a technological environment. By which I mean that it is the most interesting and stimulating form of literature today." Mr. Eric Stokes-Harding tumbled out of the rumpled bed-clothing, a striking slender figure in purple-striped pajamas. He smiled fondly across to the other of the twin beds, where Nada, his pretty bride, lay quiet beneath light silk covers. With a groan, he stood up and began a series of fantastic bending exercises. But after a few half-hearted movements, he gave it up, and walked through an open door into a small bright room, its walls covered with bookcases and also with scientific appliances that would have been strange to the man of four or five centuries before, when the Age of Aviation was beginning. Suddenly there was a sharp tingling sensation where they touched the polished surface. Yawning, Mr. Eric Stokes-Harding stood before the great open window, staring out. Below him was a wide, park-like space, green with emerald lawns, and bright with flowering plants. Two hundred yards across it rose an immense pyramidal building—an artistic structure, gleaming with white marble and bright metal, striped with the verdure of terraced roof-gardens, its slender peak rising to help support the gray, steel-ribbed glass roof above. Beyond, the park stretched away in illimitable vistas, broken with the graceful columned buildings that held up the great glass roof. Above the glass, over this New York of 2432 A. D., a freezing blizzard was sweeping. But small concern was that to the lightly clad man at the window, who was inhaling deeply the fragrant air from the plants below—air kept, winter and summer, exactly at 20° C. With another yawn, Mr. Eric Stokes-Harding turned back to the room, which was bright with the rich golden light that poured in from the suspended globes of the cold ato-light that illuminated the snow-covered city. With a distasteful grimace, he seated himself before a broad, paper-littered desk, sat a few minutes leaning back, with his hands clasped behind his head. At last he straightened reluctantly, slid a small typewriter out of its drawer, and began pecking at it impatiently. For Mr. Eric Stokes-Harding was an author. There was a whole shelf of his books on the wall, in bright jackets, red and blue and green, that brought a thrill of pleasure to the young novelist's heart when he looked up from his clattering machine. He wrote "thrilling action romances," as his enthusiastic publishers and television directors said, "of ages past, when men were men. Red-blooded heroes responding vigorously to the stirring passions of primordial life!" He was impartial as to the source of his thrills—provided they were distant enough from modern civilization. His hero was likely to be an ape-man roaring through the jungle, with a bloody rock in one hand and a beautiful girl in the other. Or a cowboy, "hard-riding, hard-shooting," the vanishing hero of the ancient ranches. Or a man marooned with a lovely woman on a desert South Sea island. His heroes were invariably strong, fearless, resourceful fellows, who could handle a club on equal terms with a cave-man, or call science to aid them in defending a beautiful mate from the terrors of a desolate wilderness. And a hundred million read Eric's novels, and watched the dramatization of them on the television screens. They thrilled at the simple, romantic lives his heroes led, paid him handsome royalties, and subconsciously shared his opinion that civilization had taken all the best from the life of man. Eric had settled down to the artistic satisfaction of describing the sensuous delight of his hero in the roasted marrow-bones of a dead mammoth, when the pretty woman in the other room stirred, and presently came tripping into the study, gay and vivacious, and—as her husband of a few months most justly thought—altogether beautiful in a bright silk dressing gown. Recklessly, he slammed the machine back into its place, and resolved to forget that his next "red-blooded action thriller" was due in the publisher's office at the end of the month. He sprang up to kiss his wife, held her embraced for a long happy moment. And then they went hand in hand, to the side of the room and punched a series of buttons on a panel—a simple way of ordering breakfast sent up the automatic shaft from the kitchens below. Nada Stokes-Harding was also an author. She wrote poems—"back to nature stuff"—simple lyrics of the sea, of sunsets, of bird songs, of bright flowers and warm winds, of thrilling communion with Nature, and growing things. Men read her poems and called her a genius. Even though the whole world had grown up into a city, the birds were extinct, there were no wild flowers, and no one had time to bother about sunsets. "Eric, darling," she said, "isn't it terrible to be cooped up here in this little flat, away from the things we both love?" "Yes, dear. Civilization has ruined the world. If we could only have lived a thousand years ago, when life was simple and natural, when men hunted and killed their meat, instead of drinking synthetic stuff, when men still had the joys of conflict, instead of living under glass, like hot-house flowers." "If we could only go somewhere—" "There isn't anywhere to go. I write about the West, Africa, South Sea Islands. But they were all filled up two hundred years ago. Pleasure resorts, sanatoriums, cities, factories." "If only we lived on Venus! I was listening to a lecture on the television, last night. The speaker said that the Planet Venus is younger than the Earth, that it has not cooled so much. It has a thick, cloudy atmosphere, and low, rainy forests. There's simple, elemental life there—like Earth had before civilization ruined it." "Yes, Kinsley, with his new infra-red ray telescope, that penetrates the cloud layers of the planet, proved that Venus rotates in about the same period as Earth; and it must be much like Earth was a million years ago." "Eric, I wonder if we could go there! It would be so thrilling to begin life like the characters in your stories, to get away from this hateful civilization, and live natural lives. Maybe a rocket—" The young author's eyes were glowing. He skipped across the floor, seized Nada, kissed her ecstatically. "Splendid! Think of hunting in the virgin forest, and bringing the game home to you! But I'm afraid there is no way.—Wait! The Cosmic Express." "The Cosmic Express?" "A new invention. Just perfected a few weeks ago, I understand. By Ludwig Von der Valls, the German physicist." "I've quit bothering about science. It has ruined nature, filled the world with silly, artificial people, doing silly, artificial things." "But this is quite remarkable, dear. A new way to travel—by ether!" "By ether!" "Yes. You know of course that energy and matter are interchangeable terms; both are simply etheric vibration, of different sorts." "Of course. That's elementary." She smiled proudly. "I can give you examples, even of the change. The disintegration of the radium atom, making helium and lead and energy . And Millikan's old proof that his Cosmic Ray is generated when particles of electricity are united to form an atom." "Fine! I thought you said you weren't a scientist." He glowed with pride. "But the method, in the new Cosmic Express, is simply to convert the matter to be carried into power, send it out as a radiant beam and focus the beam to convert it back into atoms at the destination." "But the amount of energy must be terrific—" "It is. You know short waves carry more energy than long ones. The Express Ray is an electromagnetic vibration of frequency far higher than that of even the Cosmic Ray, and correspondingly more powerful and more penetrating." The girl frowned, running slim fingers through golden-brown hair. "But I don't see how they get any recognizable object, not even how they get the radiation turned back into matter." "The beam is focused, just like the light that passes through a camera lens. The photographic lens, using light rays, picks up a picture and reproduces it again on the plate—just the same as the Express Ray picks up an object and sets it down on the other side of the world. "An analogy from television might help. You know that by means of the scanning disc, the picture is transformed into mere rapid fluctuations in the brightness of a beam of light. In a parallel manner, the focal plane of the Express Ray moves slowly through the object, progressively, dissolving layers of the thickness of a single atom, which are accurately reproduced at the other focus of the instrument—which might be in Venus! "But the analogy of the lens is the better of the two. For no receiving instrument is required, as in television. The object is built up of an infinite series of plane layers, at the focus of the ray, no matter where that may be. Such a thing would be impossible with radio apparatus because even with the best beam transmission, all but a tiny fraction of the power is lost, and power is required to rebuild the atoms. Do you understand, dear?" "Not altogether. But I should worry! Here comes breakfast. Let me butter your toast." A bell had rung at the shaft. She ran to it, and returned with a great silver tray, laden with dainty dishes, which she set on a little side table. They sat down opposite each other, and ate, getting as much satisfaction from contemplation of each other's faces as from the excellent food. When they had finished, she carried the tray to the shaft, slid it in a slot, and touched a button—thus disposing of the culinary cares of the morning. She ran back to Eric, who was once more staring distastefully at his typewriter. "Oh, darling! I'm thrilled to death about the Cosmic Express! If we could go to Venus, to a new life on a new world, and get away from all this hateful conventional society—" "We can go to their office—it's only five minutes. The chap that operates the machine for the company is a pal of mine. He's not supposed to take passengers except between the offices they have scattered about the world. But I know his weak point—" Eric laughed, fumbled with a hidden spring under his desk. A small polished object, gleaming silvery, slid down into his hand. "Old friendship, plus this, would make him—like spinach." Five minutes later Mr. Eric Stokes-Harding and his pretty wife were in street clothes, light silk tunics of loose, flowing lines—little clothing being required in the artificially warmed city. They entered an elevator and dropped thirty stories to the ground floor of the great building. There they entered a cylindrical car, with rows of seats down the sides. Not greatly different from an ancient subway car, except that it was air-tight, and was hurled by magnetic attraction and repulsion through a tube exhausted of air, at a speed that would have made an old subway rider gasp with amazement. In five more minutes their car had whipped up to the base of another building, in the business section, where there was no room for parks between the mighty structures that held the unbroken glass roofs two hundred stories above the concrete pavement. An elevator brought them up a hundred and fifty stories. Eric led Nada down a long, carpeted corridor to a wide glass door, which bore the words: COSMIC EXPRESS stenciled in gold capitals across it. As they approached, a lean man, carrying a black bag, darted out of an elevator shaft opposite the door, ran across the corridor, and entered. They pushed in after him. They were in a little room, cut in two by a high brass grill. In front of it was a long bench against the wall, that reminded one of the waiting room in an old railroad depot. In the grill was a little window, with a lazy, brown-eyed youth leaning on the shelf behind it. Beyond him was a great, glittering piece of mechanism, half hidden by the brass. A little door gave access to the machine from the space before the grill. The thin man in black, whom Eric now recognized as a prominent French heart-specialist, was dancing before the window, waving his bag frantically, raving at the sleepy boy. "Queek! I have tell you zee truth! I have zee most urgent necessity to go queekly. A patient I have in Paree, zat ees in zee most creetical condition!" "Hold your horses just a minute, Mister. We got a client in the machine now. Russian diplomat from Moscow to Rio de Janeiro.... Two hundred seventy dollars and eighty cents, please.... Your turn next. Remember this is just an experimental service. Regular installations all over the world in a year.... Ready now. Come on in." The youth took the money, pressed a button. The door sprang open in the grill, and the frantic physician leaped through it. "Lie down on the crystal, face up," the young man ordered. "Hands at your sides, don't breathe. Ready!" He manipulated his dials and switches, and pressed another button. "Why, hello, Eric, old man!" he cried. "That's the lady you were telling me about? Congratulations!" A bell jangled before him on the panel. "Just a minute. I've got a call." He punched the board again. Little bulbs lit and glowed for a second. The youth turned toward the half-hidden machine, spoke courteously. "All right, madam. Walk out. Hope you found the transit pleasant." "But my Violet! My precious Violet!" a shrill female voice came from the machine. "Sir, what have you done with my darling Violet?" "I'm sure I don't know, madam. You lost it off your hat?" "None of your impertinence, sir! I want my dog." "Ah, a dog. Must have jumped off the crystal. You can have him sent on for three hundred and—" "Young man, if any harm comes to my Violet—I'll—I'll—I'll appeal to the Society for the Prevention of Cruelty to Animals!" "Very good, madam. We appreciate your patronage." The door flew open again. A very fat woman, puffing angrily, face highly colored, clothing shimmering with artificial gems, waddled pompously out of the door through which the frantic French doctor had so recently vanished. She rolled heavily across the room, and out into the corridor. Shrill words floated back: "I'm going to see my lawyer! My precious Violet—" The sallow youth winked. "And now what can I do for you, Eric?" "We want to go to Venus, if that ray of yours can put us there." "To Venus? Impossible. My orders are to use the Express merely between the sixteen designated stations, at New York, San Francisco, Tokyo, London, Paris—" "See here, Charley," with a cautious glance toward the door, Eric held up the silver flask. "For old time's sake, and for this—" The boy seemed dazed at sight of the bright flask. Then, with a single swift motion, he snatched it out of Eric's hand, and bent to conceal it below his instrument panel. "Sure, old boy. I'd send you to heaven for that, if you'd give me the micrometer readings to set the ray with. But I tell you, this is dangerous. I've got a sort of television attachment, for focusing the ray. I can turn that on Venus—I've been amusing myself, watching the life there, already. Terrible place. Savage. I can pick a place on high land to set you down. But I can't be responsible for what happens afterward." "Simple, primitive life is what we're looking for. And now what do I owe you—" "Oh, that's all right. Between friends. Provided that stuff's genuine! Walk in and lie down on the crystal block. Hands at your sides. Don't move." The little door had swung open again, and Eric led Nada through. They stepped into a little cell, completely surrounded with mirrors and vast prisms and lenses and electron tubes. In the center was a slab of transparent crystal, eight feet square and two inches thick, with an intricate mass of machinery below it. Eric helped Nada to a place on the crystal, lay down at her side. "I think the Express Ray is focused just at the surface of the crystal, from below," he said. "It dissolves our substance, to be transmitted by the beam. It would look as if we were melting into the crystal." "Ready," called the youth. "Think I've got it for you. Sort of a high island in the jungle. Nothing bad in sight now. But, I say—how're you coming back? I haven't got time to watch you." "Go ahead. We aren't coming back." "Gee! What is it? Elopement? I thought you were married already. Or is it business difficulties? The Bears did make an awful raid last night. But you better let me set you down in Hong Kong." A bell jangled. "So long," the youth called. Nada and Eric felt themselves enveloped in fire. Sheets of white flame seemed to lap up about them from the crystal block. Suddenly there was a sharp tingling sensation where they touched the polished surface. Then blackness, blankness. The next thing they knew, the fires were gone from about them. They were lying in something extremely soft and fluid; and warm rain was beating in their faces. Eric sat up, found himself in a mud-puddle. Beside him was Nada, opening her eyes and struggling up, her bright garments stained with black mud. All about rose a thick jungle, dark and gloomy—and very wet. Palm-like, the gigantic trees were, or fern-like, flinging clouds of feathery green foliage high against a somber sky of unbroken gloom. They stood up, triumphant. "At last!" Nada cried. "We're free! Free of that hateful old civilization! We're back to Nature!" "Yes, we're on our feet now, not parasites on the machines." "It's wonderful to have a fine, strong man like you to trust in, Eric. You're just like one of the heroes in your books!" "You're the perfect companion, Nada.... But now we must be practical. We must build a fire, find weapons, set up a shelter of some kind. I guess it will be night, pretty soon. And Charley said something about savage animals he had seen in the television. "We'll find a nice dry cave, and have a fire in front of the door. And skins of animals to sleep on. And pottery vessels to cook in. And you will find seeds and grown grain." "But first we must find a flint-bed. We need flint for tools, and to strike sparks to make a fire with. We will probably come across a chunk of virgin copper, too—it's found native." Presently they set off through the jungle. The mud seemed to be very abundant, and of a most sticky consistence. They sank into it ankle deep at every step, and vast masses of it clung to their feet. A mile they struggled on, without finding where a provident nature had left them even a single fragment of quartz, to say nothing of a mass of pure copper. "A darned shame," Eric grumbled, "to come forty million miles, and meet such a reception as this!" Nada stopped. "Eric," she said, "I'm tired. And I don't believe there's any rock here, anyway. You'll have to use wooden tools, sharpened in the fire." "Probably you're right. This soil seemed to be of alluvial origin. Shouldn't be surprised if the native rock is some hundreds of feet underground. Your idea is better." "You can make a fire by rubbing sticks together, can't you?" "It can be done, I'm sure. I've never tried it, myself. We need some dry sticks, first." They resumed the weary march, with a good fraction of the new planet adhering to their feet. Rain was still falling from the dark heavens in a steady, warm downpour. Dry wood seemed scarce as the proverbial hen's teeth. "You didn't bring any matches, dear?" "Matches! Of course not! We're going back to Nature." "I hope we get a fire pretty soon." "If dry wood were gold dust, we couldn't buy a hot dog." "Eric, that reminds me that I'm hungry." He confessed to a few pangs of his own. They turned their attention to looking for banana trees, and coconut palms, but they did not seem to abound in the Venerian jungle. Even small animals that might have been slain with a broken branch had contrary ideas about the matter. At last, from sheer weariness, they stopped, and gathered branches to make a sloping shelter by a vast fallen tree-trunk. "This will keep out the rain—maybe—" Eric said hopefully. "And tomorrow, when it has quit raining—I'm sure we'll do better." They crept in, as gloomy night fell without. They lay in each other's arms, the body warmth oddly comforting. Nada cried a little. "Buck up," Eric advised her. "We're back to nature—where we've always wanted to be." With the darkness, the temperature fell somewhat, and a high wind rose, whipping cold rain into the little shelter, and threatening to demolish it. Swarms of mosquito-like insects, seemingly not inconvenienced in the least by the inclement elements, swarmed about them in clouds. Then came a sound from the dismal stormy night, a hoarse, bellowing roar, raucous, terrifying. Nada clung against Eric. "What is it, dear?" she chattered. "Must be a reptile. Dinosaur, or something of the sort. This world seems to be in about the same state as the Earth when they flourished there.... But maybe it won't find us." The roar was repeated, nearer. The earth trembled beneath a mighty tread. "Eric," a thin voice trembled. "Don't you think—it might have been better— You know the old life was not so bad, after all." "I was just thinking of our rooms, nice and warm and bright, with hot foods coming up the shaft whenever we pushed the button, and the gay crowds in the park, and my old typewriter." "Eric?" she called softly. "Yes, dear." "Don't you wish—we had known better?" "I do." If he winced at the "we" the girl did not notice. The roaring outside was closer. And suddenly it was answered by another raucous bellow, at considerable distance, that echoed strangely through the forest. The fearful sounds were repeated, alternately. And always the more distant seemed nearer, until the two sounds were together. And then an infernal din broke out in the darkness. Bellows. Screams. Deafening shrieks. Mighty splashes, as if struggling Titans had upset oceans. Thunderous crashes, as if they were demolishing forests. Eric and Nada clung to each other, in doubt whether to stay or to fly through the storm. Gradually the sound of the conflict came nearer, until the earth shook beneath them, and they were afraid to move. Suddenly the great fallen tree against which they had erected the flimsy shelter was rolled back, evidently by a chance blow from the invisible monsters. The pitiful roof collapsed on the bedraggled humans. Nada burst into tears. "Oh, if only—if only—" Suddenly flame lapped up about them, the same white fire they had seen as they lay on the crystal block. Dizziness, insensibility overcame them. A few moments later, they were lying on the transparent table in the Cosmic Express office, with all those great mirrors and prisms and lenses about them. A bustling, red-faced official appeared through the door in the grill, fairly bubbling apologies. "So sorry—an accident—inconceivable. I can't see how he got it! We got you back as soon as we could find a focus. I sincerely hope you haven't been injured." "Why—what—what—" "Why I happened in, found our operator drunk. I've no idea where he got the stuff. He muttered something about Venus. I consulted the auto-register, and found two more passengers registered here than had been recorded at our other stations. I looked up the duplicate beam coordinates, and found that it had been set on Venus. I got men on the television at once, and we happened to find you. "I can't imagine how it happened. I've had the fellow locked up, and the 'dry-laws' are on the job. I hope you won't hold us for excessive damages." "No, I ask nothing except that you don't press charges against the boy. I don't want him to suffer for it in any way. My wife and I will be perfectly satisfied to get back to our apartment." "I don't wonder. You look like you've been through—I don't know what. But I'll have you there in five minutes. My private car—" Mr. Eric Stokes-Harding, noted author of primitive life and love, ate a hearty meal with his pretty spouse, after they had washed off the grime of another planet. He spent the next twelve hours in bed. At the end of the month he delivered his promised story to his publishers, a thrilling tale of a man marooned on Venus, with a beautiful girl. The hero made stone tools, erected a dwelling for himself and his mate, hunted food for her, defended her from the mammoth saurian monsters of the Venerian jungles. The book was a huge success. THE END
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C. Something similar might have protected him and Nada from the harsh Venusian elements
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What simulations are performed by the authors to validate their approach?
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### Introduction
A significant challenge when designing robots to operate in the real world lies in the generation of control policies that can adapt to changing environments. Programming such policies is a labor and time-consuming process which requires substantial technical expertise. Imitation learning BIBREF0, is an appealing methodology that aims at overcoming this challenge – instead of complex programming, the user only provides a set of demonstrations of the intended behavior. These demonstrations are consequently distilled into a robot control policy by learning appropriate parameter settings of the controller. Popular approaches to imitation, such as Dynamic Motor Primitives (DMPs) BIBREF1 or Gaussian Mixture Regression (GMR) BIBREF2 largely focus on motion as the sole input and output modality, i.e., joint angles, forces or positions. Critical semantic and visual information regarding the task, such as the appearance of the target object or the type of task performed, is not taken into account during training and reproduction. The result is often a limited generalization capability which largely revolves around adaptation to changes in the object position. While imitation learning has been successfully applied to a wide range of tasks including table-tennis BIBREF3, locomotion BIBREF4, and human-robot interaction BIBREF5 an important question is how to incorporate language and vision into a differentiable end-to-end system for complex robot control. In this paper, we present an imitation learning approach that combines language, vision, and motion in order to synthesize natural language-conditioned control policies that have strong generalization capabilities while also capturing the semantics of the task. We argue that such a multi-modal teaching approach enables robots to acquire complex policies that generalize to a wide variety of environmental conditions based on descriptions of the intended task. In turn, the network produces control parameters for a lower-level control policy that can be run on a robot to synthesize the corresponding motion. The hierarchical nature of our approach, i.e., a high-level policy generating the parameters of a lower-level policy, allows for generalization of the trained task to a variety of spatial, visual and contextual changes. ### Introduction ::: Problem Statement:
In order to outline our problem statement, we contrast our approach to Imitation learning BIBREF0 which considers the problem of learning a policy $\mathbf {\pi }$ from a given set of demonstrations ${\cal D}=\lbrace \mathbf {d}^0,.., \mathbf {d}^m\rbrace $. Each demonstration spans a time horizon $T$ and contains information about the robot's states and actions, e.g., demonstrated sensor values and control inputs at each time step. Robot states at each time step within a demonstration are denoted by $\mathbf {x}_t$. In contrast to other imitation learning approaches, we assume that we have access to the raw camera images of the robot $_t$ at teach time step, as well as access to a verbal description of the task in natural language. This description may provide critical information about the context, goals or objects involved in the task and is denoted as $\mathbf {s}$. Given this information, our overall objective is to learn a policy $\mathbf {\pi }$ which imitates the demonstrated behavior, while also capturing semantics and important visual features. After training, we can provide the policy $\mathbf {\pi }(\mathbf {s},)$ with a different, new state of the robot and a new verbal description (instruction) as parameters. The policy will then generate the control signals needed to perform the task which takes the new visual input and semantic context int o account. ### Background
A fundamental challenge in imitation learning is the extraction of policies that do not only cover the trained scenarios, but also generalize to a wide range of other situations. A large body of literature has addressed the problem of learning robot motor skills by imitation BIBREF6, learning functional BIBREF1 or probabilistic BIBREF7 representations. However, in most of these approaches, the state vector has to be carefully designed in order to ensure that all necessary information for adaptation is available. Neural approaches to imitation learning BIBREF8 circumvent this problem by learning suitable feature representations from rich data sources for each task or for a sequence of tasks BIBREF9, BIBREF10, BIBREF11. Many of these approaches assume that either a sufficiently large set of motion primitives is already available or that a taxonomy of the task is available, i.e., semantics and motions are not trained in conjunction. The importance of maintaining this connection has been shown in BIBREF12, allowing the robot to adapt to untrained variations of the same task. To learn entirely new tasks, meta-learning aims at learning policy parameters that can quickly be fine-tuned to new tasks BIBREF13. While very successful in dealing with visual and spatial information, these approaches do not incorporate any semantic or linguistic component into the learning process. Language has shown to successfully generate task descriptions in BIBREF14 and several works have investigated the idea of combining natural language and imitation learning: BIBREF15, BIBREF16, BIBREF17, BIBREF18, BIBREF19. However, most approaches do not utilize the inherent connection between semantic task descriptions and low-level motions to train a model. Our work is most closely related to the framework introduced in BIBREF20, which also focuses on the symbol grounding problem. More specifically, the work in BIBREF20 aims at mapping perceptual features in the external world to constituents in an expert-provided natural language instruction. Our work approaches the problem of generating dynamic robot policies by fundamentally combining language, vision, and motion control in to a single differentiable neural network that can learn the cross-modal relationships found in the data with minimal human feature engineering. Unlike previous work, our proposed model is capable of directly generating complex low-level control policies from language and vision that allow the robot to reassemble motions shown during training. ### Multimodal Policy Generation via Imitation
We motivate our approach with a simple example: consider a binning task in which a 6 DOF robot has to drop an object into one of several differently shaped and colored bowls on a table. To teach this task, the human demonstrator does not only provide a kinesthetic demonstration of the desired trajectory, but also a verbal command, e.g., “Move towards the blue bowl” to the robot. In this example, the trajectory generation would have to be conditioned on the blue bowl's position which, however, has to be extracted from visual sensing. Our approach automatically detects and extracts these relationships between vision, language, and motion modalities in order to make best usage of contextual information for better generalization and disambiguation. Figure FIGREF2 (left) provides an overview of our method. Our goal is to train a deep neural network that can take as input a task description $\mathbf {s}$ and and image $$ and consequently generates robot controls. In the remainder of this paper, we will refer to our network as the mpn. Rather than immediately producing control signals, the mpn will generate the parameters for a lower-level controller. This distinction allows us to build upon well-established control schemes in robotics and optimal control. In our specific case, we use the widely used Dynamic Motor Primitives BIBREF1 as a lower-level controller for control signal generation. In essence, our network can be divided into three parts. The first part, the semantic network, is used to create a task embedding $$ from the input sentence $$ and environment image $$. In a first step, the sentence $$ is tokenized and converted into a sentence matrix ${W} \in \mathbb {R}^{l_s \times l_w} = f_W()$ by utilizing pre-trained Glove word embeddings BIBREF21 where $l_s$ is the padded-fixed-size length of the sentence and $l_w$ is the size of the glove word vectors. To extract the relationships between the words, we use use multiple CNNs $_s = f_L()$ with filter size $n \times l_w$ for varying $n$, representing different $n$-gram sizes BIBREF22. The final representation is built by flattening the individual $n$-grams with max-pooling of size $(l_s - n_i + 1)\times l_w$ and concatenating the results before using a single perceptron to detect relationships between different $n$-grams. In order to combine the sentence embedding $_s$ with the image, it is concatenated as a fourth channel to the input image $$. The task embedding $$ is produced with three blocks of convolutional layers, composed of two regular convolutions, followed by a residual convolution BIBREF23 each. In the second part, the policy translation network is used to generate the task parameters $\Theta \in \mathcal {R}^{o \times b}$ and $\in \mathcal {R}^{o}$ given a task embedding $$ where $o$ is the number of output dimensions and $b$ the number of basis functions in the DMP: where $f_G()$ and $f_H()$ are multilayer-perceptrons that use $$ after being processed in a single perceptron with weight $_G$ and bias $_G$. These parameters are then used in the third part of the network, which is a DMP BIBREF0, allowing us leverage a large body of research regarding their behavior and stability, while also allowing other extensions of DMPs BIBREF5, BIBREF24, BIBREF25 to be incorporated to our framework. ### Results
We evaluate our model in a simulated binning task in which the robot is tasked to place a cube into a bowl as outlined by the verbal command. Each environment contains between three and five objects differentiated by their size (small, large), shape (round, square) and color (red, green, blue, yellow, pink), totalling in 20 different objects. Depending on the generated scenario, combinations of these three features are necessary to distinguish the targets from each other, allowing for tasks of varying complexity. To train our model, we generated a dataset of 20,000 demonstrated 7 DOF trajectories (6 robot joints and 1 gripper dimension) in our simulated environment together with a sentence generator capable of creating natural task descriptions for each scenario. In order to create the language generator, we conducted an human-subject study to collect sentence templates of a placement task as well as common words and synonyms for each of the used features. By utilising these data, we are able to generate over 180,000 unique sentences, depending on the generated scenario. The generated parameters of the low-level DMP controller – the weights and goal position – must be sufficiently accurate in order to successfully deliver the object to the specified bin. On the right side of Figure FIGREF4, the generated weights for the DMP are shown for two tasks in which the target is close and far away from the robot, located at different sides of the table, indicating the robots ability to generate differently shaped trajectories. The accuracy of the goal position can be seen in Figure FIGREF4(left) which shows another aspect of our approach: By using stochastic forward passes BIBREF26 the model can return an estimate for the validity of a requested task in addition to the predicted goal configuration. The figure shows that the goal position of a red bowl has a relatively small distribution independently of the used sentence or location on the table, where as an invalid target (green) produces a significantly larger distribution, indicating that the requested task may be invalid. To test our model, we generated 500 new scenario testing each of the three features to identify the correct target among other bowls. A task is considered to be successfully completed when the cube is withing the boundaries of the targeted bowl. Bowls have a bounding box of 12.5 and 17.5cm edge length for the small and large variant, respectively. Our experiments showed that using the objects color or shape to uniquely identify an object allows the robot successfully complete the binning task in 97.6% and 96.0% of the cases. However, using the shape alone as a unique identifier, the task could only be completed in 79.0% of the cases. We suspect that the loss of accuracy is due to the low image resolution of the input image, preventing the network from reliably distinguishing the object shapes. In general, our approach is able to actuate the robot with an target error well below 5cm, given the target was correctly identified. ### Conclusion and Future Work
In this work, we presented an imitation learning approach combining language, vision, and motion. A neural network architecture called Multimodal Policy Network was introduced which is able to learn the cross-modal relationships in the training data and achieve high generalization and disambiguation performance as a result. Our experiments showed that the model is able to generalize towards different locations and sentences while maintaining a high success rate of delivering an object to a desired bowl. In addition, we discussed an extensions of the method that allow us to obtain uncertainty information from the model by utilizing stochastic network outputs to get a distribution over the belief. The modularity of our architecture allows us to easily exchange parts of the network. This can be utilized for transfer learning between different tasks in the semantic network or transfer between different robots by transferring the policy translation network to different robots in simulation, or to bridge the gap between simulation and reality. Figure 1: Network architecture overview. The network consists of two parts, a high-level semantic network and a low-level control network. Both networks are working seamlessly together and are utilized in an End-to-End fashion. Figure 2: Results for placing an object into bowls at different locations: (Left) Stochastic forward passes allow the model to estimate its certainty about the validity of a task. (Right) Generated weights Θ for four joints of the DMP shown for two objects close and far away of the robot.
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a simulated binning task in which the robot is tasked to place a cube into a bowl as outlined by the verbal command
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What do Herrnstein and Murray want you to believe?
A. be happy with your current status - it's where you're going to stay
B. the government should put more money into closing the socio-economic gap
C. people of all races should be treated equally
D. if you work hard enough, you can do anything
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The Bell Curve Flattened Charles Murray is a publicity genius, and the publication of his and Richard Herrnstein's book, The Bell Curve: Intelligence and Class Structure in American Life , in the fall of 1994 was his masterpiece. Virtually all ambitious trade hardcover books are preceded by an edition of 100 to 200 flimsy "galley proofs." These are sent out to people who might generate buzz for the book: blurbists, bookers for television talk shows, editors, and--most important--book critics. There is an ethos of letting the chips fall where they may about the sending out of galleys: Now the book will begin to receive uncontrolled reaction. (For example, back in 1991, Murray somehow got hold of the galleys of my own last book, and wrote me heatedly denying that he was working on a book about black genetic intellectual inferiority, as I had asserted. I left the passage in, but softened it.) The Bell Curve was not circulated in galleys before publication. The effect was, first, to increase the allure of the book (There must be something really hot in there!), and second, to ensure that no one inclined to be skeptical would be able to weigh in at the moment of publication. The people who had galley proofs were handpicked by Murray and his publisher. The ordinary routine of neutral reviewers having a month or two to go over the book with care did not occur. Another handpicked group was flown to Washington at the expense of the American Enterprise Institute and given a weekend-long personal briefing on the book's contents by Murray himself (Herrnstein had died very recently), just before publication. The result was what you'd expect: The first wave of publicity was either credulous or angry, but short on evidence, because nobody had had time to digest and evaluate the book carefully. The Bell Curve isn't a typical work of trade nonfiction. It is gotten up as a work of original scholarly research. Most works containing fresh regression analysis and historical argument from primary sources would be published in academic quarterlies that send manuscripts out for elaborate, lengthy evaluation before deciding whether to publish them. Herrnstein and Murray didn't do this, so it wasn't until a full year or more after The Bell Curve was published that the leading experts on its subject had a chance to go through the underlying data with care. Therefore, as time went on, the knowledgeability of the Bell Curve discussion grew, but the attention paid to that discussion inevitably shrank. The debate on publication day was conducted in the mass media by people with no independent ability to assess the book. Over the next few months, intellectuals took some pretty good shots at it in smaller publications like the New Republic and the New York Review of Books . It wasn't until late 1995 that the most damaging criticism of The Bell Curve began to appear, in tiny academic journals. What follows is a brief summary of that last body of work. The Bell Curve , it turns out, is full of mistakes ranging from sloppy reasoning to mis-citations of sources to outright mathematical errors. Unsurprisingly, all the mistakes are in the direction of supporting the authors' thesis. First, a quick précis of The Bell Curve . IQ tests, according to Murray and Herrnstein, measure an essential human quality, general intelligence. During the second half of the 20 th century, this quality has risen to supreme importance, because society has become increasingly complex. The intelligent have therefore gone through an "invisible migration," from points of origin all over the class system to a concentration at the top of business, government, and the professions. They are likely to become ever more dominant and prosperous. The unintelligent are falling further and further behind. Because intelligence is substantially inherited, nothing is likely to reverse this process. Blacks are overrepresented among the unintelligent. Any efforts government might make to improve the economic opportunities of poor people, especially poor black people, are likely to fail, because their poverty is so much the result of inherited low intelligence. About the best that can be done for these people is an effort to create a world of simple, decent, honorable toil for them. Herrnstein and Murray begin by telling us that the liberal position on IQ--namely, "Intelligence is a bankrupt concept"--has been discredited, and that "a scholarly consensus has been reached" around their position. This consensus is "beyond significant technical dispute." Thus, by the end of their introduction, they have arranged matters so that if intelligence has any meaning at all, the idiotic liberals stand discredited; and meanwhile, extremely broad claims for intelligence have the cover of "consensus." The notion that IQ tests are completely useless never prevailed in liberal academia to nearly the extent that Herrnstein and Murray say. A more accurate rendering of the liberal position would be that rather than a single "general intelligence," there are a handful of crucial--and separate--mental abilities; that none of these abilities is important enough to obviate the role of family background and education; and that native ability (and economic success independent of native ability) can be enhanced by improving education, training, and public health. The Bell Curve refers in passing to some of these points, but on the whole it sets up a cartoon-left position as its (easy) target. Meanwhile, the psychometricians who dominate the footnotes of The Bell Curve are John Hunter, Arthur Jensen, Malcolm Ree, and Frank Schmidt. These men are well known within the field as representing its right wing, not a mainstream consensus. The next problem with The Bell Curve 's thesis is in the idea of the rise to dominance of the cognitive elite. To the book's initial audience of Ivy Leaguers, this idea seemed valid on its face. Everybody knows that the best universities, law firms, hospitals, investment banks, and the State Department used to be run by preppies whose main virtue was fortunate birth, and are now open to one and all on the basis of merit. But the larger premise--that intelligent people used to be scattered throughout the class structure, and are now concentrated at the top--is almost impossible to prove, simply because the mass administration of mental tests is such a recent phenomenon. High scorers on mental tests do "bunch up" (as Herrnstein and Murray put it) in elite-university student bodies. But this is tautological: Any group selected on the basis of scores on mental tests will be composed disproportionately of people who score high on mental tests. Proving The Bell Curve 's thesis would require proving that success increasingly correlates with IQ in areas of life where mental tests are not the explicit gatekeepers. To see how The Bell Curve tries and fails to get around these inherent problems, see and . Having conditioned its audience to view IQ as all-important, The Bell Curve then manipulates statistics in a way that makes IQ look bigger, and everything else smaller, in determining Americans' life-chances. The basic tool of statistical social science in general, and of The Bell Curve in particular, is regression analysis, a technique used to assign weights to various factors (called "independent variables") in determining a final outcome (called the "dependent variable"). The original statistical work in The Bell Curve consists of regression analyses on a database called the National Longitudinal Study of Youth. The authors claim to demonstrate that high IQ is more predictive of economic success than any other factor, and that low IQ is more predictive of poverty and social breakdown. Virtually all the early commentators on The Bell Curve were unable to assess the merits of the regression analysis. "I am not a scientist. I know nothing about psychometrics," wrote Leon Wieseltier (who was otherwise quite critical) in a typical disclaimer. But by now the statistics have been gone over by professionals, who have come up with different results. The key points of their critique of The Bell Curve are as follows: What Herrnstein and Murray used to measure IQ is actually a measure of education as well as intelligence. All the people tracked in the National Longitudinal Study of Youth took the Armed Forces Qualifying Test, which Herrnstein and Murray treat as a good measure of intelligence. Because the material covered in the test includes subjects like trigonometry, many academic critics of The Bell Curve have objected to its use as a measure only of IQ and not at all of academic achievement. Herrnstein and Murray concede in the footnotes that scores tend to rise with the subjects' education--but they seriously underestimate the magnitude of this rise, as shows. And they resist the obvious inference that the test scores are measuring something other than intelligence. Most of The Bell Curve 's analysis is devoted to proving that IQ has more predictive power than parental "socio-economic status." But Herrnstein and Murray's method of figuring socioeconomic status seems designed to low-ball its influence, as explains. Herrnstein and Murray begin their discussion of the National Longitudinal Study of Youth data by announcing that they aren't going to analyze the effect of education, because education is too much a result of IQ. It's not an independent variable. (Of course, according to their theory, socioeconomic status is also a result of IQ, but somehow, that doesn't stop them.) Therefore, what you'd most want to know from a policy standpoint--how much education can increase opportunity--isn't dealt with in the book, except in two obscure footnotes. Both would seem to support the liberal, pro-education position that Herrnstein and Murray say is futile. One footnote shows education increasing IQ year by year. The other shows a higher correlation between college degree and family income than between IQ and family income. One of The Bell Curve 's theoretical linchpins is the high heritability of IQ. Herrnstein and Murray, sounding like the souls of caution, write that "half a century of work, now amounting to hundreds of empirical and theoretical studies, permits a broad conclusion that the genetic component of IQ is unlikely to be smaller than 40 per cent or higher than 80 per cent. ... For purposes of this discussion, we will adopt a middling estimate of 60 per cent heritability." This now looks seriously overstated. Michael Daniels, Bernie Devlin, and Kathryn Roeder of Carnegie Mellon University took the same studies on which Herrnstein and Murray based their estimate, and subjected them to a computer meta-analysis ("a powerful method of statistical analysis"-- The Bell Curve ). Their paper, which has not yet been published, says: "In brief, studies of IQ, and our reanalyses of them, suggest a narrow-sense heritability of 34 per cent and a broad-sense heritability of 46 per cent. [The difference between broad and narrow is too technical to explain in this limited space.] This is a far cry from Herrnstein and Murray's maximum value of 80 per cent or their middling value of 60 per cent. Consequently, Herrnstein and Murray give the impression that IQ is highly 'heritable,' but it is not." If the purpose of the whole exercise is to figure out what our social policies should be, then, "Which is more predictive, IQ or socioeconomic status?" isn't the essential question anyway. Making it the essential question avoids the issue of whether IQ is really so massively predictive that it drowns out everything else. (Herrnstein and Murray mostly leave the evidence for this, their central contention, to footnotes. The figures they offer are far from dispositive.) The chapter of The Bell Curve on policies that might be able to overcome the fate of a low IQ focuses mainly on whether early-childhood programs like Head Start (most of which aren't run with raising IQ as their primary goal) can raise IQ significantly over the long term, and sorrowfully concludes that they can't. What the book doesn't discuss is whether public schools--by far the biggest government social program--can raise IQ, or earnings after you control for IQ. As James Heckman of the University of Chicago wrote in the Journal of Political Economy , " Evidence of a genetic component to skills has no bearing on the efficacy of any social policy. ... The relevant issue is the cost effectiveness of the intervention." (As an example of where the kind of analysis Herrnstein and Murray didn't do can lead, a new study by Jay Girotto and Paul Peterson of Harvard shows that students who raise their grades and take harder courses can increase their IQ scores by an average of eight points during the first three years of high school.) At the beginning of The Bell Curve , Herrnstein and Murray declare that "the concept of intelligence has taken on a much higher place in the pantheon of human virtues than it deserves." And they claim that their view of IQ tests is "squarely in the middle of the scientific road." They end by expressing the hope that we can "be a society that makes good on the fundamental promise of the American tradition: the opportunity for everyone, not just the lucky ones, to live a satisfying life." Throughout, Herrnstein and Murray consistently present themselves as fair- (or even liberal-) minded technicians who have, with great caution, followed the evidence where it leads--which, unfortunately, is to a few unassailable if unpleasant scientific truths that it is their reluctant duty to report. In fact, The Bell Curve is a relentless brief for the conservative position in psychometrics and social policy. For all its talk of reflecting a consensus, the sources it draws upon are heavily skewed to the right. Herrnstein and Murray used quasi-nutty studies that support their position (as Charles Lane demonstrated in the New York Review of Books ), and ignore mainstream studies that contradict it (as Richard Nisbett showed in the New Republic ). The data in The Bell Curve are consistently massaged to produce conservative conclusions; not once is a finding that contradicts the main thesis reported in the text. ( shows how Herrnstein and Murray have made the convergence in black-white IQ scores, which they claim to find "encouraging," look smaller than it actually is.) The Bell Curve 's air of strict scientism doesn't preclude the use of lightly sourced or unsourced assertions, such as the statement that the median IQ of all black Africans is 75, or that "intermarriage among people in the top few percentiles of intelligence may be increasing far more rapidly than suspected" (no footnote). Though they piously claim not to be doing so, Herrnstein and Murray leave readers with the distinct impression that IQ is the cause of economic success and failure, and that genetic difference explains the black-white IQ gap. In the most famous passage in The Republic , Plato describes an underground cave where people are held prisoner in chains, unable to see anything but the shadows cast by figures passing outside; they mistake the shadows for reality. The Republic is probably the first place in history where an idea like that of Murray and Herrnstein's cognitive elite appears. Plato believed that through education, people could leave the cave and be able to see the truth instead of the shadows, thus fitting themselves to become the wise rulers of society. But he was quick to insert a cautionary note: Those who have left the cave might be tempted to think they can see perfectly clearly, while actually they would be "dazzled by excess of light." The image applies to The Bell Curve : Presented as an exact representation of reality, in opposition to the shadows of political correctness, it actually reflects the blinkered vision of one part of the American elite. It constantly tells these people that they are naturally superior, and offers lurid descriptions of aspects of national life that they know about only by rumor. Readers who accept The Bell Curve as tough-minded and realistic, and who assume that all criticism of it is ignorant and ideologically motivated, are not as far removed from Plato's cave as they might think. : Dumb College Students : Smart Rich People : Education and IQ : Socioeconomic Status : Black-White Convergence
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A. be happy with your current status - it's where you're going to stay
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What is the Commission?
A. The Commission is a group of elected officials that run the town of Ridgeville.
B. The Commission is a metallurgy company and the main employer in Ridgeville.
C. The Commission is a chemical company and the main employer in Ridgeville.
D. The Commission is a laboratory and the main employer in Ridgeville.
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Fallout is, of course, always disastrous— one way or another JUNIOR ACHIEVEMENT BY WILLIAM LEE ILLUSTRATED BY SCHOENHERR "What would you think," I asked Marjorie over supper, "if I should undertake to lead a junior achievement group this summer?" She pondered it while she went to the kitchen to bring in the dessert. It was dried apricot pie, and very tasty, I might add. "Why, Donald," she said, "it could be quite interesting, if I understand what a junior achievement group is. What gave you the idea?" "It wasn't my idea, really," I admitted. "Mr. McCormack called me to the office today, and told me that some of the children in the lower grades wanted to start one. They need adult guidance of course, and one of the group suggested my name." I should explain, perhaps, that I teach a course in general science in our Ridgeville Junior High School, and another in general physics in the Senior High School. It's a privilege which I'm sure many educators must envy, teaching in Ridgeville, for our new school is a fine one, and our academic standards are high. On the other hand, the fathers of most of my students work for the Commission and a constant awareness of the Commission and its work pervades the town. It is an uneasy privilege then, at least sometimes, to teach my old-fashioned brand of science to these children of a new age. "That's very nice," said Marjorie. "What does a junior achievement group do?" "It has the purpose," I told her, "of teaching the members something about commerce and industry. They manufacture simple compositions like polishing waxes and sell them from door-to-door. Some groups have built up tidy little bank accounts which are available for later educational expenses." "Gracious, you wouldn't have to sell from door-to-door, would you?" "Of course not. I'd just tell the kids how to do it." Marjorie put back her head and laughed, and I was forced to join her, for we both recognize that my understanding and "feel" for commercial matters—if I may use that expression—is almost nonexistent. "Oh, all right," I said, "laugh at my commercial aspirations. But don't worry about it, really. Mr. McCormack said we could get Mr. Wells from Commercial Department to help out if he was needed. There is one problem, though. Mr. McCormack is going to put up fifty dollars to buy any raw materials wanted and he rather suggested that I might advance another fifty. The question is, could we do it?" Marjorie did mental arithmetic. "Yes," she said, "yes, if it's something you'd like to do." We've had to watch such things rather closely for the last ten—no, eleven years. Back in the old Ridgeville, fifty-odd miles to the south, we had our home almost paid for, when the accident occurred. It was in the path of the heaviest fallout, and we couldn't have kept on living there even if the town had stayed. When Ridgeville moved to its present site, so, of course, did we, which meant starting mortgage payments all over again. Thus it was that on a Wednesday morning about three weeks later, I was sitting at one end of a plank picnic table with five boys and girls lined up along the sides. This was to be our headquarters and factory for the summer—a roomy unused barn belonging to the parents of one of the group members, Tommy Miller. "O.K.," I said, "let's relax. You don't need to treat me as a teacher, you know. I stopped being a school teacher when the final grades went in last Friday. I'm on vacation now. My job here is only to advise, and I'm going to do that as little as possible. You're going to decide what to do, and if it's safe and legal and possible to do with the starting capital we have, I'll go along with it and help in any way I can. This is your meeting." Mr. McCormack had told me, and in some detail, about the youngsters I'd be dealing with. The three who were sitting to my left were the ones who had proposed the group in the first place. Doris Enright was a grave young lady of ten years, who might, I thought, be quite a beauty in a few more years, but was at the moment rather angular—all shoulders and elbows. Peter Cope, Jr. and Hilary Matlack were skinny kids, too. The three were of an age and were all tall for ten-year-olds. I had the impression during that first meeting that they looked rather alike, but this wasn't so. Their features were quite different. Perhaps from association, for they were close friends, they had just come to have a certain similarity of restrained gesture and of modulated voice. And they were all tanned by sun and wind to a degree that made their eyes seem light and their teeth startlingly white. The two on my right were cast in a different mold. Mary McCready was a big husky redhead of twelve, with a face full of freckles and an infectious laugh, and Tommy Miller, a few months younger, was just an average, extroverted, well adjusted youngster, noisy and restless, tee-shirted and butch-barbered. The group exchanged looks to see who would lead off, and Peter Cope seemed to be elected. "Well, Mr. Henderson, a junior achievement group is a bunch of kids who get together to manufacture and sell things, and maybe make some money." "Is that what you want to do," I asked, "make money?" "Why not?" Tommy asked. "There's something wrong with making money?" "Well, sure, I suppose we want to," said Hilary. "We'll need some money to do the things we want to do later." "And what sort of things would you like to make and sell?" I asked. The usual products, of course, with these junior achievement efforts, are chemical specialties that can be made safely and that people will buy and use without misgivings—solvent to free up rusty bolts, cleaner to remove road tar, mechanic's hand soap—that sort of thing. Mr. McCormack had told me, though, that I might find these youngsters a bit more ambitious. "The Miller boy and Mary McCready," he had said, "have exceptionally high IQ's—around one forty or one fifty. The other three are hard to classify. They have some of the attributes of exceptional pupils, but much of the time they seem to have little interest in their studies. The junior achievement idea has sparked their imaginations. Maybe it'll be just what they need." Mary said, "Why don't we make a freckle remover? I'd be our first customer." "The thing to do," Tommy offered, "is to figure out what people in Ridgeville want to buy, then sell it to them." "I'd like to make something by powder metallurgy techniques," said Pete. He fixed me with a challenging eye. "You should be able to make ball bearings by molding, then densify them by electroplating." "And all we'd need is a hydraulic press," I told him, "which, on a guess, might cost ten thousand dollars. Let's think of something easier." Pete mulled it over and nodded reluctantly. "Then maybe something in the electronics field. A hi-fi sub-assembly of some kind." "How about a new detergent?" Hilary put in. "Like the liquid dishwashing detergents?" I asked. He was scornful. "No, they're formulations—you know, mixtures. That's cookbook chemistry. I mean a brand new synthetic detergent. I've got an idea for one that ought to be good even in the hard water we've got around here." "Well, now," I said, "organic synthesis sounds like another operation calling for capital investment. If we should keep the achievement group going for several summers, it might be possible later on to carry out a safe synthesis of some sort. You're Dr. Matlack's son, aren't you? Been dipping into your father's library?" "Some," said Hilary, "and I've got a home laboratory." "How about you, Doris?" I prompted. "Do you have a special field of interest?" "No." She shook her head in mock despondency. "I'm not very technical. Just sort of miscellaneous. But if the group wanted to raise some mice, I'd be willing to turn over a project I've had going at home." "You could sell mice?" Tommy demanded incredulously. "Mice," I echoed, then sat back and thought about it. "Are they a pure strain? One of the recognized laboratory strains? Healthy mice of the right strain," I explained to Tommy, "might be sold to laboratories. I have an idea the Commission buys a supply every month." "No," said Doris, "these aren't laboratory mice. They're fancy ones. I got the first four pairs from a pet shop in Denver, but they're red—sort of chipmunk color, you know. I've carried them through seventeen generations of careful selection." "Well, now," I admitted, "the market for red mice might be rather limited. Why don't you consider making an after-shave lotion? Denatured alcohol, glycerine, water, a little color and perfume. You could buy some bottles and have some labels printed. You'd be in business before you knew it." There was a pause, then Tommy inquired, "How do you sell it?" "Door-to-door." He made a face. "Never build up any volume. Unless it did something extra. You say we'd put color in it. How about enough color to leave your face looking tanned. Men won't use cosmetics and junk, but if they didn't have to admit it, they might like the shave lotion." Hilary had been deep in thought. He said suddenly, "Gosh, I think I know how to make a—what do you want to call it—a before-shave lotion." "What would that be?" I asked. "You'd use it before you shaved." "I suppose there might be people who'd prefer to use it beforehand," I conceded. "There will be people," he said darkly, and subsided. Mrs. Miller came out to the barn after a while, bringing a bucket of soft drinks and ice, a couple of loaves of bread and ingredients for a variety of sandwiches. The parents had agreed to underwrite lunches at the barn and Betty Miller philosophically assumed the role of commissary officer. She paused only to say hello and to ask how we were progressing with our organization meeting. I'd forgotten all about organization, and that, according to all the articles I had perused, is most important to such groups. It's standard practice for every member of the group to be a company officer. Of course a young boy who doesn't know any better, may wind up a sales manager. Over the sandwiches, then, I suggested nominating company officers, but they seemed not to be interested. Peter Cope waved it off by remarking that they'd each do what came naturally. On the other hand, they pondered at some length about a name for the organization, without reaching any conclusions, so we returned to the problem of what to make. It was Mary, finally, who advanced the thought of kites. At first there was little enthusiasm, then Peter said, "You know, we could work up something new. Has anybody ever seen a kite made like a wind sock?" Nobody had. Pete drew figures in the air with his hands. "How about the hole at the small end?" "I'll make one tonight," said Doris, "and think about the small end. It'll work out all right." I wished that the youngsters weren't starting out by inventing a new article to manufacture, and risking an almost certain disappointment, but to hold my guidance to the minimum, I said nothing, knowing that later I could help them redesign it along standard lines. At supper I reviewed the day's happenings with Marjorie and tried to recall all of the ideas which had been propounded. Most of them were impractical, of course, for a group of children to attempt, but several of them appeared quite attractive. Tommy, for example, wanted to put tooth powder into tablets that one would chew before brushing the teeth. He thought there should be two colors in the same bottle—orange for morning and blue for night, the blue ones designed to leave the mouth alkaline at bed time. Pete wanted to make a combination nail and wood screw. You'd drive it in with a hammer up to the threaded part, then send it home with a few turns of a screwdriver. Hilary, reluctantly forsaking his ideas on detergents, suggested we make black plastic discs, like poker chips but thinner and as cheap as possible, to scatter on a snowy sidewalk where they would pick up extra heat from the sun and melt the snow more rapidly. Afterward one would sweep up and collect the discs. Doris added to this that if you could make the discs light enough to float, they might be colored white and spread on the surface of a reservoir to reduce evaporation. These latter ideas had made unknowing use of some basic physics, and I'm afraid I relapsed for a few minutes into the role of teacher and told them a little bit about the laws of radiation and absorption of heat. "My," said Marjorie, "they're really smart boys and girls. Tommy Miller does sound like a born salesman. Somehow I don't think you're going to have to call in Mr. Wells." I do feel just a little embarrassed about the kite, even now. The fact that it flew surprised me. That it flew so confoundedly well was humiliating. Four of them were at the barn when I arrived next morning; or rather on the rise of ground just beyond it, and the kite hung motionless and almost out of sight in the pale sky. I stood and watched for a moment, then they saw me. "Hello, Mr. Henderson," Mary said, and proffered the cord which was wound on a fishing reel. I played the kite up and down for a few minutes, then reeled it in. It was, almost exactly, a wind sock, but the hole at the small end was shaped—by wire—into the general form of a kidney bean. It was beautifully made, and had a sort of professional look about it. "It flies too well," Mary told Doris. "A kite ought to get caught in a tree sometimes." "You're right," Doris agreed. "Let's see it." She gave the wire at the small end the slightest of twists. "There, it ought to swoop." Sure enough, in the moderate breeze of that morning, the kite swooped and yawed to Mary's entire satisfaction. As we trailed back to the barn I asked Doris, "How did you know that flattening the lower edge of the hole would create instability?" She looked doubtful. "Why it would have to, wouldn't it? It changed the pattern of air pressures." She glanced at me quickly. "Of course, I tried a lot of different shapes while I was making it." "Naturally," I said, and let it go at that. "Where's Tommy?" "He stopped off at the bank," Pete Cope told me, "to borrow some money. We'll want to buy materials to make some of these kites." "But I said yesterday that Mr. McCormack and I were going to advance some cash to get started." "Oh, sure, but don't you think it would be better to borrow from a bank? More businesslike?" "Doubtless," I said, "but banks generally want some security." I would have gone on and explained matters further, except that Tommy walked in and handed me a pocket check book. "I got two hundred and fifty," he volunteered—not without a hint of complacency in his voice. "It didn't take long, but they sure made it out a big deal. Half the guys in the bank had to be called in to listen to the proposition. The account's in your name, Mr. Henderson, and you'll have to make out the checks. And they want you to stop in at the bank and give them a specimen signature. Oh, yes, and cosign the note." My heart sank. I'd never had any dealings with banks except in the matter of mortgages, and bank people make me most uneasy. To say nothing of finding myself responsible for a two-hundred-and-fifty-dollar note—over two weeks salary. I made a mental vow to sign very few checks. "So then I stopped by at Apex Stationers," Tommy went on, "and ordered some paper and envelopes. We hadn't picked a name yesterday, but I figured what's to lose, and picked one. Ridge Industries, how's that?" Everybody nodded. "Just three lines on the letterhead," he explained. "Ridge Industries—Ridgeville—Montana." I got my voice back and said, "Engraved, I trust." "Well, sure," he replied. "You can't afford to look chintzy." My appetite was not at its best that evening, and Marjorie recognized that something was concerning me, but she asked no questions, and I only told her about the success of the kite, and the youngsters embarking on a shopping trip for paper, glue and wood splints. There was no use in both of us worrying. On Friday we all got down to work, and presently had a regular production line under way; stapling the wood splints, then wetting them with a resin solution and shaping them over a mandrel to stiffen, cutting the plastic film around a pattern, assembling and hanging the finished kites from an overhead beam until the cement had set. Pete Cope had located a big roll of red plastic film from somewhere, and it made a wonderful-looking kite. Happily, I didn't know what the film cost until the first kites were sold. By Wednesday of the following week we had almost three hundred kites finished and packed into flat cardboard boxes, and frankly I didn't care if I never saw another. Tommy, who by mutual consent, was our authority on sales, didn't want to sell any until we had, as he put it, enough to meet the demand, but this quantity seemed to satisfy him. He said he would sell them the next week and Mary McCready, with a fine burst of confidence, asked him in all seriousness to be sure to hold out a dozen. Three other things occurred that day, two of which I knew about immediately. Mary brought a portable typewriter from home and spent part of the afternoon banging away at what seemed to me, since I use two fingers only, a very creditable speed. And Hilary brought in a bottle of his new detergent. It was a syrupy yellow liquid with a nice collar of suds. He'd been busy in his home laboratory after all, it seemed. "What is it?" I asked. "You never told us." Hilary grinned. "Lauryl benzyl phosphonic acid, dipotassium salt, in 20% solution." "Goodness." I protested, "it's been twenty-five years since my last course in chemistry. Perhaps if I saw the formula—." He gave me a singularly adult smile and jotted down a scrawl of symbols and lines. It meant little to me. "Is it good?" For answer he seized the ice bucket, now empty of its soda bottles, trickled in a few drops from the bottle and swished the contents. Foam mounted to the rim and spilled over. "And that's our best grade of Ridgeville water," he pointed out. "Hardest in the country." The third event of Wednesday came to my ears on Thursday morning. I was a little late arriving at the barn, and was taken a bit aback to find the roadway leading to it rather full of parked automobiles, and the barn itself rather full of people, including two policemen. Our Ridgeville police are quite young men, but in uniform they still look ominous and I was relieved to see that they were laughing and evidently enjoying themselves. "Well, now," I demanded, in my best classroom voice. "What is all this?" "Are you Henderson?" the larger policeman asked. "I am indeed," I said, and a flash bulb went off. A young lady grasped my arm. "Oh, please, Mr. Henderson, come outside where it's quieter and tell me all about it." "Perhaps," I countered, "somebody should tell me." "You mean you don't know, honestly? Oh, it's fabulous. Best story I've had for ages. It'll make the city papers." She led me around the corner of the barn to a spot of comparative quiet. "You didn't know that one of your junior whatsisnames poured detergent in the Memorial Fountain basin last night?" I shook my head numbly. "It was priceless. Just before rush hour. Suds built up in the basin and overflowed, and down the library steps and covered the whole street. And the funniest part was they kept right on coming. You couldn't imagine so much suds coming from that little pool of water. There was a three-block traffic jam and Harry got us some marvelous pictures—men rolling up their trousers to wade across the street. And this morning," she chortled, "somebody phoned in an anonymous tip to the police—of course it was the same boy that did it—Tommy—Miller?—and so here we are. And we just saw a demonstration of that fabulous kite and saw all those simply captivating mice." "Mice?" "Yes, of course. Who would ever have thought you could breed mice with those cute furry tails?" Well, after a while things quieted down. They had to. The police left after sobering up long enough to give me a serious warning against letting such a thing happen again. Mr. Miller, who had come home to see what all the excitement was, went back to work and Mrs. Miller went back to the house and the reporter and photographer drifted off to file their story, or whatever it is they do. Tommy was jubilant. "Did you hear what she said? It'll make the city papers. I wish we had a thousand kites. Ten thousand. Oh boy, selling is fun. Hilary, when can you make some more of that stuff? And Doris, how many mice do you have?" Those mice! I have always kept my enthusiasm for rodents within bounds, but I must admit they were charming little beasts, with tails as bushy as miniature squirrels. "How many generations?" I asked Doris. "Seventeen. No, eighteen, now. Want to see the genetic charts?" I won't try to explain it as she did to me, but it was quite evident that the new mice were breeding true. Presently we asked Betty Miller to come back down to the barn for a conference. She listened and asked questions. At last she said, "Well, all right, if you promise me they can't get out of their cages. But heaven knows what you'll do when fall comes. They won't live in an unheated barn and you can't bring them into the house." "We'll be out of the mouse business by then," Doris predicted. "Every pet shop in the country will have them and they'll be down to nothing apiece." Doris was right, of course, in spite of our efforts to protect the market. Anyhow that ushered in our cage building phase, and for the next week—with a few interruptions—we built cages, hundreds of them, a good many for breeding, but mostly for shipping. It was rather regrettable that, after the Courier gave us most of the third page, including photographs, we rarely had a day without a few visitors. Many of them wanted to buy mice or kites, but Tommy refused to sell any mice at retail and we soon had to disappoint those who wanted kites. The Supermarket took all we had—except a dozen—and at a dollar fifty each. Tommy's ideas of pricing rather frightened me, but he set the value of the mice at ten dollars a pair and got it without any arguments. Our beautiful stationery arrived, and we had some invoice forms printed up in a hurry—not engraved, for a wonder. It was on Tuesday—following the Thursday—that a lanky young man disentangled himself from his car and strolled into the barn. I looked up from the floor where I was tacking squares of screening onto wooden frames. "Hi," he said. "You're Donald Henderson, right? My name is McCord—Jeff McCord—and I work in the Patent Section at the Commission's downtown office. My boss sent me over here, but if he hadn't, I think I'd have come anyway. What are you doing to get patent protection on Ridge Industries' new developments?" I got my back unkinked and dusted off my knees. "Well, now," I said, "I've been wondering whether something shouldn't be done, but I know very little about such matters—." "Exactly," he broke in, "we guessed that might be the case, and there are three patent men in our office who'd like to chip in and contribute some time. Partly for the kicks and partly because we think you may have some things worth protecting. How about it? You worry about the filing and final fees. That's sixty bucks per brainstorm. We'll worry about everything else." "What's to lose," Tommy interjected. And so we acquired a patent attorney, several of them, in fact. The day that our application on the kite design went to Washington, Mary wrote a dozen toy manufacturers scattered from New York to Los Angeles, sent a kite to each one and offered to license the design. Result, one licensee with a thousand dollar advance against next season's royalties. It was a rainy morning about three weeks later that I arrived at the barn. Jeff McCord was there, and the whole team except Tommy. Jeff lowered his feet from the picnic table and said, "Hi." "Hi yourself," I told him. "You look pleased." "I am," he replied, "in a cautious legal sense, of course. Hilary and I were just going over the situation on his phosphonate detergent. I've spent the last three nights studying the patent literature and a few standard texts touching on phosphonates. There are a zillion patents on synthetic detergents and a good round fifty on phosphonates, but it looks"—he held up a long admonitory hand—"it just looks as though we had a clear spot. If we do get protection, you've got a real salable property." "That's fine, Mr. McCord," Hilary said, "but it's not very important." "No?" Jeff tilted an inquiring eyebrow at me, and I handed him a small bottle. He opened and sniffed at it gingerly. "What gives?" "Before-shave lotion," Hilary told him. "You've shaved this morning, but try some anyway." Jeff looked momentarily dubious, then puddled some in his palm and moistened his jaw line. "Smells good," he noted, "and feels nice and cool. Now what?" "Wipe your face." Jeff located a handkerchief and wiped, looked at the cloth, wiped again, and stared. "What is it?" "A whisker stiffener. It makes each hair brittle enough to break off right at the surface of your skin." "So I perceive. What is it?" "Oh, just a mixture of stuff. Cookbook chemistry. Cysteine thiolactone and a fat-soluble magnesium compound." "I see. Just a mixture of stuff. And do your whiskers grow back the next day?" "Right on schedule," I said. McCord unfolded his length and stood staring out into the rain. Presently he said, "Henderson, Hilary and I are heading for my office. We can work there better than here, and if we're going to break the hearts of the razor industry, there's no better time to start than now." When they had driven off I turned and said, "Let's talk a while. We can always clean mouse cages later. Where's Tommy?" "Oh, he stopped at the bank to get a loan." "What on earth for? We have over six thousand in the account." "Well," Peter said, looking a little embarrassed, "we were planning to buy a hydraulic press. You see, Doris put some embroidery on that scheme of mine for making ball bearings." He grabbed a sheet of paper. "Look, we make a roller bearing, this shape only it's a permanent magnet. Then you see—." And he was off. "What did they do today, dear?" Marge asked as she refilled my coffee cup. "Thanks," I said. "Let's see, it was a big day. We picked out a hydraulic press, Doris read us the first chapter of the book she's starting, and we found a place over a garage on Fourth Street that we can rent for winter quarters. Oh, yes, and Jeff is starting action to get the company incorporated." "Winter quarters," Marge repeated. "You mean you're going to try to keep the group going after school starts?" "Why not? The kids can sail through their courses without thinking about them, and actually they won't put in more than a few hours a week during the school year." "Even so, it's child labor, isn't it?" "Child labor nothing. They're the employers. Jeff McCord and I will be the only employees—just at first, anyway." Marge choked on something. "Did you say you'd be an employee?" "Sure," I told her. "They've offered me a small share of the company, and I'd be crazy to turn it down. After all, what's to lose?" Transcriber's Note: This etext was produced from Analog Science Fact & Fiction July 1962. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note.
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D. The Commission is a laboratory and the main employer in Ridgeville.
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Why doesn't Charlie want to go with Laura and Mickey?
A. Charlie is not really a people person. He likes Ben, but that's about it.
B. Charlie is very self-conscious about his scars. He is uncomfortable around other people.
C. Charlie is uncomfortable with Laura and Mickey's wealth. He feels a bit shabby because his coat is missing a button.
D. Charlie is dying and Ben is the only family he has. He wants to spend his last moments with Ben.
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Spacemen Die at Home By EDWARD W. LUDWIG Illustrated by THORNE [Transcriber's Note: This etext was produced from Galaxy Science Fiction October 1951. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] One man's retreat is another's prison ... and it takes a heap of flying to make a hulk a home! Forty days of heaven and forty nights of hell. That's the way it's been, Laura. But how can I make you understand? How can I tell you what it's like to be young and a man and to dream of reaching the stars? And yet, at the same time, to be filled with a terrible, gnawing fear—a fear locked in my mind during the day and bursting out like an evil jack-in-the-box at night. I must tell you, Laura. Perhaps if I start at the beginning, the very beginning.... It was the Big Day. All the examinations, the physicals and psychos, were over. The Academy, with its great halls and classrooms and laboratories, lay hollow and silent, an exhausted thing at sleep after spawning its first-born. For it was June in this year of 1995, and we were the graduating class of the U. S. Academy of Interplanetary Flight. The first graduating class, Laura. That's why it was so important, because we were the first . We sat on a little platform, twenty-five of us. Below us was a beach of faces, most of them strange, shining like pebbles in the warm New Mexican sunlight. They were the faces of mothers and fathers and grandparents and kid brothers and sisters—the people who a short time ago had been only scrawled names on letters from home or words spoken wistfully at Christmas. They were the memory-people who, to me, had never really existed. But today they had become real, and they were here and looking at us with pride in their eyes. A voice was speaking, deep, sure, resonant. "... these boys have worked hard for six years, and now they're going to do a lot of big things. They're going to bring us the metals and minerals that we desperately need. They're going to find new land for our colonists, good rich land that will bear food and be a home for our children. And perhaps most important of all, they'll make other men think of the stars and look up at them and feel humility—for mankind needs humility." The speaker was Robert Chandler, who'd brought the first rocket down on Mars just five years ago, who'd established the first colony there, and who had just returned from his second hop to Venus. Instead of listening to his words, I was staring at his broad shoulders and his dark, crew-cut hair and his white uniform which was silk-smooth and skin-tight. I was worshiping him and hating him at the same time, for I was thinking: He's already reached Mars and Venus. Let him leave Jupiter and the others alone! Let us be the first to land somewhere! Let us be the first! Mickey Cameron, sitting next to me, dug an elbow into my ribs. "I don't see 'em, Ben," he whispered. "Where do you suppose they are?" I blinked. "Who?" "My folks." That was something I didn't have to worry about. My parents had died in a strato-jet crash when I was four, so I hadn't needed many of those "You are cordially invited" cards. Just one, which I'd sent to Charlie Taggart. Stardust Charlie, we called him, although I never knew why. He was a veteran of Everson's first trip to the Moon nearly twenty-five years ago, and he was still at it. He was Chief Jetman now on the Lunar Lady , a commercial ore ship on a shuttle between Luna City and White Sands. I remembered how, as a kid, I'd pestered him in the Long Island Spaceport, tagging after him like a puppy, and how he'd grown to like me until he became father, mother, and buddy all in one to me. And I remembered, too, how his recommendation had finally made me a cadet. My gaze wandered over the faces, but I couldn't find Charlie's. It wasn't surprising. The Lunar Lady was in White Sands now, but liberties, as Charlie said, were as scarce as water on Mars. It doesn't matter , I told myself. Then Mickey stiffened. "I see 'em, Ben! There in the fifth row!" Usually Mickey was the same whether in a furnace-hot engine room or a garden party, smiling, accepting whatever the world offered. But now a tenseness and an excitement had gripped even him. I was grateful that he was beside me; we'd been a good team during those final months at the Academy and I knew we'd be a good team in space. The Universe was mighty big, but with two of us to face it together, it would be only half as big. And then it seemed that all the proud faces were looking at us as if we were gods. A shiver went through my body. Though it was daytime, I saw the stars in my mind's vision, the great shining balls of silver, each like a voice crying out and pleading to be explored, to be touched by the sons of Earth. They expect a lot from us. They expect us to make a new kind of civilization and a better place out of Earth. They expect all this and a hell of a lot more. They think there's nothing we can't do. I felt very small and very humble. I was scared. Damned scared. At last it was over, and the proud faces descended upon us in a huge, babbling wave. Then I saw him. Good old Stardust Charlie. His wizened little body was shuffling down an aisle, his eyes shining like a child's. He'd been sandwiched, evidently, in one of the rear rows. But he wasn't the Charlie I'd seen a year ago. He'd become gaunt and old, and he walked with an unnatural stiffness. He looked so old that it was hard to believe he'd once been young. He scratched his mop of steel-gray hair and grinned. "You made it, boy," he chortled, "and by Jupiter, we'll celebrate tonight. Yes, siree, I got twenty-four hours, and we'll celebrate as good spacemen should!" Then Mickey strode up to us. He was his normal, boyish self again, walking lightly, his blond, curly-haired skull swaying as if in rhythm with some silent melody. And you, Laura, were with him. "Meet the Brat," he said. "My sister Laura." I stared almost rudely. You were like a doll lost in the immensity of your fluffy pink dress. Your hair was long and transformed into a golden froth where sunlight touched it. But your eyes were the eyes of a woman, glowing like dark stars and reflecting a softness, a gentleness that I'd never seen in eyes before. "I'm happy to meet you, Ben," you said. "I've heard of no one else for the past year." A tide of heat crept up from my collar. I stuttered through an introduction of Charlie. You and Mickey looked strangely at Charlie, and I realized that old Stardust was not a cadet's notion of the ideal spaceman. Charlie scorned the skin-tight uniforms of the government service and wore a shiny black suit that was a relic of Everson's early-day Moon Patrol. His tie was clumsily knotted, and a button on his coat was missing. And the left side of his face was streaked with dark scar tissue, the result of an atomic blowup on one of the old Moon ships. I was so accustomed to the scars, I was seldom aware of them; but others, I knew, would find them ugly. You were kind. You shook hands and said, softly: "It's a privilege to meet you, Charlie. Just think—one of Everson's men, one of the first to reach the Moon!" Charlie gulped helplessly, and Mickey said: "Still going to spend the weekend with us, aren't you, Ben?" I shook my head. "Charlie has only twenty-four hours liberty. We're planning to see the town tonight." "Why don't you both come with us?" you asked. "Our folks have their own plane, so it would be no problem. And we've got a big guest room. Charlie, wouldn't you like a home-cooked meal before going back to the Moon?" Charlie's answer was obscured by a sudden burst of coughing. I knew that he'd infinitely prefer to spend his liberty sampling Martian fizzes and Plutonian zombies. But this night seemed too sacred for Charlie's kind of celebration. "We'd really like to come," I said. On our way to the 'copter parking field, Dean Dawson passed us. He was a tall, willowy man, spectacled, looking the way an academy professor should look. "Ben," he called, "don't forget that offer. Remember you've got two months to decide." "No, thanks," I answered. "Better not count on me." A moment later Mickey said, frowning, "What was he talking about, Ben? Did he make you an offer?" I laughed. "He offered me a job here at the Academy teaching astrogation. What a life that would be! Imagine standing in a classroom for forty years when I've got the chance to—" I hesitated, and you supplied the right words: "When you've got the chance to be the first to reach a new planet. That's what most of you want, isn't it? That's what Mickey used to want." I looked at you as if you were Everson himself, because you seemed to understand the hunger that could lie in a man's heart. Then your last words came back and jabbed me: "That's what Mickey used to want." " Used to want?" I asked. "What do you mean?" You bit your lip, not answering. "What did she mean, Mickey?" Mickey looked down at his feet. "I didn't want to tell you yet, Ben. We've been together a long time, planning to be on a rocket. But—" "Yes?" "Well, what does it add up to? You become a spaceman and wear a pretty uniform. You wade through the sands of Mars and the dust of Venus. If you're lucky, you're good for five, maybe ten years. Then one thing or another gets you. They don't insure rocketmen, you know." My stomach was full of churning, biting ice. "What are you trying to say, Mickey?" "I've thought about it a long time. They want me for Cargo Supervisor of White Sands Port." He raised his hand to stop me. "I know. It's not so exciting. I'll just live a lot longer. I'm sorry, Ben." I couldn't answer. It was as if someone had whacked the back of my knees with the blast of a jet. "It doesn't change anything, Ben—right now, I mean. We can still have a good weekend." Charlie was muttering under his breath, smoldering like a bomb about to reach critical mass. I shook my head dazedly at him as we got to the 'copter. "Sure," I said to Mickey, "we can still have a good weekend." I liked your folks, Laura. There was no star-hunger in them, of course. They were simple and solid and settled, like green growing things, deep-rooted, belonging to Earth. They were content with a home that was cool on this warm summer night, with a 'copter and a tri-dimensional video, and a handsome automatic home that needed no servants or housework. Stardust Charlie was as comfortable as a Martian sand-monkey in a shower, but he tried courageously to be himself. At the dinner table he stared glassily at nothing and grated, "Only hit Mars once, but I'll never forget the kid who called himself a medic. Skipper started coughing, kept it up for three days. Whoopin' cough, the medic says, not knowin' the air had chemicals that turned to acid in your lungs. I'd never been to Mars before, but I knew better'n that. Hell, I says, that ain't whoopin' cough, that's lung-rot." That was when your father said he wasn't so hungry after all. Afterward, you and I walked onto the terrace, into the moonlit night, to watch for crimson-tailed continental rockets that occasionally streaked up from White Sands. We gazed for a few seconds up into the dark sky, and then you said: "Charlie is funny, isn't he? He's nice and I'm glad he's here, but he's sort of funny." "He's an old-time spaceman. You didn't need much education in those days, just a lot of brawn and a quick mind. It took guts to be a spaceman then." "But he wasn't always a spaceman. Didn't he ever have a family?" I smiled and shook my head. "If he had, he never mentioned it. Charlie doesn't like to be sentimental, at least not on the outside. As far as I know, his life began when he took off for the Moon with Everson." You stared at me strangely, almost in a sacred kind of way. I knew suddenly that you liked me, and my heart began to beat faster. There was silence. You were lovely, your soft hair like strands of gold, and there were flecks of silver in your dark eyes. Somehow I was afraid. I had the feeling that I shouldn't have come here. You kept looking at me until I had to ask: "What are you thinking, Laura?" You laughed, but it was a sad, fearful laugh. "No, I shouldn't be thinking it. You'd hate me if I told you, and I wouldn't want that." "I could never hate you." "It—it's about the stars," you said very softly. "I understand why you want to go to them. Mickey and I used to dream about them when we were kids. Of course I was a girl, so it was just a game to me. But once I dreamed of going to England. Oh, it was going to be so wonderful. I lived for months, just thinking about it. "One summer we went. I had fun. I saw the old buildings and castles, and the spaceports and the Channel Tube. But after it was over, I realized England wasn't so different from America. Places seem exciting before you get to them, and afterward they're not really." I frowned. "And you mean it might be the same with the stars? You think maybe I haven't grown up yet?" Anxiety darkened your features. "No, it'd be good to be a spaceman, to see the strange places and make history. But is it worth it? Is it worth the things you'd have to give up?" I didn't understand at first, and I wanted to ask, "Give up what ?" Then I looked at you and the promise in your eyes, and I knew. All through the years I'd been walking down a single, narrow path. Government boarding school, the Academy, my eyes always upward and on the stars. Now I'd stumbled into a cross-roads, beholding a strange new path that I'd never noticed before. You can go into space , I thought, and try to do as much living in ten years as normal men do in fifty. You can be like Everson, who died in a Moon crash at the age of 36, or like a thousand others who lie buried in Martian sand and Venusian dust. Or, if you're lucky, like Charlie—a kind of human meteor streaking through space, eternally alone, never finding a home. Or there's the other path. To stay on this little prison of an Earth in cool, comfortable houses. To be one of the solid, rooted people with a wife and kids. To be one of the people who live long enough to grow old, who awake to the song of birds instead of rocket grumblings, who fill their lungs with the clean rich air of Earth instead of poisonous dust. "I'm sorry," you said. "I didn't mean to make you sad, Ben." "It's all right," I said, clenching my fists. "You made sense—a lot of sense." The next morning Charlie said good-bye in our room. He rubbed his scarred face nervously as he cleared his throat with a series of thin, tight coughs. Then he pointed to a brown, faded tin box lying on the bed. "I'm leavin' that for you. It's full of old stuff, souvenirs mostly. Thought maybe you'd like to have 'em." I scowled, not understanding. "Why, Charlie? What for?" He shrugged as if afraid he might be accused of sentimentality. "Oh, it's just that I've been dodgin' meteors now for twenty-five years. That's a long time, boy. Ain't one spaceman in a thousand that lucky. Some of these days, I won't be so lucky." I tried to laugh. "You're good for another twenty-five years, Charlie." He shook his head stiffly, staring at nothing. "Maybe. Anyway, I'm gonna get off the Shuttle this time, make one more trip to Mars. Tell you what. There's a little stone cafe on Mars, the Space Rat , just off Chandler Field on the Grand Canal. When you get to Mars, take a look inside. I'll probably be there." He coughed again, a deep, rasping cough that filled his eyes with tears. "Not used to this Earth air," he muttered. "What I need's some Martian climate." Suddenly that cough frightened me. It didn't seem normal. I wondered, too, about his stiff movements and glassy stare. It was as if he were drugged. I shook the thought away. If Charlie was sick, he wouldn't talk about going to Mars. The medics wouldn't let him go even as far as Luna. We watched him leave, you and Mickey and I. "When will you be back?" you asked. Charlie's hard face contorted itself into a gargoylish grin. "Maybe a couple of months, maybe a couple of years. You know spacemen." Then he waved and strode away, a strange, gray, withered gnome of a man. I wanted him to say something, to tell me the secret that would kill the doubt worming through my brain. But he rounded a corner, still grinning and waving, and then he was gone. That afternoon Mickey showed me his room. It was more like a boy's room than a spaceman's. In it were all the little things that kids treasure—pennants, models of Everson's two ships, a tennis trophy, books, a home-made video. I began to realize how important a room like this could be to a boy. I could imagine, too, the happiness that parents felt as they watched their children grow to adulthood. I'd missed something. My folks were shadow-people, my impressions of them drawn half from ancient photos, half from imagination. For me, it had been a cold, automatic kind of life, the life of dormitories and routines and rules. I'd been so blinded by the brilliancy of my dreams, I hadn't realized I was different. My folks were killed in a rocket crash. If it weren't for rockets, I'd have lived the kind of life a kid should live. Mickey noticed my frown. "What's the matter, Ben? Still sore? I feel like a heel, but I'm just not like you and Charlie, I guess. I—" "No, I understand, Mickey. I'm not sore, really." "Listen, then. You haven't accepted any offer yet, have you?" "No. I got a couple of possibilities. Could get a berth on the Odyssey , the new ship being finished at Los Angeles. They want me, too, for the Moon Patrol, but that's old stuff, not much better than teaching. I want to be in deep space." "Well, how about staying with us till you decide? Might as well enjoy Earth life while you can. Okay?" I felt like running from the house, to forget that it existed. I wanted someone to tell me one of the old stories about space, a tale of courage that would put fuel on dying dreams. But I wanted, also, to be with you, Laura, to see your smile and the flecks of silver in your eyes and the way your nose turned upward ever so slightly when you laughed. You see, I loved you already, almost as much as I loved the stars. And I said, slowly, my voice sounding unfamiliar and far away, "Sure, I'll stay, Mickey. Sure." Forty days of joy, forty nights of fear and indecision. We did all the little things, like watching the rockets land at White Sands and flying down to the Gulf to swim in cool waters. You tried, unsuccessfully, to teach me to dance, and we talked about Everson and Charlie and the Moon and the stars. You felt you had to give the stars all the beauty and promise of a child's dream, because you knew that was what I wanted. One morning I thought, Why must I make a choice? Why can't I have both you and the stars? Would that be asking too much? All day the thought lay in my mind like fire. That evening I asked you to marry me. I said it very simply: "Laura, I want you to be my wife." You looked up at Venus, and you were silent for a long while, your face flushed. Then you murmured, "I—I want to marry you, Ben, but are you asking me to marry a spaceman or a teacher?" "Can't a spaceman marry, too?" "Yes, a spaceman can marry, but what would it be like? Don't you see, Ben? You'd be like Charlie. Gone for maybe two months, maybe two years. Then you'd have a twenty-four hour liberty—and I'd have what?" Somehow I'd expected words like these, but still they hurt. "I wouldn't have to be a spaceman forever. I could try it for a couple of years, then teach." "Would you, Ben? Would you be satisfied with just seeing Mars? Wouldn't you want to go on to Jupiter and Saturn and Uranus and on and on?" Your voice was choked, and even in the semi-darkness I saw tears glittering in your eyes. "Do you think I'd dare have children, Ben? Mickey told me what happened on the Cyclops . There was a leak in the atomic engines. The ship was flooded with radiation—just for a second. It didn't seem serious. The men had no burns. But a year later the captain had a child. And it was—" "I know, Laura. Don't say it." You had to finish. "It was a monster." That night I lay awake, the fears and doubts too frantic to let me sleep. You've got to decide now , I told myself. You can't stay here. You've got to make a choice. The teaching job was still open. The spot on the Odyssey was still open—and the big ship, it was rumored, was equipped to make it all the way to Pluto. You can take Dean Dawson's job and stay with Laura and have kids and a home and live to see what happens in this world sixty years from now. Or you can see what's on the other side of the mountain. You can be a line in a history book. I cursed. I knew what Charlie would say. He'd say, "Get the hell out of there, boy. Don't let a fool woman make a sucker out of you. Get out there on the Odyssey where you belong. We got a date on Mars, remember? At the Space Rat , just off Chandler Field on the Grand Canal." That's what he'd say. And yet I wanted you, Laura. I wanted to be with you, always. "Oh God," I moaned, "what shall I do?" Next morning the door chimes pealed, and you went to the door and brought back the audiogram. It was addressed to me; I wondered who could be sending me a message. I pressed the stud on the little gray cylinder, and a rasping, automatic voice droned: "Luna City, Luna, July 27, 1995. Regret to inform you of death of Charles Taggart, Chief Jetman...." Then there was a Latin name which was more polite than the word "lung-rot" and the metallic phrase, "This message brought to you by courtesy of United Nations Earth-Luna Communication Corps." I stood staring at the cylinder. Charles Taggart was dead. Charles Taggart was Charlie. Stardust Charlie. My heart thudded crazily against my chest. It couldn't be! Not Charlie! The audiogram had lied! I pressed the stud again. "... regret to inform you of death of Charles ..." I hurled the cylinder at the wall. It thudded, fell, rolled. The broken voice droned on. You ran to it, shut it off. "I'm sorry, Ben, so terribly—" Without answering, I walked into my room. I knew it was true now. I remembered Charlie's coughing, his gaunt features, his drugged gaze. The metallic words had told the truth. I sat for a long time on my bed, crying inside, but staring dry-eyed at Charlie's faded tin box. Then, finally, I fingered his meager possessions—a few wrinkled photos, some letters, a small black statue of a forgotten Martian god, a gold service medal from the Moon Patrol. This was what remained of Charlie after twenty-five years in space. It was a bitter bargain. A statue instead of a wife, yellowed letters instead of children, a medal instead of a home. It'd be a great future , I thought. You'd dream of sitting in a dingy stone dive on the Grand Canal with sand-wasps buzzing around smoky, stinking candles. A bottle of luchu juice and a couple of Martian girls with dirty feet for company. And a sudden cough that would be the first sign of lung-rot. To hell with it! I walked into your living room and called Dean Dawson on the visiphone. I accepted that job teaching. And now, Laura, it's nearly midnight. You're in your room, sleeping, and the house is silent. It's hard to tell you, to make you understand, and that is why I am writing this. I looked through Charlie's box again, more carefully this time, reading the old letters and studying the photographs. I believe now that Charlie sensed my indecision, that he left these things so that they could tell me what he could not express in words. And among the things, Laura, I found a ring. A wedding ring. In that past he never talked about, there was a woman—his wife. Charlie was young once, his eyes full of dreams, and he faced the same decision that I am facing. Two paths were before him, but he tried to travel both. He later learned what we already know—that there can be no compromise. And you know, too, which path he finally chose. Do you know why he had to drug himself to watch me graduate? So he could look at me, knowing that I would see the worlds he could never live to see. Charlie didn't leave just a few trinkets behind him. He left himself, Laura, for he showed me that a boy's dream can also be a man's dream. He made his last trip to Luna when he knew he was going to die. Heaven knows how he escaped a checkup. Maybe the captain understood and was kind—but that doesn't matter now. Do you know why he wanted to reach Mars? Do you know why he didn't want to die in the clean, cool air of Earth? It was because he wanted to die nearer home. His home, Laura, was the Universe, where the ship was his house, the crew his father, mother, brothers, the planets his children. You say that the beauty of the other side of the mountain vanishes after you reach it. But how can one ever be sure until the journey is made? Could I or Charlie or the thousand before us bear to look upon a star and think, I might have gone there; I could have been the first ? We said, too, that the life of a spaceman is lonely. Yet how could one be lonely when men like Charlie roam the spaceways? Charlie wanted me to himself that night after graduation. He wanted us to celebrate as spacemen should, for he knew that this would be his last night on Earth. It might have seemed an ugly kind of celebration to you, but he wanted it with all his heart, and we robbed him of it. Because of these things, Laura, I will be gone in the morning. Explain the best you can to Mickey and to your parents and Dean Dawson. Right now I've got a date that I'm going to keep—at a dingy stone cafe on Mars, the Space Rat , just off Chandler Field on the Grand Canal. Stardust Charlie will be there; he'll go with me in memory to whatever part of the Galaxy I may live to reach. And so will you, Laura. I have two wedding rings with me—his wife's ring and yours.
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D. Charlie is dying and Ben is the only family he has. He wants to spend his last moments with Ben.
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What news dataset was used?
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### Introduction
The web has provided researchers with vast amounts of unlabeled text data, and enabled the development of increasingly sophisticated language models which can achieve state of the art performance despite having no task specific training BIBREF0, BIBREF1, BIBREF2. It is desirable to adapt these models for bespoke tasks such as short text classification. Short-text is nuanced, difficult to model statistically, and sparse in features, hindering traditional analysis BIBREF3. These difficulties become further compounded when training is limited, as is the case for many practical applications. This paper provides a method to expand short-text with additional keywords, generated using a pre-trained language model. The method takes advantage of general language understanding to suggest contextually relevant new words, without necessitating additional domain data. The method can form both derivatives of the input vocabulary, and entirely new words arising from contextualised word interactions and is ideally suited for applications where data volume is limited. figureBinary Classification of short headlines into 'WorldPost' or 'Crime' categories, shows improved performance with extended pseudo headlines when the training set is small. Using: Random forest classifier, 1000 test examples, 10-fold cross validation. ### Literature Review
Document expansion methods have typically focused on creating new features with the help of custom models. Word co-occurrence models BIBREF4, topic modeling BIBREF5, latent concept expansion BIBREF6, and word embedding clustering BIBREF7, are all examples of document expansion methods that must first be trained using either the original dataset or an external dataset from within the same domain. The expansion models may therefore only be used when there is a sufficiently large training set. Transfer learning was developed as a method of reducing the need for training data by adapting models trained mostly from external data BIBREF8. Transfer learning can be an effective method for short-text classification and requires little domain specific training data BIBREF9, BIBREF10, however it demands training a new model for every new classification task and does not offer a general solution to sparse data enrichment. Recently, multi-task language models have been developed and trained using ultra-large online datasets without being confined to any narrow applications BIBREF0, BIBREF1, BIBREF2. It is now possible to benefit from the information these models contain by adapting them to the task of text expansion and text classification. This paper is a novel approach which combines the advantages of document expansion, transfer learning, and multitask modeling. It expends documents with new and relevant keywords by using the BERT pre-trained learning model, thus taking advantage of transfer learning acquired during BERT's pretraining. It is also unsupervised and requires no task specific training, thus allowing the same model to be applied to many different tasks or domains. ### Procedures ::: Dataset
The News Category Dataset BIBREF11 is a collection of headlines published by HuffPost BIBREF12 between 2012 and 2018, and was obtained online from Kaggle BIBREF13. The full dataset contains 200k news headlines with category labels, publication dates, and short text descriptions. For this analysis, a sample of roughly 33k headlines spanning 23 categories was used. Further analysis can be found in table SECREF12 in the appendix. ### Procedures ::: Word Generation
Words were generated using the BERT pre-trained model developed and trained by Google AI Language BIBREF0. BERT creates contextualized word embedding by passing a list of word tokens through 12 hidden transformer layers and generating encoded word vectors. To generate extended text, an original short-text document was passed to pre-trained BERT. At each transformer layer a new word embedding was formed and saved. BERT's vector decoder was then used to convert hidden word vectors to candidate words, the top three candidate words at each encoder layer were kept. Each input word produced 48 candidate words, however many were duplicates. Examples of generated words per layer can be found in table SECREF12 and SECREF12 in the appendix. The generated words were sorted based on frequency, duplicate words from the original input were removed, as were stop-words, punctuation, and incomplete words. The generated words were then appended to the original document to create extended pseudo documents, the extended document was limited to 120 words in order to normalize each feature set. Further analysis can be found in table SECREF12 in the appendix. figureThe proposed method uses the BERT pre-trained word embedding model to generate new words which are appended to the orignal text creating extended pseudo documents. ### Procedures ::: Topic Evaluation
To test the proposed methods ability to generate unsupervised words, it was necessary to devise a method of measuring word relevance. Topic modeling was used based on the assumption that words found in the same topic are more relevant to one another then words from different topics BIBREF14. The complete 200k headline dataset BIBREF11 was modeled using a Naïve Bayes Algorithm BIBREF15 to create a word-category co-occurrence model. The top 200 most relevant words were then found for each category and used to create the topic table SECREF12. It was assumed that each category represented its own unique topic. The number of relevant output words as a function of the headline’s category label were measured, and can be found in figure SECREF4. The results demonstrate that the proposed method could correctly identify new words relevant to the input topic at a signal to noise ratio of 4 to 1. figureThe number of generated words within each topic was counted, topics which matched the original headline label were considered 'on target'. Results indicate that the unsupervised generation method produced far more words relating to the label category then to other topics. Tested on 7600 examples spanning 23 topics. ### Procedures ::: Binary and Multi-class Classification Experiments
Three datasets were formed by taking equal length samples from each category label. The new datastes are ‘Worldpost vs Crime’, ‘Politics vs Entertainment’, and ‘Sports vs Comedy’, a fourth multiclass dataset was formed by combining the three above sets. For each example three feature options were created by extending every headline by 0, 15 and 120 words. Before every run, a test set was removed and held aside. The remaining data was sampled based on the desired training size. Each feature option was one-hot encoded using a unique tfidf-vectorizer BIBREF16 and used to train a random-forest classifier BIBREF17 with 300-estimators for binary predictions and 900-estimators for multiclass. Random forest was chosen since it performs well on small datasets and is resistant to overfitting BIBREF18. Each feature option was evaluated against its corresponding test set. 10 runs were completed for each dataset. ### Results and Analysis ::: Evaluating word relevance
It is desirable to generate new words which are relevant to the target topics and increase predictive signal, while avoiding words which are irrelevant, add noise, and mislead predictions. The strategy, described in section SECREF4, was created to measure word relevance and quantify the unsupervised model performance. It can be seen from fig SECREF4 and SECREF12 in the appendix that the proposed expansion method is effective at generating words which relate to topics of the input sentence, even from very little data. From the context of just a single word, the method can generate 3 new relevant words, and can generate as many as 10 new relevant words from sentences which contain 5 topic related words SECREF12. While the method is susceptible to noise, producing on average 1 word related to each irrelevant topic, the number of correct predictions statistically exceed the noise. Furthermore, because the proposed method does not have any prior knowledge of its target topics, it remains completely domain agnostic, and can be applied generally for short text of any topic. ### Results and Analysis ::: Evaluating word relevance ::: Binary Classification
Comparing the performance of extended pseudo documents on three separate binary classification datasets shows significant improvement from baseline in the sparse data region of 100 to 1000 training examples. The ‘Worldpost vs Crime’ dataset showed the most improvement as seen in figure SECREF1. Within the sparse data region the extended pseudo documents could achieve similar performance as original headlines with only half the data, and improve F1 score between 13.9% and 1.7% The ‘Comedy vs Sports’ dataset, seen in figure SECREF11, showed an average improvement of 2% within the sparse region. The ‘Politics vs Entertainment’ dataset, figure SECREF11, was unique. It is the only dataset for which a 15-word extended feature set surpassed the 120-words feature set. It demonstrates that the length of the extended pseudo documents can behave like a hyper parameter for certain datasets, and should be tuned according to the train-size. ### Results and Analysis ::: Evaluating word relevance ::: Multiclass Classification
The Extended pseudo documents improved multiclass performance by 4.6% on average, in the region of 100 to 3000 training examples, as seen in figure SECREF11. The results indicate the effectiveness of the proposed method at suggesting relevant words within a narrow topic domain, even without any previous domain knowledge. In each instance it was found that the extended pseudo documents only improved performance on small training sizes. This demonstrates that while the extended pseudo docs are effective at generating artificial data, they also produce a lot of noise. Once the training size exceeds a certain threshold, it becomes no longer necessary to create additional data, and using extended documents simply adds noise to an otherwise well trained model. figureBinary Classification of 'Politics' or 'Entertainment' demonstrates that the number of added words can behave like a hyper paremeter and should be tuned based on training size. Tested on 1000 examples with 10-fold cross validation figureBinary Classification of 'Politics' vs 'Sports' has less improvement compared to other datasets which indicates that the proposed method, while constructed to be domain agnostic, shows better performance towards certain topics. Tested on 1000 examples with 10-fold cross validation. figureAdded Words improve Multiclass Classification between 1.5% and 13% in the range of 150 to 2000 training examples. Tests were conducted using equal size samples of Headlines categorized into 'World-Post', 'Crime', 'Politics', 'Entertainment', 'Sports' or 'Comedy'. A 900 Estimator Random Forest classifier was trained for each each data point, tested using 2000 examples, and averaged using 10-fold cross validation. 2 ### Discussion
Generating new words based solely on ultra small prompts of 10 words or fewer is a major challenge. A short sentence is often characterized by a just a single keyword, and modeling topics from such little data is difficult. Any method of keyword generation that overly relies on the individual words will lack context and fail to add new information, while attempting to freely form new words without any prior domain knowledge is uncertain and leads to misleading suggestions. This method attempts to find balance between synonym and free-form word generation, by constraining words to fit the original sentence while still allowing for word-word and word-sentence interactions to create novel outputs. The word vectors must move through the transformer layers together and therefore maintain the same token order and semantic meaning, however they also receive new input from the surrounding words at each layer. The result, as can be seen from table SECREF12 and SECREF12 in the appendix, is that the first few transformer layers are mostly synonyms of the input sentence since the word vectors have not been greatly modified. The central transformer layers are relevant and novel, since they are still slightly constrained but also have been greatly influenced by sentence context. And the final transformer layers are mostly non-sensical, since they have been completely altered from their original state and lost their ability to retrieve real words. This method is unique since it avoids needing a prior dataset by using the information found within the weights of a general language model. Word embedding models, and BERT in particular, contain vast amounts of information collected through the course of their training. BERT Base for instance, has 110 Million parameters and was trained on both Wikipedea Corpus and BooksCorpus BIBREF0, a combined collection of over 3 Billion words. The full potential of such vastly trained general language models is still unfolding. This paper demonstrates that by carefully prompting and analysing these models, it is possible to extract new information from them, and extend short-text analysis beyond the limitations posed by word count. ### Appendix ::: Additional Tables and Figures
figureA Topic table, created from the category labels of the complete headline dataset, can be used to measure the relevance of generated words. An original headline was analyzed by counting the number of words which related to each topic. The generated words were then analyzed in the same way. The change in word count between input topics and output topics was measured and plotted as seen in figure SECREF12. figureBox plot of the number of generated words within a topic as a function of the number of input words within the same topic. Results indicate that additional related words can be generated by increasing the signal of the input prompt. Tested on 7600 examples spanning 23 topics. figureInformation regarding the original headlines, and generated words used to create extended pseudo headlines. figureTop 3 guesses for each token position at each later of a BERT pretrained embedding model. Given the input sentence '2 peoplpe injured in Indiana school shooting', the full list of generated words can be obtainedfrom the values in the table. figureTop 3 guesses for each token position at each later of a BERT pretrained embedding model. Figure 1: Binary Classification of short headlines into ’WorldPost’ or ’Crime’ categories, shows improved performance with extended pseudo headlines when the training set is small. Using: Random forest classifier, 1000 test examples, 10-fold cross validation. Figure 2: The proposed method uses the BERT pre-trained word embedding model to generate new words which are appended to the orignal text creating extended pseudo documents. Figure 3: The number of generated words within each topic was counted, topics which matched the original headline label were considered ’on target’. Results indicate that the unsupervised generation method produced far more words relating to the label category then to other topics. Tested on 7600 examples spanning 23 topics. Figure 4: Binary Classification of ’Politics’ or ’Entertainment’ demonstrates that the number of added words can behave like a hyper paremeter and should be tuned based on training size. Tested on 1000 examples with 10-fold cross validation Figure 5: Binary Classification of ’Politics’ vs ’Sports’ has less improvement compared to other datasets which indicates that the proposed method, while constructed to be domain agnostic, shows better performance towards certain topics. Tested on 1000 examples with 10-fold cross validation. Figure 6: Added Words improve Multiclass Classification between 1.5% and 13% in the range of 150 to 2000 training examples. Tests were conducted using equal size samples of Headlines categorized into ’World-Post’, ’Crime’, ’Politics’, ’Entertainment’, ’Sports’ or ’Comedy’. A 900 Estimator Random Forest classifier was trained for each each data point, tested using 2000 examples, and averaged using 10-fold cross validation. Figure 7: A Topic table, created from the category labels of the complete headline dataset, can be used to measure the relevance of generated words. Figure 8: Box plot of the number of generated words within a topic as a function of the number of input words within the same topic. Results indicate that additional related words can be generated by increasing the signal of the input prompt. Tested on 7600 examples spanning 23 topics. Figure 9: Information regarding the original headlines, and generated words used to create extended pseudo headlines. Figure 10: Top 3 guesses for each token position at each later of a BERT pretrained embedding model. Given the input sentence ’2 peoplpe injured in Indiana school shooting’, the full list of generated words can be obtainedfrom the values in the table. Figure 11: Top 3 guesses for each token position at each later of a BERT pretrained embedding model.
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collection of headlines published by HuffPost BIBREF12 between 2012 and 2018
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Which four QA systems do they use?
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### INTRODUCTION
The Semantic Web provides a large number of structured datasets in form of Linked Data. One central obstacle is to make this data available and consumable to lay users without knowledge of formal query languages such as SPARQL. In order to satisfy specific information needs of users, a typical approach are natural language interfaces to allow question answering over the Linked Data (QALD) by translating user queries into SPARQL BIBREF0 , BIBREF1 . As an alternative method, BIBREF2 propose a visual method of QA using an iterative diagrammatic approach. The diagrammatic approach relies on the visual means only, it requires more user interaction than natural language QA, but also provides additional benefits like intuitive insights into dataset characteristics, or a broader understanding of the answer and the potential to further explore the answer context, and finally allows for knowledge sharing by storing and sharing resulting diagrams. In contrast to BIBREF2 , who present the basic method and tool for diagrammatic question answering (DQA), here we evaluate DQA in comparison to natural language QALD systems. Both approaches have different characteristics, therefore we see them as complementary rather than in competition. The basic research goals are: i) Given a dataset extracted from the QALD7 benchmark, we evaluate DQA versus state-of-the-art QALD systems. ii) More specifically, we investigate if and to what extent DQA can be complementary to QALD systems, especially in cases where those systems do not find a correct answer. iii) Finally, we want to present the basic outline for the integration of the two methods. In a nutshell, users that applied DQA found the correct answer with an F1-score of 79.5%, compared to a maximum of 59.2% for the best performing QALD system. Furthermore, for the subset of questions where the QALD system could not provide a correct answer, users found the answer with 70% F1-score with DQA. We further analyze the characteristics of questions where the QALD or DQA, respectively, approach is better suited. The results indicate, that aside from the other benefits of DQA, it can be a valuable component for integration into larger QALD systems, in cases where those systems cannot find an answer, or when the user wants to explore the answer context in detail by visualizing the relevant nodes and relations. Moreover, users can verify answers given by a QALD system using DQA in case of doubt. This publication is organized as follows: After the presentation of related work in Section SECREF2 , and a brief system description of the DQA tool in Section SECREF3 , the main focus of the paper is on evaluation setup and results of the comparison of DQA and QALD, including a discussion, in Section SECREF4 . The paper concludes with Section SECREF5 . ### RELATED WORK
As introduced in BIBREF2 we understand diagrammatic question answering (DQA) as the process of QA relying solely on visual exploration using diagrams as a representation of the underlying knowledge source. The process includes (i) a model for diagrammatic representation of semantic data which supports data interaction using embedded queries, (ii) a simple method for step-by-step construction of diagrams with respect to cognitive boundaries and a layout that boosts understandability of diagrams, (iii) a library for visual data exploration and sharing based on its internal data model, and (iv) an evaluation of DQA as knowledge understanding and knowledge sharing tool. BIBREF3 propose a framework of five perspectives of knowledge visualization, which can be used to describe certain aspects of the DQA use cases, such as its goal to provide an iterative exploration method, which is accessible to any user, the possibility of knowledge sharing (via saved diagrams), or the general purpose of knowledge understanding and abstraction from technical details. Many tools exist for visual consumption and interaction with RDF knowledge bases, however, they are not designed specifically towards the question answering use case. BIBREF4 give an overview of ontology and Linked Data visualization tools, and categorize them based on the used visualization methods, interaction techniques and supported ontology constructs. Regarding language-based QA over Linked Data, BIBREF5 discuss and study the usefulness of natural language interfaces to ontology-based knowledge bases in a general way. They focus on usability of such systems for the end user, and conclude that users prefer full sentences for query formulation and that natural language interfaces are indeed useful. BIBREF0 describe the challenges of QA over knowledge bases using natural languages, and elaborate the various techniques used by existing QALD systems to overcome those challenges. In the present work, we compare DQA with four of those systems using a subset of questions of the QALD7 benchmark. Those systems are: gAnswer BIBREF6 is an approach for RDF QA that has a “graph-driven” perspective. In contrast to traditional approaches, which first try to understand the question, and then evaluate the query, in gAnswer the intention of the query is modeled in a structured way, which leads to a subgraph matching problem. Secondly, QAKiS BIBREF7 is QA system over structured knowledge bases such as DBpedia that makes use of relational patterns which capture different ways to express a certain relation in a natural language in order to construct a target-language (SPARQL) query. Further, Platypus BIBREF8 is a QA system on Wikidata. It represents questions in an internal format related to dependency-based compositional semantics which allows for question decomposition and language independence. The platform can answer complex questions in several languages by using hybrid grammatical and template-based techniques. And finally, also the WDAqua BIBREF0 system aims for language-independence and for being agnostic of the underlying knowledge base. WDAqua puts more importance on word semantics than on the syntax of the user query, and follows a processes of query expansion, SPARQL construction, query ranking and then making an answer decision. For the evaluation of QA systems, several benchmarks have been proposed such as WebQuestions BIBREF9 or SimpleQuestions BIBREF10 . However, the most popular benchmarks in the Semantic Web field arise from the QALD evaluation campaign BIBREF1 . The recent QALD7 evaluation campaign includes task 4: “English question answering over Wikidata” which serves as basis to compile our evaluation dataset. ### SYSTEM DESCRIPTION
The DQA functionality is part of the Ontodia tool. The initial idea of Ontodia was to enable the exploration of semantic graphs for ordinary users. Data exploration is about efficiently extracting knowledge from data even in situations where it is unclear what is being looked for exactly BIBREF11 . The DQA tool uses an incremental approach to exploration typically starting from a very small number of nodes. With the context menu of a particular node, relations and related nodes can be added until the diagram fulfills the information need of the user. Figure FIGREF1 gives an example of a start node, where a user wants to learn more about the painting style of Van Gogh. To illustrate the process, we give a brief example here. More details about the DQA tool, the motivation for DQA and diagram-based visualizations are found in previous work BIBREF2 , BIBREF12 . As for the example, when attempting to answer a question such as “Who is the mayor of Paris?” the first step for a DQA user is finding a suitable starting point, in our case the entity Paris. The user enters “Paris” into the search box, and can then investigate the entity on the tool canvas. The information about the entity stems from the underlying dataset, for example Wikidata. The user can – in an incremental process – search in the properties of the given entity (or entities) and add relevant entities onto the canvas. In the given example, the property “head of government” connects the mayor to the city of Paris, Anne Hidalgo. The final diagram which answers the given question is presented in Figure FIGREF3 . ### EVALUATION
Here we present the evaluation of DQA in comparison to four QALD systems. ### Evaluation Setup
As evaluation dataset, we reuse questions from the QALD7 benchmark task 4 “QA over Wikidata”. Question selection from QALD7 is based on the principles of question classification in QA BIBREF13 . Firstly, it is necessary to define question types which correspond to different scenarios of data exploration in DQA, as well as the type of expected answers and the question focus. The question focus refers to the main information in the question which help a user find the answer. We follow the model of BIBREF14 who categorize questions by their question word into WHO, WHICH, WHAT, NAME, and HOW questions. Given the question and answer type categories, we created four questionnaires with nine questions each resulting in 36 questions from the QALD dataset. The questions were picked in equal number for five basic question categories. 20 persons participated in the DQA evaluation – 14 male and six female from eight different countries. The majority of respondents work within academia, however seven users were employed in industry. 131 diagrams (of 140 expected) were returned by the users. The same 36 questions were answered using four QALD tools: WDAqua BIBREF0 , QAKiS BIBREF7 , gAnswer BIBREF6 and Platypus BIBREF8 . For the QALD tools, a human evaluator pasted the questions as is into the natural language Web interfaces, and submitted them to the systems. Typically QALD tools provide a distinct answer, which may be a simple literal, or a set of entities which represent the answer, and which can be compared to the gold standard result. However, the WDAqua system, sometimes, additionally to the direct answer to the question, provides links to documents related to the question. We always chose the answer available via direct answer. To assess the correctness of the answers given both by participants in the DQA experiments, and by the QALD system, we use the classic information retrieval metrics of precision (P), recall (R), and F1. INLINEFORM0 measures the fraction of relevant (correct) answer (items) given versus all answers (answer items) given. INLINEFORM1 is the faction of correct answer (parts) given divided by all correct ones in the gold answer, and INLINEFORM2 is the harmonic mean of INLINEFORM3 and INLINEFORM4 . As an example, if the question is “Where was Albert Einstein born?” (gold answer: “Ulm”), and the system gives two answers “Ulm” and “Bern”, then INLINEFORM5 , INLINEFORM6 and INLINEFORM7 . For DQA four participants answered each question, therefore we took the average INLINEFORM0 , INLINEFORM1 , and INLINEFORM2 values over the four evaluators as the result per question. The detailed answers by the participants and available online. ### Evaluation Results and Discussion
Table TABREF8 presents the overall evaluation metrics of DQA, and the four QALD tools studied. With the given dataset, WDAqua (56.1% F1) and gAnswer (59.2% F1) clearly outperform askplatyp.us (8.6% F1) and QAKiS (27.5% F1). Detailed results per question including the calculation of INLINEFORM0 , INLINEFORM1 and INLINEFORM2 scores are available online. DQA led to 79.5% F1 (80.1% precision and 78.5% recall). In further evaluations, we compare DQA results to WDAqua in order to study the differences and potential complementary aspects of the approaches. We selected WDAqua as representative of QALD tools, as it provides state-of-the-art results, and is well grounded in the Semantic Web community. Comparing DQA and WDAqua, the first interesting question is: To what extend is DQA helpful on questions that could not be answered by the QALD system? For WDAqua the overall F1 score on our test dataset is INLINEFORM0 . For the subset of questions where WDAqua had no, or only a partial, answer, DQA users found the correct answer in INLINEFORM1 of cases. On the other hand, the subset of questions that DQA users (partially) failed to answer, were answered correctly by WDAqua with an F1 of INLINEFORM2 . If DQA is used as a backup method for questions not correctly answered with WDAqua, then overall F1 can be raised to INLINEFORM3 . The increase from INLINEFORM4 to INLINEFORM5 demonstrates the potential of DQA as complementary component in QALD systems. As expected, questions that are difficult to answer with one approach are also harder for the other approach – as some questions in the dataset or just more complex to process and understand than others. However, almost 70% of questions not answered by WDAqua could still be answered by DQA. As examples of cases which are easier to answer for one approach than the other, a question that DQA users could answer, but where WDAqua failed is: “What is the name of the school where Obama's wife studied?”. This complex question formulation is hard to interpret correctly for a machine. In contrast to DQA, QALD systems also struggled with “Who is the son of Sonny and Cher?”. This question needs a lot of real-world knowledge to map the names Sonny and Cher to their corresponding entities. The QALD system needs to select the correct Cher entity from multiple options in Wikidata, and also to understand that “Sonny” refers to the entity Sonny Bono. The resulting answer diagram is given in Figure FIGREF17 . More simple questions, like “Who is the mayor of Paris?” were correctly answered by WDAqua, but not by all DQA users. DQA participants in this case struggled to make the leap from the noun “mayor” to the head-of-government property in Wikidata. Regarding the limits of DQA, this method has difficulties when the answer can be obtained only with joins of queries, or when it is hard to find the initial starting entities related to question focus. For example, a question like “Show me the list of African birds that are extinct.” typically requires an intersection of two (large) sets of candidates entities, ie. all African birds and extinct birds. Such a task can easily be represented in a SPARQL query, but is hard to address with diagrams, because it would require placing, and interacting with, a huge amount of nodes on the exploration canvas. Overall, the experiments indicate, that additionally to the use cases where QALD and DQA are useful on their own, there is a lot of potential in combining the two approaches, especially by providing a user the opportunity to explore the dataset with DQA if QALD did not find a correct answer, or when a user wants to confirm the QALD answer by checking in the underlying knowledge base. Furthermore, visually exploring the dataset provides added benefits, like understanding the dataset characteristics, sharing of resulting diagrams (if supported by the tool), and finding more information related to the original information need. For the integration of QALD and DQA, we envision two scenarios. The first scenario addresses plain question answering, and here DQA can be added to a QALD system for cases where a user is not satisfied with a given answer. The QALD Web interface can for example have a Explore visually with diagrams button, which brings the user to a canvas on which the entities detected by the QALD system within the question and results (if any) are displayed on the canvas as starting nodes. The user will then explore the knowledge graph and find the answers in the same way as the participants in our experiments. The first scenario can lead to a large improvement in answer F1 (see above). The second scenario of integration of QALD and DQA focuses on the exploration aspect. Even if the QALD system provides the correct answer, a user might be interested to explore the knowledge graph to validate the result and to discover more interesting information about the target entities. From an implementation and UI point of view, the same Explore visually with diagrams button and pre-population of the canvas can be used. Both scenarios also provide the additional benefits of potentially saving and sharing the created diagrams, which elaborate the relation between question and answer. ### CONCLUSIONS
In this work, we compare two approaches to answer questions over Linked Data datasets: a visual diagrammatic approach (DQA) which involves iterative exploration of the graph, and a natural language-based (QALD). The evaluations show, that DQA can be a helpful addition to pure QALD systems, both regarding evaluation metrics (precision, recall, and F1), and also for dataset understanding and further exploration. The contributions include: i) a comparative evaluation of four QALD tools and DQA with a dataset extracted from the QALD7 benchmark, ii) an investigation into the differences and potential complementary aspects of the two approaches, and iii) the proposition of integration scenarios for QALD and DQA. In future work we plan to study the integration of DQA and QALD, especially the aspect of automatically creating an initial diagram from a user query, in order to leverage the discussed potentials. We envision an integrated tool, that uses QALD as basic method to find an answer to a question quickly, but also allows to explore the knowledge graph visually to raise answer quality and support exploration with all its discussed benefits. ### ACKNOWLEDGEMENTS
This work was supported by the Government of the Russian Federation (Grant 074-U01) through the ITMO Fellowship and Professorship Program. Figure 1: After placing the Wikidata entity Van Gogh onto the canvas, searching properties related to his “style” with Ontodia DQA tool. Figure 2: Answering the question: Who is the mayor of Paris? Table 1: Overall performance of DQA and the four QALD tools – measured with precision, recall and F1 score. Figure 3: Answering the question: Who is the son of Sonny and Cher? with DQA.
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WDAqua BIBREF0 , QAKiS BIBREF7 , gAnswer BIBREF6 and Platypus BIBREF8
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A former gaming commissioner compared gambling to:
A. Cigarettes
B. Alcohol
C. Prostitution
D. Drugs
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Is <A NAME= Gambling's would-be federal regulators--the National Gambling Impact Study Commission--went to Las Vegas this week to hold hearings. In today's dispatch, we learn how gambling's foes seek to demonize wagering as a pernicious tobaccolike vice. In yesterday's dispatch, gambling's foes learn the folly of having brought their anti-sin crusade to an adult Disneyland. Tuesday's overpowering show of force by the Nevada gambling aristocracy has had at least one audible effect on the National Gambling Impact Study Commission. Wednesday, even commission Chair Kay Coles James, a gambling skeptic, succumbs to the hideous Vegas euphemism: She begins referring to the "gaming industry." After Tuesday's casino triumphalism, Wednesday is a comedown, eight hours of policy panels on teen gambling, compulsive gambling, gambling regulation, gambling marketing, and gambling credit practices. It is tough slogging, but for the first time I sense that this commission--though divided, underfunded, timid, and without any power beyond exhortation--isn't entirely useless. It may finally settle this question: Is gambling Hollywood or tobacco? Entertainment or vice? The sleek Vegas types, whose Strip palaces scramble casinos, theaters, restaurants, arcades, discos, cabarets, theme parks, concert halls, sports arenas, and museums into one giant orgy of amusement, have been selling the idea that gambling is just entertainment--Disney in the desert. This effort has largely succeeded, because Vegas is still the dominant image of American gambling, if not the dominant reality. The antis, meanwhile, cry that gambling is like cigarettes: unsafe for kids, viciously addictive, deceptively marketed, unhealthy, expensive, and unacceptable unless mightily regulated. Judging by today's hearings and by conversations with most of the commissioners, the tobacco model is winning. Today's panelists tell the commission that kids are starting to gamble too young and are getting addicted too easily, that compulsive gambling appears to be increasing as gambling spreads, that gambling marketing may be designed to addict customers, and that the industry exploits problem gamblers by allowing them to draw repeated credit card advances from ATMs on casino floors. The testimony clearly impresses the commissioners and seems especially to impress the three nonaligned commissioners who will be the swing votes on the June 1999 report. It is starting to become clear what that report will say. The commission won't (and can't) take any grand stand against gambling. Instead it will opt for small, targeted policies, concentrating on compulsive gambling. It will probably propose that casinos and state lotteries fund gambling-addiction research and that casinos take much stronger measures to bar problem gamblers from wagering. The commission may recommend that gaming taxes be used to underwrite treatment of pathological gamblers and that insurance companies be encouraged to cover gambling addiction. Similarly, the commission will try to reduce gamblers' access to cash by limiting the size of ATM advances and prodding casinos to remove the machines from their floors. The commission will also push the industry to do more to prevent kids from gambling. It will call for heavier regulation of Indian gambling and will probably try to ban or severely regulate Internet gambling, perhaps by forbidding gambling companies from running online casinos. It will rebuke state lotteries for their deceptive marketing and will try to force them to post odds and stop targeting the poor. In short, it will treat gambling as a tobaccolike vice. If the comments of the pro-industry commissioners can be believed, the industry will happily endorse such a report. Gamblers don't quite accept the cigarette analogy--though commission member Bill Bible, a former chief of the Nevada Gaming Commission, did concede that gambling was like alcohol--but they're happy to sign on to the specific measures. The casino industry is even trying to get ahead of the commission. It has already established a (mostly) independent center to fund research into pathological gambling. I suspect that the industry will not only agree to the commission's recommendations but will become their strongest advocate. Casino owners will avidly lobby Congress and state legislatures to enact the recommendations into law. Why should the pro-gamblers cooperate with a critical study? Because it provides superb cover for them. It medicalizes the problem of compulsive gambling, blaming it on psychological abnormality rather than industry machination. Likewise, cracking down on compulsives is also politically cost-effective. In exchange for losing a few compulsive gamblers, the casinos will (falsely) appear more concerned with the health of their customers than with profits. The cigarette agenda will also distract the commission and the public from the true reasons for worry. A few years ago, gambling was confined to Las Vegas and Atlantic City. It is now thriving in 48 states, and there is no sign that anyone can stop it. In this election, gambling interests dropped $100 million on a single California ballot initiative, toppled governors in two states, and bought senators and representatives by the crate. What the commission ought to be investigating is whether the gambling industry has become so powerful that it's politically untouchable. But it can't, because the gambling industry has become so powerful that it's politically untouchable. The antis can call gambling "tobacco." They can call it "vice." They can call it "a big red balloon" for all that the industry cares. As long as the commission just nibbles around the edges, the casino operators and state lotteries will be happy to indulge it. The pro-gambling folks will win credit for cooperating, without having to do anything that really hurts. The last national gambling commission was in the mid-1970s. If the gamblers play along with this commission's timid recommendations, they'll be safe for another 20 years. An Apology I owe an apology to Nevada Sen. Richard Bryan, whom I criticized yesterday for using the term "Indian country" during a speech critical of Indian casinos. As several readers pointed out to me, "Indian country" is a common phrase in the West and has no derogatory connotations. I'm sorry, Senator. Talk about quick defeats: The first sign I see outside the MGM Grand ballroom all but declares that the National Gambling Impact Study Commission has already lost. The sign reads: "National Gaming Impact Study Commission." "Gaming"? In Las Vegas, the euphemizers reign. Once upon a time, the casino owners decided that "gambling" was too crude, too avaricious, to describe their fair business. So "gambling" disappeared in Las Vegas, and "gaming" has risen in its place. He who controls language controls ideas, and at today's commission hearing, it is perfectly clear who controls the language. Video slot machines crammed into convenience stores--perhaps the most pernicious form of legal gambling there is--are called "retail gaming." People who own casinos are not "casino owners," they are "gaming visionaries." Pathological gamblers are "problem gamers"--as if they're having trouble mastering the rules of Monopoly. And the National Gambling Impact Study Commission is reborn as the National Gaming Impact Study Commission. The gambling industry did everything in its power to stop the establishment of this commission two years ago, but Congress and a fervent grassroots anti-gambling group eventually foisted it on the industry. The nine member blue-ribbon panel was charged with assessing the social and economic impact of gambling, and it will issue a final report to Congress and the president in June 1999. Even though the panel was carefully balanced between pro- and anti-gambling leaders, it was supposed to be Vegas' nemesis. The industry and Las Vegas' pro-gambling media quaked in anticipation of the onerous regulations and taxes the commission might recommend. But they quake no more. Whatever national momentum the anti-gamblers had dissolved in last week's elections. The industry routed opponents in state after state. Missouri voters passed a ballot initiative to allow boat casinos. Californians voted to expand Indian casinos. In South Carolina and Alabama, voters expelled anti-lottery, anti-gambling Republican governors and replaced them with pro-lottery Democrats. The gambling industry spent more than $100 million on political contributions and issue ads. It has never been fatter, happier, or more secure. "My goodness, no politician can withstand their resources," Focus on the Family's James Dobson, the commission's leading gambling opponent, tells me. The industry's political clout has emasculated the commission, Dobson continues: "Our report won't be acted on by the president or Congress. They are too heavily influenced by gambling money. Almost all the leaders of Congress are on the dole." It has also become obvious that the commission has too many pro-gambling members to produce a report that recommends taxes or other real penalties on the industry. So the commission's two day visit to Gomorrah has been transformed from a charged political event to a kind of victory lap for gaming. Nevada Gov. Bob Miller and the "gaming visionaries" have been planning for these hearings for months, hoping to use them to demonstrate the might and sanctity and goodness of the Nevada gambling industry. The MGM Grand, which is run by commission member Terrence Lanni, is itself the first exhibit of the Vegas triumphalists. It is gaudy testimony that consumers, at least, have no problem with this business. The MGM Grand, a k a "The City of Entertainment," has 5,000 rooms--the corridor outside my room is 200 yards long, so long I can't see its end--to feed the endless supply of slot machines, craps tables, and roulette wheels. David Cassidy performs here every night--twice! A few steps outside on the Strip is still more overwhelming evidence that Las Vegas has won the popular vote. New York, New York is just across the street, the $1.6 billion Bellagio is one door down, and a half-scale Eiffel Tower is going up next door. The setting has, as the pro-gambling folks no doubt hoped, stunned some of the gambling opponents. I asked one anti-gambling activist who had never before been to Vegas what she thinks of it. She could only blurt out "Wow." The hearings, too, reinforce the Glorious Las Vegas theme. Frank Fahrenkopf, the industry's top lobbyist (who is paid so much he can afford monogrammed shirt cuffs --I saw them), holds forth cheerfully outside the ballroom, celebrating the electoral triumph of freedom over religious moralist tyranny. Inside, the room is packed with more than 600 people in neon lime green T-shirts that read "Unions and Gaming: Together for a Better Life." They are members of the major casino union, here to cheer on their employers and their union. (Most of them, it must be said, are getting paid to do this.) Chairwoman Kay Coles James, a Christian conservative and skeptic of gambling, opens the hearing by assuring the crowd that the committee is toothless: "We're not here to take anyone's job. ... We have no power to do anything except make recommendations." This sets the mood for most of the day: Vegas is great, so you'd better leave it alone! The local government, by all appearances a wholly owned subsidiary of the casinos, puts on a bravura performance. Gov. Miller opens the show with a 15 minute hymn to Las Vegas. It is the first of many statistical barrages about Nevada's one-ders: No. 1 in job growth, No. 1 in population growth, and No. 1 on planet Earth in per capita Girl Scout troops--and Boy Scout troops! Later in the day, Nevada's senators and both its congressmen appear to chew out the commission for even thinking that Nevada might have a dark side. They pay tribute to Nevada's sophisticated gambling industry, especially its regulation (much stricter than other gambling states) and its use of gambling taxes to fund state services. It is one of the ironies of Nevada politics that its Republican congressmen (Jim Gibbons and John Ensign) end up crediting their state's success to government regulation and corporate taxation. There are also a fair share of gleeful gambling regulators, bookmakers, and casino employees among the panels of expert witnesses the commission hears from. Critics who gripe about the perils of sports gambling and the evils of convenience store slot machines leaven the pro-gambling folks. Everyone, including the gambling industry shills, agrees that Internet gambling is evil and should be destroyed. Everyone agrees to this because no one in Las Vegas is making any money off Internet gambling. If they were, you can be sure they would explain why it's as American as nickel slots and scratch-off games. Pro-Vegas forces are also perfectly happy to take shots at Indian gambling, the chief economic threat to Nevada's prosperity. The expansion of Indian casinos resulting from last week's California voter initiative will slam Las Vegas, cutting its gambling revenues by $400 million a year. So the Vegans repeatedly swing at casinos in "Indian country" (that's Nevada Sen. Richard Bryan's term--I'm not joking) for being insufficiently regulated and taxed. One tribal chief I spoke to calls this "red baiting." (Pause for an aesthetic observation: I am sitting right behind the witnesses, and after a while I begin to separate them into the Wides and the Narrows. The Wides are men in suits with enormous backs and enormous bellies, men who eat and eat and used to play football. They all testify to their love of gambling. The Narrows are thin and generally disapprove of it. I begin to wonder whether fondness for gambling correlates with general indulgence, and dislike correlates with asceticism, and decide that they probably do.) During the last hour of the day, the public comment period, the union sends a parade of casino employees to the microphone to hallelujah the gaming industry. Housekeepers, cooks, and slot change girls, almost all black or Latina, tell the same story: I was working a dead-end job in another state, "then I heard about Las Vegas, where there's opportunity!" I moved here, landed a job at a union casino with high pay, free medical insurance, a pension, and "now I am buying a house." The stories are intensely moving, by far the most persuasive tribute to the Strip that I've ever heard. Still, for all the Vegan triumphalism in the air, it's impossible not to be charmed by the chief gambling opponent, the Rev. Tom Grey. Grey is utterly irrepressible. A Vietnam rifleman turned Methodist minister, Grey has spent the last eight years evangelizing against gambling. He founded the National Coalition Against Legalized Gambling, the primary force behind the commission's creation. (Grey, in a rare acknowledgement of defeat, has just renamed it the National Coalition Against Gambling Expansion, tacitly recognizing that gambling is here to stay.) He is a genial motormouth and shameless promoter of the cause. He wears a gigantic "CasiNO" button in the casino. He posed for People in a shepherd's robe. He says "I would do anything short of lighting myself on fire in the Capitol rotunda to stop gambling." He is so excitable that I have to yank him out of the way of an oncoming car when he gets too wrapped up in one of his soliloquies. He and his Las Vegas allies, a former Las Vegas city councilman named Steve Miller and an inner city venture capitalist named Otis Harris, invite me on a tour of Las Vegas. "Behind the Mirage," they call it. For two hours, we cruise the streets behind the casinos. They show me all the evidence of gambling blight you'd never want to see, from a youth-center-turned-crack-house to pawn shops to sex shops to down at heels casinos to quickie motels. All the while, they keep up a patter about how terrible a neighbor the casino industry is and how superficial Las Vegas' prosperity is. It's very grim and mostly persuasive. Still, when we turn back on to the Strip, and pass the jaw-dropping Stratosphere and Circus Circus and Bellagio and the MGM Grand--a 30 story tower bathed in fabulous emerald light, I realize why Grey's task is hopeless here. He is committing the cardinal sin of Vegas. All he wants to do is talk about losers. In Las Vegas, under the thrilling lights of the Strip, no one wants to hear about losers. In the land of gaming, not gambling, everyone is sure he's a winner.
|
B. Alcohol
|
On Mr. Romero's ECG at discharge on 05/21/2023, what was the QRS duration?
Choose the correct answer from the following options:
A. 135 ms
B. 122 ms
C. 126 ms
D. 432 ms
E. Not specified
|
### Patient Report 0
**Dear colleague, **
We would like to report to you about our patient, Mr. David Romero, born
on 02/16/1942, who was under our inpatient care from 03/25/2016 to
03/30/2016.
**Diagnoses:**
- Suspected myocarditis
- Uncomplicated biopsy, pending results
- LifeVest has been adjusted
- Left ventricular ejection fraction of 28%
- Chronic hepatitis C
- Status post hepatitis A
- Post-antiviral therapy
- Exclusion of relevant coronary artery disease
**Medical History:** The patient was admitted with suspected myocarditis
due to a significantly impaired pump function noticed during outpatient
visits. Anamnestically, the patient reported experiencing fatigue and
exertional dyspnea since mid-December, with no recollection of a
preceding infection. Antiviral therapy with Interferon/Ribavirin for
chronic Hepatitis C had been ongoing since November. An outpatient
evaluation had excluded relevant coronary artery disease.
**Current Presentation:** Suspected inflammatory/dilated cardiomyopathy,
Indication for biopsy
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without guarding, spleen
and liver not palpable. Normal bowel sounds.
**Coronary Angiography**: Globally significantly impaired left
ventricular function (EF: 28%)
[Myocardial biopsy:]{.underline} Uncomplicated retrieval of LV
endomyocardial biopsies
[Recommendation]{.underline}: A conservative medical approach is
recommended, and further therapeutic decisions will depend on the
histological, immunohistological, and molecular biological examination
results of the now-retrieved myocardial biopsies.
[Procedure]{.underline}: Femoral closure system is applied, 6 hours of
bed rest, administration of 100 mg/day of Aspirin for 4 weeks following
left ventricular heart biopsy.
**Echocardiography before Heart Catheterization**:
Performed in sinus rhythm. Satisfactory ultrasound condition.
[Findings]{.underline}: Moderately dilated left ventricle (LVDd 64mm).
Markedly reduced systolic LV function (EF 28%). Global longitudinal
strain (2D speckle tracking): -8.6%.
Regional wall motion abnormalities: despite global hypokinesia, the
posterolateral wall (basal) contracts best. Diastolic dysfunction Grade
1 (LV relaxation disorder) (E/A 0.7) (E/E\' mean 13.8). No LV
hypertrophy. Morphologically age-appropriate heart valves. Moderately
dilated left atrium (LA Vol. 71ml). Mild mitral valve insufficiency
(Grade 1 on a 3-grade scale). Normal-sized right ventricle. Moderately
reduced RV function Normal-sized right atrium. Minimal tricuspid valve
insufficiency (Grade 0-1 on a 3-grade scale). Systolic pulmonary artery
pressure in the normal range (systolic PAP 27mmHg).
No thrombus detected. Minimal pericardial effusion, circular, maximum
2mm, no hemodynamic relevance.
**Echocardiography after Heart Catheterization:**
[Indication]{.underline}: Follow-up on pericardial effusion.
[Examination]{.underline}: TTE at rest, including duplex and
quantitative determination of parameters. [Echocardiographic
Finding:]{.underline} Regarding pericardial effusion, the status is the
same. Circular effusion, maximum 2mm.
**ECG after Heart Catheterization:**
76/min, sinus rhythm, complete left bundle branch block.
**Summary:** On 03/26/2016, biopsy and left heart catheterization were
successfully performed without complications. Here, too, the patient
exhibited a significantly impaired pump function, currently at 28%.
**Therapy and Progression:**
Throughout the inpatient stay, the patient remained cardiorespiratorily
stable at all times. Malignant arrhythmias were ruled out via telemetry.
After the intervention, echocardiography showed no pericardial effusion.
The results of the endomyocardial biopsies are still pending. An
appointment for results discussion and evaluation of further procedures
at our facility should be scheduled in 3 weeks. Following the biopsy,
Aspirin 100 as specified should be given for 4 weeks. We intensified the
ongoing heart failure therapy and added Spironolactone to the
medication, recommending further escalation based on hemodynamic
tolerability.
**Current Recommendations:** Close cardiological follow-up examinations,
electrolyte monitoring, and echocardiography are advised. Depending on
the left ventricular ejection fraction\'s course, the implantation of an
ICD or ICD/CRT system should be considered after 3 months. On the day of
discharge, we initiated the adjustment of a Life Vest, allowing the
patient to return home in good general condition.
**Medication upon Discharge: **
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torasemide (Torem) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
**Lab results upon Discharge:**
**Parameter** **Results** **Reference Range**
------------------------ ------------- ---------------------
Absolute Erythroblasts 0.01/nL \< 0.01/nL
Sodium 134 mEq/L 136-145 mEq/L
Potassium 4.5 mEq/L 3.5-4.5 mEq/L
Creatinine (Jaffé) 1.25 mg/dL 0.70-1.20 mg/dL
Urea 50 mg/dL 17-48 mg/dL
Total Bilirubin 1.9 mg/dL \< 1.20 mg/dL
CRP 4.1 mg/L \< 5.0 mg/L
Troponin-T 78 ng/L \< 14 ng/L
ALT 67 U/L \< 41 U/L
AST 78 U/L \< 50 U/L
Alkaline Phosphatase 151 U/L 40-130 U/L
gamma-GT 200 U/L 8-61 U/L
Free Triiodothyronine 2.3 ng/L 2.00-4.40 ng/L
Free Thyroxine 14.2 ng/L 9.30-17.00 ng/L
TSH 4.1 mU/L 0.27-4.20 mU/L
Hemoglobin 11.6 g/dL 13.5-17.0 g/dL
Hematocrit 34.5% 39.5-50.5%
Erythrocytes 3.7 /pL 4.3-5.8/pL
Leukocytes 9.56/nL 3.90-10.50/nL
MCV 92.5 fL 80.0-99.0 fL
MCH 31.1 pg 27.0-33.5 pg
MCHC 33.6 g/dL 31.5-36.0 g/dL
MPV 8.9 fL 7.0-12.0 fL
RDW-CV 14.0% 11.5-15.0%
Quick 89% 78-123%
INR 1.09 0.90-1.25
PTT Actin-FS 25.3 sec. 22.0-29.0 sec.
### Patient Report 1
**Dear colleague, **
We are reporting on the pending findings of the myocardial biopsies
taken from Mr. David Romero, born on 02/16/1942 on 03/26/2016 due to the
deterioration of LV function from 40% to 28% after interferon therapy
for HCV infection.
**Diagnoses:**
- Suspected myocarditis
- LifeVest
- Left ventricular ejection fraction of 28%
- Chronic hepatitis C
- Status post hepatitis A
- Post-antiviral therapy
- Exclusion of relevant coronary artery disease
**Current Medication:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torasemide (Torem) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
**Myocardial Biopsy on 01/27/2014:**
[Molecular Biology:]{.underline}
PCR examinations performed under the question of myocardial infection
with cardiotropic pathogens yielded a positive detection of HCV-specific
RNA in myocardial tissue without quantification possibility
(methodically determined). Otherwise, there was no evidence of
myocardial infection with enteroviruses, adenoviruses, Epstein-Barr
virus, Human Herpes Virus Type 6 A/B, or Erythrovirus genotypes 1/2 in
the myocardium.
[Assessment]{.underline}: Positive HCV-mRNA detection in myocardial
tissue. This positive test result does not unequivocally prove an
infection of myocardial cells, as contamination of the tissue sample
with HCV-infected peripheral blood cells cannot be ruled out in chronic
hepatitis.
**Histology and Immunohistochemistry**:
Unremarkable endocardium, normal cell content of the interstitium with
only isolated lymphocytes and histiocytes in the histologically examined
samples. Quantitatively, immunohistochemically examined native
preparations showed borderline high CD3-positive lymphocytes with a
diffuse distribution pattern at 10.2 cells/mm2. No increased
perforin-positive cytotoxic T cells. The expression of cell adhesion
molecules is discreetly elevated. Otherwise, only slight perivascular
but no interstitial fibrosis. Cardiomyocytes are properly arranged and
slightly hypertrophied (average diameter around 23 µm), the surrounding
capillaries are unremarkable. No evidence of acute
inflammation-associated myocardial cell necrosis (no active myocarditis)
and no interstitial scars from previous myocyte loss. No lipomatosis.
[Assessment:]{.underline} Based on the myocardial biopsy findings, there
is positive detection of HCV-RNA in the myocardial tissue samples, with
the possibility of tissue contamination with HCV-infected peripheral
blood cells. Significant myocardial inflammatory reaction cannot be
documented histologically and immunohistochemically. In the endocardial
samples, apart from mild hypertrophy of properly arranged
cardiomyocytes, there are no significant signs of myocardial damage
(interstitial fibrosis or scars from previous myocyte loss). Therefore,
the present findings do not indicate the need for specific further
antiviral or anti-inflammatory therapy, and the existing heart failure
medication can be continued unchanged. If LV function impairment
persists for an extended period, there is an indication for
antiarrhythmic protection of the patient using an ICD.
### Patient Report 2
**Dear colleague, **
We thank you for referring your patient Mr. David Romero, born on
02/16/1942, to us for echocardiographic follow-up on 05/04/2016.
**Diagnoses:**
- Dilatated cardiomyopathy
- LifeVest
- Left ventricular ejection fraction of 28%
- Chronic Hepatitis C
- Status post Hepatitis A
- Post-antiviral therapy
- Exclusion of relevant coronary artery disease
- Type 2 diabetes mellitus
- Hypothyroidism
**Current Medication:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torem (Torasemide) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without pressure pain,
spleen and liver not palpable. Normal bowel sounds.
**Echocardiography: M-mode and 2-dimensional.**
The left ventricle measures approximately 65/56 mm (normal up to 56 mm).
The right atrium and right ventricle are of normal dimensions.
Global progressive reduction in contractility, morphologically
unremarkable.
In Doppler echocardiography, normal heart valves are observed.
Mitral valve insufficiency Grade I.
[Assessment]{.underline}: Dilated cardiomyopathy with slightly reduced
left ventricular function. MI I TII °, PAP 23 mm Hg + CVP. No more
pulmonary embolism detectable.
**Summary:**
Currently, the cardiac situation is stable, LVEDD slightly decreasing.
### Patient Report 3
**Dear colleague, **
We thank you for referring your patient, Mr. David Romero, born on
02/16/1942 to us for echocardiographic follow-up on 06/15/2016.
**Diagnoses:**
- Dilatated cardiomyopathy
- LifeVest
- Left ventricular ejection fraction of 28%
- Chronic Hepatitis C
- Status post Hepatitis A
- Post-antiviral therapy
- Exclusion of relevant coronary artery disease
- Type 2 diabetes mellitus
- Hypothyroidism
**Medication upon Admission:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torasemide (Torem) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without guarding, spleen
and liver not palpable. Normal bowel sounds.
**Echocardiography from 06/15/2016**: Good ultrasound conditions.
The left ventricle is dilated to approximately 65/57 mm (normal up to 56
mm). The left atrium is dilated to 48 mm. Normal thickness of the left
ventricular myocardium. Ejection fraction is around 28%. Heart valves
show normal flow velocities.
**Summary:**
Currently, the cardiac situation is stable, LVEDD slightly decreasing,
potassium and creatinine levels were obtained. If EF remains this low,
an ICD may be indicated.
**Lab results from 06/15/2016:**
**Parameter** **Result** **Reference Range**
----------------------------------- ------------ ---------------------
Reticulocytes 0.01/nL \< 0.01/nL
Sodium 135 mEq/L 136-145 mEq/L
Potassium 4.8 mEq/L 3.5-4.5 mEq/L
Creatinine 1.34 mg/dL 0.70-1.20 mg/dL
BUN 49 mg/dL 17-48 mg/dL
Total Bilirubin 1.9 mg/dL \< 1.20 mg/dL
C-reactive Protein 4.1 mg/L \< 5.0 mg/L
Troponin-T 78 ng/L \< 14 ng/L
ALT 67 U/L \< 41 U/L
AST 78 U/L \< 50 U/L
Alkaline Phosphatase 151 U/L 40-130 U/L
gamma-GT 200 U/L 8-61 U/L
Free Triiodothyronine (T3) 2.3 ng/L 2.00-4.40 ng/L
Free Thyroxine (T4) 14.2 ng/L 9.30-17.00 ng/L
Thyroid Stimulating Hormone (TSH) 4.1 mU/L 0.27-4.20 mU/L
Hemoglobin 11.6 g/dL 13.5-17.0 g/dL
Hematocrit 34.5% 39.5-50.5%
Red Blood Cell Count 3.7 M/µL 4.3-5.8 M/µL
White Blood Cell Count 9.56 K/µL 3.90-10.50 K/µL
Platelet Count 280 K/µL 150-370 K/µL
MC 92.5 fL 80.0-99.0 fL
MCH 31.1 pg 27.0-33.5 pg
MCHC 33.6 g/dL 31.5-36.0 g/dL
MPV 8.9 fL 7.0-12.0 fL
RDW-CV 14.0% 11.5-15.0%
Quick 89% 78-123%
INR 1.09 0.90-1.25
Partial Thromboplastin Time 25.3 sec. 22.0-29.0 sec.
### Patient Report 4
**Dear colleague, **
We are reporting to you about Mr. David Romero, born on 02/16/1942, who
presented himself at our Cardiology University Outpatient Clinic on
06/30/2016.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function (ejection fraction
around 30%)
- LifeVest
- Planned CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Current Medication:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ---------------- ---------------
Aspirin 100 mg/tablet 1-0-0
Ramipril (Altace) 2.5 mg/tablet 1-0-1
Carvedilol (Coreg) 12.5 mg/tablet 1-0-1
Torasemide (Torem) 5 mg/tablet 1-0-0
Spironolactone (Aldactone) 25 mg/tablet 1-0-0
L-Thyroxine (Synthroid) 50 µg/tablet 1-0-0
**Echocardiography on 06/30/2016:** In sinus rhythm. Adequate ultrasound
window.
Moderately dilated left ventricle (LVDd 63mm). Significantly reduced
systolic LV function (EF biplane 29%). No LV hypertrophy.
**ECG on 06/30/2016:** Sinus rhythm, regular tracing, heart rate 69/min,
complete left bundle branch block, QRS 135 ms, ERBS with left bundle
branch block.
**Assessment**: Mr. Romero presents himself for the follow-up assessment
of known dilated cardiomyopathy. He currently reports minimal dyspnea.
Coronary heart disease has been ruled out. No virus was detected
bioptically. However, the recent echocardiography still shows severely
impaired LV function.
**Current Recommendations:** Given the presence of left bundle branch
block, there is an indication for CRT-D implantation. For this purpose,
we have scheduled a pre-admission appointment, with the implantation
planned for 07/04/2016. We kindly request a referral letter. The
LifeVest should continue to be worn until the implantation, despite the
pressure sores on the thorax.
### Patient Report 5
**Dear colleague, **
We would like to report to you about our patient, Mr. David Romero, born
on 02/16/1942, who was in our inpatient care from 07/04/2016 to
07/06/2016.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function (ejection fraction
around 30%)
- LifeVest
- Planned CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Medication upon Admission:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torem (Torasemide) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
Sitagliptin (Januvia) 100 mg 1-0-0
Insulin glargine (Lantus) 0-0-20IE
**Current Presentation:** The current admission was elective for CRT-D
implantation in dilated cardiomyopathy with severely impaired LV
function despite full heart failure medication and complete left bundle
branch block. Please refer to previous medical records for a detailed
history. On 07/05/2016, a CRT-ICD system was successfully implanted. The
peri- and post-interventional course was uncomplicated. Pneumothorax was
ruled out post-interventionally. The wound conditions are
irritation-free. The ICD card was given to the patient. We request
outpatient follow-up on the above-mentioned date for wound inspection
and CRT follow-up. Please adjust the known cardiovascular risk factors.
**Findings:**
**ECG upon Admission:** Sinus rhythm 66/min, PQ 176ms, QRS 126ms, QTc
432ms, Complete left bundle branch block with corresponding excitation
regression disorder.
**Procedure**: Implantation of a CRT-D with left ventricular multipoint
pacing left pectoral. Smooth triple puncture of the lateral left
subclavian vein and implantation of an active single-coil electrode in
the RV apex with very good electrical values. Trouble-free probing of
the CS and direct venography using a balloon occlusion catheter.
Identification of a suitable lateral vein and implantation of a
quadripolar electrode (Quartet, St. Jude Medical) with very good
electrical values. No phrenic stimulation up to 10 volts in all
polarities. Finally, implantation of an active P/S electrode in the
right atrial roof with equally very good electrical values. Connection
to the device and submuscular implantation. Wound irrigation and layered
wound closure with absorbable suture material. Finally, extensive
testing of all polarities of the LV electrode and activation of
multipoint pacing. Final setting of the ICD.
**Chest X-ray on 07/05/2016:**
[Clinical status, question, justifying indication:]{.underline} History
of CRT-D implantation. Question about lead position, pneumothorax?
**Findings**: New CRT-D unit left pectoral with leads projected onto the
right ventricle, the right atrium, and the sinus coronarius. No
pneumothorax.
Normal heart size. No pulmonary congestion. No diffuse infiltrates. No
pleural effusions.
**ECG at Discharge:** Continuous ventricular PM stimulation, HR: 66/min.
**Current Recommendations:**
- We request a follow-up appointment in our Pacemaker Clinic. Please
provide a referral slip.
- We ask for the protection of the left arm and avoidance of
elevations \> 90 degrees. Self-absorbing sutures have been used.
- We request regular wound checks.
### Patient Report 6
**Dear colleague, **
We thank you for referring your patient, Mr. David Romero, born on
02/16/1942, who presented to our Cardiological University Outpatient
Clinic on 08/26/2016.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Current Medication:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torem (Torasemide) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
Sitagliptin (Januvia) 100 mg 1-0-0
Insulin glargine (Lantus) 0-0-20IE
**Current Presentation**: Slightly increasing exertional dyspnea, no
coronary heart disease.
**Cardiovascular Risk Factors:**
- Family history: No
- Smoking: No
- Hypertension: No
- Diabetes: Yes
- Dyslipidemia: Yes
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without pressure pain,
spleen and liver not palpable. Normal bowel sounds.
**Findings**:
**Resting ECG:** Sinus rhythm, 83 bpm. Blood pressure: 120/70 mmHg.
**Echocardiography: M-mode and 2-dimensional**
Left ventricle dimensions: Approximately 57/45 mm (normal up to 56 mm),
moderately dilated
- Right atrium and right ventricle: Normal dimensions
- Normal thickness of left ventricular muscle
- Globally, mild reduction in contractility
- Heart valves: Morphologically normal
- Doppler-Echocardiography: No significant valve regurgitation
**Assessment**: Mildly dilated cardiomyopathy with slightly reduced left
ventricular function. Ejection fraction at 45 - 50%. Mild diastolic
dysfunction. Mild tricuspid regurgitation, pulmonary artery pressure 22
mm Hg, and left ventricular filling pressure slightly increased.
**Stress Echocardiography: Stress echocardiography with exercise test**
- Stress test protocol: Treadmill exercise test
- Reason for stress test: Exertional dyspnea
- Quality of the ultrasound: Good
- Initial workload: 50 watts
- Maximum workload achieved: 150 Watt
- Blood pressure response: Systolic BP increased from 112/80 mmHg to
175/90 mmHg
- Heart rate response: Increased from 71bpm to 124bpm
- Exercise terminated due to leg pain
**Resting ECG:** Sinus rhythm**.** No significant changes during
exercise
**Echocardiography at rest:** Normokinesis of all left ventricular
segments EF: 45 - 50%
**Echocardiography during exercise:** Increased contractility and wall
thickening of all segments
[Summary]{.underline}: No dynamic wall motion abnormalities. No evidence
of exercise-induced myocardial ischemia
**Carotid Doppler Ultrasound:** Both common carotid arteries are
smooth-walled**.** Intima-media thickness: 0.8 mm**.** Small plaque in
the carotid bulb on both sides**.** Normal flow in the internal and
external carotid arteries**.** Normal dimensions and flow in the
vertebral arteries
**Summary:** Non-obstructive carotid plaques**.** Indicated to lower LDL
to below 1.8 mmol/L
**Summary:**
- Stress echocardiography shows no evidence of ischemia, EF \>45-50%
- Carotid duplex shows minimal non-obstructive plaques
- Increase Simvastatin to 20 mg, target LDL-C \< 1.8 mmol/L
### Patient Report 7
**Dear colleague, **
We would like to inform you about the results of the cardiac
catheterization of Mr. David Romero, born on 02/16/1942 performed by us
on 08/10/2022.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Procedure:** Right femoral artery puncture. Left ventriculography with
a 5F pigtail catheter in the right anterior oblique projection. Coronary
angiography with 5F JL4.0 and 5F JR 4.0 catheters. End-diastolic
pressure in the left ventricle within the normal range, measured in
mmHg. No pathological pressure gradient across the aortic valve.
**Coronary angiography:**
- Unremarkable left main stem.
- The left anterior descending (LAD) artery shows mild wall changes,
with a maximum stenosis of 20-\<30%.
- The robust right coronary artery (RCA) is stenosed proximally by
30-40%, subsequently ectatic and then stenosed to 40-\<50% distally.
Slow contrast clearance. The right coronary artery is also stenosed
up to 30%.
- Left-dominant coronary circulation.
**Assessment**: Diffuse coronary atherosclerosis with less than 50%
stenosis in the RCA and evidence of endothelial dysfunction.
**Current Recommendations:**
- Initiation of Ranolazine
- Additional stress myocardial perfusion scintigraphy
### Patient Report 8
**Dear colleague, **
We would like to inform you about the results of the Myocardial
Perfusion Scintigraphy performed on our patient, Mr. David Romero, born
on 02/16/1942, on 09/23/2022.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function (ejection fraction
around 30%)
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without guarding, spleen
and liver not palpable. Normal bowel sounds.
**Myocardial Perfusion Scintigraphy:**
The myocardial perfusion scintigraphy was conducted using 365 MBq of
99m-Technetium MIBI during pharmacological stress and 383 MBq of
99m-Technetium MIBI at rest.
[Technique]{.underline}: Initially, the patient was pharmacologically
stressed with the intravenous administration of 400 µg of Regadenoson
over 20 seconds, accompanied by ergometer exercise at 50 W.
Subsequently, the intravenous injection of the radiopharmaceutical was
performed. The maximum blood pressure achieved during the stress phase
was 143/84 mm Hg, and the maximum heart rate reached was 102 beats per
minute.
Approximately 60 minutes later, ECG-triggered acquisition of a
360-degree SPECT study was conducted with reconstructions of short and
long-axis slices.
Due to inhomogeneities in the myocardial wall segments during stress,
rest images were acquired on another examination day. Following the
intravenous injection of the radiopharmaceutical, ECG-triggered
acquisition of a 360-degree SPECT study was performed, including
short-axis and long-axis slices, approximately 60 minutes later.
[Clinical Information:]{.underline} Known coronary heart disease (RCA
50%). ICD/CRT pacemaker.
[Findings]{.underline}: No clear perfusion defects are seen in the
scintigraphic images acquired after pharmacologic exposure to
Regadenoson. This finding remains unchanged in the scintigraphic images
acquired at rest.
Quantitative analysis shows a normal-sized ventricle with a normal left
ventricular ejection fraction (LVEF) of 53% under exercise conditions
and 47% at rest (EDV 81 mL). There are no clear wall motion
abnormalities. In the gated SPECT analysis, there are no definite wall
motion abnormalities observed in both stress and rest conditions.
**Quantitative Scoring:**
- SSS (Summed Stress Score): 3 (4.4%)
- SRS (Summed Rest Score): 0 (0.0%)
- SDS (Summed Difference Score): 3 (4.4%)
**Assessment**: No evidence of myocardial perfusion defects with
Regadenoson stress or at rest. Normal ventricular size and function with
no significant wall motion abnormalities.
### Patient Report 9
**Dear colleague, **
We would like to report on our patient, Mr. David Romero, born on
02/16/1942, who was under our inpatient care from 05/20/2023 to
05/21/2023.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Medical History:** The patient was admitted for device replacement due
and upgrading to a CRT-P pacemaker. At admission, the patient reported
no complaints of fever, cough, dyspnea, chest pain, or melena.
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without guarding, spleen
and liver not palpable. Normal bowel sounds.
**Medication upon Admission**
**Medication** **Dosage** **Frequency**
--------------------------- -------------- ----------------------
Insulin glargine (Lantus) 450 E/1.5 ml 0-0-0-6-8 IU
Insulin lispro (Humalog) 300 E/3 ml 5-8 IU-5-8 IU-5-8 IU
Levothyroxine (Synthroid) 100 mcg 1-0-0-0
Colecalciferol 12.5 mcg 2-0-0-0
Atorvastatin (Lipitor) 21.7 mg 0-0-1-0
Amlodipine (Norvasc) 6.94 mg 1-0-0-0
Ramipril (Altace) 5 mg 1-0-0-0
Torasemide (Torem) 5 mg 0-0-0.5-0
Carvedilol (Coreg) 25 mg 0.5-0-0.5-0
Simvastatin (Zocor) 40 mg 0-0-0.5-0
Aspirin 100 mg 1-0-0-0
**Therapy and Progression:** The patient\'s current admission was
elective for the implantation of a 3-chamber CRT-D device due to device
depletion. The procedure was performed without complications on
05/20/2023. The post-interventional course was uneventful. The
implantation site showed no irritation or significant hematoma at the
time of discharge, and no pneumothorax was detected on X-ray.
To protect the surgical wound, we request dry wound dressing for the
next 10 days and clinical wound checks. Suture removal is not necessary
with absorbable suture material. We advise against arm elevation for the
next 4 weeks, avoiding heavy lifting on the side of the device pocket
and gradual, pain-adapted full range of motion after 4 weeks.
**Current Recommendations:** We kindly request an outpatient follow-up
appointment in our Pacemaker Clinic.
**Medication upon Discharge:**
**Medication ** **Dosage ** **Frequency**
----------------------------- --------------- -----------------------
Insulin glargine (Lantus) 450 E./1.5 ml 0-0-0-/6-8 IU
Insulin lispro (Humalog) 300 E./3 ml 5-8 IU/-5-8 IU/5-8 IU
Levothyroxine (Synthroid) 100 µg 1-0-0-0
Colecalciferol (Vitamin D3) 12.5 µg 2-0-0-0
Atorvastatin (Lipitor) 21.7 mg 0-0-1-0
Amlodipine (Norvasc) 6.94 mg 1-0-0-0
Ramipril (Altace) 5 mg 1-0-0-0
Torasemide (Torem) 5 mg 0-0-0.5-0
Carvedilol (Coreg) 25 mg 0.5-0-0.5-0
Simvastatin (Zocor) 40 mg 0-0-0.5-0
Aspirin 100 mg 1-0-0-0
Colecalciferol 12.5 µg 2-0-0-0
**Addition: Findings:**
**ECG at Discharge:** Sinus rhythm, ventricular pacing, QRS 122ms, QTc
472ms
**Rhythm Examination on 05/20/2023:**
[Results:]{.underline} Replacement of a 3-chamber CRT-D device (new:
SJM/Abbott Quadra Assura) due to impending battery depletion:
Uncomplicated replacement. Tedious freeing of the submuscular device and
proximal lead portions using a plasma blade. Extraction of the old
device. Connection to the new device. Avoidance of device fixation in
the submuscular position. Hemostasis by electrocauterization. Layered
wound closure. Skin closure with absorbable intracutaneous sutures. End
adjustment of the CRT-D device is complete. [Procedure]{.underline}:
Compression of the wound with a sandbag and local cooling. First
outpatient follow-up in 8 weeks through our pacemaker clinic (please
schedule an appointment before discharge). Postoperative chest X-ray is
not necessary. Cefuroxime 1.5 mg again tonight.
**Transthoracic Echocardiography on 05/18/2023**
**Results:** Globally mildly impaired systolic LV function. Diastolic
dysfunction Grade 1 (LV relaxation disorder).
- Right Ventricle: Normal-sized right ventricle. Normal RV function.
Pulmonary arterial pressure is normal.
- Left Atrium: Slightly dilated left atrium.
- Right Atrium: Normal-sized right atrium.
- Mitral Valve: Morphologically unremarkable. Minimal mitral valve
regurgitation.
- Aortic Valve: Mildly sclerotic aortic valve cusps. No aortic valve
insufficiency. No aortic valve stenosis (AV PGmax 7 mmHg).
- Tricuspid Valve: Delicate tricuspid valve leaflets. Minimal
tricuspid valve regurgitation (TR Pmax 26 mmHg).
- Pulmonary Valve: No pulmonary valve insufficiency. Pericardium: No
pericardial effusion.
**Assessment**: Examination in sinus rhythm with bundle branch block.
Moderate ultrasound windows. Normal-sized left ventricle (LVED 54 mm)
with mildly reduced systolic LV function (EF biplan 55%) with mildly
reduced contractility without regional emphasis. Mild LV hypertrophy,
predominantly septal, without obstruction. Diastolic dysfunction Grade 1
(E/A 0.47) with a normal LV filling index (E/E\' mean 3.5). Slightly
sclerotic aortic valve without stenosis, no AI. Slightly dilated left
atrium (LAVI 31 ml/m²). Minimal MI. Normal-sized right ventricle with
normal function. Normal-sized right atrium (RAVI 21 ml/m²). Minimal TI.
As far as assessable, systolic PA pressure is within the normal range.
The IVC cannot be viewed from the subcostal angle. No thrombi are
visible. As far as assessable, no pericardial effusion is visible.
**Chest X-ray in two planes on 05/20/2023: **
[Clinical Information, Question, Justification:]{.underline} Post CRT
device replacement. Inquiry about position, pneumothorax.
[Findings]{.underline}: No pneumothorax following CRT device
replacement.
### Patient Report 0
**Dear colleague, **
We are writing to provide an update on Mr. David Romero, born on
02/16/1942, who presented at our Rhythm Clinic on 09/29/2023.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Current Medication:**
**Medication** **Dosage** **Frequency**
----------------------------- ------------------ ---------------
Lantus (Insulin glargine) 450 Units/1.5 mL 0-0-0-/6-8
Humalog (Insulin lispro) 300 Units/3 mL 5-8/0/5-8/5-8
Levothyroxine (Synthroid) 100 mcg 1-0-0-0
Vitamin D3 (Colecalciferol) 12.5 mcg 2-0-0-0
Lipitor (Atorvastatin) 21.7 mg 0-0-1-0
Norvasc (Amlodipine) 6.94 mg 1-0-0-0
Altace (Ramipril) 5 mg 1-0-0-0
Demadex (Torasemide) 5 mg 0-0-0.5-0
Coreg (Carvedilol) 25 mg 0.5-0-0.5-0
Zocor (Simvastatin) 40 mg 0-0-0.5-0
Aspirin 100 mg 1-0-0-0
Vitamin D3 (Colecalciferol) 12.5 mcg 2-0-0-0
**Measurement Results:**
Battery/Capacitor: Status: OK, Voltage: 8.4V
- Right Atrial: 375 Ohms 3.80 mV 0.375 V 0.50 ms
- Right Ventricular: 388 Ohms 11.80 mV 0.750 V 0.50 ms
- Left Ventricular: 350 Ohms 0.625 V 0.50 ms
- Defibrillation Impedance: Right Ventricular: 48 Ohms
**Implant Settings:**
- Bradycardia Setting: Mode: DDD
- Tachycardia Settings: Zone Detection Interval (ms) Detection Beats
ATP Shocks Details Status
- VFVF 260 ms 30 /
- VTVT1 330 ms 55 /
<!-- -->
- Probe Settings: Lead Sensitivity Sensing Polarity/Vector
Amplification/Pulse Width Stimulation Polarity/Vector Auto Amplitude
Control
- Right Atrial: 0.30 mV Bipolar/ 1.375 V/0.50 ms Bipolar/
- Right Ventricular: Bipolar/ 2.000 V/0.50 ms Bipolar/
- Left Ventricular: 2.000 V/0.50 ms tip 1 - RV Coil
**Assessment:**
- Routine visit with normal device function.
- Normal sinus rhythm with a heart rate of 65/min.
- Balanced heart rate histogram with a plateau at 60-70 bpm.
- Wound conditions are unremarkable.
- Battery status: OK.
- Atrial probe: Intact
- Right ventricular probe: Intact
- Left ventricular probe: Intact
- A follow-up appointment for the patient is requested in 6 months.
**Lab results:**
**Parameter** **Result** **Reference Range**
----------------------------------- ------------ ---------------------
Reticulocytes 0.01/nL \< 0.01/nL
Sodium 137 mEq/L 136-145 mEq/L
Potassium 4.2 mEq/L 3.5-4.5 mEq/L
Creatinine 1.34 mg/dL 0.70-1.20 mg/dL
BUN 49 mg/dL 17-48 mg/dL
Total Bilirubin 1.8 mg/dL \< 1.20 mg/dL
C-reactive Protein 5.9 mg/L \< 5.0 mg/L
ALT 67 U/L \< 41 U/L
AST 78 U/L \< 50 U/L
Alkaline Phosphatase 151 U/L 40-130 U/L
Gamma-Glutamyl Transferase 200 U/L 8-61 U/L
Free Triiodothyronine (T3) 2.3 ng/L 2.00-4.40 ng/L
Free Thyroxine (T4) 14.2 ng/L 9.30-17.00 ng/L
Thyroid Stimulating Hormone (TSH) 4.1 mU/L 0.27-4.20 mU/L
Hemoglobin 11.6 g/dL 13.5-17.0 g/dL
Hematocrit 34.5% 39.5-50.5%
Red Blood Cell Count 3.7 M/µL 4.3-5.8 M/µL
White Blood Cell Count 9.56 K/µL 3.90-10.50 K/µL
MCV 92.7 fL 80.0-99.0 fL
MCH 31.8 pg 27.0-33.5 pg
MCHC 33.9 g/dL 31.5-36.0 g/dL
MPV 8.9 fL 7.0-12.0 fL
RDW-CV 14.2% 11.5-15.0%
Quick 89% 78-123%
INR 1.09 0.90-1.25
Partial Thromboplastin Time 25.3 sec. 22.0-29.0 sec.
|
122 ms
|
Who is Honey?
A. Judy's sister-in-law
B. Judy's younger sister
C. their mutual friend
D. Judy's grandmother
|
The Haunted Fountain CHAPTER I An Unsolved Mystery “Tell Judy about it,” begged Lois. “Please, Lorraine, it can’t be as bad as it appears. There isn’t anything that Judy can’t solve.” Lorraine tilted her head disdainfully. “We’re sisters now. We’re both Farringdon-Petts and should be loyal to each other. But you always did take Judy’s part. She was the one who nearly spoiled our double wedding trying to solve a mystery. I don’t believe she’d understand—understand any better than I do. Everyone has problems, and I’m sure Judy is no exception.” “You’re right, Lorraine,” announced Judy, coming in to serve dessert to the two friends she had invited for lunch at Peter’s suggestion. “I do have problems, and there are plenty of mysteries I can’t solve.” “Name one,” charged Lois. “Just mention one single spooky thing you couldn’t explain, and I’ll believe you. I’ve seen you in action, Judy Bolton—” “Judy Dobbs, remember?” “Well, you were Judy Bolton when you solved all those mysteries. I met you when the whole valley below the big Roulsville dam was threatened by flood and you solved that—” “That,” declared Judy, “was my brother Horace, not me. He was the hero without even meaning to be. He was the one who rode through town and warned people that the flood was coming. I was off chasing a shadow.” “A vanishing shadow,” Lois said with a sigh. “What you did wasn’t easy, Judy.” “It didn’t need to be as hard as it was,” Judy confessed. “I know now that keeping that promise not to talk about the dam was a great big mistake and could have cost lives. I should have told Arthur.” “Please,” Lorraine said, a pained expression clouding her pretty face, “let’s not talk about him now.” “Very well,” Judy agreed. “What shall we talk about?” “You,” Lois said, “and all the mysteries you’ve solved. Maybe you were mistaken about a thing or two before the flood, but what about the haunted house you moved into? You were the one who tracked down the ghosts in the attic and the cellar and goodness knows where all. You’ve been chasing ghosts ever since I met you, and not one of them did you fail to explain in some sensible, logical fashion.” “Before I met you,” Judy said, thinking back, “there were plenty of them I couldn’t explain. There was one I used to call the spirit of the fountain, but what she was or how she spoke to me is more than I know. If my grandparents knew, they weren’t telling. And now they’re both dead and I can’t ask them. They left me a lot of unsolved mysteries along with this house. Maybe I’ll find the answers to some of them when I finish sorting Grandma’s things. They’re stored in one end of the attic.” “Another haunted attic? How thrilling!” exclaimed Lois. “Why don’t you have another ghost party and show up the spooks?” “I didn’t say the attic was haunted.” Judy was almost sorry she had mentioned it. She wasn’t in the mood for digging up old mysteries, but Lois and Lorraine insisted. It all began, she finally told them, the summer before they met. Horace had just started working on the paper. Judy remembered that it was Lorraine’s father, Richard Thornton Lee, who gave him his job with the Farringdon Daily Herald . He had turned in some interesting church news, convincing Mr. Lee that he had in him the makings of a good reporter. And so it was that he spent the summer Judy was remembering in Farringdon where the Farringdon-Petts had their turreted mansion, while she had to suffer the heat and loneliness of Dry Brook Hollow. Her thoughts were what had made it so hard, she confessed now as she reviewed everything that had happened. She just couldn’t help resenting the fact that her parents left her every summer while they went off on a vacation by themselves. What did they think she would do? “You’ll have plenty to read,” her father had told her. “I bought you six new books in that mystery series you like. When they’re finished there are plenty of short stories around. Your grandmother never throws anything away. She has magazines she’s saved since your mother was a girl. If you ask for them she’ll let you have the whole stack. I know how you love to read.” “I do, Dad, but if the magazines are that old—” Judy had stopped. She had seen her father’s tired eyes and had realized that a busy doctor needed a vacation much more than a schoolgirl who had too little to do. He and Judy’s mother usually went to the beach hotel where they had honeymooned. It was a precious memory. Every summer Dr. Bolton and his wife relived it. And every summer Judy went to stay with her grandmother Smeed, who scolded and fussed and tried to pretend she wasn’t glad to have her. “You here again?” she had greeted her that summer, and Judy hadn’t noticed her old eyes twinkling behind her glasses. “What do you propose to do with yourself this time?” “Read,” Judy had told her. “Mom and Dad say you have a whole stack of old magazines—” “In the attic. Go up and look them over if you can stand the heat.” Judy went, not to look over the old magazines so much as to escape to a place where she could have a good cry. It was the summer before her fifteenth birthday. In another year she would have outgrown her childish resentment of her parents’ vacation or be grown up enough to ask them to let her have a vacation of her own. In another year she would be summering among the beautiful Thousand Islands and solving a mystery to be known as the Ghost Parade . “A whole parade of ghosts,” Lois would be telling her, “and you solved everything.” But then she didn’t even know Lois. She had no idea so many thrilling adventures awaited her. There seemed to be nothing—nothing—and so the tears came and spilled over on one of the magazines. As Judy wiped it away she noticed that it had fallen on a picture of a fountain. “A fountain with tears for water. How strange!” she remembered saying aloud. Judy had never seen a real fountain. The thrill of walking up to the door of the palatial Farringdon-Pett mansion was still ahead of her. On the lawn a fountain still caught and held rainbows like those she was to see on her honeymoon at Niagara Falls. But all that was in the future. If anyone had told the freckled-faced, pigtailed girl that she would one day marry Peter Dobbs, she would have laughed in their faces. “That tease!” For then she knew Peter only as an older boy who used to tease her and call her carrot-top until one day she yelled back at him, “Carrot-tops are green and so are you!” Peter was to win Judy’s heart when he gave her a kitten and suggested the name Blackberry for him. The kitten was now a dignified family cat. But the summer Judy found the picture of a fountain and spilled tears on it she had no kitten. She had nothing, she confessed, not even a friend. It had helped to pretend the fountain in the picture was filled with all the tears lonely girls like herself had ever cried. “But that would make it enchanted!” she had suddenly exclaimed. “If I could find it I’d wish—” A step had sounded on the stairs. Judy remembered it distinctly. She had turned to see her grandmother and to hear her say in her usual abrupt fashion, “Enchanted fountain, indeed! If you let people know your wishes instead of muttering them to yourself, most of them aren’t so impossible.” “Were they?” asked Lois. She and Lorraine had listened to this much of what Judy was telling them without interruption. “That’s the unsolved mystery,” Judy replied. “There weren’t any of them impossible.” And she went on to tell them how, the very next day, her grandparents had taken her to a fountain exactly like the one in the picture. It was in the center of a deep, circular pool with steps leading up to it. Beside the steps were smaller fountains with the water spurting from the mouths of stone lions. Judy had stared at them a moment and then climbed the steps to the pool. “Am I dreaming?” she remembered saying aloud. “Is this beautiful fountain real?” A voice had answered, although she could see no one. “Make your wishes, Judy. Wish wisely. If you shed a tear in the fountain your wishes will surely come true.” “A tear?” Judy had asked. “How can I shed a tear when I’m happy? This is a wonderful place.” “Shed a tear in the fountain and your wishes will surely come true,” the voice had repeated. “But what is there to cry about?” “You found plenty to cry about back at your grandmother’s house,” the mysterious voice had reminded her. “Weren’t you crying on my picture up there in the attic?” “Then you—you are the fountain!” Judy remembered exclaiming. “But a fountain doesn’t speak. It doesn’t have a voice.” “Wish wisely,” the voice from the fountain had said in a mysterious whisper. CHAPTER II If Wishes Came True “Did you?” Lois interrupted the story to ask excitedly. “Oh, Judy! Don’t keep us in suspense any longer. What did you wish?” “Patience,” Judy said with a smile. “I’m coming to that.” First, she told her friends, she had to think of a wise wish. There had been so much she wanted in those early days before the flood. Dora Scott had been her best friend in Roulsville, but she had moved away. “You see,” she explained, “I made the mistake of having just one best friend. There wasn’t anybody in Dry Brook Hollow. I remember thinking of how lonely I was and how I wished for a friend or a sister, and suddenly a tear splashed in the water. It made little ripples. I thought I had to wish quickly before they vanished, and so I began naming the things I wanted as fast as I could. I’m not sure they were wise wishes. They seem rather selfish to me, now. I wasn’t thinking of anybody but me, Judy Bolton, and what I wanted. It wasn’t until after I began to think of others that my wishes started to come true.” “But what were they?” Lois insisted. Lorraine seemed unusually quiet and thoughtful. Judy did not notice the fear in her eyes as she replied airily, “Oh, didn’t I tell you? I wished for lots of friends and a sister, and I wished I could marry a G-man and solve a lot of mysteries and that’s as far as I got when the ripples vanished. I thought the spell was broken and so I didn’t wish for anything more.” “Wasn’t there anything more you wanted?” Lois asked. “Of course,” replied Judy. “There were lots more things. I wanted to go places, of course, and keep pets, and have a nice home, and—” “And your wishes all came true!” “Every one of them,” Judy agreed, “even the one about the sister. You see, it wasn’t a baby sister I wanted. It was a sister near my own age. That seemed impossible at the time, but the future did hold a sister for me.” “It held one for me, too,” Lois said, squeezing Lorraine’s hand under the table. “Don’t you think sisters should tell each other their problems, Judy?” “Honey and I always do,” she replied “but then it was different. I didn’t know I would marry Peter or that he would become a G-man, and he didn’t know he had a sister. It is strange, isn’t it? But the strangest thing of all was the fountain itself.” “Why?” asked Lorraine. “Do you still think it was enchanted?” Lois laughed at this, but Judy was serious as she answered, “I was still little girl enough to think so at the time. I wandered around, growing very drowsy. Then I found a hammock and climbed into it. I must have gone to sleep, because I remember waking up and wondering if the voice in the fountain had been a dream.” “A hammock?” Lois questioned. “Are you sure it wasn’t a flying carpet?” “No, it was a hammock all right,” Judy assured her, laughing. “It was hung between two trees in a beautiful garden all enclosed in rose trellises thick with roses. Did I tell you it was June?” “All the year around?” Again Lois laughed. But Lorraine said abruptly, “Let’s not talk about rose gardens in June. It’s a long way from June to December.” “Do you mean a garden changes? I know,” Judy said, “but I think this one would be beautiful at any time of the year. There were rhododendrons, too, and I don’t know how many different kinds of evergreens. I explored the garden all around the fountain.” “And then what happened?” Lorraine urged her. “Yes, yes. Go on,” entreated Lois. “I didn’t dream you’d kept anything that exciting a secret. Why didn’t you try to solve the mystery?” “I think I would have tried,” Judy admitted, “if I had been older or more experienced. I really should have investigated it more thoroughly and learned the secret of the fountain. But after the ripples went away it didn’t speak to me any more, and I didn’t really think it had heard my wishes. I was still wishing for a friend when I met you, Lois. It did seem impossible for us to be friends at first, didn’t it? Lorraine was your friend.” “I did make trouble for you,” Lorraine remembered. “It was all because of my foolish jealousy.” “It was nothing compared to the trouble caused by the Roulsville flood,” declared Judy. “After that things started happening so fast that I completely forgot about the fountain. Honestly, Lois, I don’t believe I thought about it again until after we moved to Farringdon and I walked up to your door and saw the fountain on your lawn.” “The Farringdon-Pett puddle, I always called it,” Lois said with a giggle. “I’ve seen lots nicer fountains.” “You have?” asked Judy. “Then maybe you’ve seen the one I’ve been telling you about. I think the picture of it is still in the attic. Come on up and I’ll show you.” Lois and Lorraine had finished their dessert while Judy was telling them the story of the fountain. Somehow, she wasn’t hungry for hers. She had tasted it too often while she was making it. “I’ll leave it for Blackberry,” she decided. Lois watched in amusement as the cat lapped up the chocolate pudding after Judy had mixed it generously with cream. “Sometimes,” Judy said fondly, “Blackberry thinks he’s a person. He eats everything we eat, including lettuce. Do you mind if he comes with us, Lorraine? He wants to explore the attic, too.” “He’ll remember he’s a cat fast enough if there are any mice up there,” Lois said with a giggle. Leaving the table, they all started upstairs with the cat bounding ahead of them. In modernizing her grandparents’ house to suit her own and Peter’s tastes, Judy had seen to it that the old stair door was removed. But there was still a door closing off the narrower stairs that led to the attic. Blackberry reached it first and yowled for Judy to open it. “He can read my mind. He always knows where I’m going,” Judy said as the door creaked open and the cat shot through it. A moment later a weird rolling noise came from the floor above. “Come on. There’s nothing up here to be afraid of,” Judy urged her friends. “Maybe not, but I’m beginning to get the shivers,” confessed Lois as she followed Judy to the sewing room at the top of the last flight of stairs. “So am I,” Lorraine admitted. “I’m not superstitious about black cats, but they are creepy. Does Blackberry have to roll spools across the floor?” “Now he thinks he’s a kitten,” laughed Judy. Pausing at still another door that led to the darker part of the attic, she turned and said mysteriously, “Up here we can all turn back the clock. Does anybody care to explore the past?” The exploration began enthusiastically with Judy relating still more of what she remembered about the fountain. “When I told Grandma about it she laughed and said I must have dreamed it. She said if wishes came true that easily she’d be living in a castle. But would she?” Judy wondered. “When I first remember this house she was still burning kerosene lamps like those you see on that high shelf by the window. I think she and Grandpa like the way they lived without any modern conveniences or anything.” “I think so, too,” Lois agreed, looking around the old attic with a shiver. “It is strange they both died the same winter, isn’t it?” “Maybe they wanted it that way. Maybe they wished neither of them would outlive the other. If they did wish in the fountain,” Judy went on more thoughtfully, “I’m sure that was one of their wishes. Another could have been to keep the good old days, as Grandma used to call them. That one came true in a way. They did manage to keep a little of the past when they kept all these old things. That’s what I meant about turning back the clock.” “If wishes came true I’d like to turn it back a little myself,” Lorraine began. “It would be nice if things were the way they used to be when I trusted Arthur—” “Don’t you trust him now?” Judy asked. Afterwards she was sorry for the interruption. Lois and Judy both questioned Lorraine, but that was all she would say. Judy wondered, as they searched through the old magazines, what was wrong. Lorraine was of a jealous disposition. Was the green-eyed monster coming between her and her handsome husband, Arthur Farringdon-Pett? Until now they had seemed blissfully happy. But there was no happiness in Lorraine’s face as she gazed at a picture of one of the fountains and then said in a tight little voice, “It is. It’s the very same one.” “But that’s the picture I’ve been searching for!” Judy said eagerly. “Do you know where it is?” “I can’t be sure. But if it ever was enchanted, I’m sure it isn’t now. Let’s go,” Lorraine said suddenly to Lois. Judy knew she was suggesting a fast trip home. But, apparently, Lois did not understand it that way. If she did, she pretended not to. “Where?” she asked. “To the fountain? I’d love to, wouldn’t you, Judy?” “I certainly would,” Judy replied enthusiastically. “Do you recognize it, too?” “I think so,” Lois answered after studying a little more closely the picture they had found. “It looks like the fountain on the Brandt estate.” “The department store Brandts?” Judy questioned. “Then my grandparents must have driven old Fanny all the way to Farringdon.” “Not quite all the way,” Lorraine objected. “The Brandts own that stretch of woods just before you come into the city. You’ve passed it lots of times.” “Of course,” agreed Judy. She put the magazine back in its place under the eaves and turned eagerly to her friends. “I do remember a road turning off into the woods and going on uphill,” she told them. “I never thought it led to a house, though. There isn’t even a gate. Could that be the road my grandparents took?” “Why don’t we take it ourselves and find out?” Lois suggested. CHAPTER III A Strange Encounter Lorraine was not too enthusiastic about the proposed trip to the Brandt estate. Finally she agreed to it under one condition. They were not to drive all the way to the house which, she said, was just over the hilltop. They were to park the car where no one would see it and follow the path to the fountain. “But suppose we can’t find the path?” asked Judy. “You’ll remember it, won’t you?” Judy thought she would, but she wasn’t too sure. She and Lois both argued that it would be better to inquire at the house. Lois knew Helen Brandt slightly. “She’d be glad to show us around. This way it looks as if we’re planning a crime,” Lois said as they started off in the blue car she was driving. It was a neat little car, not too conspicuous, and easy to park in out-of-the-way places. Judy laughed and said if they did find the fountain she thought she’d wish for one exactly like it. “Well, you know what your grandmother said about wishes, don’t you?” Lorraine asked. “If you let people know about them instead of muttering them to yourself most of them aren’t so impossible.” “Quite true,” Judy agreed. “I’ll let Peter know about this one. He’s my Santa Claus, and it will soon be Christmas. Maybe I should have worn the fur coat he gave me last year.” “Your reversible’s better in case it rains. It’s too warm for snow. We picked a perfect day for this trip,” Lois continued, guiding the car around curves as it climbed the steep hill beyond Dry Brook Hollow. The trip was a short one. In twenty minutes they had covered the distance that had seemed such a long way to Judy when she was riding in her grandfather’s wagon. “I’ve been thinking about it,” she said, “and I’ve just about figured out how it happened. I didn’t think my grandparents knew the Brandts well enough to pay them a visit, though. We must have looked queer driving up to a beautiful estate in Grandpa’s old farm wagon. I do remember that Grandma had some hooked rugs to deliver. But that still doesn’t explain what happened afterwards. When I woke up in the hammock I was alone in the garden. Horse, wagon, grandparents—all had disappeared.” “How could they?” asked Lois. “Anyway,” Lorraine began, “you had a chance to see how beautiful everything was before—” Again she broke off as if there were something she wanted to tell but didn’t quite dare. “Before what?” questioned Judy. “Oh, nothing. Forget I said anything about it. You were telling us how you woke up in the hammock, but you never did explain how you got back home,” Lorraine reminded her. “Didn’t I?” asked Judy. “I’d forgotten a lot of it, but it’s beginning to come back now. I do remember driving home along this road. You see, I thought my grandparents had left me in the garden for a surprise and would return for me. I told you I was all alone. There wasn’t a house in sight.” “The Brandt house is just over the top of this next hill,” Lois put in. “I know. You told me that. Now I know why I couldn’t see it. All I could see was a windowless old tower and a path leading in that direction. Naturally, I followed it. There’s something about a path in the woods that always tempts me.” “We know that, Judy. Honey told us all about your latest mystery. You followed a trail or something.” “Well, this trail led out of the rose garden where the hammock was and then through an archway,” Judy continued. “All sorts of little cupids and gnomes peered out at me from unexpected places. I was actually scared by the time I reached the old tower. There wasn’t time to explore it. Just then I heard the rumble of my grandfather’s wagon and knew he was driving off without me.” “He was!” Judy’s friends both chorused in surprise, and Lois asked, “Why would he do a thing like that?” “I think now it was just to tease me. He did stop and wait for me after a while,” Judy remembered. “The rugs were gone. Grandma must have delivered them, but I didn’t ask where. If she made them for Mrs. Brandt they may still be there.” “I wouldn’t depend on it,” Lorraine said as they turned up the narrow road to the Brandt estate. “Watch out!” Judy suddenly exclaimed. “There’s another car coming.” As Lois swerved to avoid the oncoming car, Lorraine ducked her head. She kept herself hidden behind Judy until the car had passed. The man driving it was a stranger to Judy, but she would remember his hypnotic, dark eyes and swarthy complexion for a long time. The soft brown hat he was wearing covered most of his hair. “What’s the matter with you two?” asked Lois when the car had passed. “Aren’t you a little old for playing hide and seek?” “I wasn’t—playing. Let’s not go up there,” Lorraine begged. “I don’t think the Brandts live there any more.” “Maybe not, but we can pretend we think they do, can’t we?” Judy replied a little uncertainly. She was beginning to suspect that Lorraine knew more about the Brandt estate than she was telling. Lois kept on driving along the narrow, gravelly road. Soon there were more evergreens and a hedge of rhododendrons to be seen. They looked very green next to the leafless trees in the woods beyond. The sky was gray with white clouds being driven across it by the wind. “There’s the tower!” Lorraine exclaimed. “I can see it over to the left. It looks like something out of Grimm’s Fairy Tales, doesn’t it?” “It looks grim all right,” agreed Judy. “I wonder what it is.” “I suppose it’s nothing but an old water tower. It would be fun to explore it, though,” Lois said. “But if there are new people living here they’ll never give us permission.” “We might explore it without permission,” Judy suggested daringly. “Come on!” she urged her friends as Lois parked the car in a cleared place beside the road. “Who’s going to stop us? And who wants to explore a gloomy old tower, anyway? Let’s look for the fountain.” “Do you think we should?” Lorraine asked. “It won’t be enchanted. I told you—” “You told us very little,” Lois reminded her. “If you know anything about the people who live here now, I think you ought to let us know. Otherwise, I’m afraid we won’t be very welcome.” “I don’t think they’ll welcome us, anyway. I do know who they are,” Lorraine admitted. “You remember Roger Banning from school, don’t you? I’ve seen him around here. His family must have acquired sudden wealth, or else he’s just working on the estate.” “Then you’ve been here lately? Why didn’t you tell me?” asked Lois. “We always used to go places together.” “It wasn’t important,” Lorraine replied evasively. “I was just out for a drive.” “You plutocrats!” laughed Judy. “Each with a car of your own. You’re not interested in Roger Banning, are you, Lois? I’m sure you can do better than that. I did know him slightly, but not from school. The boys and girls were separated and went to different high schools by the time we moved to Farringdon. I remember his pal, Dick Hartwell, a lot better. He was in our young people’s group at church.” “Sh!” Lois cautioned her. “Nice people no longer mention Dick Hartwell’s name. He’s doing time.” “For what?” asked Judy. Like Peter, her FBI husband, she preferred facts to gossip. “Forgery, I guess. He stole some checkbooks from his father’s desk and forged the names of a lot of important business people. I think he forged some legal documents, too. Anyway, he went to the Federal Penitentiary. It was all in the papers,” Lorraine told her. Now Judy did remember. It was something she would have preferred to forget. She liked to think she was a good judge of character, and she had taken Dick Hartwell for a quiet, refined boy who would never stoop to crime. “I don’t see what all this has to do with the fountain,” Lois said impatiently. “Are we going to look for it, or aren’t we?” “Of course we are. That’s what we came for. I just like to know what a tiger looks like before he springs at me,” Judy explained. “You seem to think there’s danger in this expedition of ours, don’t you?” asked Lorraine. “I don’t know what to think. You’re the one who seems to know the answers, but you’re not telling. Hiding your face back there gave you away. You’ve seen that character who drove down this road and, for some reason, you were afraid he would see you. Why, Lorraine? Why didn’t you want to be recognized?” Lorraine hesitated a moment and then replied evasively, “People don’t generally enter private estates without an invitation. That’s all.” “I’d better turn the car around,” Lois decided, “in case we have to leave in a hurry. I don’t expect we’ll encounter any tigers, but we may be accused of trespassing.” “I’m sure we will be,” announced Judy as two dark-coated figures strode down the road toward them. “You drove right by a NO TRESPASSING sign, and this isn’t a welcoming committee coming to meet us!”
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A. Judy's sister-in-law
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Why are people insistent on pointing out others' flaws?
A. Being polite is considered too passive in the society.
B. Pointing out flaws is considered positive feedback for those pretending to be human.
C. Being insecure and not taking criticism is a sign of weakness in the society.
D. Pointing out flaws is part of the social rapport for this group, and is considered normal.
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THE PERFECTIONISTS By ARNOLD CASTLE ILLUSTRATED by SUMMERS Is there something wrong with you? Do you fail to fit in with your group? Nervous, anxious, ill-at-ease? Happy about it? Lucky you! Frank Pembroke sat behind the desk of his shabby little office over Lemark's Liquors in downtown Los Angeles and waited for his first customer. He had been in business for a week and as yet had had no callers. Therefore, it was with a mingled sense of excitement and satisfaction that he greeted the tall, dark, smooth-faced figure that came up the stairs and into the office shortly before noon. "Good day, sir," said Pembroke with an amiable smile. "I see my advertisement has interested you. Please stand in that corner for just a moment." Opening the desk drawer, which was almost empty, Pembroke removed an automatic pistol fitted with a silencer. Pointing it at the amazed customer, he fired four .22 caliber longs into the narrow chest. Then he made a telephone call and sat down to wait. He wondered how long it would be before his next client would arrive. The series of events leading up to Pembroke's present occupation had commenced on a dismal, overcast evening in the South Pacific a year earlier. Bound for Sydney, two days out of Valparaiso, the Colombian tramp steamer Elena Mia had encountered a dense greenish fog which seemed vaguely redolent of citrus trees. Standing on the forward deck, Pembroke was one of the first to perceive the peculiar odor and to spot the immense gray hulk wallowing in the murky distance. Then the explosion had come, from far below the waterline, and the decks were awash with frantic crewmen, officers, and the handful of passengers. Only two lifeboats were launched before the Elena Mia went down. Pembroke was in the second. The roar of the sinking ship was the last thing he heard for some time. Pembroke came as close to being a professional adventurer as one can in these days of regimented travel, organized peril, and political restriction. He had made for himself a substantial fortune through speculation in a great variety of properties, real and otherwise. Life had given him much and demanded little, which was perhaps the reason for his restiveness. Loyalty to person or to people was a trait Pembroke had never recognized in himself, nor had it ever been expected of him. And yet he greatly envied those staunch patriots and lovers who could find it in themselves to elevate the glory and safety of others above that of themselves. Lacking such loyalties, Pembroke adapted quickly to the situation in which he found himself when he regained consciousness. He awoke in a small room in what appeared to be a typical modern American hotel. The wallet in his pocket contained exactly what it should, approximately three hundred dollars. His next thought was of food. He left the room and descended via the elevator to the restaurant. Here he observed that it was early afternoon. Ordering a full dinner, for he was unusually hungry, he began to study the others in the restaurant. Many of the faces seemed familiar; the crew of the ship, probably. He also recognized several of the passengers. However, he made no attempt to speak to them. After his meal, he bought a good corona and went for a walk. His situation could have been any small western American seacoast city. He heard the hiss of the ocean in the direction the afternoon sun was taking. In his full-gaited walk, he was soon approaching the beach. On the sand he saw a number of sun bathers. One in particular, an attractive woman of about thirty, tossed back her long, chestnut locks and gazed up intently at Pembroke as he passed. Seldom had he enjoyed so ingenuous an invitation. He halted and stared down at her for a few moments. "You are looking for someone?" she inquired. "Much of the time," said the man. "Could it be me?" "It could be." "Yet you seem unsure," she said. Pembroke smiled, uneasily. There was something not entirely normal about her conversation. Though the rest of her compensated for that. "Tell me what's wrong with me," she went on urgently. "I'm not good enough, am I? I mean, there's something wrong with the way I look or act. Isn't there? Please help me, please!" "You're not casual enough, for one thing," said Pembroke, deciding to play along with her for the moment. "You're too tense. Also you're a bit knock-kneed, not that it matters. Is that what you wanted to hear?" "Yes, yes—I mean, I suppose so. I can try to be more casual. But I don't know what to do about my knees," she said wistfully, staring across at the smooth, tan limbs. "Do you think I'm okay otherwise? I mean, as a whole I'm not so bad, am I? Oh, please tell me." "How about talking it over at supper tonight?" Pembroke proposed. "Maybe with less distraction I'll have a better picture of you—as a whole." "Oh, that's very generous of you," the woman told him. She scribbled a name and an address on a small piece of paper and handed it to him. "Any time after six," she said. Pembroke left the beach and walked through several small specialty shops. He tried to get the woman off his mind, but the oddness of her conversation continued to bother him. She was right about being different, but it was her concern about being different that made her so. How to explain that to her? Then he saw the weird little glass statuette among the usual bric-a-brac. It rather resembled a ground hog, had seven fingers on each of its six limbs, and smiled up at him as he stared. "Can I help you, sir?" a middle-aged saleswoman inquired. "Oh, good heavens, whatever is that thing doing here?" Pembroke watched with lifted eyebrows as the clerk whisked the bizarre statuette underneath the counter. "What the hell was that?" Pembroke demanded. "Oh, you know—or don't you? Oh, my," she concluded, "are you one of the—strangers?" "And if I were?" "Well, I'd certainly appreciate it if you'd tell me how I walk." She came around in front of the counter and strutted back and forth a few times. "They tell me I lean too far forward," she confided. "But I should think you'd fall down if you didn't." "Don't try to go so fast and you won't fall down," suggested Pembroke. "You're in too much of a hurry. Also those fake flowers on your blouse make you look frumpy." "Well, I'm supposed to look frumpy," the woman retorted. "That's the type of person I am. But you can look frumpy and still walk natural, can't you? Everyone says you can." "Well, they've got a point," said Pembroke. "Incidentally, just where are we, anyway? What city is this?" "Puerto Pacifico," she told him. "Isn't that a lovely name? It means peaceful port. In Spanish." That was fine. At least he now knew where he was. But as he left the shop he began checking off every west coast state, city, town, and inlet. None, to the best of his knowledge, was called Puerto Pacifico. He headed for the nearest service station and asked for a map. The attendant gave him one which showed the city, but nothing beyond. "Which way is it to San Francisco?" asked Pembroke. "That all depends on where you are," the boy returned. "Okay, then where am I?" "Pardon me, there's a customer," the boy said. "This is Puerto Pacifico." Pembroke watched him hurry off to service a car with a sense of having been given the runaround. To his surprise, the boy came back a few minutes later after servicing the automobile. "Say, I've just figured out who you are," the youngster told him. "I'd sure appreciate it if you'd give me a little help on my lingo. Also, you gas up the car first, then try to sell 'em the oil—right?" "Right," said Pembroke wearily. "What's wrong with your lingo? Other than the fact that it's not colloquial enough." "Not enough slang, huh? Well, I guess I'll have to concentrate on that. How about the smile?" "Perfect," Pembroke told him. "Yeah?" said the boy delightedly. "Say, come back again, huh? I sure appreciate the help. Keep the map." "Thanks. One more thing," Pembroke said. "What's over that way—outside the city?" "Sand." "How about that way?" he asked, pointing north. "And that way?" pointing south. "More of the same." "Any railroads?" "That we ain't got." "Buses? Airlines?" The kid shook his head. "Some city." "Yeah, it's kinda isolated. A lot of ships dock here, though." "All cargo ships, I'll bet. No passengers," said Pembroke. "Right," said the attendant, giving with his perfect smile. "No getting out of here, is there?" "That's for sure," the boy said, walking away to wait on another customer. "If you don't like the place, you've had it." Pembroke returned to the hotel. Going to the bar, he recognized one of the Elena Mia's paying passengers. He was a short, rectangular little man in his fifties named Spencer. He sat in a booth with three young women, all lovely, all effusive. The topic of the conversation turned out to be precisely what Pembroke had predicted. "Well, Louisa, I'd say your only fault is the way you keep wigglin' your shoulders up 'n' down. Why'n'sha try holdin' 'em straight?" "I thought it made me look sexy," the redhead said petulantly. "Just be yourself, gal," Spencer drawled, jabbing her intimately with a fat elbow, "and you'll qualify." "Me, me," the blonde with a feather cut was insisting. "What is wrong with me?" "You're perfect, sweetheart," he told her, taking her hand. "Ah, come on," she pleaded. "Everyone tells me I chew gum with my mouth open. Don't you hate that?" "Naw, that's part of your charm," Spencer assured her. "How 'bout me, sugar," asked the girl with the coal black hair. "Ah, you're perfect, too. You are all perfect. I've never seen such a collection of dolls as parade around this here city. C'mon, kids—how 'bout another round?" But the dolls had apparently lost interest in him. They got up one by one and walked out of the bar. Pembroke took his rum and tonic and moved over to Spencer's booth. "Okay if I join you?" "Sure," said the fat man. "Wonder what the hell got into those babes?" "You said they were perfect. They know they're not. You've got to be rough with them in this town," said Pembroke. "That's all they want from us." "Mister, you've been doing some thinkin', I can see," said Spencer, peering at him suspiciously. "Maybe you've figured out where we are." "Your bet's as good as mine," said Pembroke. "It's not Wellington, and it's not Brisbane, and it's not Long Beach, and it's not Tahiti. There are a lot of places it's not. But where the hell it is, you tell me. "And, by the way," he added, "I hope you like it in Puerto Pacifico. Because there isn't any place to go from here and there isn't any way to get there if there were." "Pardon me, gentlemen, but I'm Joe Valencia, manager of the hotel. I would be very grateful if you would give me a few minutes of honest criticism." "Ah, no, not you, too," groaned Spencer. "Look, Joe, what's the gag?" "You are newcomers, Mr. Spencer," Valencia explained. "You are therefore in an excellent position to point out our faults as you see them." "Well, so what?" demanded Spencer. "I've got more important things to do than to worry about your troubles. You look okay to me." "Mr. Valencia," said Pembroke. "I've noticed that you walk with a very slight limp. If you have a bad leg, I should think you would do better to develop a more pronounced limp. Otherwise, you may appear to be self-conscious about it." Spencer opened his mouth to protest, but saw with amazement that it was exactly this that Valencia was seeking. Pembroke was amused at his companion's reaction but observed that Spencer still failed to see the point. "Also, there is a certain effeminateness in the way in which you speak," said Pembroke. "Try to be a little more direct, a little more brusque. Speak in a monotone. It will make you more acceptable." "Thank you so much," said the manager. "There is much food for thought in what you have said, Mr. Pembroke. However, Mr. Spencer, your value has failed to prove itself. You have only yourself to blame. Cooperation is all we require of you." Valencia left. Spencer ordered another martini. Neither he nor Pembroke spoke for several minutes. "Somebody's crazy around here," the fat man muttered after a few moments. "Is it me, Frank?" "No. You just don't belong here, in this particular place," said Pembroke thoughtfully. "You're the wrong type. But they couldn't know that ahead of time. The way they operate it's a pretty hit-or-miss operation. But they don't care one bit about us, Spencer. Consider the men who went down with the ship. That was just part of the game." "What the hell are you sayin'?" asked Spencer in disbelief. "You figure they sunk the ship? Valencia and the waitress and the three babes? Ah, come on." "It's what you think that will determine what you do, Spencer. I suggest you change your attitude; play along with them for a few days till the picture becomes a little clearer to you. We'll talk about it again then." Pembroke rose and started out of the bar. A policeman entered and walked directly to Spencer's table. Loitering at the juke box, Pembroke overheard the conversation. "You Spencer?" "That's right," said the fat man sullenly. "What don't you like about me? The truth , buddy." "Ah, hell! Nothin' wrong with you at all, and nothin'll make me say there is," said Spencer. "You're the guy, all right. Too bad, Mac," said the cop. Pembroke heard the shots as he strolled casually out into the brightness of the hotel lobby. While he waited for the elevator, he saw them carrying the body into the street. How many others, he wondered, had gone out on their backs during their first day in Puerto Pacifico? Pembroke shaved, showered, and put on the new suit and shirt he had bought. Then he took Mary Ann, the woman he had met on the beach, out to dinner. She would look magnificent even when fully clothed, he decided, and the pale chartreuse gown she wore hardly placed her in that category. Her conversation seemed considerably more normal after the other denizens of Puerto Pacifico Pembroke had listened to that afternoon. After eating they danced for an hour, had a few more drinks, then went to Pembroke's room. He still knew nothing about her and had almost exhausted his critical capabilities, but not once had she become annoyed with him. She seemed to devour every factual point of imperfection about herself that Pembroke brought to her attention. And, fantastically enough, she actually appeared to have overcome every little imperfection he had been able to communicate to her. It was in the privacy of his room that Pembroke became aware of just how perfect, physically, Mary Ann was. Too perfect. No freckles or moles anywhere on the visible surface of her brown skin, which was more than a mere sampling. Furthermore, her face and body were meticulously symmetrical. And she seemed to be wholly ambidextrous. "With so many beautiful women in Puerto Pacifico," said Pembroke probingly, "I find it hard to understand why there are so few children." "Yes, children are decorative, aren't they," said Mary Ann. "I do wish there were more of them." "Why not have a couple of your own?" he asked. "Oh, they're only given to maternal types. I'd never get one. Anyway, I won't ever marry," she said. "I'm the paramour type." It was obvious that the liquor had been having some effect. Either that, or she had a basic flaw of loquacity that no one else had discovered. Pembroke decided he would have to cover his tracks carefully. "What type am I?" he asked. "Silly, you're real. You're not a type at all." "Mary Ann, I love you very much," Pembroke murmured, gambling everything on this one throw. "When you go to Earth I'll miss you terribly." "Oh, but you'll be dead by then," she pouted. "So I mustn't fall in love with you. I don't want to be miserable." "If I pretended I was one of you, if I left on the boat with you, they'd let me go to Earth with you. Wouldn't they?" "Oh, yes, I'm sure they would." "Mary Ann, you have two other flaws I feel I should mention." "Yes? Please tell me." "In the first place," said Pembroke, "you should be willing to fall in love with me even if it will eventually make you unhappy. How can you be the paramour type if you refuse to fall in love foolishly? And when you have fallen in love, you should be very loyal." "I'll try," she said unsurely. "What else?" "The other thing is that, as my mistress, you must never mention me to anyone. It would place me in great danger." "I'll never tell anyone anything about you," she promised. "Now try to love me," Pembroke said, drawing her into his arms and kissing with little pleasure the smooth, warm perfection of her tanned cheeks. "Love me my sweet, beautiful, affectionate Mary Ann. My paramour." Making love to Mary Ann was something short of ecstasy. Not for any obvious reason, but because of subtle little factors that make a woman a woman. Mary Ann had no pulse. Mary Ann did not perspire. Mary Ann did not fatigue gradually but all at once. Mary Ann breathed regularly under all circumstances. Mary Ann talked and talked and talked. But then, Mary Ann was not a human being. When she left the hotel at midnight, Pembroke was quite sure that she understood his plan and that she was irrevocably in love with him. Tomorrow might bring his death, but it might also ensure his escape. After forty-two years of searching for a passion, for a cause, for a loyalty, Frank Pembroke had at last found his. Earth and the human race that peopled it. And Mary Ann would help him to save it. The next morning Pembroke talked to Valencia about hunting. He said that he planned to go shooting out on the desert which surrounded the city. Valencia told him that there were no living creatures anywhere but in the city. Pembroke said he was going out anyway. He picked up Mary Ann at her apartment and together they went to a sporting goods store. As he guessed there was a goodly selection of firearms, despite the fact that there was nothing to hunt and only a single target range within the city. Everything, of course, had to be just like Earth. That, after all, was the purpose of Puerto Pacifico. By noon they had rented a jeep and were well away from the city. Pembroke and Mary Ann took turns firing at the paper targets they had purchased. At twilight they headed back to the city. On the outskirts, where the sand and soil were mixed and no footprints would be left, Pembroke hopped off. Mary Ann would go straight to the police and report that Pembroke had attacked her and that she had shot him. If necessary, she would conduct the authorities to the place where they had been target shooting, but would be unable to locate the spot where she had buried the body. Why had she buried it? Because at first she was not going to report the incident. She was frightened. It was not airtight, but there would probably be no further investigation. And they certainly would not prosecute Mary Ann for killing an Earthman. Now Pembroke had himself to worry about. The first step was to enter smoothly into the new life he had planned. It wouldn't be so comfortable as the previous one, but should be considerably safer. He headed slowly for the "old" part of town, aging his clothes against buildings and fences as he walked. He had already torn the collar of the shirt and discarded his belt. By morning his beard would grow to blacken his face. And he would look weary and hungry and aimless. Only the last would be a deception. Two weeks later Pembroke phoned Mary Ann. The police had accepted her story without even checking. And when, when would she be seeing him again? He had aroused her passion and no amount of long-distance love could requite it. Soon, he assured her, soon. "Because, after all, you do owe me something," she added. And that was bad because it sounded as if she had been giving some womanly thought to the situation. A little more of that and she might go to the police again, this time for vengeance. Twice during his wanderings Pembroke had seen the corpses of Earthmen being carted out of buildings. They had to be Earthmen because they bled. Mary Ann had admitted that she did not. There would be very few Earthmen left in Puerto Pacifico, and it would be simple enough to locate him if he were reported as being on the loose. There was no out but to do away with Mary Ann. Pembroke headed for the beach. He knew she invariably went there in the afternoon. He loitered around the stalls where hot dogs and soft drinks were sold, leaning against a post in the hot sun, hat pulled down over his forehead. Then he noticed that people all about him were talking excitedly. They were discussing a ship. It was leaving that afternoon. Anyone who could pass the interview would be sent to Earth. Pembroke had visited the docks every day, without being able to learn when the great exodus would take place. Yet he was certain the first lap would be by water rather than by spaceship, since no one he had talked to in the city had ever heard of spaceships. In fact, they knew very little about their masters. Now the ship had arrived and was to leave shortly. If there was any but the most superficial examination, Pembroke would no doubt be discovered and exterminated. But since no one seemed concerned about anything but his own speech and behavior, he assumed that they had all qualified in every other respect. The reason for transporting Earth People to this planet was, of course, to apply a corrective to any of the Pacificos' aberrant mannerisms or articulation. This was the polishing up phase. Pembroke began hobbling toward the docks. Almost at once he found himself face to face with Mary Ann. She smiled happily when she recognized him. That was a good thing. "It is a sign of poor breeding to smile at tramps," Pembroke admonished her in a whisper. "Walk on ahead." She obeyed. He followed. The crowd grew thicker. They neared the docks and Pembroke saw that there were now set up on the roped-off wharves small interviewing booths. When it was their turn, he and Mary Ann each went into separate ones. Pembroke found himself alone in the little room. Then he saw that there was another entity in his presence confined beneath a glass dome. It looked rather like a groundhog and had seven fingers on each of its six limbs. But it was larger and hairier than the glass one he had seen at the gift store. With four of its limbs it tapped on an intricate keyboard in front of it. "What is your name?" queried a metallic voice from a speaker on the wall. "I'm Jerry Newton. Got no middle initial," Pembroke said in a surly voice. "Occupation?" "I work a lot o' trades. Fisherman, fruit picker, fightin' range fires, vineyards, car washer. Anything. You name it. Been out of work for a long time now, though. Goin' on five months. These here are hard times, no matter what they say." "What do you think of the Chinese situation?" the voice inquired. "Which situation's 'at?" "Where's Seattle?" "Seattle? State o' Washington." And so it went for about five minutes. Then he was told he had qualified as a satisfactory surrogate for a mid-twentieth century American male, itinerant type. "You understand your mission, Newton?" the voice asked. "You are to establish yourself on Earth. In time you will receive instructions. Then you will attack. You will not see us, your masters, again until the atmosphere has been sufficiently chlorinated. In the meantime, serve us well." He stumbled out toward the docks, then looked about for Mary Ann. He saw her at last behind the ropes, her lovely face in tears. Then she saw him. Waving frantically, she called his name several times. Pembroke mingled with the crowd moving toward the ship, ignoring her. But still the woman persisted in her shouting. Sidling up to a well-dressed man-about-town type, Pembroke winked at him and snickered. "You Frank?" he asked. "Hell, no. But some poor punk's sure red in the face, I'll bet," the man-about-town said with a chuckle. "Those high-strung paramour types always raising a ruckus. They never do pass the interview. Don't know why they even make 'em." Suddenly Mary Ann was quiet. "Ambulance squad," Pembroke's companion explained. "They'll take her off to the buggy house for a few days and bring her out fresh and ignorant as the day she was assembled. Don't know why they keep making 'em, as I say. But I guess there's a call for that type up there on Earth." "Yeah, I reckon there is at that," said Pembroke, snickering again as he moved away from the other. "And why not? Hey? Why not?" Pembroke went right on hating himself, however, till the night he was deposited in a field outside of Ensenada, broke but happy, with two other itinerant types. They separated in San Diego, and it was not long before Pembroke was explaining to the police how he had drifted far from the scene of the sinking of the Elena Mia on a piece of wreckage, and had been picked up by a Chilean trawler. How he had then made his way, with much suffering, up the coast to California. Two days later, his identity established and his circumstances again solvent, he was headed for Los Angeles to begin his save-Earth campaign. Now, seated at his battered desk in the shabby rented office over Lemark's Liquors, Pembroke gazed without emotion at the two demolished Pacificos that lay sprawled one atop the other in the corner. His watch said one-fifteen. The man from the FBI should arrive soon. There were footsteps on the stairs for the third time that day. Not the brisk, efficient steps of a federal official, but the hesitant, self-conscious steps of a junior clerk type. Pembroke rose as the young man appeared at the door. His face was smooth, unpimpled, clean-shaven, without sweat on a warm summer afternoon. "Are you Dr. Von Schubert?" the newcomer asked, peering into the room. "You see, I've got a problem—" The four shots from Pembroke's pistol solved his problem effectively. Pembroke tossed his third victim onto the pile, then opened a can of lager, quaffing it appreciatively. Seating himself once more, he leaned back in the chair, both feet upon the desk. He would be out of business soon, once the FBI agent had got there. Pembroke was only in it to get the proof he would need to convince people of the truth of his tale. But in the meantime he allowed himself to admire the clipping of the newspaper ad he had run in all the Los Angeles papers for the past week. The little ad that had saved mankind from God-knew-what insidious menace. It read: ARE YOU IMPERFECT? LET DR. VON SCHUBERT POINT OUT YOUR FLAWS IT IS HIS GOAL TO MAKE YOU THE AVERAGE FOR YOUR TYPE FEE—$3.75 MONEY BACK IF NOT SATISFIED! THE END Transcriber's Note: This etext was produced from Amazing Science Fiction Stories January 1960. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note.
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B. Pointing out flaws is considered positive feedback for those pretending to be human.
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Which real-world datasets did they use?
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### Introduction
Characteristic metrics are a set of unsupervised measures that quantitatively describe or summarize the properties of a data collection. These metrics generally do not use ground-truth labels and only measure the intrinsic characteristics of data. The most prominent example is descriptive statistics that summarizes a data collection by a group of unsupervised measures such as mean or median for central tendency, variance or minimum-maximum for dispersion, skewness for symmetry, and kurtosis for heavy-tailed analysis. In recent years, text classification, a category of Natural Language Processing (NLP) tasks, has drawn much attention BIBREF0, BIBREF1, BIBREF2 for its wide-ranging real-world applications such as fake news detection BIBREF3, document classification BIBREF4, and spoken language understanding (SLU) BIBREF5, BIBREF6, BIBREF7, a core task of conversational assistants like Amazon Alexa or Google Assistant. However, there are still insufficient characteristic metrics to describe a collection of texts. Unlike numeric or categorical data, simple descriptive statistics alone such as word counts and vocabulary size are difficult to capture the syntactic and semantic properties of a text collection. In this work, we propose a set of characteristic metrics: diversity, density, and homogeneity to quantitatively summarize a collection of texts where the unit of texts could be a phrase, sentence, or paragraph. A text collection is first mapped into a high-dimensional embedding space. Our characteristic metrics are then computed to measure the dispersion, sparsity, and uniformity of the distribution. Based on the choice of embedding methods, these characteristic metrics can help understand the properties of a text collection from different linguistic perspectives, for example, lexical diversity, syntactic variation, and semantic homogeneity. Our proposed diversity, density, and homogeneity metrics extract hard-to-visualize quantitative insight for a better understanding and comparison between text collections. To verify the effectiveness of proposed characteristic metrics, we first conduct a series of simulation experiments that cover various scenarios in two-dimensional as well as high-dimensional vector spaces. The results show that our proposed quantitative characteristic metrics exhibit several desirable and intuitive properties such as robustness and linear sensitivity of the diversity metric with respect to random down-sampling. Besides, we investigate the relationship between the characteristic metrics and the performance of a renowned model, BERT BIBREF8, on the text classification task using two public benchmark datasets. Our results demonstrate that there are high correlations between text classification model performance and the characteristic metrics, which shows the efficacy of our proposed metrics. ### Related Work
A building block of characteristic metrics for text collections is the language representation method. A classic way to represent a sentence or a paragraph is n-gram, with dimension equals to the size of vocabulary. More advanced methods learn a relatively low dimensional latent space that represents each word or token as a continuous semantic vector such as word2vec BIBREF9, GloVe BIBREF10, and fastText BIBREF11. These methods have been widely adopted with consistent performance improvements on many NLP tasks. Also, there has been extensive research on representing a whole sentence as a vector such as a plain or weighted average of word vectors BIBREF12, skip-thought vectors BIBREF13, and self-attentive sentence encoders BIBREF14. More recently, there is a paradigm shift from non-contextualized word embeddings to self-supervised language model (LM) pretraining. Language encoders are pretrained on a large text corpus using a LM-based objective and then re-used for other NLP tasks in a transfer learning manner. These methods can produce contextualized word representations, which have proven to be effective for significantly improving many NLP tasks. Among the most popular approaches are ULMFiT BIBREF2, ELMo BIBREF15, OpenAI GPT BIBREF16, and BERT BIBREF8. In this work, we adopt BERT, a transformer-based technique for NLP pretraining, as the backbone to embed a sentence or a paragraph into a representation vector. Another stream of related works is the evaluation metrics for cluster analysis. As measuring property or quality of outputs from a clustering algorithm is difficult, human judgment with cluster visualization tools BIBREF17, BIBREF18 are often used. There are unsupervised metrics to measure the quality of a clustering result such as the Calinski-Harabasz score BIBREF19, the Davies-Bouldin index BIBREF20, and the Silhouette coefficients BIBREF21. Complementary to these works that model cross-cluster similarities or relationships, our proposed diversity, density and homogeneity metrics focus on the characteristics of each single cluster, i.e., intra cluster rather than inter cluster relationships. ### Proposed Characteristic Metrics
We introduce our proposed diversity, density, and homogeneity metrics with their detailed formulations and key intuitions. Our first assumption is, for classification, high-quality training data entail that examples of one class are as differentiable and distinct as possible from another class. From a fine-grained and intra-class perspective, a robust text cluster should be diverse in syntax, which is captured by diversity. And each example should reflect a sufficient signature of the class to which it belongs, that is, each example is representative and contains certain salient features of the class. We define a density metric to account for this aspect. On top of that, examples should also be semantically similar and coherent among each other within a cluster, where homogeneity comes in play. The more subtle intuition emerges from the inter-class viewpoint. When there are two or more class labels in a text collection, in an ideal scenario, we would expect the homogeneity to be monotonically decreasing. Potentially, the diversity is increasing with respect to the number of classes since text clusters should be as distinct and separate as possible from one another. If there is a significant ambiguity between classes, the behavior of the proposed metrics and a possible new metric as a inter-class confusability measurement remain for future work. In practice, the input is a collection of texts $\lbrace x_1, x_2, ..., x_m\rbrace $, where $x_i$ is a sequence of tokens $x_{i1}, x_{i2}, ..., x_{il}$ denoting a phrase, a sentence, or a paragraph. An embedding method $\mathcal {E}$ then transforms $x_i$ into a vector $\mathcal {E}(x_i)=e_i$ and the characteristic metrics are computed with the embedding vectors. For example, Note that these embedding vectors often lie in a high-dimensional space, e.g. commonly over 300 dimensions. This motivates our design of characteristic metrics to be sensitive to text collections of different properties while being robust to the curse of dimensionality. We then assume a set of clusters created over the generated embedding vectors. In classification tasks, the embeddings pertaining to members of a class form a cluster, i.e., in a supervised setting. In an unsupervised setting, we may apply a clustering algorithm to the embeddings. It is worth noting that, in general, the metrics are independent of the assumed underlying grouping method. ### Proposed Characteristic Metrics ::: Diversity
Embedding vectors of a given group of texts $\lbrace e_1, ..., e_m\rbrace $ can be treated as a cluster in the high-dimensional embedding space. We propose a diversity metric to estimate the cluster's dispersion or spreadness via a generalized sense of the radius. Specifically, if a cluster is distributed as a multi-variate Gaussian with a diagonal covariance matrix $\Sigma $, the shape of an isocontour will be an axis-aligned ellipsoid in $\mathbb {R}^{H}$. Such isocontours can be described as: where $x$ are all possible points in $\mathbb {R}^{H}$ on an isocontour, $c$ is a constant, $\mu $ is a given mean vector with $\mu _j$ being the value along $j$-th axis, and $\sigma ^2_j$ is the variance of the $j$-th axis. We leverage the geometric interpretation of this formulation and treat the square root of variance, i.e., standard deviation, $\sqrt{\sigma ^2_j}$ as the radius $r_j$ of the ellipsoid along the $j$-th axis. The diversity metric is then defined as the geometric mean of radii across all axes: where $\sigma _i$ is the standard deviation or square root of the variance along the $i$-th axis. In practice, to compute a diversity metric, we first calculate the standard deviation of embedding vectors along each dimension and take the geometric mean of all calculated values. Note that as the geometric mean acts as a dimensionality normalization, it makes the diversity metric work well in high-dimensional embedding spaces such as BERT. ### Proposed Characteristic Metrics ::: Density
Another interesting characteristic is the sparsity of the text embedding cluster. The density metric is proposed to estimate the number of samples that falls within a unit of volume in an embedding space. Following the assumption mentioned above, a straight-forward definition of the volume can be written as: up to a constant factor. However, when the dimension goes higher, this formulation easily produces exploding or vanishing density values, i.e., goes to infinity or zero. To accommodate the impact of high-dimensionality, we impose a dimension normalization. Specifically, we introduce a notion of effective axes, which assumes most variance can be explained or captured in a sub-space of a dimension $\sqrt{H}$. We group all the axes in this sub-space together and compute the geometric mean of their radii as the effective radius. The dimension-normalized volume is then formulated as: Given a set of embedding vectors $\lbrace e_1, ..., e_m\rbrace $, we define the density metric as: In practice, the computed density metric values often follow a heavy-tailed distribution, thus sometimes its $\log $ value is reported and denoted as $density (log\-scale)$. ### Proposed Characteristic Metrics ::: Homogeneity
The homogeneity metric is proposed to summarize the uniformity of a cluster distribution. That is, how uniformly the embedding vectors of the samples in a group of texts are distributed in the embedding space. We propose to quantitatively describe homogeneity by building a fully-connected, edge-weighted network, which can be modeled by a Markov chain model. A Markov chain's entropy rate is calculated and normalized to be in $[0, 1]$ range by dividing by the entropy's theoretical upper bound. This output value is defined as the homogeneity metric detailed as follows: To construct a fully-connected network from the embedding vectors $\lbrace e_1, ..., e_m\rbrace $, we compute their pairwise distances as edge weights, an idea similar to AttriRank BIBREF22. As the Euclidean distance is not a good metric in high-dimensions, we normalize the distance by adding a power $\log (n\_dim)$. We then define a Markov chain model with the weight of $edge(i, j)$ being and the conditional probability of transition from $i$ to $j$ can be written as All the transition probabilities $p(i \rightarrow j)$ are from the transition matrix of a Markov chain. An entropy of this Markov chain can be calculated as where $\nu _i$ is the stationary distribution of the Markov chain. As self-transition probability $p(i \rightarrow i)$ is always zero because of zero distance, there are $(m - 1)$ possible destinations and the entropy's theoretical upper bound becomes Our proposed homogeneity metric is then normalized into $[0, 1]$ as a uniformity measure: The intuition is that if some samples are close to each other but far from all the others, the calculated entropy decreases to reflect the unbalanced distribution. In contrast, if each sample can reach other samples within more-or-less the same distances, the calculated entropy as well as the homogeneity measure would be high as it implies the samples could be more uniformly distributed. ### Simulations
To verify that each proposed characteristic metric holds its desirable and intuitive properties, we conduct a series of simulation experiments in 2-dimensional as well as 768-dimensional spaces. The latter has the same dimensionality as the output of our chosen embedding method-BERT, in the following Experiments section. ### Simulations ::: Simulation Setup
The base simulation setup is a randomly generated isotropic Gaussian blob that contains $10,000$ data points with the standard deviation along each axis to be $1.0$ and is centered around the origin. All Gaussian blobs are created using make_blobs function in the scikit-learn package. Four simulation scenarios are used to investigate the behavior of our proposed quantitative characteristic metrics: Down-sampling: Down-sample the base cluster to be $\lbrace 90\%, 80\%, ..., 10\%\rbrace $ of its original size. That is, create Gaussian blobs with $\lbrace 9000, ..., 1000\rbrace $ data points; Varying Spread: Generate Gaussian blobs with standard deviations of each axis to be $\lbrace 2.0, 3.0, ..., 10.0\rbrace $; Outliers: Add $\lbrace 50, 100, ..., 500\rbrace $ outlier data points, i.e., $\lbrace 0.5\%, ..., 5\%\rbrace $ of the original cluster size, randomly on the surface with a fixed norm or radius; Multiple Sub-clusters: Along the 1th-axis, with $10,000$ data points in total, create $\lbrace 1, 2, ..., 10\rbrace $ clusters with equal sample sizes but at increasing distance. For each scenario, we simulate a cluster and compute the characteristic metrics in both 2-dimensional and 768-dimensional spaces. Figure FIGREF17 visualizes each scenario by t-distributed Stochastic Neighbor Embedding (t-SNE) BIBREF23. The 768-dimensional simulations are visualized by down-projecting to 50 dimensions via Principal Component Analysis (PCA) followed by t-SNE. ### Simulations ::: Simulation Results
Figure FIGREF24 summarizes calculated diversity metrics in the first row, density metrics in the second row, and homogeneity metrics in the third row, for all simulation scenarios. The diversity metric is robust as its values remain almost the same to the down-sampling of an input cluster. This implies the diversity metric has a desirable property that it is insensitive to the size of inputs. On the other hand, it shows a linear relationship to varying spreads. It is another intuitive property for a diversity metric that it grows linearly with increasing dispersion or variance of input data. With more outliers or more sub-clusters, the diversity metric can also reflect the increasing dispersion of cluster distributions but is less sensitive in high-dimensional spaces. For the density metrics, it exhibits a linear relationship to the size of inputs when down-sampling, which is desired. When increasing spreads, the trend of density metrics corresponds well with human intuition. Note that the density metrics decrease at a much faster rate in higher-dimensional space as log-scale is used in the figure. The density metrics also drop when adding outliers or having multiple distant sub-clusters. This makes sense since both scenarios should increase the dispersion of data and thus increase our notion of volume as well. In multiple sub-cluster scenario, the density metric becomes less sensitive in the higher-dimensional space. The reason could be that the sub-clusters are distributed only along one axis and thus have a smaller impact on volume in higher-dimensional spaces. As random down-sampling or increasing variance of each axis should not affect the uniformity of a cluster distribution, we expect the homogeneity metric remains approximately the same values. And the proposed homogeneity metric indeed demonstrates these ideal properties. Interestingly, for outliers, we first saw huge drops of the homogeneity metric but the values go up again slowly when more outliers are added. This corresponds well with our intuitions that a small number of outliers break the uniformity but more outliers should mean an increase of uniformity because the distribution of added outliers themselves has a high uniformity. For multiple sub-clusters, as more sub-clusters are presented, the homogeneity should and does decrease as the data are less and less uniformly distributed in the space. To sum up, from all simulations, our proposed diversity, density, and homogeneity metrics indeed capture the essence or intuition of dispersion, sparsity, and uniformity in a cluster distribution. ### Experiments
The two real-world text classification tasks we used for experiments are sentiment analysis and Spoken Language Understanding (SLU). ### Experiments ::: Chosen Embedding Method
BERT is a self-supervised language model pretraining approach based on the Transformer BIBREF24, a multi-headed self-attention architecture that can produce different representation vectors for the same token in various sequences, i.e., contextual embeddings. When pretraining, BERT concatenates two sequences as input, with special tokens $[CLS], [SEP], [EOS]$ denoting the start, separation, and end, respectively. BERT is then pretrained on a large unlabeled corpus with objective-masked language model (MLM), which randomly masks out tokens, and the model predicts the masked tokens. The other classification task is next sentence prediction (NSP). NSP is to predict whether two sequences follow each other in the original text or not. In this work, we use the pretrained $\text{BERT}_{\text{BASE}}$ which has 12 layers (L), 12 self-attention heads (A), and 768 hidden dimension (H) as the language embedding to compute the proposed data metrics. The off-the-shelf pretrained BERT is obtained from GluonNLP. For each sequence $x_i = (x_{i1}, ..., x_{il})$ with length $l$, BERT takes $[CLS], x_{i1}, ..., x_{il}, [EOS]$ as input and generates embeddings $\lbrace e_{CLS}, e_{i1}, ..., e_{il}, e_{EOS}\rbrace $ at the token level. To obtain the sequence representation, we use a mean pooling over token embeddings: where $e_i \in \mathbb {R}^{H}$. A text collection $\lbrace x_1, ..., x_m\rbrace $, i.e., a set of token sequences, is then transformed into a group of H-dimensional vectors $\lbrace e_1, ..., e_m\rbrace $. We compute each metric as described previously, using three BERT layers L1, L6, and L12 as the embedding space, respectively. The calculated metric values are averaged over layers for each class and averaged over classes weighted by class size as the final value for a dataset. ### Experiments ::: Experimental Setup
In the first task, we use the SST-2 (Stanford Sentiment Treebank, version 2) dataset BIBREF25 to conduct sentiment analysis experiments. SST-2 is a sentence binary classification dataset with train/dev/test splits provided and two types of sentence labels, i.e., positive and negative. The second task involves two essential problems in SLU, which are intent classification (IC) and slot labeling (SL). In IC, the model needs to detect the intention of a text input (i.e., utterance, conveys). For example, for an input of I want to book a flight to Seattle, the intention is to book a flight ticket, hence the intent class is bookFlight. In SL, the model needs to extract the semantic entities that are related to the intent. From the same example, Seattle is a slot value related to booking the flight, i.e., the destination. Here we experiment with the Snips dataset BIBREF26, which is widely used in SLU research. This dataset contains test spoken utterances (text) classified into one of 7 intents. In both tasks, we used the open-sourced GluonNLP BERT model to perform text classification. For evaluation, sentiment analysis is measured in accuracy, whereas IC and SL are measured in accuracy and F1 score, respectively. BERT is fine-tuned on train/dev sets and evaluated on test sets. We down-sampled SST-2 and Snips training sets from $100\%$ to $10\%$ with intervals being $10\%$. BERT's performance is reported for each down-sampled setting in Table TABREF29 and Table TABREF30. We used entire test sets for all model evaluations. To compare, we compute the proposed data metrics, i.e., diversity, density, and homogeneity, on the original and the down-sampled training sets. ### Experiments ::: Experimental Results
We will discuss the three proposed characteristic metrics, i.e., diversity, density, and homogeneity, and model performance scores from down-sampling experiments on the two public benchmark datasets, in the following subsections: ### Experiments ::: Experimental Results ::: SST-2
In Table TABREF29, the sentiment classification accuracy is $92.66\%$ without down-sampling, which is consistent with the reported GluonNLP BERT model performance on SST-2. It also indicates SST-2 training data are differentiable between label classes, i.e., from the positive class to the negative class, which satisfies our assumption for the characteristic metrics. Decreasing the training set size does not reduce performance until it is randomly down-sampled to only $20\%$ of the original size. Meanwhile, density and homogeneity metrics also decrease significantly (highlighted in bold in Table TABREF29), implying a clear relationship between these metrics and model performance. ### Experiments ::: Experimental Results ::: Snips
In Table TABREF30, the Snips dataset seems to be distinct between IC/SL classes since the IC accurcy and SL F1 are as high as $98.71\%$ and $96.06\%$ without down-sampling, respectively. Similar to SST-2, this implies that Snips training data should also support the inter-class differentiability assumption for our proposed characteristic metrics. IC accuracy on Snips remains higher than $98\%$ until we down-sample the training set to $20\%$ of the original size. In contrast, SL F1 score is more sensitive to the down-sampling of the training set, as it starts decreasing when down-sampling. When the training set is only $10\%$ left, SL F1 score drops to $87.20\%$. The diversity metric does not decrease immediately until the training set equals to or is less than $40\%$ of the original set. This implies that random sampling does not impact the diversity, if the sampling rate is greater than $40\%$. The training set is very likely to contain redundant information in terms of text diversity. This is supported by what we observed as model has consistently high IC/SL performances between $40\%$-$100\%$ down-sampling ratios. Moreover, the biggest drop of density and homogeneity (highlighted in bold in Table TABREF30) highly correlates with the biggest IC/SL drop, at the point the training set size is reduced from $20\%$ to $10\%$. This suggests that our proposed metrics can be used as a good indicator of model performance and for characterizing text datasets. ### Analysis
We calculate and show in Table TABREF35 the Pearson's correlations between the three proposed characteristic metrics, i.e., diversity, density, and homogeneity, and model performance scores from down-sampling experiments in Table TABREF29 and Table TABREF30. Correlations higher than $0.5$ are highlighted in bold. As mentioned before, model performance is highly correlated with density and homogeneity, both are computed on the train set. Diversity is only correlated with Snips SL F1 score at a moderate level. These are consistent with our simulation results, which shows that random sampling of a dataset does not necessarily affect the diversity but can reduce the density and marginally homogeneity due to the decreasing of data points in the embedding space. However, the simultaneous huge drops of model performance, density, and homogeneity imply that there is only limited redundancy and more informative data points are being thrown away when down-sampling. Moreover, results also suggest that model performance on text classification tasks corresponds not only with data diversity but also with training data density and homogeneity as well. ### Conclusions
In this work, we proposed several characteristic metrics to describe the diversity, density, and homogeneity of text collections without using any labels. Pre-trained language embeddings are used to efficiently characterize text datasets. Simulation and experiments showed that our intrinsic metrics are robust and highly correlated with model performance on different text classification tasks. We would like to apply the diversity, density, and homogeneity metrics for text data augmentation and selection in a semi-supervised manner as our future work. Figure 1: Visualization of the simulations including base setting, down-sampling, varying spreads, adding outliers, and multiple sub-clusters in 2-dimensional and 768-dimensional spaces. Figure 2: Diversity, density, and homogeneity metric values in each simulation scenario. Table 1: The experimental results of diversity, density, and homogeneity metrics with classification accuracy on the SST-2 dataset. Table 2: The experimental results of diversity, density, and homogeneity metrics with intent classification (IC) accuracy and slot labeling (SL) F1 scores on the Snips dataset. Experimental setup is the same as that in Table 1. Table 3: The Pearson’s correlation (Corr.) between proposed characteristic metrics (diversity, density, and homogeneity) and model accuracy (Acc.) or F1 scores from down-sampling experiments in Table 1 and Table 2.
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SST-2, Snips
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What portion of the journey was spent in cryosleep?
A. 4 months
B. They did not use cryosleep.
C. 6 months
D. 8 months
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THE DOPE on Mars By JACK SHARKEY Somebody had to get the human angle on this trip ... but what was humane about sending me? Illustrated by WOOD My agent was the one who got me the job of going along to write up the first trip to Mars. He was always getting me things like that—appearances on TV shows, or mentions in writers' magazines. If he didn't sell much of my stuff, at least he sold me . "It'll be the biggest break a writer ever got," he told me, two days before blastoff. "Oh, sure there'll be scientific reports on the trip, but the public doesn't want them; they want the human slant on things." "But, Louie," I said weakly, "I'll probably be locked up for the whole trip. If there are fights or accidents, they won't tell me about them." "Nonsense," said Louie, sipping carefully at a paper cup of scalding coffee. "It'll be just like the public going along vicariously. They'll identify with you." "But, Louie," I said, wiping the dampness from my palms on the knees of my trousers as I sat there, "how'll I go about it? A story? An article? A you-are-there type of report? What?" Louie shrugged. "So keep a diary. It'll be more intimate, like." "But what if nothing happens?" I insisted hopelessly. Louie smiled. "So you fake it." I got up from the chair in his office and stepped to the door. "That's dishonest," I pointed out. "Creative is the word," Louie said. So I went on the first trip to Mars. And I kept a diary. This is it. And it is honest. Honest it is. October 1, 1960 They picked the launching date from the March, 1959, New York Times , which stated that this was the most likely time for launching. Trip time is supposed to take 260 days (that's one way), so we're aimed toward where Mars will be (had better be, or else). There are five of us on board. A pilot, co-pilot, navigator and biochemist. And, of course, me. I've met all but the pilot (he's very busy today), and they seem friendly enough. Dwight Kroger, the biochemist, is rather old to take the "rigors of the journey," as he puts it, but the government had a choice between sending a green scientist who could stand the trip or an accomplished man who would probably not survive, so they picked Kroger. We've blasted off, though, and he's still with us. He looks a damn sight better than I feel. He's kind of balding, and very iron-gray-haired and skinny, but his skin is tan as an Indian's, and right now he's telling jokes in the washroom with the co-pilot. Jones (that's the co-pilot; I didn't quite catch his first name) is scarlet-faced, barrel-chested and gives the general appearance of belonging under the spreading chestnut tree, not in a metal bullet flinging itself out into airless space. Come to think of it, who does belong where we are? The navigator's name is Lloyd Streeter, but I haven't seen his face yet. He has a little cubicle behind the pilot's compartment, with all kinds of maps and rulers and things. He keeps bent low over a welded-to-the-wall (they call it the bulkhead, for some reason or other) table, scratching away with a ballpoint pen on the maps, and now and then calling numbers over a microphone to the pilot. His hair is red and curly, and he looks as though he'd be tall if he ever gets to stand up. There are freckles on the backs of his hands, so I think he's probably got them on his face, too. So far, all he's said is, "Scram, I'm busy." Kroger tells me that the pilot's name is Patrick Desmond, but that I can call him Pat when I get to know him better. So far, he's still Captain Desmond to me. I haven't the vaguest idea what he looks like. He was already on board when I got here, with my typewriter and ream of paper, so we didn't meet. My compartment is small but clean. I mean clean now. It wasn't during blastoff. The inertial gravities didn't bother me so much as the gyroscopic spin they put on the ship so we have a sort of artificial gravity to hold us against the curved floor. It's that constant whirly feeling that gets me. I get sick on merry-go-rounds, too. They're having pork for dinner today. Not me. October 2, 1960 Feeling much better today. Kroger gave me a box of Dramamine pills. He says they'll help my stomach. So far, so good. Lloyd came by, also. "You play chess?" he asked. "A little," I admitted. "How about a game sometime?" "Sure," I said. "Do you have a board?" He didn't. Lloyd went away then, but the interview wasn't wasted. I learned that he is tall and does have a freckled face. Maybe we can build a chessboard. With my paper and his ballpoint pen and ruler, it should be easy. Don't know what we'll use for pieces, though. Jones (I still haven't learned his first name) has been up with the pilot all day. He passed my room on the way to the galley (the kitchen) for a cup of dark brown coffee (they like it thick) and told me that we were almost past the Moon. I asked to look, but he said not yet; the instrument panel is Top Secret. They'd have to cover it so I could look out the viewing screen, and they still need it for steering or something. I still haven't met the pilot. October 3, 1960 Well, I've met the pilot. He is kind of squat, with a vulturish neck and close-set jet-black eyes that make him look rather mean, but he was pleasant enough, and said I could call him Pat. I still don't know Jones' first name, though Pat spoke to him, and it sounded like Flants. That can't be right. Also, I am one of the first five men in the history of the world to see the opposite side of the Moon, with a bluish blurred crescent beyond it that Pat said was the Earth. The back of the Moon isn't much different from the front. As to the space in front of the ship, well, it's all black with white dots in it, and none of the dots move, except in a circle that Pat says is a "torque" result from the gyroscopic spin we're in. Actually, he explained to me, the screen is supposed to keep the image of space locked into place no matter how much we spin. But there's some kind of a "drag." I told him I hoped it didn't mean we'd land on Mars upside down. He just stared at me. I can't say I was too impressed with that 16 x 19 view of outer space. It's been done much better in the movies. There's just no awesomeness to it, no sense of depth or immensity. It's as impressive as a piece of velvet with salt sprinkled on it. Lloyd and I made a chessboard out of a carton. Right now we're using buttons for men. He's one of these fast players who don't stop and think out their moves. And so far I haven't won a game. It looks like a long trip. October 4, 1960 I won a game. Lloyd mistook my queen-button for my bishop-button and left his king in jeopardy, and I checkmated him next move. He said chess was a waste of time and he had important work to do and he went away. I went to the galley for coffee and had a talk about moss with Kroger. He said there was a good chance of lichen on Mars, and I misunderstood and said, "A good chance of liking what on Mars?" and Kroger finished his coffee and went up front. When I got back to my compartment, Lloyd had taken away the chessboard and all his buttons. He told me later he needed it to back up a star map. Pat slept mostly all day in his compartment, and Jones sat and watched the screen revolve. There wasn't much to do, so I wrote a poem, sort of. Mary, Mary, quite contrary, How does your garden grow? With Martian rime, Venusian slime, And a radioactive hoe. I showed it to Kroger. He says it may prove to be environmentally accurate, but that I should stick to prose. October 5, 1960 Learned Jones' first name. He wrote something in the ship's log, and I saw his signature. His name is Fleance, like in "Macbeth." He prefers to be called Jones. Pat uses his first name as a gag. Some fun. And only 255 days to go. April 1, 1961 I've skipped over the last 177 days or so, because there's nothing much new. I brought some books with me on the trip, books that I'd always meant to read and never had the time. So now I know all about Vanity Fair , Pride and Prejudice , War and Peace , Gone with the Wind , and Babbitt . They didn't take as long as I thought they would, except for Vanity Fair . It must have been a riot when it first came out. I mean, all those sly digs at the aristocracy, with copious interpolations by Mr. Thackeray in case you didn't get it when he'd pulled a particularly good gag. Some fun. And only 78 days to go. June 1, 1961 Only 17 days to go. I saw Mars on the screen today. It seems to be descending from overhead, but Pat says that that's the "torque" doing it. Actually, it's we who are coming in sideways. We've all grown beards, too. Pat said it was against regulations, but what the hell. We have a contest. Longest whiskers on landing gets a prize. I asked Pat what the prize was and he told me to go to hell. June 18, 1961 Mars has the whole screen filled. Looks like Death Valley. No sign of canals, but Pat says that's because of the dust storm down below. It's nice to have a "down below" again. We're going to land, so I have to go to my bunk. It's all foam rubber, nylon braid supports and magnesium tubing. Might as well be cement for all the good it did me at takeoff. Earth seems awfully far away. June 19, 1961 Well, we're down. We have to wear gas masks with oxygen hook-ups. Kroger says the air is breathable, but thin, and it has too much dust in it to be any fun to inhale. He's all for going out and looking for lichen, but Pat says he's got to set up camp, then get instructions from Earth. So we just have to wait. The air is very cold, but the Sun is hot as hell when it hits you. The sky is a blinding pink, or maybe more of a pale fuchsia. Kroger says it's the dust. The sand underfoot is kind of rose-colored, and not really gritty. The particles are round and smooth. No lichen so far. Kroger says maybe in the canals, if there are any canals. Lloyd wants to play chess again. Jones won the beard contest. Pat gave him a cigar he'd smuggled on board (no smoking was allowed on the ship), and Jones threw it away. He doesn't smoke. June 20, 1961 Got lost today. Pat told me not to go too far from camp, so, when I took a stroll, I made sure every so often that I could still see the rocket behind me. Walked for maybe an hour; then the oxygen gauge got past the halfway mark, so I started back toward the rocket. After maybe ten steps, the rocket disappeared. One minute it was standing there, tall and silvery, the next instant it was gone. Turned on my radio pack and got hold of Pat. Told him what happened, and he told Kroger. Kroger said I had been following a mirage, to step back a bit. I did, and I could see the ship again. Kroger said to try and walk toward where the ship seemed to be, even when it wasn't in view, and meantime they'd come out after me in the jeep, following my footprints. Started walking back, and the ship vanished again. It reappeared, disappeared, but I kept going. Finally saw the real ship, and Lloyd and Jones waving their arms at me. They were shouting through their masks, but I couldn't hear them. The air is too thin to carry sound well. All at once, something gleamed in their hands, and they started shooting at me with their rifles. That's when I heard the noise behind me. I was too scared to turn around, but finally Jones and Lloyd came running over, and I got up enough nerve to look. There was nothing there, but on the sand, paralleling mine, were footprints. At least I think they were footprints. Twice as long as mine, and three times as wide, but kind of featureless because the sand's loose and dry. They doubled back on themselves, spaced considerably farther apart. "What was it?" I asked Lloyd when he got to me. "Damned if I know," he said. "It was red and scaly, and I think it had a tail. It was two heads taller than you." He shuddered. "Ran off when we fired." "Where," said Jones, "are Pat and Kroger?" I didn't know. I hadn't seen them, nor the jeep, on my trip back. So we followed the wheel tracks for a while, and they veered off from my trail and followed another, very much like the one that had been paralleling mine when Jones and Lloyd had taken a shot at the scaly thing. "We'd better get them on the radio," said Jones, turning back toward the ship. There wasn't anything on the radio but static. Pat and Kroger haven't come back yet, either. June 21, 1961 We're not alone here. More of the scaly things have come toward the camp, but a few rifle shots send them away. They hop like kangaroos when they're startled. Their attitudes aren't menacing, but their appearance is. And Jones says, "Who knows what's 'menacing' in an alien?" We're going to look for Kroger and Pat today. Jones says we'd better before another windstorm blows away the jeep tracks. Fortunately, the jeep has a leaky oil pan, so we always have the smears to follow, unless they get covered up, too. We're taking extra oxygen, shells, and rifles. Food, too, of course. And we're locking up the ship. It's later , now. We found the jeep, but no Kroger or Pat. Lots of those big tracks nearby. We're taking the jeep to follow the aliens' tracks. There's some moss around here, on reddish brown rocks that stick up through the sand, just on the shady side, though. Kroger must be happy to have found his lichen. The trail ended at the brink of a deep crevice in the ground. Seems to be an earthquake-type split in solid rock, with the sand sifting over this and the far edge like pink silk cataracts. The bottom is in the shade and can't be seen. The crack seems to extend to our left and right as far as we can look. There looks like a trail down the inside of the crevice, but the Sun's setting, so we're waiting till tomorrow to go down. Going down was Jones' idea, not mine. June 22, 1961 Well, we're at the bottom, and there's water here, a shallow stream about thirty feet wide that runs along the center of the canal (we've decided we're in a canal). No sign of Pat or Kroger yet, but the sand here is hard-packed and damp, and there are normal-size footprints mingled with the alien ones, sharp and clear. The aliens seem to have six or seven toes. It varies from print to print. And they're barefoot, too, or else they have the damnedest-looking shoes in creation. The constant shower of sand near the cliff walls is annoying, but it's sandless (shower-wise) near the stream, so we're following the footprints along the bank. Also, the air's better down here. Still thin, but not so bad as on the surface. We're going without masks to save oxygen for the return trip (Jones assures me there'll be a return trip), and the air's only a little bit sandy, but handkerchiefs over nose and mouth solve this. We look like desperadoes, what with the rifles and covered faces. I said as much to Lloyd and he told me to shut up. Moss all over the cliff walls. Swell luck for Kroger. We've found Kroger and Pat, with the help of the aliens. Or maybe I should call them the Martians. Either way, it's better than what Jones calls them. They took away our rifles and brought us right to Kroger and Pat, without our even asking. Jones is mad at the way they got the rifles so easily. When we came upon them (a group of maybe ten, huddling behind a boulder in ambush), he fired, but the shots either bounced off their scales or stuck in their thick hides. Anyway, they took the rifles away and threw them into the stream, and picked us all up and took us into a hole in the cliff wall. The hole went on practically forever, but it didn't get dark. Kroger tells me that there are phosphorescent bacteria living in the mold on the walls. The air has a fresh-dug-grave smell, but it's richer in oxygen than even at the stream. We're in a small cave that is just off a bigger cave where lots of tunnels come together. I can't remember which one we came in through, and neither can anyone else. Jones asked me what the hell I kept writing in the diary for, did I want to make it a gift to Martian archeologists? But I said where there's life there's hope, and now he won't talk to me. I congratulated Kroger on the lichen I'd seen, but he just said a short and unscientific word and went to sleep. There's a Martian guarding the entrance to our cave. I don't know what they intend to do with us. Feed us, I hope. So far, they've just left us here, and we're out of rations. Kroger tried talking to the guard once, but he (or it) made a whistling kind of sound and flashed a mouthful of teeth. Kroger says the teeth are in multiple rows, like a tiger shark's. I'd rather he hadn't told me. June 23, 1961, I think We're either in a docket or a zoo. I can't tell which. There's a rather square platform surrounded on all four sides by running water, maybe twenty feet across, and we're on it. Martians keep coming to the far edge of the water and looking at us and whistling at each other. A little Martian came near the edge of the water and a larger Martian whistled like crazy and dragged it away. "Water must be dangerous to them," said Kroger. "We shoulda brought water pistols," Jones muttered. Pat said maybe we can swim to safety. Kroger told Pat he was crazy, that the little island we're on here underground is bordered by a fast river that goes into the planet. We'd end up drowned in some grotto in the heart of the planet, says Kroger. "What the hell," says Pat, "it's better than starving." It is not. June 24, 1961, probably I'm hungry . So is everybody else. Right now I could eat a dinner raw, in a centrifuge, and keep it down. A Martian threw a stone at Jones today, and Jones threw one back at him and broke off a couple of scales. The Martian whistled furiously and went away. When the crowd thinned out, same as it did yesterday (must be some sort of sleeping cycle here), Kroger talked Lloyd into swimming across the river and getting the red scales. Lloyd started at the upstream part of the current, and was about a hundred yards below this underground island before he made the far side. Sure is a swift current. But he got the scales, walked very far upstream of us, and swam back with them. The stream sides are steep, like in a fjord, and we had to lift him out of the swirling cold water, with the scales gripped in his fist. Or what was left of the scales. They had melted down in the water and left his hand all sticky. Kroger took the gummy things, studied them in the uncertain light, then tasted them and grinned. The Martians are made of sugar. Later, same day . Kroger said that the Martian metabolism must be like Terran (Earth-type) metabolism, only with no pancreas to make insulin. They store their energy on the outside of their bodies, in the form of scales. He's watched them more closely and seen that they have long rubbery tubes for tongues, and that they now and then suck up water from the stream while they're watching us, being careful not to get their lips (all sugar, of course) wet. He guesses that their "blood" must be almost pure water, and that it washes away (from the inside, of course) the sugar they need for energy. I asked him where the sugar came from, and he said probably their bodies isolated carbon from something (he thought it might be the moss) and combined it with the hydrogen and oxygen in the water (even I knew the formula for water) to make sugar, a common carbohydrate. Like plants, on Earth, he said. Except, instead of using special cells on leaves to form carbohydrates with the help of sunpower, as Earth plants do in photosynthesis (Kroger spelled that word for me), they used the shape of the scales like prisms, to isolate the spectra (another Kroger word) necessary to form the sugar. "I don't get it," I said politely, when he'd finished his spiel. "Simple," he said, as though he were addressing me by name. "They have a twofold reason to fear water. One: by complete solvency in that medium, they lose all energy and die. Two: even partial sprinkling alters the shape of the scales, and they are unable to use sunpower to form more sugar, and still die, if a bit slower." "Oh," I said, taking it down verbatim. "So now what do we do?" "We remove our boots," said Kroger, sitting on the ground and doing so, "and then we cross this stream, fill the boots with water, and spray our way to freedom." "Which tunnel do we take?" asked Pat, his eyes aglow at the thought of escape. Kroger shrugged. "We'll have to chance taking any that seem to slope upward. In any event, we can always follow it back and start again." "I dunno," said Jones. "Remember those teeth of theirs. They must be for biting something more substantial than moss, Kroger." "We'll risk it," said Pat. "It's better to go down fighting than to die of starvation." The hell it is. June 24, 1961, for sure The Martians have coal mines. That's what they use those teeth for. We passed through one and surprised a lot of them chewing gritty hunks of anthracite out of the walls. They came running at us, whistling with those tubelike tongues, and drooling dry coal dust, but Pat swung one of his boots in an arc that splashed all over the ground in front of them, and they turned tail (literally) and clattered off down another tunnel, sounding like a locomotive whistle gone berserk. We made the surface in another hour, back in the canal, and were lucky enough to find our own trail to follow toward the place above which the jeep still waited. Jones got the rifles out of the stream (the Martians had probably thought they were beyond recovery there) and we found the jeep. It was nearly buried in sand, but we got it cleaned off and running, and got back to the ship quickly. First thing we did on arriving was to break out the stores and have a celebration feast just outside the door of the ship. It was pork again, and I got sick. June 25, 1961 We're going back . Pat says that a week is all we were allowed to stay and that it's urgent to return and tell what we've learned about Mars (we know there are Martians, and they're made of sugar). "Why," I said, "can't we just tell it on the radio?" "Because," said Pat, "if we tell them now, by the time we get back we'll be yesterday's news. This way we may be lucky and get a parade." "Maybe even money," said Kroger, whose mind wasn't always on science. "But they'll ask why we didn't radio the info, sir," said Jones uneasily. "The radio," said Pat, nodding to Lloyd, "was unfortunately broken shortly after landing." Lloyd blinked, then nodded back and walked around the rocket. I heard a crunching sound and the shattering of glass, not unlike the noise made when one drives a rifle butt through a radio. Well, it's time for takeoff. This time it wasn't so bad. I thought I was getting my space-legs, but Pat says there's less gravity on Mars, so escape velocity didn't have to be so fast, hence a smoother (relatively) trip on our shock-absorbing bunks. Lloyd wants to play chess again. I'll be careful not to win this time. However, if I don't win, maybe this time I'll be the one to quit. Kroger is busy in his cramped lab space trying to classify the little moss he was able to gather, and Jones and Pat are up front watching the white specks revolve on that black velvet again. Guess I'll take a nap. June 26, 1961 Hell's bells . Kroger says there are two baby Martians loose on board ship. Pat told him he was nuts, but there are certain signs he's right. Like the missing charcoal in the air-filtration-and-reclaiming (AFAR) system. And the water gauges are going down. But the clincher is those two sugar crystals Lloyd had grabbed up when we were in that zoo. They're gone. Pat has declared a state of emergency. Quick thinking, that's Pat. Lloyd, before he remembered and turned scarlet, suggested we radio Earth for instructions. We can't. Here we are, somewhere in a void headed for Earth, with enough air and water left for maybe three days—if the Martians don't take any more. Kroger is thrilled that he is learning something, maybe, about Martian reproductive processes. When he told Pat, Pat put it to a vote whether or not to jettison Kroger through the airlock. However, it was decided that responsibility was pretty well divided. Lloyd had gotten the crystals, Kroger had only studied them, and Jones had brought them aboard. So Kroger stays, but meanwhile the air is getting worse. Pat suggested Kroger put us all into a state of suspended animation till landing time, eight months away. Kroger said, "How?" June 27, 1961 Air is foul and I'm very thirsty. Kroger says that at least—when the Martians get bigger—they'll have to show themselves. Pat says what do we do then ? We can't afford the water we need to melt them down. Besides, the melted crystals might all turn into little Martians. Jones says he'll go down spitting. Pat says why not dismantle interior of rocket to find out where they're holing up? Fine idea. How do you dismantle riveted metal plates? June 28, 1961 The AFAR system is no more and the water gauges are still dropping. Kroger suggests baking bread, then slicing it, then toasting it till it turns to carbon, and we can use the carbon in the AFAR system. We'll have to try it, I guess. The Martians ate the bread. Jones came forward to tell us the loaves were cooling, and when he got back they were gone. However, he did find a few of the red crystals on the galley deck (floor). They're good-sized crystals, too. Which means so are the Martians. Kroger says the Martians must be intelligent, otherwise they couldn't have guessed at the carbohydrates present in the bread after a lifelong diet of anthracite. Pat says let's jettison Kroger. This time the vote went against Kroger, but he got a last-minute reprieve by suggesting the crystals be pulverized and mixed with sulphuric acid. He says this'll produce carbon. I certainly hope so. So does Kroger. Brief reprieve for us. The acid-sugar combination not only produces carbon but water vapor, and the gauge has gone up a notch. That means that we have a quart of water in the tanks for drinking. However, the air's a bit better, and we voted to let Kroger stay inside the rocket. Meantime, we have to catch those Martians. June 29, 1961 Worse and worse . Lloyd caught one of the Martians in the firing chamber. We had to flood the chamber with acid to subdue the creature, which carbonized nicely. So now we have plenty of air and water again, but besides having another Martian still on the loose, we now don't have enough acid left in the fuel tanks to make a landing. Pat says at least our vector will carry us to Earth and we can die on our home planet, which is better than perishing in space. The hell it is. March 3, 1962 Earth in sight . The other Martian is still with us. He's where we can't get at him without blow-torches, but he can't get at the carbon in the AFAR system, either, which is a help. However, his tail is prehensile, and now and then it snakes out through an air duct and yanks food right off the table from under our noses. Kroger says watch out. We are made of carbohydrates, too. I'd rather not have known. March 4, 1962 Earth fills the screen in the control room. Pat says if we're lucky, he might be able to use the bit of fuel we have left to set us in a descending spiral into one of the oceans. The rocket is tighter than a submarine, he insists, and it will float till we're rescued, if the plates don't crack under the impact. We all agreed to try it. Not that we thought it had a good chance of working, but none of us had a better idea. I guess you know the rest of the story, about how that destroyer spotted us and got us and my diary aboard, and towed the rocket to San Francisco. News of the "captured Martian" leaked out, and we all became nine-day wonders until the dismantling of the rocket. Kroger says he must have dissolved in the water, and wonders what that would do. There are about a thousand of those crystal-scales on a Martian. So last week we found out, when those red-scaled things began clambering out of the sea on every coastal region on Earth. Kroger tried to explain to me about salinity osmosis and hydrostatic pressure and crystalline life, but in no time at all he lost me. The point is, bullets won't stop these things, and wherever a crystal falls, a new Martian springs up in a few weeks. It looks like the five of us have abetted an invasion from Mars. Needless to say, we're no longer heroes. I haven't heard from Pat or Lloyd for a week. Jones was picked up attacking a candy factory yesterday, and Kroger and I were allowed to sign on for the flight to Venus scheduled within the next few days—because of our experience. Kroger says there's only enough fuel for a one-way trip. I don't care. I've always wanted to travel with the President. —JACK SHARKEY Transcriber's Note: This etext was produced from Galaxy Magazine June 1960. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note.
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B. They did not use cryosleep.
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What is the unspoken warning of the psychologist?
A. Even good jobs get boring on Terra.
B. Private citizens do not enjoy the same rights as spacemen.
C. The culture on Terra is radically different from the culture in space.
D. The gravity on Terra could make a spaceman feel sick all the time.
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SEA LEGS By FRANK QUATTROCCHI Illustrated by EMSH [Transcriber's Note: This etext was produced from Galaxy Science Fiction November 1951. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Rootless and footloose, a man in space can't help but dream of coming home. But something nobody should do is bet on the validity of a homesick dream! Flight Officer Robert Craig surrendered the tube containing his service record tapes and stood waiting while the bored process clerk examined the seal. "Your clearance," said the clerk. Craig handed him a battered punch card and watched the man insert it in the reproducer. He felt anxiety as the much-handled card refused for a time to match the instrument's metal contact points. The line of men behind Craig fidgeted. "You got to get this punched by Territorial," said the clerk. "Take it back to your unit's clearance office." "Look again, Sergeant," Craig said, repressing his irritation. "It ain't notched." "The hell it isn't." The man examined the card with squinting care and nodded finally. "It's so damn notched," he complained. "You ought to take care of that card; can't get on without one." Craig hesitated before moving. "Next," said the clerk, "What you waiting for?" "Don't I take my 201 file?" "We send it on ahead. Go to Grav 1 desk." A murmur greeted the order. Craig experienced the thrill of knowing the envy of the others. Grav 1—that meant Terra. He crossed the long, dreary room, knowing the eyes of the other men were upon him. "Your service tapes," the next noncom said. "Where you going?" "Grav 1—Terra," fumbled Craig. "Los Angeles." "Los Angeles, eh? Where in Los Angeles?" "I—I—" Craig muttered, fumbling in his pockets. "No specific destination," supplied the man as he punched a key on a small instrument, "Air-lock ahead and to your right. Strip and follow the robot's orders. Any metal?" "Metal?" asked Craig. "You know, metal ." "Well, my identification key." "Here," commanded the clerk, extending a plastic envelope. Craig moved in the direction indicated. He fought the irrational fear that he had missed an important step in the complicated clerical process. He cursed the grudging attitude of the headquarters satellite personnel and felt the impotence of a spaceman who had long forgotten the bureaucracy of a rear area base. The knowledge that much of it was motivated by envy soothed him as he clumsily let himself into the lock. "Place your clothing in the receptacle provided and assume a stationary position on the raised podium in the center of the lock." Craig obeyed the robot voice and began reluctantly to remove his flight jacket. Its incredibly fine-grained leather would carry none of the strange, foreign associations for the base station clerk who would appropriate it. He would never know the beautiful, gentle beast that supplied this skin. "You are retarding the progress of others. Please respond more quickly to your orders." Craig quickly removed the last of his clothing. It was impossible to hate a robot, but one could certainly hate those who set it into operation. "You will find a red button at your feet. Lower your head and depress that button." Stepping on the button with his bare foot produced an instant of brilliant blue illumination. A small scratch on his arm stung briefly and he was somewhat blinded by the flash even through his eyelids, but that was all there was to the sterilizing process. "Your clothing and effects will be in the dressing room immediately beyond the locked door." He found his clothing cleanly and neatly hung on plastic hangers just inside the door to the dressing room. The few personal items he carried in his pockets were still there. The Schtann flight jacket was actually there, looking like new, its space-blue unfaded and as wonderfully pliant as before. "Insert your right arm into the instrument on the central table," commanded the same voice he had heard before. "Turn your arm until the scratch is in contact with the metal plate. There will be a slight pain, but it is necessary to treat the small injury you have been disregarding." Craig obeyed and clenched his teeth against a sharp stinging. His respect for the robot-controlled equipment of bases had risen. When he withdrew his arm, the scratch was neatly coated with a layer of flesh-colored plastic material. He dressed quickly and was on the verge of asking the robot for instructions, when a man appeared in the open doorway. "I am Captain Wyandotte," said the man in a pleasant voice. "Well, what's next?" asked Craig somewhat more belligerently than he had intended. The man smiled. "Your reaction is quite natural. You are somewhat aggressive after Clerical, eh?" "I'm a little anxious to get home, I suppose," said Craig defensively. "By 'home' you mean Terra. But you've never been there, have you?" "No, but my father—" "Your parents left Terra during the Second Colonization of Cassiopeia II, didn't they?" "Yes," Craig said. He was uncomfortable; Wyandotte seemed to know all about him. "We might say you've been away quite a while, eh?" "I was entered as a spaceman when I was 16," Craig said. "I've never been down for any period as yet." "You mean you haven't been in a gravity system?" "Oh, I've landed a few times, even walked around for a while...." "With the help of paraoxylnebutal," supplied the captain. "Well, sure." "Mr. Craig, I suppose you've guessed that the next step in our little torture system here is psych." "So I gathered." The captain laughed reassuringly. "No, don't put up your guard again. The worst is over. Short of Gravitational conditioning, there is nothing to stop you from going to Terra." "Sorry, I guess I'm a little touchy. This is my first time...." "Quite natural. But it being your first time—in quite a number of ways, I might add—it will be necessary for you to undergo some conditioning." "Conditioning?" asked Craig. "Yes. You have spent eleven years in space. Your body is conditioned to a normal state of free fall, or at best to a state of acceleration." "Yeah, I know. Once on Gerymeade...." "You were ill, couldn't keep your balance, felt dizzy. That is why all spacemen carry PON, paraoxylnebutal, with them. It helps suppress certain physiological reactions to an entirely new set of conditions. Channels of the ear, for example. They play an important part in our awareness of balance. They operate on a simple gravity principle. Without gravity they act up for a time, then gradually lose function. Returning to gravity is rather frightening at first." "I know all about this, Captain." "You've undoubtedly read popularizations in tapezines. But you have experienced it briefly." "I expect to have some trouble at first." Craig was disturbed by the wordy psychologist. What was the man actually saying? "Do you know what sailors of ancient times meant by 'sea legs?'" asked Wyandotte. "Men on a rolling ocean acclimated themselves to a rolling horizontal. They had trouble when they went ashore and the horizontal didn't roll any more. "It meant more than that. There were excellent psychological reasons for the old stereotype, the 'drunken sailor.' A port city was a frightening thing to an old sailor—but let's begin our little job at the beginning. I'll turn you over to psychometry for the usual tests and pick you up tomorrow morning at, say, 0900." During the days that followed, the psychologist seemed to Craig to become progressively more didactic. He would deliver long speeches about the "freedom of open space." He spoke repetitiously of the "growing complexity of Terran society." And yet the man could not be pinned down to any specific condition the spaceman would find intolerable. Craig began to hate the delay that kept him from Terra. Through the ports of the headquarters base satellite, he scanned the constellations for the scores of worlds he had visited during his eleven years in space. They were incredibly varied, even those that supported life. He had weathered difficult landings on worlds with rip-tide gravities, had felt the pull of the incredible star-tides imparted by twin and even triple star systems. He had been on Einstein IV, the planet of eight moons, and had felt the pulse of all eight of the satellites at once that no PON could completely nullify. But even if he could accept the psychologist's authority for the cumulative effect of a gravity system, he could not understand the unspoken warning he felt underlying all that the man said. "Of course it has changed," Craig was protesting. "Anyway, I never really knew very much about Terra. So what? I know it won't be as it was in tapezines either." "Yet you are so completely sure you will want to live out your life there, that you are willing to give up space service for it." "We've gone through this time and time again," Craig said wearily. "I gave you my reasons for quitting space. We analyzed them. You agreed that you could not decide that for me and that my decision is logical. You tell me spacemen don't settle down on Terra. Yet you won't—or can't—tell me why. I've got a damned good job there—" "You may find that 'damned good jobs' become boring." "So I'll transfer. I don't know what you're trying to get at, Captain, but you're not talking me out of going back. If the service needs men so badly, let them get somebody else. I've put in my time." "Do you really think that's my reason?" "Sure. What else can it be?" "Mr. Craig," the psychologist said slowly, "you have my authorization for you to return to Terra as a private citizen of that planet. You will be given a very liberal supply of PON—which you will definitely need. Good luck. You'll need that too." On the eighth day, two attendants, who showed the effects of massive doses of PON to protect themselves from the centrifugal force, had to carry a man out of the tank. Many others asked to be removed, begged to be allowed to withdraw their resignations. "The twelfth day is the worst," a grizzled spaceman told Craig. "That's when the best of 'em want out." Craig clenched the iron rung of his bed and struggled to bring the old man's face into focus. "How ... how do they know when you ought ... to come out?" he asked between waves of nausea. "Blood pressure. They get you just before you go into shock." "How can they tell?" Craig fought down his growing panic. "I can't." "That strap around your belly. You mean you ain't noticed it?" "Haven't noticed much of anything." "Well, it's keyed to give them some kind of signal." The old man lapsed into silence. Craig wished him to continue. He desperately wanted something to distract his mind from the ghastly conditioning process. Slowly at first, the lines formed by seams in the metal ceiling began to bend. Here it came again! "Old man!" shouted Craig. "Yeah, son. They've dropped it down a notch." "Dropped ... it ... down?" "Maybe that ain't scientific, but it's the way I always think of it." "Can't they ... drop it down continuously?" "They tried that a few times—once when I was aboard. You wouldn't like it, kid. You wouldn't like it at all." "How ... many times ... do they drop it?" "Four times during the day, three at night. Twenty days." A nightmare of visual sensations ebbed into Craig's mind. He was vaguely aware of the moans of other men in the vaultlike room. Wave upon wave of nausea swept him as he watched the seam lines bend and warp fantastically. He snapped his eyelids shut, only to begin feeling the nightmarish bodily sensations once more. He felt the cot slowly rise longitudinally, felt himself upside down, then the snap of turning right side up once more—and he knew that neither he nor the cot had moved so much as an inch. Craig heard the voices around him, muffled, as though talking through wadding. "... got it bad." "We better take him out." "... pretty bad." "He'll go into shock." "... never make it the twelfth." "We better yank him." "I'm ... all right," Craig mumbled at the voices. He struggled with the bonds of his cot. With terrible effort he forced his eyes open. Two white-clad figures, ridiculously out of proportion, hovered wraithlike over him. Four elongated eyes peered at him. Attendants coming for to take me home.... "Touch me and I'll kick your teeth in!" he yelled. "I'm going to Terra. Wish you were going to Terra?" Then it was better. Oddly, he passed the twelfth day easily. By the fourteenth day, Craig knew he could stand Grav 1. The whine of the centrifuge's motors had diminished to a low hum. Either that or they had begun to produce ultra-sonic waves. Craig was not sure. Most of the men had passed through the torments of gravitational conditioning. The huge headquarters base centrifuge aboard the man-made satellite had gradually caused their bodies to respond once more to a single source of pull. They were now ready to become inhabitants of planets again, instead of free-falling ships. On the eighteenth day, automatic machinery freed them from their imprisoning cots. Clumsily and awkwardly at first, the men began to walk, to hold their heads and arms in proper attitudes. They laughed and joked about it and kidded those who were slow at adjusting. Then they again began taking paraoxylnebutal in preparation for the free-fall flight to Terra. Only one of the score of men in the centrifuge tank remained voluntarily in his cot. "Space article violator," the old man informed Craig. "Psycho, I think. Went amuck with some extraterritorials. Killed a dozen." "What will they do, exile him?" "Not to Chociante, if that's what you mean. They just jerked his space card and gave him a one-way ticket to Terra." "For twelve murders?" asked Craig incredulously. "That's enough, son." The old man eyed Craig for an instant before looking away. "Pick something to talk about. What do you figure on doing when you get to Terra, for instance?" "I'm going into Import. My father was in it for twenty years." "Sure," said the old spaceman, watching a group of young crewmen engaged in an animated conversation. "It's a good job. There's a future to it." "Yeah." Why did he have to explain anything at all to the old space tramp? "Once I get set up, I'll probably try to open my own business." "And spend your weekends on Luna." Craig half rose from his cot, jarred into anger. But the old spaceman turned, smiling wryly. "Don't get hot, kid. I guess I spent too long in Zone V." He paused to examine his wrinkled hands. They were indelibly marked with lever callouses. "You get to thinking anyone who stays closer'n eighty light years from Terra is a land-lubber." Craig relaxed, realizing he had acted childishly. "Used to think the same. Then I took the exam and got this job." "Whereabouts?" "Los Angeles." The old man looked up at Craig. "You don't know much about Terra, do you, son?" "Not much." "Yeah. Well, I hope you ain't disappointed." "My father was born there, but I never saw it. Never hit the Solar System, matter of fact. Never saw much of anything close up. I stood it a long time, old man, this hitting atmospheres all over the Universe." But the spaceman seemed to have lost interest. He was unpacking some personal belongings from a kit. "What are you doing in Grav 1?" Craig asked. The old man's face clouded for an instant. "In the old days, they used to say us old-timers acted like clocks. They used to say we just ran down. Now they got some fancy psychology name for it." Craig regretted his question. He would have muttered some word of apology, but the old man continued. "Maybe you've read some of the old sea stories, or more'n likely had 'em read to you. Sailors could go to sea until they just sort of dried up. The sea tanned their skins and stiffened their bones, but it never stiffened their hearts. When they got old, it just pulled them in. "But space is different. Space is raw and new. It tugs at your guts. It sends the blood rushing through your veins. It's like loving. You don't become a part of space the way you do the old sea, though. It leaves you strictly alone. Except that it sucks you dry, takes all the soup out of you, leaves you brittle and old—old as a dehydrated piece of split leather. "Then one day it shoots a spurt of blood around in one of your old veins. Something gives. Space is through with you then. And if you can stand this whirligig conditioning, you're through with space." " You can't figure it. Some of 'em urp all over and turn six shades of green. " " You got to watch the ones that don't. " " Yeah, you got to watch the ones that don't. Especially the old ones. " " He's old. You think it was his heart? " " Who knows? " " They'll dump him, won't they? " " After a tracer is sent through. But it won't do any good. " " He probably outlived everybody that ever knew him. " " Wouldn't be surprised. Here, grab his leg. " Robert Craig folded the flight jacket tightly and stuffed it into the cylindrical carton. A sleeve unwound just as he did so, making it difficult to fit into the place he had made for it. Exasperated, he refolded it and jammed it in place. Smaller rolls of underclothing were then fitted in. When he was satisfied with the layer, he tossed in a small handful of crystals and began to fill the next layer. After the carton was completely filled, he ignited the sealing strip and watched as the plastic melted into a single, seamless whole. It was ready for irradiation. Probably in another ten years his son-to-be would put it on and play spaceman. But Craig swore he'd make sure that the kid knew what a stinking life it was. At 1300 hours, the ferry bumped heavily alongside the starboard lock. It was the signal for relief in the passengers' quarters; many were beginning to feel a reaction to the short free-fall flight from the headquarters satellite. The audio called out: "Flight Officer Robert Craig. Flight Officer Robert Craig. Report to Orderly 12. Report to Orderly 12 through the aft door." With pangs of anxiety he could not completely suppress, Craig obeyed. Orderly 12 handed him a message container. "Who's it from? Somebody on Terra?" "From a private spaceman named Morgan Brockman." " Brockman? " "He was with you in the grav tank." "The old man!" The message container produced a battered punch card. Craig straightened it and was about to reach into his pocket for a hand transcriber. But then he noticed the card bore only a few irregular punches and was covered with rough hand printing. Son, when the flunkies get around to giving you this, they'll have shot me out the tube. How do I know? Same way you know when your turbos are going to throw a blade. It's good this way. There's something you can do for me if you want to. Way back, some fifty years ago, there was a woman. She was my wife. It's a long story I won't bother you with. Anyway, I left her. Wanted to take her along with me, but she wouldn't go. Earth was a lot different then than it is now. They don't have to tell me; I know. I saw it coming and so did Ethel. We talked about it and I knew I had to go. She wouldn't or couldn't go. Wanted me to stay, but I couldn't. I tried to send her some units once in a while. Don't know if she ever got them. Sometimes I forgot to send them at all. You know, you're way out across the Galaxy, while she's home. Go see her if you can, son. Will you? Make sure she gets the unit transfer I made out. It isn't much out of seventy years of living, but she may need it. And maybe you can tell her a little bit about what it means to be out there. Tell her it's open and free and when you got hold of those levers and you're trying for an orbit on something big and new and green.... Hell, you remember. You know how to tell her. Her name is Ethel Brockman. I know she'll still use my name. Her address is or was East 71, North 101, Number 4. You can trace her easy if she moved. Women don't generally shove off and not leave a forwarding address. Not Ethel, at least. Craig put the battered card in his pocket and walked back through the door to the passenger room. How did you explain to an old woman why her husband deserted her fifty years before? Some kind of story about one's duty to the Universe? No, the old man had not been in Intergalactic. He had been a tramp spaceman. Well, why had he left? Fifty years in space. Fifty years! Zone V had been beyond anybody's imagination that long ago. He must have been in on the first Cetusian flights and shot the early landings in Cetus II. God only knew how many times he had battled Zone 111b pirates.... Damn the old man! How did one explain? Craig descended the ramp from the huge jet and concentrated on his impressions. One day he would recall this moment, his first on the planet Terra. He tried to recall his first thrill at seeing Los Angeles, 1500 square miles of it, from the ship as it entered the atmosphere. He was about to step off the last step when a man appeared hurriedly. A rather plump man, he displayed a toothy smile on his puffy red face. "A moment, sir. Just a little greeting from the Terra. You understand, of course. Purely routine." Craig remained on the final step of the ramp, puzzled. The man turned to a companion at his right. "We can see that this gentleman has come from a long, long way off, can't we?" The other man did not look up. He was peering into what seemed to Craig to be a kind of camera. "We can allow the gentlemen to continue now, can't we? It wasn't that we believed for a minute, you understand ... purely routine." Both men were gone in an instant, leaving Craig completely bewildered. "You goin' to move on, buddy, or you want to go back?" Craig turned to face a line of his fellow passengers up the ramp behind him. "Who was that?" Craig asked. "Customs. Bet you never got such a smooth screening before, eh?" "You mean he screened me? What for?" "Hard to say," the other passenger said. "You'll get used to this. They get it over with quick." Craig made his way toward the spaceport administration building. His first physical contact with Terra had passed unnoticed. "Sir! Sir!" cried a voice behind him. He wheeled to see a man walking briskly toward him. "You dropped this, sir. Quite by accident, of course." Craig examined the small object the man had given him before rushing off toward an exit. It was an empty PON tube he had just discarded. He couldn't understand why the man had bothered until he realized that the plastaloid floor of the lobby displayed not the faintest scrap of paper nor trace of dirt. The Import personnel man was toying with a small chip of gleaming metal. He did not look directly at Craig for more than an instant at a time, and commented on Craig's description of his trip through the city only very briefly between questions. "It's a good deal bigger than I imagined," Craig was saying. "Haven't seen much of it, of course. Thought I'd check in here with you first." "Yes, naturally." "Thought you could give me some idea of conditions...." "Conditions?" "For instance, what part of the city I should live in. That is, what part is closest to where I'll work." "I see," said the man noncommittally. It seemed to Craig that he was about to add something. He did not, however, but instead rose from his chair and walked to the large window overlooking an enormous section of the city far below. He stared out the window for a time, leaving Craig seated uncomfortably in the silent room. There was a distracted quality about him, Craig thought. "You are the first man we have had from the Intergalactic Service," the personnel man said finally. "That so?" "Yes." He turned to face Craig briefly before continuing. "You must find it very strange here." "Well, I've never seen a city so big." "Yes, so big. And also...." He seemed to consider many words before completing the sentence. "And also different." "I haven't been here very long," said Craig. "Matter of fact, I haven't been anywhere very long. This is my first real experience with life on a planet. As an adult, anyway." The personnel man seated himself once more and pressed a button on a small instrument. A secretary entered the office from a door to Craig's left. "Miss Wendel, this is Mr. Craig. Mr. Craig, my secretary. Mr. Craig will enter Minerals and Metals, Zone V." They exchanged formal greetings. She was a moderately pretty girl of medium height and, to Craig, a pleasantly rounded figure. He would have attempted to catch her eye had she not immediately occupied herself with unfolding the legs of a small instrument she was carrying. "This is Mr. Craig's first landing on Terra, Miss Wendel," the personnel man continued. "Actually, we shall have to consider him in much the same way we would an extraterrestrial." The girl glanced at Craig, casting him a cool, impersonal smile. "He was formerly a flight officer in the Intergalactic Space Service." The statement was delivered in an almost exaggeratedly casual tone. The girl glanced at him once more, this time with a definite quizzical look in her brown eyes. "Three complete tours of duty, I believe." "Four," corrected Craig. "Four tours of three years each, minus a year's terminal leave." "I take it you have no identification card?" the man asked. "The one I held in the service. It's pretty comprehensive." The other turned to the secretary. "You'll see that he is assisted in filing his application, won't you? A provisional Code II. That will enable you to enter all Import offices freely, Mr. Craig." "Will he need a food and—clothing ration also?" asked the girl, without looking at Craig. "Yes." The man laughed. "You'll excuse us, Mr. Craig. We realize that you couldn't be expected to be familiar with Terra's fashions. In your present outfit you would certainly be typed as a ... well, you'd be made uncomfortable." Craig reddened in spite of himself. He had bought the suit on Ghandii. "A hick," he supplied. "I wouldn't go that far, but some people might." Craig noted the pleasant way the girl filled her trim, rather severe business suit. He amused himself by calculating stress patterns in its plain woven material as she assembled the forms for him. "Here, Mr. Craig. I believe these are complete." "They look pretty complicated." "Not at all. The questions are quite explicit." Craig looked them over quickly. "I guess so. Say, Miss Wendel, I was wondering—I don't know the city at all. Maybe you could go with me to have dinner. It must be almost dinnertime now. You could sort of check me out on some...." "I'm afraid that would be quite impossible. You couldn't gain admittance to any office you need to visit tonight. Therefore, it is impossible for me to be of any assistance to you." "Oh, come now, Miss Wendel. There are women aboard spaceships. I'm not a starved wolf." "Certainly you are not, Mr. Craig. But it is not possible for me...." "You said that already, but you can have dinner with me. Just company." "I'm afraid I don't understand." The Galactic hotel strove to preserve an archaic tone of hospitality. It advertised "a night's lodgings" and it possessed a bellboy. The bellboy actually carried Craig's plasticarton and large file of punch cards and forms to his room. Tired from the long, confusing day, Craig was not impressed. He vaguely wondered if the little drama of the hotel carried so far as a small fee to be paid the bellboy, and he hoped he would have the right size of Terran units in his wallet. Outside the door to the room, the bellboy stopped and turned to Craig. "For five I'll tell you where it is," he said in a subdued tone. "Tell me where what is?" "You know, the mike." "Mike?" "All right, mister, three units, then. I wasn't trying to hold you up." "You mean a microphone?" asked Craig, mechanically fishing for his wallet. "Sure, they don't put in screens here. Wanted to, but the boss convinced 'em there aren't any Freedomites ever stay here." "Where is the microphone?" Craig asked as he found a ten unit note. He was too puzzled to wonder what he was expected to do with the information. "It's in the bed illuminator. You can short it out with a razor blade. Or I'll do it for another two." "Never mind," Craig said wearily. He waited while the bellboy inserted a key into the door and opened it for him. "I can get you a sensatia-tape," whispered the boy when they had entered. He nudged Craig wickedly. "You know what they're like?" "Yeah," Craig said disgustedly. Traffic in the illicit mental-image tapes was known as far into space as lonely men had penetrated. Intergalactic considered them as great a menace to mental and moral stability as the hectopiates. Craig wearily got the man out of the room, took a PON pill, and eased himself into the bed. It had been a weird day and he had not liked it. There was no telling how long it would take him to shake his—sea legs, the psychologist had called it. One thing was sure: Terra aggressively went after its strangers.
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C. The culture on Terra is radically different from the culture in space.
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What was the primary diagnosis that led to Mr. Fisher's hospitalization from 04/19/2009 to 04/28/2009?
Choose the correct answer from the following options:
A. Urosepsis
B. Coronary artery disease
C. Progressive deterioration of renal transplant function
D. Acute postrenal kidney failure
E. Anastomotic stricture
|
### Patient Report 0
**Dear colleague, **
We are reporting to you regarding our patient, Mr. Alan Fisher, born on
12/09/1953. He was under our inpatient care from 04/19/2009 to
04/28/2009.
**Diagnoses:**
- Progressive deterioration of renal transplant function (creeping
creatinine) without evidence of biopsy-proven rejection
- Isovolumetric tubular epithelial vacuolization
**Other Diagnoses:**
- History of renal transplantation on 10/25/1995
- Dual immunosuppression with Cyclosporin A/Steroid since 10/1995
- Terminal renal insufficiency due to chronic pyelonephritis and
nephrolithiasis
- Chronic hemodialysis from 09-10/1995
- Right laparoscopic nephrectomy on 03/2007 due to suspected renal
cell carcinoma, histologically not confirmed
- Incisional hernia after nephrectomy, diagnosed on 07/2007
- Secondary hyperparathyroidism
- Coronary artery disease, CAD-3:
- Previous anterior wall infarction in 1989, treated with
thrombolysis and PTCA
- PTCA + stent in the right coronary artery (RIVA) in 05/1995
- PTCA + drug-eluting stent (DES) in RIVA on 05/15/2005
- PTCA + Genous (anti CD34+ Antibody-coated) in RIVA on 08/14/2006
- Remaining: 75% stenosis in D1 and occlusion of the small RCA
(last cardiac catheterization on 03/24/2008)
- Stress echocardiography planned for 01/09 if ischemia is
detected, followed by bypass surgery if necessary
- Right superficial femoral artery profundaplasty on 03/11/2007
- Permanent atrial fibrillation, diagnosed in 03/07, unsuccessful
cardioversion on 03/2008, anticoagulated with Marcumar
- Arterial hypertension
- Hyperlipoproteinemia, possible dose-dependent Fluvastatin
intolerance
- COPD GOLD Stage II
- Mild sleep apnea syndrome in 01/2005
- Massive diverticulosis (last colonoscopy on 07/2008)
- History of Hepatitis B infection
- Cholecystolithiasis
**Medical History:** Mr. Fisher was admitted for a renal transplant
biopsy due to progressive deterioration of transplant function (creeping
creatinine). His recent creatinine values had increased to around 1.4 --
1.6 mg/dL, while they had previously been around 1.1 mg/dL.
**Therapy and Progression:** Following appropriate preparation and
informed consent, a complication-free transplant puncture was performed.
The biopsy showed isometric tubular epithelial vacuolization without
significant findings. This was followed by adjustment of Cyclosporin-A
levels and the addition of a lymphocyte proliferation inhibitor to the
existing immunosuppressive dual therapy. There was a significant
increase in Cyclosporin-A levels at one point due to accidental double
dosing by the patient, but levels returned to the target range. This
might explain the current rise in creatinine. Another explanation could
be recurrent hypotensive blood pressure dysregulations, leading to the
discontinuation of Minoxidile medication. For chronic atrial
fibrillation, anticoagulation therapy with Marcumar was restarted during
hospitalization and should be continued as an outpatient according to
the target INR. Low molecular weight heparin administration could be
discontinued.
**Physical Examination:** Patient in good general condition. Oriented in
all aspects. No dyspnea. No cyanosis. No edema. Warm and dry skin.
Normal nasal and pharyngeal findings. Pupils round, equal, and react
promptly to light bilaterally. Moist tongue. Pharynx and buccal mucosa
unremarkable. No jugular vein distension. No carotid bruits heard.
Palpation of lymph nodes unremarkable. Palpation of the thyroid gland
unremarkable, freely movable.
Lungs: Normal chest shape, moderately mobile, resonant percussion sound,
vesicular breath sounds bilaterally, no wheezing or crackles heard.
Heart: Irregular heart action, normal rate; heart sounds clear, no
pathological sounds. Abdomen: Peristalsis and bowel sounds normal in all
quadrants; soft abdomen, markedly obese, no tenderness, no palpable
masses, liver and spleen not palpable due to limited access, non-tender
kidneys. Large reducible incisional hernia on the right side following
nephrectomy.
Extremities: Occluded fistula on the right forearm. Normal peripheral
pulses; joints freely movable. Strength, motor function, and sensation
are unremarkable.
**Kidney Biopsy on 04/19/2009:** Complication-free biopsy of the
transplant kidney.
Findings: Erythematous macules.
Recommendation: Follow-up in 3 months.
**Ultrasound of Transplant Kidney on 04/20/2009:** Transplant kidney
well visualized, located in the left iliac fossa, measurable,
oval-shaped. Parenchymal echogenicity normal, normal corticomedullary
differentiation. No evidence of arteriovenous fistula or hematoma after
kidney biopsy.
**Pathological-anatomical assessment on 04/19/2009:**
**Macroscopic Findings:** Singular Nodule Identified: Dimensions
measuring 8 mm.
**Microscopic Examination:**
Sampled Tissue: Renal cortex
Identified Components:
- Glomeruli: Nine observed
- Interlobular Artery: One segment present
- Absence of medullary tissue
**Diagnostic Observations:** There were no signs of inflammation or
scarring in the renal cortex. The glomeruli appeared normocellular, and
no signs of inflammation or pathological changes were observed in them.
The peritubular capillaries were free of inflammation, and the specific
test for C4d staining yielded negative results. The arterioles within
the tissue had thin walls, and there was no evidence of inflammation in
this vascular component.
The interlobular artery was also thin-walled and showed no evidence of
inflammation.
A notable finding was extensive damage to the tubular epithelium. The
damage was characterized by isometric microvesicular cytoplasmic
transformation, which exceeded 80%. Importantly, there was no evidence
of cell necrosis and only minimal flattening of cells was observed. In
addition, no pathological imprints, microcalcifications, or nuclear
inclusion bodies were observed in the tubular epithelium.
**Summary:** The predominant pathological finding in this case is
substantial tubular damage. Consequently, it is highly advisable to
closely monitor immunosuppression levels in the patient\'s management.
Further comprehensive evaluation is strongly recommended to determine
the underlying cause of the observed tubular damage and to address the
clinical question concerning the presence of Chronic Allograft
Nephropathy or the potential involvement of an infection in the clinical
presentation.
**Chest X-ray (2 views) on 04/22/2009:**
[Findings]{.underline}: No pneumothorax, no effusion. No evidence of
pneumonia. No focal findings. Left-biased heart without decompensation.
Mediastinum centrally positioned, not widened. Unremarkable depiction of
central hilar structures. Thoracic hyperkyphosis.
**Current Recommenations:** We request regular outpatient monitoring of
retention parameters (initially every 2-3 weeks) and are available for
further questions at the provided telephone number.
**Lab results upon Discharge**
**Parameter** **Results** **Reference Range**
---------------------------------------------- ------------- ---------------------
Sodium 144 mEq/L 134-145 mEq/L
Potassium 3.7 mEq/L 3.4-5.2 mEq/L
Calcium 9.48 mg/dL 8.6-10.6 mg/dL
Chloride 106 mEq/L 95-112 mEq/L
Phosphorus 2.88 mg/dL 2.5-4.5 mg/dL
Transferrin Saturation 20 % 16-45 %
Magnesium 1.9 mg/dL 1.8-2.6 mg/dL
Creatinine 1.88 mg/dL \<1.2 mg/dL
Glomerular Filtration Rate 36 mL/min \>90 mL/min
BUN (Blood Urea Nitrogen) 60 mg/dL 14-46 mg/dL
Uric Acid 4.6 mg/dL 3.0-6.9 mg/dL
Total Bilirubin 0.5 mg/dL \<1 mg/dL
Albumin 4.0 g/dL 3.6-5.0 g/dL
Total Protein 6.8 g/dL 6.5-8.7 g/dL
C-Reactive Protein 0.19 mg/dL \<0.5 mg/dL
Transferrin 269 mg/dL 200-360 mg/dL
Ferritin 110 ng/mL 30-300 ng/mL
ALT (Alanine Aminotransferase) 17 U/L \<45 U/L
AST (Aspartate Aminotransferase) 20 U/L \<50 U/L
Alkaline Phosphatase 119 U/L 40-129 U/L
GGT (Gamma-Glutamyltransferase) 94 U/L \<55 U/L
Lipase 61 U/L \<70 U/L
TSH (Thyroid-Stimulating Hormone) 0.54 mIU/L 0.27-4.20 mIU/L
Hemoglobin 14.5 g/dL 14.0-17.5 g/dL
Hematocrit 43% 40-52%
Red Blood Cells 4.60 M/uL 4.6-6.2 M/uL
White Blood Cells 8.78 K/uL 4.5-11.0 K/uL
Platelets 205 K/uL 150-400 K/uL
MCV 94 fL 81-100 fL
MCH 31.5 pg 27-34 pg
MCHC 33.5 g/dL 32.4-35.0 g/dL
MPV 11 fL 7-12 fL
RDW 14.8 % 11.9-14.5 %
Neutrophils 3.72 K/uL 1.8-7.7 K/uL
Lymphocytes 2.37 K/uL 1.4-3.7 K/uL
Monocytes 0.93 K/uL 0.2-1.0 K/uL
Eosinophils 1.67 K/uL \<0.7 K/uL
Basophils 0.09 K/uL 0.01-0.10 K/uL
Nucleated Red Blood Cells Negative \<0.01 K/uL
APTT (Activated Partial Thromboplastin Time) 45.1 sec 26-40 sec
Antithrombin Activity 85 % 80-120 %
**Medication upon discharge**
**Medication ** **Dosage** **Frequency**
-------------------------------- ------------ ---------------
Cyclosporine (Neoral) 1 mg 1-0-1
Mycophenolic Acid (Myfortic) 180 mg 1-0-1
Prednisone (Deltasone) 5 mg 1-0-0
Aspirin 81 mg 1-0-0
Candesartan (Atacand) 16 mg 0-0-1
Metoprolol (Lopressor) 50 mg 1-1-1-1
Isosorbide Dinitrate (Isordil) 60 mg 1-0-0
Torsemide (Demadex) 10 mg As directed
Ranitidine (Zantac) 300 mg 0-0-1
Fluvastatin (Lescol) 20 mg 0-0-1
Allopurinol (Zyloprim) 100 mg 0-1-0
Tamsulosin (Flomax) 0.4 mg 1-0-0
### Patient Report 1
**Dear colleague, **
We are writing to provide an update on our patient, Mr. Alan Fisher,
born on 12/09/1953.
He was under our inpatient care from 10/02/2018 to 10/03/2018.
**Diagnoses:**
- Urosepsis
- Acute postrenal kidney failure
**Other Diagnoses:**
- History of renal transplantation on 10/25/1995
- Dual immunosuppression with Cyclosporin A/Steroid since 10/1995
- Terminal renal insufficiency due to chronic pyelonephritis and
nephrolithiasis
- Chronic hemodialysis from 09-10/1995
- Right laparoscopic nephrectomy on 03/2007 due to suspected renal
cell carcinoma, histologically not confirmed
- Incisional hernia after nephrectomy, diagnosed on 07/2007
- Secondary hyperparathyroidism
- Coronary artery disease, CAD-3:
- Previous anterior wall infarction in 1989, treated with
thrombolysis and PTCA
- PTCA + stent in the right coronary artery (RIVA) in 05/1995
- PTCA + drug-eluting stent (DES) in RIVA on 05/15/2005
- PTCA + Genous (anti CD34+ Antibody-coated) in RIVA on 08/14/2006
- Remaining: 75% stenosis in D1 and occlusion of the small RCA
(last cardiac catheterization on 03/24/2008)
- Stress echocardiography planned for 01/09 if ischemia is
detected, followed by bypass surgery if necessary
- Right superficial femoral artery profundaplasty on 03/11/2007
- Permanent atrial fibrillation, diagnosed in 03/07, unsuccessful
cardioversion on 03/2008, anticoagulated with Marcumar
- Arterial hypertension
- Hyperlipoproteinemia, possible dose-dependent Fluvastatin
intolerance
- COPD GOLD Stage II
- Mild sleep apnea syndrome in 01/2005
- Massive diverticulosis (last colonoscopy on 07/2008)
- History of Hepatitis B infection
- Cholecystolithiasis
**Previous Surgeries:** Previous prostate vesiculectomy with regional
lymphadenectomy
**Planned procedure:** Urethro-cystoscopy with catheter placement for
urethral stricture
**Medical History:** The patient was admitted through our emergency
department upon referral by the outpatient urologist due to suspicion of
a urethral stricture. Mr. Fisher reports a worsening urinary retention
for approximately 6 months. Despite multiple unsuccessful attempts at
catheter placement, ureterocystoscopy with catheter insertion was
performed. Intraoperatively, purulent cystitis and a bladder outlet
obstruction were observed.
Mr. Fisher regularly attends follow-up examinations for his history of
kidney transplantation in 1995 and previous prostate vesiculectomy with
regional lymphadenectomy in 01/2018.
**Physical Examination:** Neurology: RASS 0, alert, CAM-ICU negative, no
new focal neurology
Lungs: Bilateral air entry, no rales or wheezing, sufficient gas
exchange on 2L/O2 Cardiovascular: Normal sinus rhythm, normotensive on
0.01 µg/kg/min NA
Abdomen: Soft, no guarding, sparse peristalsis, advanced oral diet,
regular bowel movements
Diuresis: Normal urine output, retention values within normal range,
goal: balanced fluid status
Skin/Wounds: Non-irritated, no peripheral edema
**Therapy and Progression**: We received Mr. Fisher, who was awake and
spontaneously breathing under a 2L O2 mask via nasal cannula, to our
intensive care unit due to urosepsis. To maintain an adequate
circulation, low-dose catecholamine therapy was required but could be
discontinued on the first postoperative day. Pulmonary function remained
stable with intensive non-invasive ventilation and breathing training.
Given his immunosuppression, we escalated the intraoperatively initiated
anti-infective therapy from Ceftriaxone to Piperacillin/Tazobactam.
Pneumococcal and Legionella rapid tests were negative. Following
appropriate volume resuscitation and diuretic therapy with Furosemide,
diuresis became sufficient. Oral diet progression occurred without
complications. Anticoagulation was initially in prophylactic dosing with
Heparin and later switched to therapeutic dosing with Enoxaparin.
**Current Recommendations:**
- Switch unfractionated Heparin to Fragmin
- baseline Crea 2mg/dL, target CyA level: 50-60ng/mL, Myfortic
continued.
- Urological care of the stricture in progress, leave catheter until
then.
- Mobilization
**Medication upon Discharge:**
**Medication (Brand)** **Dosage** **Frequency**
---------------------------------- ------------ ---------------
Torsemide (Demadex) 10 mg 1-1-0-0
Prednisone (Deltasone) 5 mg 1-1-0-0
Pantoprazole (Protonix) 20 mg 1-1-0-0
Mycophenolate Mofetil (CellCept) 360 mg 1-0-1-0
Metoprolol Succinate (Toprol-XL) 100 mg 1-0-1-0
Magnesium Oxide 400 mg 1-0-0-0
Ciclosporin (Neoral) 100 mg 60-0-70-0
Candesartan (Atacand) 16 mg 0-0.5-0-0
Atorvastatin (Lipitor) 40 mg 0-0-0-1
Allopurinol (Zyloprim) 100 mg 1-0-0-0
Aspirin 81 mg 1-0-0-0
Paracetamol (Tylenol) 500 mg As needed
### Patient Report 2
**Dear colleague, **
We are reporting to you about our patient, Mr. Alan Fisher, born on
12/09/1953.
He was under our inpatient care from 11/04/2018 to 11/12/2018.
**Current Symptoms:** Decreased diuresis, rising creatinine, frustrating
catheterization.
**Diagnoses:**
- Acute on chronic graft failure
<!-- -->
- Creatinine increased from 1.56 mg/dL to a maximum of 2.35 mg/dL.
- Likely postrenal origin due to urethral stricture; sonographically,
Grade II urinary stasis with urinary retention and residual urine
formation.
- Frustrating catheterization due to urethral stricture
- Urethro-cystoscopy with bougie and catheter placement
- Parainfectious component in purulent cystitis with urosepsis
- Discharged with indwelling catheter
- Inpatient readmission to the colleagues in Urology for internal
urethrotomy
**Other Diagnoses:**
- History of renal transplantation on 10/25/1995
- Dual immunosuppression with Cyclosporin A/Steroid since 10/1995
- Terminal renal insufficiency due to chronic pyelonephritis and
nephrolithiasis
- Chronic hemodialysis from 09-10/1995
- Right laparoscopic nephrectomy on 03/2007 due to suspected renal
cell carcinoma, histologically not confirmed
- Incisional hernia after nephrectomy, diagnosed on 07/2007
- Secondary hyperparathyroidism
- Coronary artery disease, CAD-3:
- Previous anterior wall infarction in 1989, treated with
thrombolysis and PTCA
- PTCA + stent in the right coronary artery (RIVA) in 05/1995
- PTCA + drug-eluting stent (DES) in RIVA on 05/15/2005
- PTCA + Genous (anti CD34+ Antibody-coated) in RIVA on 08/14/2006
- Remaining: 75% stenosis in D1 and occlusion of the small RCA
(last cardiac catheterization on 03/24/2008)
- Stress echocardiography planned for 01/09 if ischemia is
detected, followed by bypass surgery if necessary
- Right superficial femoral artery profundaplasty on 03/11/2007
- Permanent atrial fibrillation, diagnosed in 03/07, unsuccessful
cardioversion on 03/2008, anticoagulated with Marcumar
- Arterial hypertension
- Hyperlipoproteinemia, possible dose-dependent Fluvastatin
intolerance
- COPD GOLD Stage II
- Mild sleep apnea syndrome in 01/2005
- Massive diverticulosis (last colonoscopy on 07/2008)
- History of Hepatitis B infection
- Cholecystolithiasis
**Medical History:** The patient was admitted through our emergency
department upon referral by an outpatient urologist due to suspected
urethral stricture. Mr. Fisher reports increasing difficulty urinating
for approximately 6 months. He has to \"squeeze out\" his bladder
completely. Frustrating catheterization was performed due to urinary
retention. Intraoperatively, purulent cystitis and bladder outlet
stenosis were observed. Mr. Fisher regularly undergoes follow-up
examinations for a history of kidney transplantation in 1995 and a
prostate vesiculectomy with regional lymphadenectomy in 01/2018.
**Vegetative Findings:** The patient had a bowel movement 4 days ago,
indwelling catheter irritation (3L of diuresis the previous day), no
nausea/vomiting, no fever or night sweats, weight loss of 30kg from
February to April 2020.
**Physical Capacity:** Limited, can still climb 2 stairs but needs to
take a break due to shortness of breath.
**Physical Examination:** Temperature 37.4°C, Blood pressure 128/72
mmHg; Pulse 72/min; Respiratory rate 15/min, O2 saturation under 2L O2:
96%
Awake, alert, cooperative, oriented to time, place, person, and
situation.
[Head/Neck:]{.underline} Non-tender nerve exit points; Clear paranasal
sinuses; moist and pink mucous membranes; unremarkable dentition; moist
and glossy tongue; non-palpable thyroid enlargement.
[Chest]{.underline}: Normal configuration; Non-tender spine; free renal
beds bilaterally.
[Heart]{.underline}: Rhythmic, clear heart sounds, normal rate, no
splitting; non-distended jugular veins. [Lungs]{.underline}: Vesicular
breath sounds; Resonant percussion note; no adventitious sounds; no
stridor; normal chest expansion.
[Abdomen]{.underline}: Protuberant, known incisional hernia, normal
peristalsis in all quadrants; soft; no pathological resistance; no
tenderness; liver palpable below the costal margin; spleen not palpable.
[Lymph nodes:]{.underline} No pathologically enlarged cervical nodes
palpable; axillary and inguinal nodes not palpable.
Skin: No pathological skin findings.
[Extremities:]{.underline} Warm; mild bilateral ankle edema.
[Pulse status (right/left):]{.underline} A. carotis +/+, A. radialis
+/+, A. femoralis +/+, A. tibialis post. +/+, A. dorsalis ped. +/+
[Neurological]{.underline}: Oriented and unremarkable.
**Therapy and Progression:** The patient was admitted through our
emergency department upon referral by an outpatient urologist due to
suspected urethral stricture, which had been causing increasingly
difficult urination for approximately 6 months. Sonography showed Grade
II urinary stasis with urinary retention and residual urine. Frustrating
catheterization was performed, followed by ureterocystoscopy with bougie
and catheter placement. Intraoperatively, purulent cystitis and bladder
outlet stenosis were observed. Laboratory tests revealed acute kidney
transplant failure, with creatinine increasing from 1.56 mg/dL to 2.35
mg/dL, along with significantly elevated infection parameters: CRP up to
186 mg/dL, PCT 12.82 µg/L, and leukocytosis of 21.6/nL. After obtaining
blood cultures, empirical antibiotic therapy with Ceftriaxone was
initiated. Upon detecting Pseudomonas aeruginosa, therapy was switched
to Piperacillin/Tazobactam on 12/06/20 and continued until 12/13/20.
Under this treatment, infection parameters significantly improved, and
Mr. Fisher remained afebrile. Kidney retention parameters also decreased
to a discharge creatinine of 2.05 mg/dL. Regarding the urethral
stricture, he was initially discharged with an indwelling catheter. A
follow-up appointment for internal urethrotomy and potentially Allium
stent placement was scheduled for 4 weeks later. During the hospital
stay, ciclosporin levels remained within the target range. Following
prostate vesiculectomy earlier in the year, anticoagulation was switched
from Enoxaparin to Apixaban 2.5 mg twice daily, and Aspirin therapy was
discontinued.
**Recommendations**: We recommend regular monitoring of kidney retention
parameters and infection parameters. Regarding the urethral stricture,
the patient will be discharged with an indwelling catheter. We scheduled
a follow-up with colleagues in Urology for internal urethrotomy and
potentially Allium stent placement. Pause oral anticoagulation with
Apixaban one day before inpatient admission.
**Medication upon Discharge:**
**Medication** **Dosage** **Frequency**
---------------------------------- ------------ ---------------
Apixaban (Eliquis) 2.5 mg 1-0-1-0
Ciclosporin (Neoral) 100 mg 60-0-70-0
Mycophenolic Acid (Myfortic) 360 mg 1-0-1-0
Prednisone (Deltasone) 5 mg 1-0-0-0
Metoprolol Succinate (Toprol-XL) 95 mg 1-0-1-0
Candesartan (Atacand) 8 mg 0-1-0-0
Torsemide (Demadex) 10 mg 1-1-0-0
Atorvastatin (Lipitor) 40 mg 0-0-0-1
Pantoprazole (Protonix) 20 mg 1-0-0-0
Vitamin D3 (Cholecalciferol) 20,000 IU Pause
Magnesium Oxide 400 mg 1-0-0-0
### Patient Report 3
**Dear colleague, **
We are reporting to you regarding our patient, Mr. Alan Fisher, born on
12/09/1953, who was under outpatient care on 07/01/2019.
**Current Symptoms:** Pain on the left side at rib level**,** Dyspnea
**Diagnoses:**
- Infection of unclear origin
- CT Thorax and Abdomen showed no focus
- Urine dipstick and cultures were bland
- Antibiotics: Meropenem from 06/11/2019 to 06/19/2019
- Acute Transplant Dysfunction
- Serum Creatinine: 2.4 -\> 4.5 -\> 2.6 mg/dl
- Renal ultrasound: 123 x 54 x 24 mm, not dilated, some areas of
increased echogenicity, no twinkling, no acoustic shadowing, no
signs of urolithiasis.
**Other Diagnoses:**
- History of renal transplantation on 10/25/1995
- Dual immunosuppression with Cyclosporin A/Steroid since 10/1995
- Terminal renal insufficiency due to chronic pyelonephritis and
nephrolithiasis
- Chronic hemodialysis from 09-10/1995
- Right laparoscopic nephrectomy on 03/2007 due to suspected renal
cell carcinoma, histologically not confirmed
- Incisional hernia after nephrectomy, diagnosed on 07/2007
- Secondary hyperparathyroidism
- Coronary artery disease, CAD-3:
- Previous anterior wall infarction in 1989, treated with
thrombolysis and PTCA
- PTCA + stent in the right coronary artery (RIVA) in 05/1995
- PTCA + drug-eluting stent (DES) in RIVA on 05/15/2005
- PTCA + Genous (anti CD34+ Antibody-coated) in RIVA on 08/14/2006
- Remaining: 75% stenosis in D1 and occlusion of the small RCA
(last cardiac catheterization on 03/24/2008)
- Stress echocardiography planned for 01/09 if ischemia is
detected, followed by bypass surgery if necessary
- Right superficial femoral artery profundaplasty on 03/11/2007
- Permanent atrial fibrillation, diagnosed in 03/07, unsuccessful
cardioversion on 03/2008, anticoagulated with Marcumar
- Arterial hypertension
- Hyperlipoproteinemia, possible dose-dependent Fluvastatin
intolerance
- COPD GOLD Stage II
- Mild sleep apnea syndrome in 01/2005
- Massive diverticulosis (last colonoscopy on 07/2008)
- History of Hepatitis B infection
- Cholecystolithiasis
**Medical History:** Initial presentation was at the local emergency
department on referral from the primary care physician for suspected
acute coronary syndrome. Mr. Fisher described left-sided rib pain, which
was related to breathing and pressure, as well as dyspnea for a few
days. Laboratory tests showed acute-on-chronic kidney failure and
elevated infection parameters. A urine dipstick test was negative for
nitrites and leukocytes. Chest CT ruled out pulmonary pathology, and
acute coronary syndrome was also excluded. Mr. Fisher reported a urinary
tract infection about 4 weeks ago, which was treated with antibiotics as
an outpatient.
**Physical Examination:** Alert, oriented, cooperative, and responsive
to time, place, person, and situation
[Head/Neck:]{.underline} Non-tender nerve exit points; clear nasal
sinuses; moist pink mucous membranes; unremarkable dental status; moist
tongue
[Chest]{.underline}: Normal configuration; no tenderness in the spine;
both renal beds free
[Heart]{.underline}: Arrhythmic heart sounds, pure, tachycardic, not
split
[Lungs]{.underline}: Vesicular breath sounds; somewhat decreased breath
sounds bilaterally; no adventitious sounds; no stridor
[Abdomen]{.underline}: Regular peristalsis in all quadrants; soft; right
lower abdomen notably distended with increased vascular markings, liver
and spleen not palpable, transplant kidney non-tender
[Lymph Nodes:]{.underline} No pathologically enlarged cervical lymph
nodes palpable
[Skin]{.underline}: No pathological skin findings
[Extremities:]{.underline} Warm; no edema; cyanosis of toes bilaterally
after prolonged leg dependency
- Pulse status (right/left): Carotid artery +/+, Radial artery +/+,
Posterior tibial artery +/+
- Neurology: Normal cranial nerves; round, moderately dilated pupils;
prompt bilateral pupillary light reflex; no sensory or motor
deficits; ubiquitous muscle strength 5/5
**Therapy and Progression:** We admitted the patient for further
diagnosis and treatment. Initially suspected acute coronary syndrome was
ruled out. Laboratory results showed elevated retention and infection
parameters. With volume substitution, we achieved baseline creatinine
levels again. The transplant kidney appeared non-dilated and
well-perfused. For the infection, the patient received the mentioned
imaging studies, which did not reveal any definitive findings. Our urine
analyses and cultures also showed bland results. It should be noted that
prior outpatient treatment for suspected urinary tract infection was
likely with cotrimoxazole. Ultimately, considering the recent
antibiograms, we decided on a calculated antibiotic therapy with
Meropenem. This led to a significant improvement in infection
parameters. The last measured Ciclosporin level was slightly
subtherapeutic, so we adjusted the dosage accordingly. We recommend
follow-up with the primary care physician.
**Chest CT on 06/10/2019:**
[Clinical Information, Question, Justification]{.underline}: Patient
with a history of kidney transplantation. Bursting pain on both sides at
the ribcage. Cough. Elevated inflammatory markers. Question about
infiltrates, pleural effusion, congestion.
[Technique]{.underline}: Digital overview radiographs. Plain 80-line CT
of the chest. MPR (Multiplanar reconstruction). DLP (Dose-Length
Product) 120.6 mGy\*cm.
[Findings]{.underline}: No previous images available for comparison.
Symmetric thyroid. Minimal pericardial effusion, accentuated at the
base, measuring up to 8 mm in width (Series 5, Image 293). Coronary
atherosclerosis. No pathologically enlarged lymph nodes in the
mediastinum, axilla, or hilum on plain images. Multisegmental calcified
(micro)nodules. No suspicious pulmonary nodules indicative of
malignancy. No pneumonic infiltrates. No pleural effusions. No
pneumothorax. No pulmonary venous congestion. Delicate scar tissue at
the bases bilaterally. Small axial hiatal hernia. Rounded soft tissue
structure in the right adrenal space (Series 5, measuring 411 x 10 mm).
Incidentally captured at the image margins is a shrunken left kidney.
Spondylosis deformans of the thoracic spine. Interpretation: No
pneumonic infiltrates. No pleural effusions. No pulmonary venous
congestion. Minimal pericardial effusion. Multisegmental calcified
(micro)nodules, likely post-inflammatory.
**Abdomen/Pelvis CT on 06/14/2019:**
[Clinical Information, Question, Justification:]{.underline} Acute
kidney failure. Question regarding kidney or ureteral stones.
[Technique]{.underline}: Plain 80-line CT of the abdomen. MPR. DLP 947
mGy\*cm. Findings and [Interpretation:]{.underline}
The left transplant kidney shows pelvic dilation with an expanded renal
pelvis and ureter (hydronephrosis grade II) but no evidence of stones.
Status post-right nephrectomy. Shrunken left kidney. Known large,
broad-based right-sided abdominal wall weakness with prolapsed
intestinal loops and mesenteric fat tissue without evidence of
incarceration. No ileus. Diverticulosis of the sigmoid colon. Small
axial hiatal hernia. No free or encapsulated fluid or free air in the
abdomen with the right diaphragmatic dome not fully visualized.
Cholecystolithiasis. No cholestasis. Vascular sclerosis. No
lymphadenopathy. Bilaterally aerated lung bases captured without change.
Unchanged irregularly thickened and coarsely structured right iliac
bone, consistent with Paget\'s disease.
**Recommendations:**
Ciclosporin level monitoring
**Medication upon discharge:**
**Medication ** **Dosage** **Frequency**
---------------------------------- ------------ ---------------
Atorvastatin (Lipitor) 40 mg 0-0-0-1
Candesartan Cilexetil (Atacand) 8 mg 0-1-0-0
Prednisone (Deltasone) 5 mg 1-0-0-0
Vitamin D3 (Cholecalciferol) 20,000 IU 1 x/week
Apixaban (Eliquis) 2.5 mg 1-0-1-0
Magnesium Oxide 400 mg 1-0-0-0
Metoprolol Succinate (Toprol-XL) 95 mg 1-0-1-0
Mycophenolic Acid (Myfortic) 360 mg 1-0-1-0
Pantoprazole (Protonix) 20 mg 1-0-0-0
Ciclosporin (Neoral) 100 mg 70-0-70-0
### Patient Report 4
**Dear colleague, **
We would like to inform you about our patient, Mr. Alan Fisher, born on
12/09/1953, who was under our inpatient care from 02/19/2020 to
03/01/2020.
**Current Symptoms:** Decreased general condition, weakness,
decompensation
**Diagnosis**: Acute episode of recurrent urinary tract infection with
detection of E. faecalis, E. faecium, and Enterobacter cloacae in urine
(blood cultures sterile).
**Other Diagnoses:**
- History of renal transplantation on 10/25/1995
- Dual immunosuppression with Cyclosporin A/Steroid since 10/1995
- Terminal renal insufficiency due to chronic pyelonephritis and
nephrolithiasis
- Chronic hemodialysis from 09-10/1995
- Right laparoscopic nephrectomy on 03/2007 due to suspected renal
cell carcinoma, histologically not confirmed
- Incisional hernia after nephrectomy, diagnosed on 07/2007
- Secondary hyperparathyroidism
- Coronary artery disease, CAD-3:
- Previous anterior wall infarction in 1989, treated with
thrombolysis and PTCA
- PTCA + stent in the right coronary artery (RIVA) in 05/1995
- PTCA + drug-eluting stent (DES) in RIVA on 05/15/2005
- PTCA + Genous (anti CD34+ Antibody-coated) in RIVA on 08/14/2006
- Remaining: 75% stenosis in D1 and occlusion of the small RCA
(last cardiac catheterization on 03/24/2008)
- Stress echocardiography planned for 01/09 if ischemia is
detected, followed by bypass surgery if necessary
- Right superficial femoral artery profundaplasty on 03/11/2007
- Permanent atrial fibrillation, diagnosed in 03/07, unsuccessful
cardioversion on 03/2008, anticoagulated with Marcumar
- Arterial hypertension
- Hyperlipoproteinemia, possible dose-dependent Fluvastatin
intolerance
- COPD GOLD Stage II
- Mild sleep apnea syndrome in 01/2005
- Massive diverticulosis (last colonoscopy on 07/2008)
- History of Hepatitis B infection
- Cholecystolithiasis
**Medical History:** The patient was admitted through our internal
medicine emergency department. He presented with worsening general
condition and increasing weakness, following the recommendation of our
local nephrological telemedicine. He particularly noticed the increasing
weakness when getting up, describing his legs as feeling like rubber. He
also experienced shortness of breath. His walking distance was greater
than 100 meters. There was no fever, chills, nausea, vomiting, dysuria,
or changes in bowel movements. Before the outpatient visit, the patient
had collected urine for 24 hours, totaling 1700 ml, with a fluid intake
of approximately 2 liters. His blood pressure at home was approximately
120/60 mmHg. In the emergency department, he had negative urinary
dipstick results and a non-specific chest X-ray. Blood and urine
cultures were obtained, and he was subsequently transferred to our
general ward. No angina pectoris symptoms. The patient had normal bowel
movements, specifically no melena, and no blood-tinged stools. Urine was
described as clear and light.
**Physical Examination:** Alert, oriented, cooperative, oriented to
time, place, person, and situation. Height 179 cm; Weight 114 kg
[Head/neck:]{.underline} No tender nerve exit points; Clear nasal
sinuses; No tenderness over the skull; Mucous membranes pink and moist;
Dental status is rehabilitated; Tongue moist and glossy
[Thorax]{.underline}: Normally shaped; Spine without tenderness; Renal
regions free of tenderness
[Heart]{.underline}: Heart sounds are faint, arrhythmic, clear, regular
rate, no splitting of heart sounds; Jugular veins are not distended
[Lungs]{.underline}: Faint vesicular breath sounds; Resonant percussion
note; Dullness on the left, no added sounds; No stridor; Normal breath
excursion
[Abdomen]{.underline}: Large right abdominal wall hernia, normal
peristalsis in all quadrants; Soft; No pathological resistances; No
tenderness (especially not over the left lower abdomen)
[Skin status:]{.underline} No pathological skin findings
Extremities: Warm; Mild edema.
[Neurology:]{.underline} Alert. No focal deficits
**Treatment and Progression:** The patient was admitted through our
emergency department due to a decrease in general condition and
weakness, accompanied by significantly elevated laboratory infection
parameters and slightly worsened retention parameters (Creatinine max
3.4 mg/dL compared to the current baseline of 3 mg/dL). Upon admission,
apart from a known and persistent leukocyturia since 2020, there were no
indications of any other infectious focus. We were able to detect
Enterobacter cloacae and Enterococcus faecalis in the urine, and we
initially treated the patient with intravenous Tazobactam. Blood
cultures remained sterile. The patient\'s general condition improved
within a few days, along with a regression of infection parameters.
For further investigation of recurrent urinary tract infections (UTIs)
and in the context of a history of urethral stricture treatment in
February 2021 with bougienage of the urethra one year ago, a urological
consultation was arranged. During this consultation, there was suspicion
of a recurrence of the urethral stricture due to a significant residual
urine volume of 175 ml. A scheduled readmission for repeat surgical
management was set for May 16, 2022. Due to the lack of normalization of
elevated infection parameters and significant residual urine, a urinary
catheter was inserted. Subsequently, Enterococcus faecium was detected,
and we continued treatment with oral Linezolid after the completion of
intravenous antibiotic therapy.
The antibiotic treatment was planned to continue on an outpatient basis
for a total of 10 days. We kindly request an outpatient follow-up to
monitor infection parameters next week. The urinary catheter will be
maintained until the urological follow-up appointment, and the patient
has been provided with a prescription for medication.
Furthermore, the patient exhibited atrial tachyarrhythmia. We reduced
the heart rate using Digoxin, as the patient was already on maximum
beta-blocker therapy. The atrial tachyarrhythmia significantly improved
under this treatment.
Additionally, there was a non-puncture-worthy pleural effusion and a
chronic pericardial effusion, which was not hemodynamically relevant.
There were no clinical indications of pericarditis.
**Current Recommendations:**
1. Inpatient admission to Urology Department.
2. Outpatient laboratory monitoring and referral issuance by the
primary care physician.
### Patient Report 5
**Dear colleague, **
We are reporting on mutual patient, Mr. Alan Fisher, born on 12/09/1953,
who was under our inpatient care from 03/14/2020 to 03/15/2020.
**Diagnoses**: Anastomotic stricture following history of prostatectomy
and history of urethrotomy interna.
**Other Diagnoses:**
- History of renal transplantation on 10/25/1995
- Dual immunosuppression with Cyclosporin A/Steroid since 10/1995
- Terminal renal insufficiency due to chronic pyelonephritis and
nephrolithiasis
- Chronic hemodialysis from 09-10/1995
- Right laparoscopic nephrectomy on 03/2007 due to suspected renal
cell carcinoma, histologically not confirmed
- Incisional hernia after nephrectomy, diagnosed on 07/2007
- Secondary hyperparathyroidism
- Coronary artery disease, CAD-3:
- Previous anterior wall infarction in 1989, treated with
thrombolysis and PTCA
- PTCA + stent in the right coronary artery (RIVA) in 05/1995
- PTCA + drug-eluting stent (DES) in RIVA on 05/15/2005
- PTCA + Genous (anti CD34+ Antibody-coated) in RIVA on 08/14/2006
- Remaining: 75% stenosis in D1 and occlusion of the small RCA
(last cardiac catheterization on 03/24/2008)
- Stress echocardiography planned for 01/09 if ischemia is
detected, followed by bypass surgery if necessary
- Right superficial femoral artery profundaplasty on 03/11/2007
- Permanent atrial fibrillation, diagnosed in 03/07, unsuccessful
cardioversion on 03/2008, anticoagulated with Marcumar
- Arterial hypertension
- Hyperlipoproteinemia, possible dose-dependent Fluvastatin
intolerance
- COPD GOLD Stage II
- Mild sleep apnea syndrome in 01/2005
- Massive diverticulosis (last colonoscopy on 07/2008)
- History of Hepatitis B infection
- Cholecystolithiasis
**Procedure**:
- Urethrotomy interna according to Sachse
- Calculated intravenous antibiotic therapy with Meropenem starting on
03/14/2020
- Extension of therapy to include antifungal treatment with
Fluconazole on 03/15/2020
**Medical History:** The patient presents with a recurrence of
symptomatic urethral stricture at the anastomosis site following
prostatectomy. The main symptoms are frequent urination, dysuria, and
residual urine formation up to 175 ml. In January 2019, urethrotomy
interna was already performed. Since the last hospitalization due to a
urinary tract infection, the patient has had a continuous
catheterization.
**Physical Examination:** Patient in a reduced general condition and
obese nutritional status. The abdomen is soft, without signs of
resistance or pain. Kidney beds on both sides are indolent.
**Urine Diagnostics**: Urine dipstick: Leukocytes 500, Nitrite negative,
Erythrocytes 50
**Microbiology**: Candida in urine, collected by the general
practitioner on 03/11/2020.
**Chest X-ray in two planes on 02/19/2020:**
[Clinical Information, Question, Justification for the
Examination]{.underline}: Deterioration of general condition. History of
recurrent sepsis. History of lung transplantation. Infiltrates?
**Findings**: The heart is shifted to the left and has a mitral
configuration. No signs of acute congestion. The mediastinum shows no
signs of emphysema, is centrally located, and of normal width. No active
pneumonia in the ventilated lung regions. Progressive costophrenic angle
effusion on the left. No pleural effusion on the right, as far as can be
assessed. No pneumothorax. Degenerative changes in the spine.
Hyperkyphosis of the thoracic spine.
**Therapy and Progression:** The above-mentioned procedure was performed
without complication. Scar tissue at the level of the bladder sphincter
was incised. The postoperative course was uneventful. The transurethral
indwelling catheter was removed on the 19th postoperative day. At the
time of discharge, the patient could urinate without residual urine with
a good urinary stream. We discharged the patient on 03/19/2020 for
further outpatient care.
**Medication upon Discharge:**
**Medication ** **Dosage** **Frequency**
---------------------------------------- ------------------- ------------------
Magnesium Oxide 400 mg 1-0-0-0
Atorvastatin (Lipitor) 43.3 mg 0-0-1-0
Candesartan Cilexetil (Atacand) 16 mg 1-1-0-1
Prednisone (Deltasone) 5 mg 1-0-0-0
Vitamin D3 (Cholecalciferol, oily) 20,000 IU 1x every 2 weeks
Apixaban (Eliquis) 2.5 mg 1-0-1-0
Metoprolol Succinate (Toprol-XL) 95 mg 1-0-1-0
Mycophenolic Acid (Myfortic) 385 mg 1-0-1-0
Pantoprazole (Protonix) 22.6 mg 1-0-0-0
Piperacillin/Tazobactam (Zosyn) 4.17 g and 0.54 g 1-1-1-0
Cyclosporine, microemulsified (Neoral) 10 mg 1-0-1-0
Cyclosporine, microemulsified (Neoral) 50 mg 1-0-1-0
Torsemide (Demadex) 10 mg 2-1-0-0
**Lab results upon Discharge:**
**Parameter** **Results** **Reference Range**
------------------------------------------- ------------------ ---------------------
Sodium 141 mEq/L 136-145 mEq/L
Potassium 3.9 mEq/L 3.5-4.5 mEq/L
Creatinine 3.02 mg/dL 0.70-1.20 mg/dL
Estimated GFR (eGFR) 19 mL/min/1.73m² \-
Total Bilirubin 0.73 mg/dL \< 1.20 mg/dL
Direct Bilirubin 0.41 mg/dL \< 0.30 mg/dL
C-reactive Protein 78.3 mg/dL \< 5.0 mg/dL
Alanine Aminotransferase 35 U/L \< 41 U/L
Aspartate Aminotransferase 33 U/L \< 50 U/L
Alkaline Phosphatase 273 U/L 40-130 U/L
Gamma-Glutamyl Transferase 184 U/L 8-61 U/L
Lipase 102 U/L 13-60 U/L
Hemoglobin 12.3 g/dL 12.5-17.2 g/dL
Hematocrit 39.0% 37.0-49.0%
Red Blood Cells 4.2 M/uL 4.0-5.6 M/uL
White Blood Cells 10.41 K/uL 3.90-10.50 K/uL
Platelets 488 K/uL 150-370 K/uL
Mean Corpuscular Volume 92.4 fL 80.0-101.0 fL
Mean Corpuscular Hemoglobin 29.1 pg 27.0-34.0 pg
Mean Corpuscular Hemoglobin Concentration 31.5 g/dL 31.5-36.0 g/dL
Mean Platelet Volume 10.3 fL 7.0-12.0 fL
Red Cell Distribution Width 13.5% 11.5-15.0%
|
Progressive deterioration of renal transplant function
|
What wouldn't the author say about Unmade Beds?
A. it is a new genre of film
B. the film is dishonest and scripted
C. the characters aren't likable
D. this film will inspire many more like it to be created
|
Dirty Laundry Now and then, a documentary film comes along that makes us re-examine the rules that unofficially govern the genre: Can there be a middle ground between fiction and fact? Can a documentary use scripted scenes and yet remain ontologically authentic? How much can you stylize material before you alter the reality that you're striving, at least in theory, to capture? Unmade Beds , Nicholas Barker's " 'real life' feature film," has proudly worn its mongrel status as a "directed" documentary of single life in the big city, employing, in the face of criticism, what amounts to a cackling-punk defiance. The movie tracks four aging New Yorkers--two men, two women--through their lonely dating rituals, in the process depicting a universe of lusty, coupled-up haves and downcast, excluded have-nots, all viewed Rear Window -style through rectangular openings in the massive apartment houses in which they reside. This is not cinema vérité , and nothing has been left to chance. The director selected his four subjects from many hundreds of potential candidates, followed them around for months, and then scripted their monologues and dialogues to reflect what he says he saw. Calling his own film "an exercise in mendacity," Barker goes on, "I'm quite happy to tell lies about my characters and even collude with their self-delusions if it enables me to communicate larger dramatic truths." Spurned by U.S. distributors, Unmade Beds opened two weeks ago in a small screening room in downtown Manhattan, where it proceeded to set box office records and generate lots of (largely favorable) press. In part due to smart publicity, which has bannered some of the bad reviews and commentary ("I have to tell you that this film upset me so much that I really don't want to have anything to do with it"--a New York publicist), it threatens to become a cause célèbre --and to be coming soon to a theater near you. It's always nice to see distributors proved wrong about the merits of "difficult" films, but in this case I think they did the decent thing. Unmade Beds isn't just bad--it's obnoxiously, noxiously bad, a freak show for the empathetically challenged. The outrage it has prompted isn't the Puritan kind; it's more like legitimate revulsion at watching a blowhard pervert people's lives in the name of "larger dramatic truths." Those truths are large, all right. Take Michael, the 40-year-old, 5 foot 4 inch lonely guy who has been looking for a wife for almost two decades. If you were to walk past him on the street, you might think that a man of his small stature might have some trouble getting dates and be rather bitter about it. The larger dramatic truth is that Michael has lots of trouble getting dates and is very bitter about it. Just in case you feel too sorry for him, however, Barker is careful to include a homophobic monologue in which Michael complains about young women who waste their lives hanging out with effeminate males. Michael turns out to be the film's most sympathetic subject--by a wide margin. At least he's not Mikey, a paunchy 54-year-old who writes but can't sell screenplays and who always flees blind dates, because the women he gets fixed up with are "mutts." Sounding like one of the low-level gangsters who posture like kingpins in Donnie Brasco , Mikey talks a lot about mutts. He also reminisces about that 24 hour period in the '70s when he managed to sleep with three different beautiful women, whose pictures he shows off. These days, all he meets are mutts. He comes off as a pathetic little loser--a mutt. Aimee, on the other hand, is a pathetic big loser, weighing in at 225 pounds. Determined to get married before she turns 30, she generally is filmed beside bags of groceries and assorted junk foods. She cries about her situation to her thin friend, Laurie, who, in one scene, gently mentions Aimee's weight. Clearly the scene is scripted, but Aimee does a good job acting taken aback. She has always been fat--and she's "OK with it," and a man just has to accept it. This is followed by more talk about how you attract men. Will they respect you if you call them back? If you express too much interest? "Or," the viewer thinks, "if you're 225 pounds?" The only natural performer here is Brenda, a garrulous exhibitionist who blossoms with the camera on her--she could have a career as a Penny Marshall-style character actress. Divorced and aging, Brenda needs money and is willing to charge for her sexual services. It shouldn't be too difficult, because men are always showing her their dicks ("I'm up to two dicks a day"). They meet her and, a few minutes later, they show her their dicks. Weird, huh? What Barker leaves out (it's in a New York Observer article) is that Brenda, a former lap dancer, works in marketing at a strip joint. Presumably, men standing next to her in line at McDonald's don't show her their dicks. Nor, presumably, does she show them her breasts--although she bares them for Barker's camera, jabbering about her body while she doffs her clothes and steps into the shower and soaps up. Barker might have crafted his subjects' monologues from their own words, but he has robbed them of their spontaneity--and, thus, of their essence. They aren't thinking or trying to come to grips with their situations in front of your eyes, because they already know what they're going to say: They've been fixed like butterflies on the ends of pins and held up for voyeuristic inspection. The scenes with friends and confidantes have a crude, programmatic purpose. You can imagine the director composing a shot (the shots are tightly composed and elaborately lighted) and reminding them, "In this scene she points out that you should lose weight and you get shocked and defensive. Ready ... Action." Call me square, but I find this antithetical to the documentary spirit. An Englishman who trained as an anthropologist before going to work for BBC Television, Barker clearly made up his mind about his material before his cameras began to roll--so it's no surprise that it feels prechewed and predigested. When reality interfered (Brenda apparently did not go through with a marriage to an immigrant in search of a green card for $10,000, as she does on-screen), Barker brushed the truth aside as immaterial, following her up the steps of City Hall in her wedding dress because it was "true to her character." But what separates documentary from fiction is that real people are often more complicated, and more conflicted, than finished characters--as Brenda proved to be more (or, at least, other) than the sum of her parts. That's the kind of truth that reveals itself to documentary filmmakers after the fact, when they go over footage and discover unexpected patterns, dissonances, glimmers of a universe that's richer and messier than the one they set out to portray. So what are Barker's "larger dramatic truths"? Single people in big cities can be desperate. Single people fear they're going to die alone--unloved and unloving. People are judged and, in turn, judge others by how they look. Big news. One could argue, charitably, that the movie is meant to be prescriptive, that Barker intends for us to regard the ways in which his subjects delude themselves and thereby learn to see through our own self-delusions. But Barker hasn't concocted a larger dramatic structure that would hold those larger dramatic truths together and help us comprehend where these people went wrong. He dramatizes right up to the point where a dramatist would be expected to provide some insight--and then, hey, he's a documentarian. Unmade Beds might make a good date movie. There's little to argue about in its subjects' personalities--both males and females will find them repulsive--and the picture the film paints of single life in the big city is so bleak that you'll probably want to jump into bed with whoever is sitting next to you. Anything to keep from turning into one of those people. The Slums of Beverly Hills also walks a line between two genres, in this case coming-of-age sex comedy and autobiographical monologue. Tamara Jenkins, the writer and first-time director, has an eye for absurd juxtapositions that was obviously sharpened by the pain of her nomadic upbringing. Her protagonist (Natasha Lyonne) spends her teen-age years being shuttled with her two brothers from one cheap dive to another in the 90210 ZIP code, all because her egregiously unsuccessful father (Alan Arkin) wants them to be educated in the best schools. ("Furniture's temporary; education is permanent.") It's a major omission, then, that we never see those schools or the kids' interaction with their stable, well-to-do Beverly Hills counterparts. We can't tell if the father is, on some weird level, justified in his fervor, or whether he's screwing up his children--subjecting them to humiliation and robbing them of a sense of permanence--for no reason. Jenkins hasn't quite figured out how to shape her narrative, which is full of episodes that are there because they actually happened but that don't have a payoff. I almost wish she'd included more voice-over narration, more commentary on the things that, as a filmmaker, she hasn't learned to bring out. The Slums of Beverly Hills never gels, but it has a likable spirit, and it's exceedingly easy on the eye, with lots of pretty girls and wry evocations of '70s fashions and decor. The father, to obtain financial support from his wealthy brother (Carl Reiner), volunteers to take in his vaguely schizzy, dipsomaniacal niece (Marisa Tomei). She and her cousin compare breasts, play with vibrators, and talk in pig Latinish gibberish, but Jenkins never lets the proceedings get too sentimental: The whimsy is always cut with an acidic awareness of the family's desperation. "Are we middle-class now?" ask the children, hopefully, before another crisis sends them back into their van, cruising past the movie stars' mansions, in the mean streets of Beverly Hills. Grading on the steep curve established by summer blockbuster seasons past, these have turned out to be a pretty good few months at the movies. Even the commercial swill ( Deep Impact , Armageddon , The Mask of Zorro , Small Soldiers , Snake Eyes , Halloween: H20 ) has been of a high grade, and Saving Private Ryan and Return to Paradise were Vitalis slaps in the kisser for people woozy from all the warm weather escapism. Out of Sight was tender and charming, as was, in its gross-out way, There's Something About Mary . And, on the indie front, The Opposite of Sex , Buffalo 66 , and Pi have proved that there's still commercial life after Sundance. Sure, we had stinkers, but even Godzilla was fun to jeer at. And there's something reassuring about the fact that The Avengers is so rotten: proof yet again that people with piles of money can hire wizard production designers but can't fake class. I don't know who the credited screenwriter, Don MacPherson, is, but it's unlikely that he has ever seen an episode of the old Avengers , let alone sussed out the source of its appeal. Opening with a slapstick sequence of agent John Steed (Ralph Fiennes) doing kung fu, the film shifts to a scene in which he meets Mrs. Peel (Uma Thurman) while sitting naked in a sauna with only a newspaper to cover his private parts. The series was erotic in a way only prim English humor can be: The Old Boy Steed was capable of throwing a punch and bonking someone with his bowler, but he left the karate kicking to his liberated, leather-suited distaff associate. Here their roles have been witlessly muddled, and MacPherson's idea of banter is to have the pair complete each other's clichés. Whereas the original Steed, Patrick Macnee, was to the English Men's Club born, Fiennes is an eternal caddie. The willowy Thurman looks great in her outfits, but it's ever more apparent that she isn't much of an actress--at least, not a trained one--and her attempts at insouciance are embarrassingly arch. As the eccentric master villain who controls the weather, even Sean Connery is flat-out terrible, acting high on the hog. To think Connery once found the Bond films so far beneath him! When he sputters lines like "Time to die!" one imagines Dr. No, Goldfinger, and Blofeld snickering in the wings.
|
D. this film will inspire many more like it to be created
|
What is the quantity of restructuring costs directly outlined in AES Corporation's income statements for FY2022? If restructuring costs are not explicitly outlined then state 0.
|
Evidence 0:
Consolidated Statements of Operations
Years ended December 31, 2022, 2021, and 2020
2022
2021
2020
(in millions, except per share amounts)
Revenue:
Regulated
$
3,538
$
2,868
$
2,661
Non-Regulated
9,079
8,273
6,999
Total revenue
12,617
11,141
9,660
Cost of Sales:
Regulated
(3,162)
(2,448)
(2,235)
Non-Regulated
(6,907)
(5,982)
(4,732)
Total cost of sales
(10,069)
(8,430)
(6,967)
Operating margin
2,548
2,711
2,693
General and administrative expenses
(207)
(166)
(165)
Interest expense
(1,117)
(911)
(1,038)
Interest income
389
298
268
Loss on extinguishment of debt
(15)
(78)
(186)
Other expense
(68)
(60)
(53)
Other income
102
410
75
Loss on disposal and sale of business interests
(9)
(1,683)
(95)
Goodwill impairment expense
(777)
Asset impairment expense
(763)
(1,575)
(864)
Foreign currency transaction gains (losses)
(77)
(10)
55
Other non-operating expense
(175)
(202)
INCOME (LOSS) FROM CONTINUING OPERATIONS BEFORE TAXES AND EQUITY IN EARNINGS OF AFFILIATES
(169)
(1,064)
488
Income tax benefit (expense)
(265)
133
(216)
Net equity in losses of affiliates
(71)
(24)
(123)
INCOME (LOSS) FROM CONTINUING OPERATIONS
(505)
(955)
149
Gain from disposal of discontinued businesses, net of income tax expense of $0, $1, and $0, respectively
4
3
NET INCOME (LOSS)
(505)
(951)
152
Less: Net loss (income) attributable to noncontrolling interests and redeemable stock of subsidiaries
(41)
542
(106)
NET INCOME (LOSS) ATTRIBUTABLE TO THE AES CORPORATION
$
(546)
$
(409)
$
46
|
0
|
According to the film reviewer, how does the reporter in "Velvet Goldmine" view the protagonist?
A. With revulsion
B. With jealousy
C. With admiration
D. With consternation
|
Warrior Queens Elizabeth is a lurid paraphrase of the old Groucho Marx line about Doris Day: "I knew the Virgin Queen before she was a virgin." As the movie tells it, she was a sylvan, redheaded princess (Cate Blanchett) given to gamboling with her fella (Joseph Fiennes) between periods of internment in the Tower of London on charges of conspiring to overthrow her half-sister, the heatedly Catholic Queen Mary (Kathy Burke). The daughter of the second wife of Henry VIII, Anne Boleyn, and therefore dubbed a bastard by the papists, the Protestant Elizabeth ascends the throne to find the air still thick with smoke from roasted heretics, a team of skulking Catholics plotting her assassination, and a council of advisers (lords, bishops, sundry old boys) who snigger openly at the prospect of taking orders from a woman. Only a strategic marriage to a Spaniard or a Frenchman will mollify all factions, her advisers insist, but the pickings prove dismal. (Her French suitor enjoys wearing dresses.) After skulls are smashed, throats slit, and bosoms skewered in the name of Christ, Elizabeth decides to: a) "unsex" herself and become a symbol--the Virgin Queen, married only to England; and b) entertain dissenting opinions exclusively from those whose heads are affixed to spikes. You can't be both a queenly queen and a womanly woman, says the script (by Michael Hirst)--at least not in 1554. (The director, Shekhar Kapur, made the same point in his grim 1994 Indian epic The Bandit Queen , against a backdrop of scrubby plains along the Ganges.) Is this feminist take historically accurate? Probably, although the evidence suggests that Elizabeth had developed a head for stratagems earlier in life (her position had been precarious since the beheading of her mother) and came to the throne with few girlish illusions about How Things Work in a barbarous state. That said, the movie's approach makes for juicy melodrama. The tone of Elizabeth comes nearer to the nihilistic relish of Jacobeans such as John Ford and John Webster than to the more sorrowful horror of the Elizabethan dramatists Ben Jonson and William Shakespeare. It's even closer to a Jacobean drama of our own age: The Godfather (1972), which it emulates by cutting back-and-forth between queen and courtiers in prayer and the roundup and slaughter of Catholics on their privies, in bed with their mistresses, and so on. Their severed heads look on, wide-eyed, as Elizabeth directs her hair to be shorn--images of her girlhood flashing by as her locks rain down--and then walks weightily to her throne, now a chalk-faced gorgon. With all due respect to Blanchett, Bette Davis, and Glenda Jackson, my favorite Elizabeth I remains Miranda Richardson's capricious, baby-talking psychopath on the BBC comedy Blackadder II . (Casting about for a new lord high executioner, she mews to Rowan Atkinson, "There are thousands of Catholics simply dying to have their heads sneaked off --and there's no one to organize it.") But Blanchett comes in a close second, pulling off the transition from hapless young woman to coolly ruthless monarch with uncommon subtlety. Gradually expunging all empathy from her moist, pink eyes and permitting her visage to ossify, she gives this carnival of carnage an awe-inspiring center. A more subversive sort of queen is on display in Velvet Goldmine , Todd Haynes' musical fantasia on the early '70s era of "glam" or "glitter" rock. Here the monarch is a David Bowie-esque singer called Brian Slade (Jonathan Rhys-Meyers) and his spidery, space-age alter ego, Maxwell Demon. The movie opens with a spaceship depositing an infant Oscar Wilde on the stoop of a Dublin townhouse. Then it skips ahead to track a jade pin (it signifies hedonistic liberation) from the custody of a young Wilde to a swishy fringe creature called Jack Fairy to the regal Slade, a bisexual superstar who carries the news to all the young dudes. After that, we're in an Orwellian 1984 that's presided over by a vaguely fascist president and by arena rockers who serve as propagandists for a repressively conformist state. Whatever happened to Brian Slade, the glitter kids, the visionary exhibitionists and gleeful poseurs? Borrowing its framework from Citizen Kane , the movie follows a reporter (Christian Bale) assigned to reconstruct Slade's life and solve the mystery of his whereabouts. Whatever you make of Velvet Goldmine (opinions have ranged from rapturous to casually dismissive), it's like no other musical ever made. It's determinedly swirling, discursive, elliptical. Now the story is told by an omniscient narrator, now a TV reporter, now a participant. Now it's flashing back, now forward. Every other line of dialogue is a cue for one of its dazzling numbers, largely covers of songs by Brian Eno, Bryan Ferry, and T. Rex. The narrative is a challenge to keep up with, but then, great artists often invent their own syntax. In the '80s, Haynes employed Barbie dolls to depict the rise and wasting away from anorexia of the singer Karen Carpenter. Lucky audiences who caught Superstar: The Karen Carpenter Story (it was shelved when Richard Carpenter served the producers with an order to cease and desist exhibition) began by laughing at this elaborately posed, soft-rock femme, only to discover by the climax that the cultural forces that were eating at her (and that kept her from eating) had grown heartbreakingly palpable. Poison (1991), Haynes' Genêt-inspired exploration of transgression, didn't overcome its own artiness. But Safe (1995), the story of a Reagan-era housewife (Julianne Moore) convinced that her environment is poisoning her, is an entrancing meditation on the power of culture to crush the individual. Despite its ironic detachment, the film draws you into its heroine's sickly state: Breathing oxygen from a canister inside a high-tech igloo, she dwindles to nearly nothing, the modern incarnation of the Incredible Shrinking Man. (It was partly my passion for Haynes' films that led me to accept a job offer from his indefatigable producer Christine Vachon last year to collaborate on a nuts-and-bolts book about producing, Shooting To Kill . So my review of Velvet Goldmine --like my review of Vachon's other recent release, Happiness --should be read as the work of a partisan. But not a blind partisan.) In Velvet Goldmine , Haynes sets out to demonstrate the power of popular music to change people's lives--to tell them it's OK to fashion themselves into anything they please. The core of the movie turns out not to be the Bowie figure but the journalist, Arthur Stuart, who was a witness to the events he's now reconstructing. Bale is such an expressive performer that Stuart's remembrance of things past attains a Proustian intensity. To him, Slade was a sexual messiah. I've never seen a more vivid distillation of rock's allure than the scene in which he reverently opens the new Brian Slade album--its centerfold image is a lithe, naked, green-tinged Maxwell Demon--slips the vinyl out of its paper jacket and, after gingerly setting the LP on the turntable, props a chair under the doorknob to keep the uncomprehending world at bay. But if Haynes wants Velvet Goldmine to be an anthem to the principles Bowie once embodied--the embrace of artifice and the smashing of conventional sexual roles--he also wants to portray the rocker as a hollow opportunist who abandoned glam and bisexuality for the life of a corporate superstar, throwing in his lot with the forces of repression. That's a lot to cover. An actor of stature might have bridged these two impulses, but the beautiful, brazenly slim-hipped Rhys-Meyers doesn't make his lines sound as if he's thinking them up on the spot, and Slade's self-destructive passion for Curt Wild (Ewan McGregor), the film's fuzzy, sweet Iggy Pop figure, seems less an emotional imperative than a thematic one. A case can be made that Velvet Goldmine isn't fully filled in, and that Haynes, who has never shaken off his background as a semiotics major, has made a movie that's all signifiers. I sometimes found myself wishing he would let the picture catch its breath, that the performers would stop coming at me in stroboscopic flashes. But then I'd be swept up in the sinuous motion of his filmmaking, in the elation of watching point of view passed like a baton from hand to hand, in the liberating force of his language and soundtrack. Velvet Goldmine might seem like a collection of baubles, but those baubles are strung. Is Brad Pitt the worst actor on earth? The case could be made, and Meet Joe Black could serve as Exhibit A. Pitt plays two roles in this seven course schlockfest. He's (briefly) a slick but wholesome yuppie and then (interminably) Death, who takes over the young man's body when he's thumped by a couple of cars in the movie's most promising moment. Bleached so blond that he looks like an irradiated android, Pitt expels all expression from his face and all tone from his voice. He speaks very, very slowly. The stunt half-works, at least until he's supposed to undergo an inner transformation and acquire human emotions--whereupon his face remains just as blank. Pitt's conception of the role is an idée fixe by someone who doesn't appear to have an idée in his head. Martin Brest, the director, is known for shooting a ton of footage and then "finding" his films in the editing room. What do you suppose he "found" when he scrutinized these miles of celluloid with Pitt doing nothing and taking his sweet time doing it? The first adaptation of this story (originally a play) was the 1934 Death Takes a Holiday , which came in at a perky 78 minutes. A conceit this fragile needs to whiz along to keep our disbelief in suspension, but Meet Joe Black grinds on for three hours (longer than either Beloved or Saving Private Ryan ), and Pitt acts as if he has leased the screen by the year. Anthony Hopkins plays the zillionaire communications baron whom Death enlists in the hope of understanding the human condition--an odd choice for a tour guide, since most people's condition doesn't involve personal helicopters, sprawling mansions on Long Island Sound, or Manhattan apartments that sport Olympic-size swimming pools. Four screenwriters, among them the great Bo Goldman ( Melvin and Howard , 1980; Shoot the Moon , 1982), labored on this moldy script, which features characters who ask questions that begin "Am I to understand that ...?" and a corporate villain who directs another character to "wake up and smell the thorns." It apparently never occurred to even one of these overpaid scribes to eliminate Hopkins' rueful realization that he'd "never write the great American novel"--no kidding, given his flagrantly Welsh accent. Actually, Hopkins gives this humanistic magnate considerable weight, so that whether or not Death takes him before he can stop to smell the roses and make amends to his neglected children becomes a matter of some suspense. The rest of the cast works with equal fortitude, especially Jeffrey Tambor (Hank "Hey now!" Kingsley on The Larry Sanders Show ) as Hopkins' milksop son-in-law and Marcia Gay Harden as his party planning, perpetually wilting elder daughter. As the younger daughter, the dark eyed, spaghetti thin Claire Forlani has to carry the picture's bathos on her exquisite shoulders. Her tremulous thoroughbred act wears thin, but it's hardly her fault: She has to emote like mad opposite a black pit of death--or is that the Black Death of Pitt?
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C. With admiration
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What is the dataset used in the paper?
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### Introduction
All over the world, languages are disappearing at an unprecedented rate, fostering the need for specific tools aimed to aid field linguists to collect, transcribe, analyze, and annotate endangered language data (e.g. BIBREF0, BIBREF1). A remarkable effort in this direction has improved the data collection procedures and tools BIBREF2, BIBREF3, enabling to collect corpora for an increasing number of endangered languages (e.g. BIBREF4). One of the basic tasks of computational language documentation (CLD) is to identify word or morpheme boundaries in an unsegmented phonemic or orthographic stream. Several unsupervised monolingual word segmentation algorithms exist in the literature, based, for instance, on information-theoretic BIBREF5, BIBREF6 or nonparametric Bayesian techniques BIBREF7, BIBREF8. These techniques are, however, challenged in real-world settings by the small amount of available data. A possible remedy is to take advantage of glosses or translations in a foreign, well-resourced language (WL), which often exist for such data, hoping that the bilingual context will provide additional cues to guide the segmentation algorithm. Such techniques have already been explored, for instance, in BIBREF9, BIBREF10 in the context of improving statistical alignment and translation models; and in BIBREF11, BIBREF12, BIBREF13 using Attentional Neural Machine Translation (NMT) models. In these latter studies, word segmentation is obtained by post-processing attention matrices, taking attention information as a noisy proxy to word alignment BIBREF14. In this paper, we explore ways to exploit neural machine translation models to perform unsupervised boundary detection with bilingual information. Our main contribution is a new loss function for jointly learning alignment and segmentation in neural translation models, allowing us to better control the length of utterances. Our experiments with an actual under-resourced language (UL), Mboshi BIBREF17, show that this technique outperforms our bilingual segmentation baseline. ### Recurrent architectures in NMT
In this section, we briefly review the main concepts of recurrent architectures for machine translation introduced in BIBREF18, BIBREF19, BIBREF20. In our setting, the source and target sentences are always observed and we are mostly interested in the attention mechanism that is used to induce word segmentation. ### Recurrent architectures in NMT ::: RNN encoder-decoder
Sequence-to-sequence models transform a variable-length source sequence into a variable-length target output sequence. In our context, the source sequence is a sequence of words $w_1, \ldots , w_J$ and the target sequence is an unsegmented sequence of phonemes or characters $\omega _1, \ldots , \omega _I$. In the RNN encoder-decoder architecture, an encoder consisting of a RNN reads a sequence of word embeddings $e(w_1),\dots ,e(w_J)$ representing the source and produces a dense representation $c$ of this sentence in a low-dimensional vector space. Vector $c$ is then fed to an RNN decoder producing the output translation $\omega _1,\dots ,\omega _I$ sequentially. At each step of the input sequence, the encoder hidden states $h_j$ are computed as: In most cases, $\phi $ corresponds to a long short-term memory (LSTM) BIBREF24 unit or a gated recurrent unit (GRU) BIBREF25, and $h_J$ is used as the fixed-length context vector $c$ initializing the RNN decoder. On the target side, the decoder predicts each word $\omega _i$, given the context vector $c$ (in the simplest case, $h_J$, the last hidden state of the encoder) and the previously predicted words, using the probability distribution over the output vocabulary $V_T$: where $s_i$ is the hidden state of the decoder RNN and $g$ is a nonlinear function (e.g. a multi-layer perceptron with a softmax layer) computed by the output layer of the decoder. The hidden state $s_i$ is then updated according to: where $f$ again corresponds to the function computed by an LSTM or GRU cell. The encoder and the decoder are trained jointly to maximize the likelihood of the translation $\mathrm {\Omega }=\Omega _1, \dots , \Omega _I$ given the source sentence $\mathrm {w}=w_1,\dots ,w_J$. As reference target words are available during training, $\Omega _i$ (and the corresponding embedding) can be used instead of $\omega _i$ in Equations (DISPLAY_FORM5) and (DISPLAY_FORM6), a technique known as teacher forcing BIBREF26. ### Recurrent architectures in NMT ::: The attention mechanism
Encoding a variable-length source sentence in a fixed-length vector can lead to poor translation results with long sentences BIBREF19. To address this problem, BIBREF20 introduces an attention mechanism which provides a flexible source context to better inform the decoder's decisions. This means that the fixed context vector $c$ in Equations (DISPLAY_FORM5) and (DISPLAY_FORM6) is replaced with a position-dependent context $c_i$, defined as: where weights $\alpha _{ij}$ are computed by an attention model made of a multi-layer perceptron (MLP) followed by a softmax layer. Denoting $a$ the function computed by the MLP, then where $e_{ij}$ is known as the energy associated to $\alpha _{ij}$. Lines in the attention matrix $A = (\alpha _{ij})$ sum to 1, and weights $\alpha _{ij}$ can be interpreted as the probability that target word $\omega _i$ is aligned to source word $w_j$. BIBREF20 qualitatively investigated such soft alignments and concluded that their model can correctly align target words to relevant source words (see also BIBREF27, BIBREF28). Our segmentation method (Section SECREF3) relies on the assumption that the same holds when aligning characters or phonemes on the target side to source words. ### Attention-based word segmentation
Recall that our goal is to discover words in an unsegmented stream of target characters (or phonemes) in the under-resourced language. In this section, we first describe a baseline method inspired by the “align to segment” of BIBREF12, BIBREF13. We then propose two extensions providing the model with a signal relevant to the segmentation process, so as to move towards a joint learning of segmentation and alignment. ### Attention-based word segmentation ::: Align to segment
An attention matrix $A = (\alpha _{ij})$ can be interpreted as a soft alignment matrix between target and source units, where each cell $\alpha _{ij}$ corresponds to the probability for target symbols $\omega _i$ (here, a phone) to be aligned to the source word $w_j$ (cf. Equation (DISPLAY_FORM10)). In our context, where words need to be discovered on the target side, we follow BIBREF12, BIBREF13 and perform word segmentation as follows: train an attentional RNN encoder-decoder model with attention using teacher forcing (see Section SECREF2); force-decode the entire corpus and extract one attention matrix for each sentence pair. identify boundaries in the target sequences. For each target unit $\omega _i$ of the UL, we identify the source word $w_{a_i}$ to which it is most likely aligned : $\forall i, a_i = \operatornamewithlimits{argmax}_j \alpha _{ij}$. Given these alignment links, a word segmentation is computed by introducing a word boundary in the target whenever two adjacent units are not aligned with the same source word ($a_i \ne a_{i+1}$). Considering a (simulated) low-resource setting, and building on BIBREF14's work, BIBREF11 propose to smooth attentional alignments, either by post-processing attention matrices, or by flattening the softmax function in the attention model (see Equation (DISPLAY_FORM10)) with a temperature parameter $T$. This makes sense as the authors examine attentional alignments obtained while training from UL phonemes to WL words. But when translating from WL words to UL characters, this seems less useful: smoothing will encourage a character to align to many words. This technique is further explored by BIBREF29, who make the temperature parameter trainable and specific to each decoding step, so that the model can learn how to control the softness or sharpness of attention distributions, depending on the current word being decoded. ### Attention-based word segmentation ::: Towards joint alignment and segmentation
One limitation in the approach described above lies in the absence of signal relative to segmentation during RNN training. Attempting to move towards a joint learning of alignment and segmentation, we propose here two extensions aimed at introducing constraints derived from our segmentation heuristic in the training process. ### Attention-based word segmentation ::: Towards joint alignment and segmentation ::: Word-length bias
Our first extension relies on the assumption that the length of aligned source and target words should correlate. Being in a relationship of mutual translation, aligned words are expected to have comparable frequencies and meaning, hence comparable lengths. This means that the longer a source word is, the more target units should be aligned to it. We implement this idea in the attention mechanism as a word-length bias, changing the computation of the context vector from Equation (DISPLAY_FORM9) to: where $\psi $ is a monotonically increasing function of the length $|w_j|$ of word $w_j$. This will encourage target units to attend more to longer source words. In practice, we choose $\psi $ to be the identity function and renormalize so as to ensure that lines still sum to 1 in the attention matrices. The context vectors $c_i$ are now computed with attention weights $\tilde{\alpha }_{ij}$ as: We finally derive the target segmentation from the attention matrix $A = (\tilde{\alpha }_{ij})$, following the method of Section SECREF11. ### Attention-based word segmentation ::: Towards joint alignment and segmentation ::: Introducing an auxiliary loss function
Another way to inject segmentation awareness inside our training procedure is to control the number of target words that will be produced during post-processing. The intuition here is that notwithstanding typological discrepancies, the target segmentation should yield a number of target words that is close to the length of the source. To this end, we complement the main loss function with an additional term $\mathcal {L}_\mathrm {AUX}$ defined as: The rationale behind this additional term is as follows: recall that a boundary is then inserted on the target side whenever two consecutive units are not aligned to the same source word. The dot product between consecutive lines in the attention matrix will be close to 1 if consecutive target units are aligned to the same source word, and closer to 0 if they are not. The summation thus quantifies the number of target units that will not be followed by a word boundary after segmentation, and $I - \sum _{i=1}^{I-1} \alpha _{i,*}^\top \alpha _{i+1, *}$ measures the number of word boundaries that are produced on the target side. Minimizing this auxiliary term should guide the model towards learning attention matrices resulting in target segmentations that have the same number of words on the source and target sides. Figure FIGREF25 illustrates the effect of our auxiliary loss on an example. Without auxiliary loss, the segmentation will yield, in this case, 8 target segments (Figure FIGREF25), while the attention learnt with auxiliary loss will yield 5 target segments (Figure FIGREF25); source sentence, on the other hand, has 4 tokens. ### Experiments and discussion
In this section, we describe implementation details for our baseline segmentation system and for the extensions proposed in Section SECREF17, before presenting data and results. ### Experiments and discussion ::: Implementation details
Our baseline system is our own reimplementation of Bahdanau's encoder-decoder with attention in PyTorch BIBREF31. The last version of our code, which handles mini-batches efficiently, heavily borrows from Joost Basting's code. Source sentences include an end-of-sentence (EOS) symbol (corresponding to $w_J$ in our notation) and target sentences include both a beginning-of-sentence (BOS) and an EOS symbol. Padding of source and target sentences in mini-batches is required, as well as masking in the attention matrices and during loss computation. Our architecture follows BIBREF20 very closely with some minor changes. We use a single-layer bidirectional RNN BIBREF32 with GRU cells: these have been shown to perform similarly to LSTM-based RNNs BIBREF33, while computationally more efficient. We use 64-dimensional hidden states for the forward and backward RNNs, and for the embeddings, similarly to BIBREF12, BIBREF13. In Equation (DISPLAY_FORM4), $h_j$ corresponds to the concatenation of the forward and backward states for each step $j$ of the source sequence. The alignment MLP model computes function $a$ from Equation (DISPLAY_FORM10) as $a(s_{i-1}, h_j)=v_a^\top \tanh (W_a s_{i-1} + U_a h_j)$ – see Appendix A.1.2 in BIBREF20 – where $v_a$, $W_a$, and $U_a$ are weight matrices. For the computation of weights $\tilde{\alpha _{ij}}$ in the word-length bias extension (Equation (DISPLAY_FORM21)), we arbitrarily attribute a length of 1 to the EOS symbol on the source side. The decoder is initialized using the last backward state of the encoder and a non-linear function ($\tanh $) for state $s_0$. We use a single-layer GRU RNN; hidden states and output embeddings are 64-dimensional. In preliminary experiments, and as in BIBREF34, we observed better segmentations adopting a “generate first” approach during decoding, where we first generate the current target word, then update the current RNN state. Equations (DISPLAY_FORM5) and (DISPLAY_FORM6) are accordingly modified into: During training and forced decoding, the hidden state $s_i$ is thus updated using ground-truth embeddings $e(\Omega _{i})$. $\Omega _0$ is the BOS symbol. Our implementation of the output layer ($g$) consists of a MLP and a softmax. We train for 800 epochs on the whole corpus with Adam (the learning rate is 0.001). Parameters are updated after each mini-batch of 64 sentence pairs. A dropout layer BIBREF35 is applied to both source and target embedding layers, with a rate of 0.5. The weights in all linear layers are initialized with Glorot's normalized method (Equation (16) in BIBREF36) and bias vectors are initialized to 0. Embeddings are initialized with the normal distribution $\mathcal {N}(0, 0.1)$. Except for the bridge between the encoder and the decoder, the initialization of RNN weights is kept to PyTorch defaults. During training, we minimize the NLL loss $\mathcal {L}_\mathrm {NLL}$ (see Section SECREF3), adding optionally the auxiliary loss $\mathcal {L}_\mathrm {AUX}$ (Section SECREF22). When the auxiliary loss term is used, we schedule it to be integrated progressively so as to avoid degenerate solutions with coefficient $\lambda _\mathrm {AUX}(k)$ at epoch $k$ defined by: where $K$ is the total number of epochs and $W$ a wait parameter. The complete loss at epoch $k$ is thus $\mathcal {L}_\mathrm {NLL} + \lambda _\mathrm {AUX} \cdot \mathcal {L}_\mathrm {AUX}$. After trying values ranging from 100 to 700, we set $W$ to 200. We approximate the absolute value in Equation (DISPLAY_FORM24) by $|x| \triangleq \sqrt{x^2 + 0.001}$, in order to make the auxiliary loss function differentiable. ### Experiments and discussion ::: Data and evaluation
Our experiments are performed on an actual endangered language, Mboshi (Bantu C25), a language spoken in Congo-Brazzaville, using the bilingual French-Mboshi 5K corpus of BIBREF17. On the Mboshi side, we consider alphabetic representation with no tonal information. On the French side,we simply consider the default segmentation into words. We denote the baseline segmentation system as base, the word-length bias extension as bias, and the auxiliary loss extensions as aux. We also report results for a variant of aux (aux+ratio), in which the auxiliary loss is computed with a factor corresponding to the true length ratio $r_\mathrm {MB/FR}$ between Mboshi and French averaged over the first 100 sentences of the corpus. In this variant, the auxiliary loss is computed as $\vert I - r_\mathrm {MB/FR} \cdot J - \sum _{i=1}^{I-1} \alpha _{i,*}^\top \alpha _{i+1, *} \vert $. We report segmentation performance using precision, recall, and F-measure on boundaries (BP, BR, BF), and tokens (WP, WR, WF). We also report the exact-match (X) metric which computes the proportion of correctly segmented utterances. Our main results are in Figure FIGREF47, where we report averaged scores over 10 runs. As a comparison with another bilingual method inspired by the “align to segment” approach, we also include the results obtained using the statistical models of BIBREF9, denoted Pisa, in Table TABREF46. ### Experiments and discussion ::: Discussion
A first observation is that our baseline method base improves vastly over Pisa's results (by a margin of about 30% on boundary F-measure, BF). ### Experiments and discussion ::: Discussion ::: Effects of the word-length bias
The integration of a word-bias in the attention mechanism seems detrimental to segmentation performance, and results obtained with bias are lower than those obtained with base, except for the sentence exact-match metric (X). To assess whether the introduction of word-length bias actually encourages target units to “attend more” to longer source word in bias, we compute the correlation between the length of source word and the quantity of attention these words receive (for each source position, we sum attention column-wise: $\sum _i \tilde{\alpha }_{ij}$). Results for all segmentation methods are in Table TABREF50. bias increases the correlation between word lengths and attention, but this correlation being already high for all methods (base, or aux and aux+ratio), our attempt to increase it proves here detrimental to segmentation. ### Experiments and discussion ::: Discussion ::: Effects of the auxiliary loss
For boundary F-measures (BF) in Figure FIGREF47, aux performs similarly to base, but with a much higher precision, and degraded recall, indicating that the new method does not oversegment as much as base. More insight can be gained from various statistics on the automatically segmented data presented in Table TABREF52. The average token and sentence lengths for aux are closer to their ground-truth values (resp. 4.19 characters and 5.96 words). The global number of tokens produced is also brought closer to its reference. On token metrics, a similar effect is observed, but the trade-off between a lower recall and an increased precision is more favorable and yields more than 3 points in F-measure. These results are encouraging for documentation purposes, where precision is arguably a more valuable metric than recall in a semi-supervised segmentation scenario. They, however, rely on a crude heuristic that the source and target sides (here French and Mboshi) should have the same number of units, which are only valid for typologically related languages and not very accurate for our dataset. As Mboshi is more agglutinative than French (5.96 words per sentence on average in the Mboshi 5K, vs. 8.22 for French), we also consider the lightly supervised setting where the true length ratio is provided. This again turns out to be detrimental to performance, except for the boundary precision (BP) and the sentence exact-match (X). Note also that precision becomes stronger than recall for both boundary and token metrics, indicating under-segmentation. This is confirmed by an average token length that exceeds the ground-truth (and an average sentence length below the true value, see Table TABREF52). Here again, our control of the target length proves effective: compared to base, the auxiliary loss has the effect to decrease the average sentence length and move it closer to its observed value (5.96), yielding an increased precision, an effect that is amplified with aux+ratio. By tuning this ratio, it is expected that we could even get slightly better results. ### Related work
The attention mechanism introduced by BIBREF20 has been further explored by many researchers. BIBREF37, for instance, compare a global to a local approach for attention, and examine several architectures to compute alignment weights $\alpha _{ij}$. BIBREF38 additionally propose a recurrent version of the attention mechanism, where a “dynamic memory” keeps track of the attention received by each source word, and demonstrate better translation results. A more general formulation of the attention mechanism can, lastly, be found in BIBREF39, where structural dependencies between source units can be modeled. With the goal of improving alignment quality, BIBREF40 computes a distance between attentions and word alignments learnt with the reparameterization of IBM Model 2 from BIBREF41; this distance is then added to the cost function during training. To improve alignments also, BIBREF14 introduce several refinements to the attention mechanism, in the form of structural biases common in word-based alignment models. In this work, the attention model is enriched with features able to control positional bias, fertility, or symmetry in the alignments, which leads to better translations for some language pairs, under low-resource conditions. More work seeking to improve alignment and translation quality can be found in BIBREF42, BIBREF43, BIBREF44, BIBREF45, BIBREF46, BIBREF47. Another important line of reseach related to work studies the relationship between segmentation and alignment quality: it is recognized that sub-lexical units such as BPE BIBREF48 help solve the unknown word problem; other notable works around these lines include BIBREF49 and BIBREF50. CLD has also attracted a growing interest in recent years. Most recent work includes speech-to-text translation BIBREF51, BIBREF52, speech transcription using bilingual supervision BIBREF53, both speech transcription and translation BIBREF54, or automatic phonemic transcription of tonal languages BIBREF55. ### Conclusion
In this paper, we explored neural segmentation methods extending the “align to segment” approach, and proposed extensions to move towards joint segmentation and alignment. This involved the introduction of a word-length bias in the attention mechanism and the design of an auxiliary loss. The latter approach yielded improvements over the baseline on all accounts, in particular for the precision metric. Our results, however, lag behind the best monolingual performance for this dataset (see e.g. BIBREF56). This might be due to the difficulty of computing valid alignments between phonemes and words in very limited data conditions, which remains very challenging, as also demonstrated by the results of Pisa. However, unlike monolingual methods, bilingual methods generate word alignments and their real benefit should be assessed with alignment based metrics. This is left for future work, as reference word alignments are not yet available for our data. Other extensions of this work will focus on ways to mitigate data sparsity with weak supervision information, either by using lists of frequent words or the presence of certain word boundaries on the target side or by using more sophisticated attention models in the spirit of BIBREF14 or BIBREF39. Figure 1: Effect of the auxiliary loss (LNLL) on an example attention matrix for a sentence pair. Lines are indexed by target characters (or phonemes) and columns, by source words; lighter squares correspond to higher attention weights αij . Table 1: Equivalent segmentation results with Pisa [10]. Figure 2: Boundary and token metrics (F-measure, precision, recall), and sentence exact-match (X) with methods BASE, BIAS, AUX, and AUX+RATIO, on the Mboshi 5K corpus. Horizontal colored lines correspond to values averaged over the 10 runs. Table 2: Correlation (avg. over 10 runs) between word length and attention (p-value for Pearson coefficient is 0 for each run) for methods BASE, BIAS, AUX, and AUX+RATIO. Table 3: Statistics on segmentations produced by methods BASE, BIAS, AUX, and AUX+RATIO, on the Mboshi 5K corpus: number of tokens, types, average token length (in characters), average sentence lengths (in tokens), averaged over 10 runs. Figure 3: Statistics on segmentations produced by methods BASE, BIAS, AUX, and AUX+RATIO, on the Mboshi 5K corpus: number of tokens, types, average token length (in characters), average sentence lengths (in tokens). Solid (teal-colored) lines correspond to average values (10 runs). Dashed (red) lines indicate the ground-truth values in the Mboshi 5K corpus.
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French-Mboshi 5K corpus
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Which doesn't describe Mrs. Deshazaway?
A. she cares about Humphrey
B. she was enthusiastic and passionate
C. she cares about what her neighbors think
D. she doesn't believe in love
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A FALL OF GLASS By STANLEY R. LEE Illustrated by DILLON [Transcriber's Note: This etext was produced from Galaxy Magazine October 1960. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] The weatherman was always right: Temperature, 59; humidity, 47%; occasional light showers—but of what? The pockets of Mr. Humphrey Fownes were being picked outrageously. It was a splendid day. The temperature was a crisp 59 degrees, the humidity a mildly dessicated 47%. The sun was a flaming orange ball in a cloudless blue sky. His pockets were picked eleven times. It should have been difficult. Under the circumstances it was a masterpiece of pocket picking. What made it possible was Humphrey Fownes' abstraction; he was an uncommonly preoccupied individual. He was strolling along a quiet residential avenue: small private houses, one after another, a place of little traffic and minimum distractions. But he was thinking about weather, which was an unusual subject to begin with for a person living in a domed city. He was thinking so deeply about it that it never occurred to him that entirely too many people were bumping into him. He was thinking about Optimum Dome Conditions (a crisp 59 degrees, a mildly dessicated 47%) when a bogus postman, who pretended to be reading a postal card, jostled him. In the confusion of spilled letters and apologies from both sides, the postman rifled Fownes's handkerchief and inside jacket pockets. He was still thinking about temperature and humidity when a pretty girl happened along with something in her eye. They collided. She got his right and left jacket pockets. It was much too much for coincidence. The sidewalk was wide enough to allow four people to pass at one time. He should surely have become suspicious when two men engaged in a heated argument came along. In the ensuing contretemps they emptied his rear pants pockets, got his wristwatch and restored the contents of the handkerchief pocket. It all went off very smoothly, like a game of put and take—the sole difference being that Humphrey Fownes had no idea he was playing. There was an occasional tinkle of falling glass. It fell on the streets and houses, making small geysers of shiny mist, hitting with a gentle musical sound, like the ephemeral droppings of a celesta. It was precipitation peculiar to a dome: feather-light fragments showering harmlessly on the city from time to time. Dome weevils, their metal arms reaching out with molten glass, roamed the huge casserole, ceaselessly patching and repairing. Humphrey Fownes strode through the puffs of falling glass still intrigued by a temperature that was always 59 degrees, by a humidity that was always 47%, by weather that was always Optimum. It was this rather than skill that enabled the police to maintain such a tight surveillance on him, a surveillance that went to the extent of getting his fingerprints off the postman's bag, and which photographed, X-rayed and chemically analyzed the contents of his pockets before returning them. Two blocks away from his home a careless housewife spilled a five-pound bag of flour as he was passing. It was really plaster of Paris. He left his shoe prints, stride measurement, height, weight and handedness behind. By the time Fownes reached his front door an entire dossier complete with photographs had been prepared and was being read by two men in an orange patrol car parked down the street. Lanfierre had undoubtedly been affected by his job. Sitting behind the wheel of the orange car, he watched Humphrey Fownes approach with a distinct feeling of admiration, although it was an odd, objective kind of admiration, clinical in nature. It was similar to that of a pathologist observing for the first time a new and particularly virulent strain of pneumococcus under his microscope. Lanfierre's job was to ferret out aberration. It couldn't be tolerated within the confines of a dome. Conformity had become more than a social force; it was a physical necessity. And, after years of working at it, Lanfierre had become an admirer of eccentricity. He came to see that genuine quirks were rare and, as time went on, due partly to his own small efforts, rarer. Fownes was a masterpiece of queerness. He was utterly inexplicable. Lanfierre was almost proud of Humphrey Fownes. "Sometimes his house shakes ," Lanfierre said. "House shakes," Lieutenant MacBride wrote in his notebook. Then he stopped and frowned. He reread what he'd just written. "You heard right. The house shakes ," Lanfierre said, savoring it. MacBride looked at the Fownes house through the magnifying glass of the windshield. "Like from ... side to side ?" he asked in a somewhat patronizing tone of voice. "And up and down." MacBride returned the notebook to the breast pocket of his orange uniform. "Go on," he said, amused. "It sounds interesting." He tossed the dossier carelessly on the back seat. Lanfierre sat stiffly behind the wheel, affronted. The cynical MacBride couldn't really appreciate fine aberrations. In some ways MacBride was a barbarian. Lanfierre had held out on Fownes for months. He had even contrived to engage him in conversation once, a pleasantly absurd, irrational little chat that titillated him for weeks. It was only with the greatest reluctance that he finally mentioned Fownes to MacBride. After years of searching for differences Lanfierre had seen how extraordinarily repetitious people were, echoes really, dimly resounding echoes, each believing itself whole and separate. They spoke in an incessant chatter of cliches, and their actions were unbelievably trite. Then a fine robust freak came along and the others—the echoes—refused to believe it. The lieutenant was probably on the point of suggesting a vacation. "Why don't you take a vacation?" Lieutenant MacBride suggested. "It's like this, MacBride. Do you know what a wind is? A breeze? A zephyr?" "I've heard some." "They say there are mountain-tops where winds blow all the time. Strong winds, MacBride. Winds like you and I can't imagine. And if there was a house sitting on such a mountain and if winds did blow, it would shake exactly the way that one does. Sometimes I get the feeling the whole place is going to slide off its foundation and go sailing down the avenue." Lieutenant MacBride pursed his lips. "I'll tell you something else," Lanfierre went on. "The windows all close at the same time. You'll be watching and all of a sudden every single window in the place will drop to its sill." Lanfierre leaned back in the seat, his eyes still on the house. "Sometimes I think there's a whole crowd of people in there waiting for a signal—as if they all had something important to say but had to close the windows first so no one could hear. Why else close the windows in a domed city? And then as soon as the place is buttoned up they all explode into conversation—and that's why the house shakes." MacBride whistled. "No, I don't need a vacation." A falling piece of glass dissolved into a puff of gossamer against the windshield. Lanfierre started and bumped his knee on the steering wheel. "No, you don't need a rest," MacBride said. "You're starting to see flying houses, hear loud babbling voices. You've got winds in your brain, Lanfierre, breezes of fatigue, zephyrs of irrationality—" At that moment, all at once, every last window in the house slammed shut. The street was deserted and quiet, not a movement, not a sound. MacBride and Lanfierre both leaned forward, as if waiting for the ghostly babble of voices to commence. The house began to shake. It rocked from side to side, it pitched forward and back, it yawed and dipped and twisted, straining at the mooring of its foundation. The house could have been preparing to take off and sail down the.... MacBride looked at Lanfierre and Lanfierre looked at MacBride and then they both looked back at the dancing house. "And the water ," Lanfierre said. "The water he uses! He could be the thirstiest and cleanest man in the city. He could have a whole family of thirsty and clean kids, and he still wouldn't need all that water." The lieutenant had picked up the dossier. He thumbed through the pages now in amazement. "Where do you get a guy like this?" he asked. "Did you see what he carries in his pockets?" "And compasses won't work on this street." The lieutenant lit a cigarette and sighed. He usually sighed when making the decision to raid a dwelling. It expressed his weariness and distaste for people who went off and got neurotic when they could be enjoying a happy, normal existence. There was something implacable about his sighs. "He'll be coming out soon," Lanfierre said. "He eats supper next door with a widow. Then he goes to the library. Always the same. Supper at the widow's next door and then the library." MacBride's eyebrows went up a fraction of an inch. "The library?" he said. "Is he in with that bunch?" Lanfierre nodded. "Should be very interesting," MacBride said slowly. "I can't wait to see what he's got in there," Lanfierre murmured, watching the house with a consuming interest. They sat there smoking in silence and every now and then their eyes widened as the house danced a new step. Fownes stopped on the porch to brush the plaster of paris off his shoes. He hadn't seen the patrol car and this intense preoccupation of his was also responsible for the dancing house—he simply hadn't noticed. There was a certain amount of vibration, of course. He had a bootleg pipe connected into the dome blower system, and the high-pressure air caused some buffeting against the thin walls of the house. At least, he called it buffeting; he'd never thought to watch from outside. He went in and threw his jacket on the sofa, there being no room left in the closets. Crossing the living room he stopped to twist a draw-pull. Every window slammed shut. "Tight as a kite," he thought, satisfied. He continued on toward the closet at the foot of the stairs and then stopped again. Was that right? No, snug as a hug in a rug . He went on, thinking: The old devils. The downstairs closet was like a great watch case, a profusion of wheels surrounding the Master Mechanism, which was a miniature see-saw that went back and forth 365-1/4 times an hour. The wheels had a curious stateliness about them. They were all quite old, salvaged from grandfather's clocks and music boxes and they went around in graceful circles at the rate of 30 and 31 times an hour ... although there was one slightly eccentric cam that vacillated between 28 and 29. He watched as they spun and flashed in the darkness, and then set them for seven o'clock in the evening, April seventh, any year. Outside, the domed city vanished. It was replaced by an illusion. Or, as Fownes hoped it might appear, the illusion of the domed city vanished and was replaced by a more satisfactory, and, for his specific purpose, more functional, illusion. Looking through the window he saw only a garden. Instead of an orange sun at perpetual high noon, there was a red sun setting brilliantly, marred only by an occasional arcover which left the smell of ozone in the air. There was also a gigantic moon. It hid a huge area of sky, and it sang. The sun and moon both looked down upon a garden that was itself scintillant, composed largely of neon roses. Moonlight, he thought, and roses. Satisfactory. And cocktails for two. Blast, he'd never be able to figure that one out! He watched as the moon played, Oh, You Beautiful Doll and the neon roses flashed slowly from red to violet, then went back to the closet and turned on the scent. The house began to smell like an immensely concentrated rose as the moon shifted to People Will Say We're In Love . He rubbed his chin critically. It seemed all right. A dreamy sunset, an enchanted moon, flowers, scent. They were all purely speculative of course. He had no idea how a rose really smelled—or looked for that matter. Not to mention a moon. But then, neither did the widow. He'd have to be confident, assertive. Insist on it. I tell you, my dear, this is a genuine realistic romantic moon. Now, does it do anything to your pulse? Do you feel icy fingers marching up and down your spine? His own spine didn't seem to be affected. But then he hadn't read that book on ancient mores and courtship customs. How really odd the ancients were. Seduction seemed to be an incredibly long and drawn-out process, accompanied by a considerable amount of falsification. Communication seemed virtually impossible. "No" meant any number of things, depending on the tone of voice and the circumstances. It could mean yes, it could mean ask me again later on this evening. He went up the stairs to the bedroom closet and tried the rain-maker, thinking roguishly: Thou shalt not inundate. The risks he was taking! A shower fell gently on the garden and a male chorus began to chant Singing in the Rain . Undiminished, the yellow moon and the red sun continued to be brilliant, although the sun occasionally arced over and demolished several of the neon roses. The last wheel in the bedroom closet was a rather elegant steering wheel from an old 1995 Studebaker. This was on the bootleg pipe; he gingerly turned it. Far below in the cellar there was a rumble and then the soft whistle of winds came to him. He went downstairs to watch out the living room window. This was important; the window had a really fixed attitude about air currents. The neon roses bent and tinkled against each other as the wind rose and the moon shook a trifle as it whispered Cuddle Up a Little Closer . He watched with folded arms, considering how he would start. My dear Mrs. Deshazaway. Too formal. They'd be looking out at the romantic garden; time to be a bit forward. My very dear Mrs. Deshazaway. No. Contrived. How about a simple, Dear Mrs. Deshazaway . That might be it. I was wondering, seeing as how it's so late, if you wouldn't rather stay over instead of going home.... Preoccupied, he hadn't noticed the winds building up, didn't hear the shaking and rattling of the pipes. There were attic pipes connected to wall pipes and wall pipes connected to cellar pipes, and they made one gigantic skeleton that began to rattle its bones and dance as high-pressure air from the dome blower rushed in, slowly opening the Studebaker valve wider and wider.... The neon roses thrashed about, extinguishing each other. The red sun shot off a mass of sparks and then quickly sank out of sight. The moon fell on the garden and rolled ponderously along, crooning When the Blue of the Night Meets the Gold of the Day . The shaking house finally woke him up. He scrambled upstairs to the Studebaker wheel and shut it off. At the window again, he sighed. Repairs were in order. And it wasn't the first time the winds got out of line. Why didn't she marry him and save all this bother? He shut it all down and went out the front door, wondering about the rhyme of the months, about stately August and eccentric February and romantic April. April. Its days were thirty and it followed September. And all the rest have thirty-one. What a strange people, the ancients! He still didn't see the orange car parked down the street. "Men are too perishable," Mrs. Deshazaway said over dinner. "For all practical purposes I'm never going to marry again. All my husbands die." "Would you pass the beets, please?" Humphrey Fownes said. She handed him a platter of steaming red beets. "And don't look at me that way," she said. "I'm not going to marry you and if you want reasons I'll give you four of them. Andrew. Curt. Norman. And Alphonse." The widow was a passionate woman. She did everything passionately—talking, cooking, dressing. Her beets were passionately red. Her clothes rustled and her high heels clicked and her jewelry tinkled. She was possessed by an uncontrollable dynamism. Fownes had never known anyone like her. "You forgot to put salt on the potatoes," she said passionately, then went on as calmly as it was possible for her to be, to explain why she couldn't marry him. "Do you have any idea what people are saying? They're all saying I'm a cannibal! I rob my husbands of their life force and when they're empty I carry their bodies outside on my way to the justice of the peace." "As long as there are people," he said philosophically, "there'll be talk." "But it's the air! Why don't they talk about that? The air is stale, I'm positive. It's not nourishing. The air is stale and Andrew, Curt, Norman and Alphonse couldn't stand it. Poor Alphonse. He was never so healthy as on the day he was born. From then on things got steadily worse for him." "I don't seem to mind the air." She threw up her hands. "You'd be the worst of the lot!" She left the table, rustling and tinkling about the room. "I can just hear them. Try some of the asparagus. Five. That's what they'd say. That woman did it again. And the plain fact is I don't want you on my record." "Really," Fownes protested. "I feel splendid. Never better." He could hear her moving about and then felt her hands on his shoulders. "And what about those very elaborate plans you've been making to seduce me?" Fownes froze with three asparagus hanging from his fork. "Don't you think they'll find out? I found out and you can bet they will. It's my fault, I guess. I talk too much. And I don't always tell the truth. To be completely honest with you, Mr. Fownes, it wasn't the old customs at all standing between us, it was air. I can't have another man die on me, it's bad for my self-esteem. And now you've gone and done something good and criminal, something peculiar." Fownes put his fork down. "Dear Mrs. Deshazaway," he started to say. "And of course when they do find out and they ask you why, Mr. Fownes, you'll tell them. No, no heroics, please! When they ask a man a question he always answers and you will too. You'll tell them I wanted to be courted and when they hear that they'll be around to ask me a few questions. You see, we're both a bit queer." "I hadn't thought of that," Fownes said quietly. "Oh, it doesn't really matter. I'll join Andrew, Curt, Norman—" "That won't be necessary," Fownes said with unusual force. "With all due respect to Andrew, Curt, Norman and Alphonse, I might as well state here and now I have other plans for you, Mrs. Deshazaway." "But my dear Mr. Fownes," she said, leaning across the table. "We're lost, you and I." "Not if we could leave the dome," Fownes said quietly. "That's impossible! How?" In no hurry, now that he had the widow's complete attention, Fownes leaned across the table and whispered: "Fresh air, Mrs. Deshazaway? Space? Miles and miles of space where the real-estate monopoly has no control whatever? Where the wind blows across prairies ; or is it the other way around? No matter. How would you like that , Mrs. Deshazaway?" Breathing somewhat faster than usual, the widow rested her chin on her two hands. "Pray continue," she said. "Endless vistas of moonlight and roses? April showers, Mrs. Deshazaway. And June, which as you may know follows directly upon April and is supposed to be the month of brides, of marrying. June also lies beyond the dome." "I see." " And ," Mr. Fownes added, his voice a honeyed whisper, "they say that somewhere out in the space and the roses and the moonlight, the sleeping equinox yawns and rises because on a certain day it's vernal and that's when it roams the Open Country where geigers no longer scintillate." " My. " Mrs. Deshazaway rose, paced slowly to the window and then came back to the table, standing directly over Fownes. "If you can get us outside the dome," she said, "out where a man stays warm long enough for his wife to get to know him ... if you can do that, Mr. Fownes ... you may call me Agnes." When Humphrey Fownes stepped out of the widow's house, there was a look of such intense abstraction on his features that Lanfierre felt a wistful desire to get out of the car and walk along with the man. It would be such a deliciously insane experience. ("April has thirty days," Fownes mumbled, passing them, "because thirty is the largest number such that all smaller numbers not having a common divisor with it are primes ." MacBride frowned and added it to the dossier. Lanfierre sighed.) Pinning his hopes on the Movement, Fownes went straight to the library several blocks away, a shattered depressing place given over to government publications and censored old books with holes in them. It was used so infrequently that the Movement was able to meet there undisturbed. The librarian was a yellowed, dog-eared woman of eighty. She spent her days reading ancient library cards and, like the books around her, had been rendered by time's own censor into near unintelligibility. "Here's one," she said to him as he entered. " Gulliver's Travels. Loaned to John Wesley Davidson on March 14, 1979 for five days. What do you make of it?" In the litter of books and cards and dried out ink pads that surrounded the librarian, Fownes noticed a torn dust jacket with a curious illustration. "What's that?" he said. "A twister," she replied quickly. "Now listen to this . Seven years later on March 21, 1986, Ella Marshall Davidson took out the same book. What do you make of that ?" "I'd say," Humphrey Fownes said, "that he ... that he recommended it to her, that one day they met in the street and he told her about this book and then they ... they went to the library together and she borrowed it and eventually, why eventually they got married." "Hah! They were brother and sister!" the librarian shouted in her parched voice, her old buckram eyes laughing with cunning. Fownes smiled weakly and looked again at the dust jacket. The twister was unquestionably a meteorological phenomenon. It spun ominously, like a malevolent top, and coursed the countryside destructively, carrying a Dorothy to an Oz. He couldn't help wondering if twisters did anything to feminine pulses, if they could possibly be a part of a moonlit night, with cocktails and roses. He absently stuffed the dust jacket in his pocket and went on into the other rooms, the librarian mumbling after him: "Edna Murdoch Featherstone, April 21, 1991," as though reading inscriptions on a tombstone. The Movement met in what had been the children's room, where unpaid ladies of the afternoon had once upon a time read stories to other people's offspring. The members sat around at the miniature tables looking oddly like giants fled from their fairy tales, protesting. "Where did the old society fail?" the leader was demanding of them. He stood in the center of the room, leaning on a heavy knobbed cane. He glanced around at the group almost complacently, and waited as Humphrey Fownes squeezed into an empty chair. "We live in a dome," the leader said, "for lack of something. An invention! What is the one thing that the great technological societies before ours could not invent, notwithstanding their various giant brains, electronic and otherwise?" Fownes was the kind of man who never answered a rhetorical question. He waited, uncomfortable in the tight chair, while the others struggled with this problem in revolutionary dialectics. " A sound foreign policy ," the leader said, aware that no one else had obtained the insight. "If a sound foreign policy can't be created the only alternative is not to have any foreign policy at all. Thus the movement into domes began— by common consent of the governments . This is known as self-containment." Dialectically out in left field, Humphrey Fownes waited for a lull in the ensuing discussion and then politely inquired how it might be arranged for him to get out. "Out?" the leader said, frowning. "Out? Out where?" "Outside the dome." "Oh. All in good time, my friend. One day we shall all pick up and leave." "And that day I'll await impatiently," Fownes replied with marvelous tact, "because it will be lonely out there for the two of us. My future wife and I have to leave now ." "Nonsense. Ridiculous! You have to be prepared for the Open Country. You can't just up and leave, it would be suicide, Fownes. And dialectically very poor." "Then you have discussed preparations, the practical necessities of life in the Open Country. Food, clothing, a weapon perhaps? What else? Have I left anything out?" The leader sighed. "The gentleman wants to know if he's left anything out," he said to the group. Fownes looked around at them, at some dozen pained expressions. "Tell the man what he's forgotten," the leader said, walking to the far window and turning his back quite pointedly on them. Everyone spoke at the same moment. " A sound foreign policy ," they all said, it being almost too obvious for words. On his way out the librarian shouted at him: " A Tale of a Tub , thirty-five years overdue!" She was calculating the fine as he closed the door. Humphrey Fownes' preoccupation finally came to an end when he was one block away from his house. It was then that he realized something unusual must have occurred. An orange patrol car of the security police was parked at his front door. And something else was happening too. His house was dancing. It was disconcerting, and at the same time enchanting, to watch one's residence frisking about on its foundation. It was such a strange sight that for the moment he didn't give a thought to what might be causing it. But when he stepped gingerly onto the porch, which was doing its own independent gavotte, he reached for the doorknob with an immense curiosity. The door flung itself open and knocked him back off the porch. From a prone position on his miniscule front lawn, Fownes watched as his favorite easy chair sailed out of the living room on a blast of cold air and went pinwheeling down the avenue in the bright sunshine. A wild wind and a thick fog poured out of the house. It brought chairs, suits, small tables, lamps trailing their cords, ashtrays, sofa cushions. The house was emptying itself fiercely, as if disgorging an old, spoiled meal. From deep inside he could hear the rumble of his ancient upright piano as it rolled ponderously from room to room. He stood up; a wet wind swept over him, whipping at his face, toying with his hair. It was a whistling in his ears, and a tingle on his cheeks. He got hit by a shoe. As he forced his way back to the doorway needles of rain played over his face and he heard a voice cry out from somewhere in the living room. "Help!" Lieutenant MacBride called. Standing in the doorway with his wet hair plastered down on his dripping scalp, the wind roaring about him, the piano rumbling in the distance like thunder, Humphrey Fownes suddenly saw it all very clearly. " Winds ," he said in a whisper. "What's happening?" MacBride yelled, crouching behind the sofa. " March winds," he said. "What?!" "April showers!" The winds roared for a moment and then MacBride's lost voice emerged from the blackness of the living room. "These are not Optimum Dome Conditions!" the voice wailed. "The temperature is not 59 degrees. The humidity is not 47%!" Fownes held his face up to let the rain fall on it. "Moonlight!" he shouted. "Roses! My soul for a cocktail for two!" He grasped the doorway to keep from being blown out of the house. "Are you going to make it stop or aren't you!" MacBride yelled. "You'll have to tell me what you did first!" "I told him not to touch that wheel! Lanfierre. He's in the upstairs bedroom!" When he heard this Fownes plunged into the house and fought his way up the stairs. He found Lanfierre standing outside the bedroom with a wheel in his hand. "What have I done?" Lanfierre asked in the monotone of shock. Fownes took the wheel. It was off a 1995 Studebaker. "I'm not sure what's going to come of this," he said to Lanfierre with an astonishing amount of objectivity, "but the entire dome air supply is now coming through my bedroom." The wind screamed. "Is there something I can turn?" Lanfierre asked. "Not any more there isn't." They started down the stairs carefully, but the wind caught them and they quickly reached the bottom in a wet heap. Recruiting Lieutenant MacBride from behind his sofa, the men carefully edged out of the house and forced the front door shut. The wind died. The fog dispersed. They stood dripping in the Optimum Dome Conditions of the bright avenue. "I never figured on this ," Lanfierre said, shaking his head. With the front door closed the wind quickly built up inside the house. They could see the furnishing whirl past the windows. The house did a wild, elated jig. "What kind of a place is this?" MacBride said, his courage beginning to return. He took out his notebook but it was a soggy mess. He tossed it away. "Sure, he was different ," Lanfierre murmured. "I knew that much." When the roof blew off they weren't really surprised. With a certain amount of equanimity they watched it lift off almost gracefully, standing on end for a moment before toppling to the ground. It was strangely slow motion, as was the black twirling cloud that now rose out of the master bedroom, spewing shorts and socks and cases every which way. " Now what?" MacBride said, thoroughly exasperated, as this strange black cloud began to accelerate, whirling about like some malevolent top.... Humphrey Fownes took out the dust jacket he'd found in the library. He held it up and carefully compared the spinning cloud in his bedroom with the illustration. The cloud rose and spun, assuming the identical shape of the illustration. "It's a twister," he said softly. "A Kansas twister!" "What," MacBride asked, his bravado slipping away again, "what ... is a twister?" The twister roared and moved out of the bedroom, out over the rear of the house toward the side of the dome. "It says here," Fownes shouted over the roaring, "that Dorothy traveled from Kansas to Oz in a twister and that ... and that Oz is a wonderful and mysterious land beyond the confines of everyday living ." MacBride's eyes and mouth were great zeros. "Is there something I can turn?" Lanfierre asked. Huge chunks of glass began to fall around them. "Fownes!" MacBride shouted. "This is a direct order! Make it go back!" But Fownes had already begun to run on toward the next house, dodging mountainous puffs of glass as he went. "Mrs. Deshazaway!" he shouted. "Yoo-hoo, Mrs. Deshazaway!" The dome weevils were going berserk trying to keep up with the precipitation. They whirred back and forth at frightful speed, then, emptied of molten glass, rushed to the Trough which they quickly emptied and then rushed about empty-handed. "Yoo-hoo!" he yelled, running. The artificial sun vanished behind the mushrooming twister. Optimum temperature collapsed. "Mrs. Deshazaway! Agnes , will you marry me? Yoo-hoo!" Lanfierre and Lieutenant MacBride leaned against their car and waited, dazed. There was quite a large fall of glass.
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D. she doesn't believe in love
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Why didn't Laura say yes?
A. she isn't interested in marrying Ben
B. Mickey wouldn't want that
C. she was jealous of Ben's future plans
D. she knows he wants to go to space
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Spacemen Die at Home By EDWARD W. LUDWIG Illustrated by THORNE [Transcriber's Note: This etext was produced from Galaxy Science Fiction October 1951. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] One man's retreat is another's prison ... and it takes a heap of flying to make a hulk a home! Forty days of heaven and forty nights of hell. That's the way it's been, Laura. But how can I make you understand? How can I tell you what it's like to be young and a man and to dream of reaching the stars? And yet, at the same time, to be filled with a terrible, gnawing fear—a fear locked in my mind during the day and bursting out like an evil jack-in-the-box at night. I must tell you, Laura. Perhaps if I start at the beginning, the very beginning.... It was the Big Day. All the examinations, the physicals and psychos, were over. The Academy, with its great halls and classrooms and laboratories, lay hollow and silent, an exhausted thing at sleep after spawning its first-born. For it was June in this year of 1995, and we were the graduating class of the U. S. Academy of Interplanetary Flight. The first graduating class, Laura. That's why it was so important, because we were the first . We sat on a little platform, twenty-five of us. Below us was a beach of faces, most of them strange, shining like pebbles in the warm New Mexican sunlight. They were the faces of mothers and fathers and grandparents and kid brothers and sisters—the people who a short time ago had been only scrawled names on letters from home or words spoken wistfully at Christmas. They were the memory-people who, to me, had never really existed. But today they had become real, and they were here and looking at us with pride in their eyes. A voice was speaking, deep, sure, resonant. "... these boys have worked hard for six years, and now they're going to do a lot of big things. They're going to bring us the metals and minerals that we desperately need. They're going to find new land for our colonists, good rich land that will bear food and be a home for our children. And perhaps most important of all, they'll make other men think of the stars and look up at them and feel humility—for mankind needs humility." The speaker was Robert Chandler, who'd brought the first rocket down on Mars just five years ago, who'd established the first colony there, and who had just returned from his second hop to Venus. Instead of listening to his words, I was staring at his broad shoulders and his dark, crew-cut hair and his white uniform which was silk-smooth and skin-tight. I was worshiping him and hating him at the same time, for I was thinking: He's already reached Mars and Venus. Let him leave Jupiter and the others alone! Let us be the first to land somewhere! Let us be the first! Mickey Cameron, sitting next to me, dug an elbow into my ribs. "I don't see 'em, Ben," he whispered. "Where do you suppose they are?" I blinked. "Who?" "My folks." That was something I didn't have to worry about. My parents had died in a strato-jet crash when I was four, so I hadn't needed many of those "You are cordially invited" cards. Just one, which I'd sent to Charlie Taggart. Stardust Charlie, we called him, although I never knew why. He was a veteran of Everson's first trip to the Moon nearly twenty-five years ago, and he was still at it. He was Chief Jetman now on the Lunar Lady , a commercial ore ship on a shuttle between Luna City and White Sands. I remembered how, as a kid, I'd pestered him in the Long Island Spaceport, tagging after him like a puppy, and how he'd grown to like me until he became father, mother, and buddy all in one to me. And I remembered, too, how his recommendation had finally made me a cadet. My gaze wandered over the faces, but I couldn't find Charlie's. It wasn't surprising. The Lunar Lady was in White Sands now, but liberties, as Charlie said, were as scarce as water on Mars. It doesn't matter , I told myself. Then Mickey stiffened. "I see 'em, Ben! There in the fifth row!" Usually Mickey was the same whether in a furnace-hot engine room or a garden party, smiling, accepting whatever the world offered. But now a tenseness and an excitement had gripped even him. I was grateful that he was beside me; we'd been a good team during those final months at the Academy and I knew we'd be a good team in space. The Universe was mighty big, but with two of us to face it together, it would be only half as big. And then it seemed that all the proud faces were looking at us as if we were gods. A shiver went through my body. Though it was daytime, I saw the stars in my mind's vision, the great shining balls of silver, each like a voice crying out and pleading to be explored, to be touched by the sons of Earth. They expect a lot from us. They expect us to make a new kind of civilization and a better place out of Earth. They expect all this and a hell of a lot more. They think there's nothing we can't do. I felt very small and very humble. I was scared. Damned scared. At last it was over, and the proud faces descended upon us in a huge, babbling wave. Then I saw him. Good old Stardust Charlie. His wizened little body was shuffling down an aisle, his eyes shining like a child's. He'd been sandwiched, evidently, in one of the rear rows. But he wasn't the Charlie I'd seen a year ago. He'd become gaunt and old, and he walked with an unnatural stiffness. He looked so old that it was hard to believe he'd once been young. He scratched his mop of steel-gray hair and grinned. "You made it, boy," he chortled, "and by Jupiter, we'll celebrate tonight. Yes, siree, I got twenty-four hours, and we'll celebrate as good spacemen should!" Then Mickey strode up to us. He was his normal, boyish self again, walking lightly, his blond, curly-haired skull swaying as if in rhythm with some silent melody. And you, Laura, were with him. "Meet the Brat," he said. "My sister Laura." I stared almost rudely. You were like a doll lost in the immensity of your fluffy pink dress. Your hair was long and transformed into a golden froth where sunlight touched it. But your eyes were the eyes of a woman, glowing like dark stars and reflecting a softness, a gentleness that I'd never seen in eyes before. "I'm happy to meet you, Ben," you said. "I've heard of no one else for the past year." A tide of heat crept up from my collar. I stuttered through an introduction of Charlie. You and Mickey looked strangely at Charlie, and I realized that old Stardust was not a cadet's notion of the ideal spaceman. Charlie scorned the skin-tight uniforms of the government service and wore a shiny black suit that was a relic of Everson's early-day Moon Patrol. His tie was clumsily knotted, and a button on his coat was missing. And the left side of his face was streaked with dark scar tissue, the result of an atomic blowup on one of the old Moon ships. I was so accustomed to the scars, I was seldom aware of them; but others, I knew, would find them ugly. You were kind. You shook hands and said, softly: "It's a privilege to meet you, Charlie. Just think—one of Everson's men, one of the first to reach the Moon!" Charlie gulped helplessly, and Mickey said: "Still going to spend the weekend with us, aren't you, Ben?" I shook my head. "Charlie has only twenty-four hours liberty. We're planning to see the town tonight." "Why don't you both come with us?" you asked. "Our folks have their own plane, so it would be no problem. And we've got a big guest room. Charlie, wouldn't you like a home-cooked meal before going back to the Moon?" Charlie's answer was obscured by a sudden burst of coughing. I knew that he'd infinitely prefer to spend his liberty sampling Martian fizzes and Plutonian zombies. But this night seemed too sacred for Charlie's kind of celebration. "We'd really like to come," I said. On our way to the 'copter parking field, Dean Dawson passed us. He was a tall, willowy man, spectacled, looking the way an academy professor should look. "Ben," he called, "don't forget that offer. Remember you've got two months to decide." "No, thanks," I answered. "Better not count on me." A moment later Mickey said, frowning, "What was he talking about, Ben? Did he make you an offer?" I laughed. "He offered me a job here at the Academy teaching astrogation. What a life that would be! Imagine standing in a classroom for forty years when I've got the chance to—" I hesitated, and you supplied the right words: "When you've got the chance to be the first to reach a new planet. That's what most of you want, isn't it? That's what Mickey used to want." I looked at you as if you were Everson himself, because you seemed to understand the hunger that could lie in a man's heart. Then your last words came back and jabbed me: "That's what Mickey used to want." " Used to want?" I asked. "What do you mean?" You bit your lip, not answering. "What did she mean, Mickey?" Mickey looked down at his feet. "I didn't want to tell you yet, Ben. We've been together a long time, planning to be on a rocket. But—" "Yes?" "Well, what does it add up to? You become a spaceman and wear a pretty uniform. You wade through the sands of Mars and the dust of Venus. If you're lucky, you're good for five, maybe ten years. Then one thing or another gets you. They don't insure rocketmen, you know." My stomach was full of churning, biting ice. "What are you trying to say, Mickey?" "I've thought about it a long time. They want me for Cargo Supervisor of White Sands Port." He raised his hand to stop me. "I know. It's not so exciting. I'll just live a lot longer. I'm sorry, Ben." I couldn't answer. It was as if someone had whacked the back of my knees with the blast of a jet. "It doesn't change anything, Ben—right now, I mean. We can still have a good weekend." Charlie was muttering under his breath, smoldering like a bomb about to reach critical mass. I shook my head dazedly at him as we got to the 'copter. "Sure," I said to Mickey, "we can still have a good weekend." I liked your folks, Laura. There was no star-hunger in them, of course. They were simple and solid and settled, like green growing things, deep-rooted, belonging to Earth. They were content with a home that was cool on this warm summer night, with a 'copter and a tri-dimensional video, and a handsome automatic home that needed no servants or housework. Stardust Charlie was as comfortable as a Martian sand-monkey in a shower, but he tried courageously to be himself. At the dinner table he stared glassily at nothing and grated, "Only hit Mars once, but I'll never forget the kid who called himself a medic. Skipper started coughing, kept it up for three days. Whoopin' cough, the medic says, not knowin' the air had chemicals that turned to acid in your lungs. I'd never been to Mars before, but I knew better'n that. Hell, I says, that ain't whoopin' cough, that's lung-rot." That was when your father said he wasn't so hungry after all. Afterward, you and I walked onto the terrace, into the moonlit night, to watch for crimson-tailed continental rockets that occasionally streaked up from White Sands. We gazed for a few seconds up into the dark sky, and then you said: "Charlie is funny, isn't he? He's nice and I'm glad he's here, but he's sort of funny." "He's an old-time spaceman. You didn't need much education in those days, just a lot of brawn and a quick mind. It took guts to be a spaceman then." "But he wasn't always a spaceman. Didn't he ever have a family?" I smiled and shook my head. "If he had, he never mentioned it. Charlie doesn't like to be sentimental, at least not on the outside. As far as I know, his life began when he took off for the Moon with Everson." You stared at me strangely, almost in a sacred kind of way. I knew suddenly that you liked me, and my heart began to beat faster. There was silence. You were lovely, your soft hair like strands of gold, and there were flecks of silver in your dark eyes. Somehow I was afraid. I had the feeling that I shouldn't have come here. You kept looking at me until I had to ask: "What are you thinking, Laura?" You laughed, but it was a sad, fearful laugh. "No, I shouldn't be thinking it. You'd hate me if I told you, and I wouldn't want that." "I could never hate you." "It—it's about the stars," you said very softly. "I understand why you want to go to them. Mickey and I used to dream about them when we were kids. Of course I was a girl, so it was just a game to me. But once I dreamed of going to England. Oh, it was going to be so wonderful. I lived for months, just thinking about it. "One summer we went. I had fun. I saw the old buildings and castles, and the spaceports and the Channel Tube. But after it was over, I realized England wasn't so different from America. Places seem exciting before you get to them, and afterward they're not really." I frowned. "And you mean it might be the same with the stars? You think maybe I haven't grown up yet?" Anxiety darkened your features. "No, it'd be good to be a spaceman, to see the strange places and make history. But is it worth it? Is it worth the things you'd have to give up?" I didn't understand at first, and I wanted to ask, "Give up what ?" Then I looked at you and the promise in your eyes, and I knew. All through the years I'd been walking down a single, narrow path. Government boarding school, the Academy, my eyes always upward and on the stars. Now I'd stumbled into a cross-roads, beholding a strange new path that I'd never noticed before. You can go into space , I thought, and try to do as much living in ten years as normal men do in fifty. You can be like Everson, who died in a Moon crash at the age of 36, or like a thousand others who lie buried in Martian sand and Venusian dust. Or, if you're lucky, like Charlie—a kind of human meteor streaking through space, eternally alone, never finding a home. Or there's the other path. To stay on this little prison of an Earth in cool, comfortable houses. To be one of the solid, rooted people with a wife and kids. To be one of the people who live long enough to grow old, who awake to the song of birds instead of rocket grumblings, who fill their lungs with the clean rich air of Earth instead of poisonous dust. "I'm sorry," you said. "I didn't mean to make you sad, Ben." "It's all right," I said, clenching my fists. "You made sense—a lot of sense." The next morning Charlie said good-bye in our room. He rubbed his scarred face nervously as he cleared his throat with a series of thin, tight coughs. Then he pointed to a brown, faded tin box lying on the bed. "I'm leavin' that for you. It's full of old stuff, souvenirs mostly. Thought maybe you'd like to have 'em." I scowled, not understanding. "Why, Charlie? What for?" He shrugged as if afraid he might be accused of sentimentality. "Oh, it's just that I've been dodgin' meteors now for twenty-five years. That's a long time, boy. Ain't one spaceman in a thousand that lucky. Some of these days, I won't be so lucky." I tried to laugh. "You're good for another twenty-five years, Charlie." He shook his head stiffly, staring at nothing. "Maybe. Anyway, I'm gonna get off the Shuttle this time, make one more trip to Mars. Tell you what. There's a little stone cafe on Mars, the Space Rat , just off Chandler Field on the Grand Canal. When you get to Mars, take a look inside. I'll probably be there." He coughed again, a deep, rasping cough that filled his eyes with tears. "Not used to this Earth air," he muttered. "What I need's some Martian climate." Suddenly that cough frightened me. It didn't seem normal. I wondered, too, about his stiff movements and glassy stare. It was as if he were drugged. I shook the thought away. If Charlie was sick, he wouldn't talk about going to Mars. The medics wouldn't let him go even as far as Luna. We watched him leave, you and Mickey and I. "When will you be back?" you asked. Charlie's hard face contorted itself into a gargoylish grin. "Maybe a couple of months, maybe a couple of years. You know spacemen." Then he waved and strode away, a strange, gray, withered gnome of a man. I wanted him to say something, to tell me the secret that would kill the doubt worming through my brain. But he rounded a corner, still grinning and waving, and then he was gone. That afternoon Mickey showed me his room. It was more like a boy's room than a spaceman's. In it were all the little things that kids treasure—pennants, models of Everson's two ships, a tennis trophy, books, a home-made video. I began to realize how important a room like this could be to a boy. I could imagine, too, the happiness that parents felt as they watched their children grow to adulthood. I'd missed something. My folks were shadow-people, my impressions of them drawn half from ancient photos, half from imagination. For me, it had been a cold, automatic kind of life, the life of dormitories and routines and rules. I'd been so blinded by the brilliancy of my dreams, I hadn't realized I was different. My folks were killed in a rocket crash. If it weren't for rockets, I'd have lived the kind of life a kid should live. Mickey noticed my frown. "What's the matter, Ben? Still sore? I feel like a heel, but I'm just not like you and Charlie, I guess. I—" "No, I understand, Mickey. I'm not sore, really." "Listen, then. You haven't accepted any offer yet, have you?" "No. I got a couple of possibilities. Could get a berth on the Odyssey , the new ship being finished at Los Angeles. They want me, too, for the Moon Patrol, but that's old stuff, not much better than teaching. I want to be in deep space." "Well, how about staying with us till you decide? Might as well enjoy Earth life while you can. Okay?" I felt like running from the house, to forget that it existed. I wanted someone to tell me one of the old stories about space, a tale of courage that would put fuel on dying dreams. But I wanted, also, to be with you, Laura, to see your smile and the flecks of silver in your eyes and the way your nose turned upward ever so slightly when you laughed. You see, I loved you already, almost as much as I loved the stars. And I said, slowly, my voice sounding unfamiliar and far away, "Sure, I'll stay, Mickey. Sure." Forty days of joy, forty nights of fear and indecision. We did all the little things, like watching the rockets land at White Sands and flying down to the Gulf to swim in cool waters. You tried, unsuccessfully, to teach me to dance, and we talked about Everson and Charlie and the Moon and the stars. You felt you had to give the stars all the beauty and promise of a child's dream, because you knew that was what I wanted. One morning I thought, Why must I make a choice? Why can't I have both you and the stars? Would that be asking too much? All day the thought lay in my mind like fire. That evening I asked you to marry me. I said it very simply: "Laura, I want you to be my wife." You looked up at Venus, and you were silent for a long while, your face flushed. Then you murmured, "I—I want to marry you, Ben, but are you asking me to marry a spaceman or a teacher?" "Can't a spaceman marry, too?" "Yes, a spaceman can marry, but what would it be like? Don't you see, Ben? You'd be like Charlie. Gone for maybe two months, maybe two years. Then you'd have a twenty-four hour liberty—and I'd have what?" Somehow I'd expected words like these, but still they hurt. "I wouldn't have to be a spaceman forever. I could try it for a couple of years, then teach." "Would you, Ben? Would you be satisfied with just seeing Mars? Wouldn't you want to go on to Jupiter and Saturn and Uranus and on and on?" Your voice was choked, and even in the semi-darkness I saw tears glittering in your eyes. "Do you think I'd dare have children, Ben? Mickey told me what happened on the Cyclops . There was a leak in the atomic engines. The ship was flooded with radiation—just for a second. It didn't seem serious. The men had no burns. But a year later the captain had a child. And it was—" "I know, Laura. Don't say it." You had to finish. "It was a monster." That night I lay awake, the fears and doubts too frantic to let me sleep. You've got to decide now , I told myself. You can't stay here. You've got to make a choice. The teaching job was still open. The spot on the Odyssey was still open—and the big ship, it was rumored, was equipped to make it all the way to Pluto. You can take Dean Dawson's job and stay with Laura and have kids and a home and live to see what happens in this world sixty years from now. Or you can see what's on the other side of the mountain. You can be a line in a history book. I cursed. I knew what Charlie would say. He'd say, "Get the hell out of there, boy. Don't let a fool woman make a sucker out of you. Get out there on the Odyssey where you belong. We got a date on Mars, remember? At the Space Rat , just off Chandler Field on the Grand Canal." That's what he'd say. And yet I wanted you, Laura. I wanted to be with you, always. "Oh God," I moaned, "what shall I do?" Next morning the door chimes pealed, and you went to the door and brought back the audiogram. It was addressed to me; I wondered who could be sending me a message. I pressed the stud on the little gray cylinder, and a rasping, automatic voice droned: "Luna City, Luna, July 27, 1995. Regret to inform you of death of Charles Taggart, Chief Jetman...." Then there was a Latin name which was more polite than the word "lung-rot" and the metallic phrase, "This message brought to you by courtesy of United Nations Earth-Luna Communication Corps." I stood staring at the cylinder. Charles Taggart was dead. Charles Taggart was Charlie. Stardust Charlie. My heart thudded crazily against my chest. It couldn't be! Not Charlie! The audiogram had lied! I pressed the stud again. "... regret to inform you of death of Charles ..." I hurled the cylinder at the wall. It thudded, fell, rolled. The broken voice droned on. You ran to it, shut it off. "I'm sorry, Ben, so terribly—" Without answering, I walked into my room. I knew it was true now. I remembered Charlie's coughing, his gaunt features, his drugged gaze. The metallic words had told the truth. I sat for a long time on my bed, crying inside, but staring dry-eyed at Charlie's faded tin box. Then, finally, I fingered his meager possessions—a few wrinkled photos, some letters, a small black statue of a forgotten Martian god, a gold service medal from the Moon Patrol. This was what remained of Charlie after twenty-five years in space. It was a bitter bargain. A statue instead of a wife, yellowed letters instead of children, a medal instead of a home. It'd be a great future , I thought. You'd dream of sitting in a dingy stone dive on the Grand Canal with sand-wasps buzzing around smoky, stinking candles. A bottle of luchu juice and a couple of Martian girls with dirty feet for company. And a sudden cough that would be the first sign of lung-rot. To hell with it! I walked into your living room and called Dean Dawson on the visiphone. I accepted that job teaching. And now, Laura, it's nearly midnight. You're in your room, sleeping, and the house is silent. It's hard to tell you, to make you understand, and that is why I am writing this. I looked through Charlie's box again, more carefully this time, reading the old letters and studying the photographs. I believe now that Charlie sensed my indecision, that he left these things so that they could tell me what he could not express in words. And among the things, Laura, I found a ring. A wedding ring. In that past he never talked about, there was a woman—his wife. Charlie was young once, his eyes full of dreams, and he faced the same decision that I am facing. Two paths were before him, but he tried to travel both. He later learned what we already know—that there can be no compromise. And you know, too, which path he finally chose. Do you know why he had to drug himself to watch me graduate? So he could look at me, knowing that I would see the worlds he could never live to see. Charlie didn't leave just a few trinkets behind him. He left himself, Laura, for he showed me that a boy's dream can also be a man's dream. He made his last trip to Luna when he knew he was going to die. Heaven knows how he escaped a checkup. Maybe the captain understood and was kind—but that doesn't matter now. Do you know why he wanted to reach Mars? Do you know why he didn't want to die in the clean, cool air of Earth? It was because he wanted to die nearer home. His home, Laura, was the Universe, where the ship was his house, the crew his father, mother, brothers, the planets his children. You say that the beauty of the other side of the mountain vanishes after you reach it. But how can one ever be sure until the journey is made? Could I or Charlie or the thousand before us bear to look upon a star and think, I might have gone there; I could have been the first ? We said, too, that the life of a spaceman is lonely. Yet how could one be lonely when men like Charlie roam the spaceways? Charlie wanted me to himself that night after graduation. He wanted us to celebrate as spacemen should, for he knew that this would be his last night on Earth. It might have seemed an ugly kind of celebration to you, but he wanted it with all his heart, and we robbed him of it. Because of these things, Laura, I will be gone in the morning. Explain the best you can to Mickey and to your parents and Dean Dawson. Right now I've got a date that I'm going to keep—at a dingy stone cafe on Mars, the Space Rat , just off Chandler Field on the Grand Canal. Stardust Charlie will be there; he'll go with me in memory to whatever part of the Galaxy I may live to reach. And so will you, Laura. I have two wedding rings with me—his wife's ring and yours.
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D. she knows he wants to go to space
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Which words best describe the mob of creatures?
A. ugly, hairy, and clever
B. monstrous, large, and foolish
C. slow, strong, and mean
D. tall, thick, and caring
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Spawning Ground By LESTER DEL REY They weren't human. They were something more—and something less—they were, in short, humanity's hopes for survival! [Transcriber's Note: This etext was produced from Worlds of If Science Fiction, September 1961. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] The Starship Pandora creaked and groaned as her landing pads settled unevenly in the mucky surface of the ugly world outside. She seemed to be restless to end her fool's errand here, two hundred light years from the waiting hordes on Earth. Straining metal plates twanged and echoed through her hallways. Captain Gwayne cursed and rolled over, reaching for his boots. He was a big, rawboned man, barely forty; but ten years of responsibility had pressed down his shoulders and put age-feigning hollows under his reddened eyes. The starlanes between Earth and her potential colonies were rough on the men who traveled them now. He shuffled toward the control room, grumbling at the heavy gravity. Lieutenant Jane Corey looked up, nodding a blonde head at him as he moved toward the ever-waiting pot of murky coffee. "Morning, Bob. You need a shave." "Yeah." He swallowed the hot coffee without tasting it, then ran a hand across the dark stubble on his chin. It could wait. "Anything new during the night?" "About a dozen blobs held something like a convention a little ways north of us. They broke up about an hour ago and streaked off into the clouds." The blobs were a peculiarity of this planet about which nobody knew anything. They looked like overgrown fireballs, but seemed to have an almost sentient curiosity about anything moving on the ground. "And our two cadets sneaked out again. Barker followed them, but lost them in the murk. I've kept a signal going to guide them back." Gwayne swore softly to himself. Earth couldn't turn out enough starmen in the schools, so promising kids were being shipped out for training as cadets on their twelfth birthday. The two he'd drawn, Kaufman and Pinelli, seemed to be totally devoid of any sense of caution. Of course there was no obvious need for caution here. The blobs hadn't seemed dangerous, and the local animals were apparently all herbivorous and harmless. They were ugly enough, looking like insects in spite of their internal skeletons, with anywhere from four to twelve legs each on their segmented bodies. None acted like dangerous beasts. But something had happened to the exploration party fifteen years back, and to the more recent ship under Hennessy that was sent to check up. He turned to the port to stare out at the planet. The Sol-type sun must be rising, since there was a dim light. But the thick clouds that wrapped the entire world diffused its rays into a haze. For a change, it wasn't raining, though the ground was covered by thick swirls of fog. In the distance, the tops of shrubs that made a scrub forest glowed yellow-green. Motions around them suggested a herd of feeding animals. Details were impossible to see through the haze. Even the deep gorge where they'd found Hennessy's carefully buried ship was completely hidden by the fog. There were three of the blobs dancing about over the grazing animals now, as they often seemed to do. Gwayne stared at them for a minute, trying to read sense into the things. If he had time to study them.... But there was no time. Earth had ordered him to detour here, after leaving his load of deep-sleep stored colonists on Official World 71, to check on any sign of Hennessy. He'd been here a week longer than he should have stayed already. If there was no sign in another day or so of what had happened to the men who'd deserted their ship and its equipment, he'd have to report back. He would have left before, if a recent landslip hadn't exposed enough of the buried ship for his metal locators to spot from the air by luck. It had obviously been hidden deep enough to foil the detectors originally. "Bob!" Jane Corey's voice cut through his pondering. "Bob, there are the kids!" Before he could swing to follow her pointing finger, movement caught his eye. The blobs had left the herd. Now the three were streaking at fantastic speed to a spot near the ship, to hover excitedly above something that moved there. He saw the two cadets then, heading back to the waiting ship, just beyond the movement he'd seen through the mist. Whatever was making the fog swirl must have reached higher ground. Something began to heave upwards. It was too far to see clearly, but Gwayne grabbed the microphone, yelling into the radio toward the cadets. They must have seen whatever it was just as the call reached them. Young Kaufman grabbed at Pinelli, and they swung around together. Then the mists cleared. Under the dancing blobs, a horde of things was heading for the cadets. Shaggy heads, brute bodies vaguely man-like! One seemed to be almost eight feet tall, leading the others directly toward the spacesuited cadets. Some of the horde were carrying spears or sticks. There was a momentary halt, and then the leader lifted one arm, as if motioning the others forward. "Get the jeeps out!" Gwayne yelled at Jane. He yanked the door of the little officers' lift open and jabbed the down button. It was agonizingly slow, but faster than climbing down. He ripped the door back at the exit deck. Men were dashing in, stumbling around in confusion. But someone was taking over now—one of the crew women. The jeeps were lining up. One, at the front, was stuttering into life, and Gwayne dashed for it as the exit port slid back. There was no time for suits or helmets. The air on the planet was irritating and vile smelling, but it could be breathed. He leaped to the seat, to see that the driver was Doctor Barker. At a gesture, the jeep rolled down the ramp, grinding its gears into second as it picked up speed. The other two followed. There was no sign of the cadets at first. Then Gwayne spotted them; surrounded by the menacing horde. Seen from here, the things looked horrible in a travesty of manhood. The huge leader suddenly waved and pointed toward the jeeps that were racing toward him. He made a fantastic leap backwards. Others swung about, two of them grabbing up the cadets. The jeep was doing twenty miles an hour now, but the horde began to increase the distance, in spite of the load of the two struggling boys! The creatures dived downward into lower ground, beginning to disappear into the mists. "Follow the blobs," Gwayne yelled. He realized now he'd been a fool to leave his suit; the radio would have let him keep in contact with the kids. But it was too late to go back. The blobs danced after the horde. Barker bounced the jeep downward into a gorge. Somewhere the man had learned to drive superlatively; but he had to slow as the fog thickened lower down. Then it cleared to show the mob of creatures doubling back on their own trail to confuse the pursuers. There was no time to stop. The jeep plowed through them. Gwayne had a glimpse of five-foot bodies tumbling out of the way. Monstrously coarse faces were half hidden by thick hair. A spear crunched against the windshield from behind, and Gwayne caught it before it could foul the steering wheel. It had a wickedly beautiful point of stone. The creatures vanished as Barker fought to turn to follow them. The other jeeps were coming up, by the sound of their motors, but too late to help. They'd have to get to the group with the cadets in a hurry or the horde would all vanish in the uneven ground, hidden by the fog. A blob dropped down, almost touching Gwayne. He threw up an instinctive hand. There was a tingling as the creature seemed to pass around it. It lifted a few inches and drifted off. Abruptly, Barker's foot ground at the brake. Gwayne jolted forward against the windshield, just as he made out the form of the eight-foot leader. The thing was standing directly ahead of him, a cadet on each shoulder. The wheels locked and the jeep slid protestingly forward. The creature leaped back. But Gwayne was out of the jeep before it stopped, diving for the figure. It dropped the boys with a surprised grunt. The arms were thin and grotesque below the massively distorted shoulders, but amazingly strong. Gwayne felt them wrench at him as his hands locked on the thick throat. A stench of alien flesh was in his nose as the thing fell backwards. Doc Barker had hit it seconds after the captain's attack. Its head hit rocky ground with a dull, heavy sound, and it collapsed. Gwayne eased back slowly, but it made no further move, though it was still breathing. Another jeep had drawn up, and men were examining the cadets. Pinelli was either laughing or crying, and Kaufman was trying to break free to kick at the monster. But neither had been harmed. The two were loaded onto a jeep while men helped Barker and Gwayne stow the bound monster on another before heading back. "No sign of skull fracture. My God, what a tough brute!" Barker shook his own head, as if feeling the shock of the monster's landing. "I hope so," Gwayne told him. "I want that thing to live—and you're detailed to save it and revive it. Find out if it can make sign language or draw pictures. I want to know what happened to Hennessy and why that ship was buried against detection. This thing may be the answer." Barker nodded grimly. "I'll try, though I can't risk drugs on an alien metabolism." He sucked in on the cigarette he'd dug out, then spat sickly. Smoke and this air made a foul combination. "Bob, it still makes no sense. We've scoured this planet by infra-red, and there was no sign of native villages or culture. We should have found some." "Troglodytes, maybe," Gwayne guessed. "Anyhow, send for me when you get anything. I've got to get this ship back to Earth. We're overstaying our time here already." The reports from the cadets were satisfactory enough. They'd been picked up and carried, but no harm had been done them. Now they were busy being little heroes. Gwayne sentenced them to quarters as soon as he could, knowing their stories would only get wilder and less informative with retelling. If they could get any story from the captured creature, they might save time and be better off than trying to dig through Hennessy's ship. That was almost certainly spoorless by now. The only possible answer seemed to be that the exploring expedition and Hennessy's rescue group had been overcome by the aliens. It was an answer, but it left a lot of questions. How could the primitives have gotten to the men inside Hennessy's ship? Why was its fuel dumped? Only men would have known how to do that. And who told these creatures that a space ship's metal finders could be fooled by a little more than a hundred feet of solid rock? They'd buried the ship cunningly, and only the accidental slippage had undone their work. Maybe there would never be a full answer, but he had to find something—and find it fast. Earth needed every world she could make remotely habitable, or mankind was probably doomed to extinction. The race had blundered safely through its discovery of atomic weapons into a peace that had lasted two hundred years. It had managed to prevent an interplanetary war with the Venus colonists. It had found a drive that led to the stars, and hadn't even found intelligent life there to be dangerous on the few worlds that had cultures of their own. But forty years ago, observations from beyond the Solar System had finally proved that the sun was going to go nova. It wouldn't be much of an explosion, as such things go—but it would render the whole Solar System uninhabitable for millenia. To survive, man had to colonize. And there were no worlds perfect for him, as Earth had been. The explorers went out in desperation to find what they could; the terraforming teams did what they could. And then the big starships began filling worlds with colonists, carried in deep sleep to conserve space. Almost eighty worlds. The nearest a four month journey from Earth and four more months back. In another ten years, the sun would explode, leaving man only on the footholds he was trying to dig among other solar systems. Maybe some of the strange worlds would let men spread his seed again. Maybe none would be spawning grounds for mankind in spite of the efforts. Each was precious as a haven for the race. If this world could be used, it would be nearer than most. If not, as it now seemed, no more time could be wasted here. Primitives could be overcome, maybe. It would be ruthless and unfair to strip them of their world, but the first law was survival. But how could primitives do what these must have done? He studied the spear he had salvaged. It was on a staff made of cemented bits of smaller wood from the scrub growth, skillfully laminated. The point was of delicately chipped flint, done as no human hand had been able to do for centuries. "Beautiful primitive work," he muttered. Jane pulled the coffee cup away from her lips and snorted. "You can see a lot more of it out there," she suggested. He went to the port and glanced out. About sixty of the things were squatting in the clearing fog, holding lances and staring at the ship. They were perhaps a thousand yards away, waiting patiently. For what? For the return of their leader—or for something that would give the ship to them? Gwayne grabbed the phone and called Barker. "How's the captive coming?" Barker's voice sounded odd. "Physically fine. You can see him. But—" Gwayne dropped the phone and headed for the little sick bay. He swore at Doc for not calling him at once, and then at himself for not checking up sooner. Then he stopped at the sound of voices. There was the end of a question from Barker and a thick, harsh growling sound that lifted the hair along the nape of Gwayne's neck. Barker seemed to understand, and was making a comment as the captain dashed in. The captive was sitting on the bunk, unbound and oddly unmenacing. The thick features were relaxed and yet somehow intent. He seemed to make some kind of a salute as he saw Gwayne enter, and his eyes burned up unerringly toward the device on the officer's cap. "Haarroo, Cabbaan!" the thing said. "Captain Gwayne, may I present your former friend, Captain Hennessy?" Barker said. There was a grin on the doctor's lips, but his face was taut with strain. The creature nodded slowly and drew something from the thick hair on its head. It was the golden comet of a captain. "He never meant to hurt the kids—just to talk to them," Barker cut in quickly. "I've got some of the story. He's changed. He can't talk very well. Says they've had to change the language around to make the sounds fit, and he's forgotten how to use what normal English he can. But it gets easier as you listen. It's Hennessy, all right. I'm certain." Gwayne had his own ideas on that. It was easy for an alien to seize on the gold ornament of a captive earthman, even to learn a little English, maybe. But Hennessy had been his friend. "How many barmaids in the Cheshire Cat? How many pups did your oldest kid's dog have? How many were brown?" The lips contorted into something vaguely like a smile, and the curiously shaped fingers that could handle no human-designed equipment spread out. Three. Seven. Zero. The answers were right. By the time the session was over, Gwayne had begun to understand the twisted speech from inhuman vocal cords better. But the story took a long time telling. When it was finished, Gwayne and Barker sat for long minutes in silence. Finally Gwayne drew a shuddering breath and stood up. "Is it possible, Doc?" "No," Barker said flatly. He spread his hands and grimaced. "No. Not by what I know. But it happened. I've looked at a few tissues under the microscope. The changes are there. It's hard to believe about their kids. Adults in eight years, but they stay shorter. It can't be a hereditary change—the things that affect the body don't change the germ plasm. But in this case, what changed Hennessy is real, so maybe the fact that the change is passed on is as real as he claims." Gwayne led the former Hennessy to the exit. The waiting blobs dropped down to touch the monstrous man, then leaped up again. The crowd of monsters began moving forward toward their leader. A few were almost as tall as Hennessy, but most were not more than five feet high. The kids of the exploring party.... Back in the control room, Gwayne found the emergency release levers, set the combinations and pressed the studs. There was a hiss and gurgle as the great tanks of fuel discharged their contents out onto the ground where no ingenuity could ever recover it to bring life to the ship again. He'd have to tell the men and women of the crew later, after he'd had time to organize things and present it all in a way they could accept, however much they might hate it at first. But there was no putting off giving the gist of it to Jane. "It was the blobs," he summarized it. "They seem to be amused by men. They don't require anything from us, but they like us around. Hennessy doesn't know why. They can change our cells, adapt us. Before men came, all life here had twelve legs. Now they're changing that, as we've seen. "And they don't have to be close to do it. We've all been outside the hull. It doesn't show yet—but we're changed. In another month, Earth food would kill us. We've got to stay here. We'll bury the ships deeper this time, and Earth won't find us. They can't risk trying a colony where three ships vanish, so we'll just disappear. And they'll never know." Nobody would know. Their children—odd children who matured in eight years—would be primitive savages in three generations. The Earth tools would be useless, impossible for the hands so radically changed. Nothing from the ship would last. Books could never be read by the new eyes. And in time, Earth wouldn't even be a memory to this world. She was silent a long time, staring out of the port toward what must now be her home. Then she sighed. "You'll need practice, but the others don't know you as well as I do, Bob. I guess we can fix it so they'll believe it all. And it's too late now. But we haven't really been changed yet, have we?" "No," he admitted. Damn his voice! He'd never been good at lying. "No. They have to touch us. I've been touched, but the rest could go back." She nodded. He waited for the condemnation, but there was only puzzlement in her face. "Why?" And then, before he could answer, her own intelligence gave her the same answer he had found for himself. "The spawning ground!" It was the only thing they could do. Earth needed a place to plant her seed, but no world other than Earth could ever be trusted to preserve that seed for generation after generation. Some worlds already were becoming uncertain. Here, though, the blobs had adapted men to the alien world instead of men having to adapt the whole planet to their needs. Here, the strange children of man's race could grow, develop and begin the long trek back to civilization. The gadgets would be lost for a time. But perhaps some of the attitudes of civilized man would remain to make the next rise to culture a better one. "We're needed here," he told her, his voice pleading for the understanding he couldn't yet fully give himself. "These people need as rich a set of bloodlines as possible to give the new race strength. The fifty men and women on this ship will be needed to start them with a decent chance. We can't go to Earth, where nobody would believe or accept the idea—or even let us come back. We have to stay here." She smiled then and moved toward him, groping for his strength. "Be fruitful," she whispered. "Be fruitful and spawn and replenish an earth." "No," he told her. "Replenish the stars." But she was no longer listening, and that part of his idea could wait. Some day, though, their children would find a way to the starlanes again, looking for other worlds. With the blobs to help them, they could adapt to most worlds. The unchanged spirit would lead them through all space, and the changing bodies would claim worlds beyond numbering. Some day, the whole universe would be a spawning ground for the children of men!
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A. ugly, hairy, and clever
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Why did Nancy allow the man claiming to be her brother to take her child?
A. She believes that she can trust her brother with Reggie.
B. She knows that Reggie is actually Kanad, and feels no attachment toward him.
C. She is hypnotized by Arvid 6, who is posing as her nonexistent brother.
D. She is being bribed by Tendal 13 and Arvid 6 to give Reggie away.
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Transcriber's Note: This etext was produced from Space Science Fiction May 1952. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. THE ULTROOM ERROR by JERRY SOHL Smith admitted he had made an error involving a few murders—and a few thousand years. He was entitled to a sense of humor, though, even in the Ultroom! HB73782. Ultroom error. Tendal 13. Arvid 6. Kanad transfer out of 1609 complete, intact, but too near limit of 1,000 days. Next Kanad transfer ready. 1951. Reginald, son of Mr. and Mrs. Martin Laughton, 3495 Orland Drive, Marionville, Illinois, U. S. A. Arrive his 378th day. TB73782. Nancy Laughton sat on the blanket she had spread on the lawn in her front yard, knitting a pair of booties for the PTA bazaar. Occasionally she glanced at her son in the play pen, who was getting his daily dose of sunshine. He was gurgling happily, examining a ball, a cheese grater and a linen baby book, all with perfunctory interest. When she looked up again she noticed a man walking by—except he turned up the walk and crossed the lawn to her. He was a little taller than her husband, had piercing blue eyes and a rather amused set to his lips. "Hello, Nancy," he said. "Hello, Joe," she answered. It was her brother who lived in Kankakee. "I'm going to take the baby for a while," he said. "All right, Joe." He reached into the pen, picked up the baby. As he did so the baby's knees hit the side of the play pen and young Laughton let out a scream—half from hurt and half from sudden lack of confidence in his new handler. But this did not deter Joe. He started off with the child. Around the corner and after the man came a snarling mongrel dog, eyes bright, teeth glinting in the sunlight. The man did not turn as the dog threw himself at him, burying his teeth in his leg. Surprised, the man dropped the screaming child on the lawn and turned to the dog. Joe seemed off balance and he backed up confusedly in the face of the snapping jaws. Then he suddenly turned and walked away, the dog at his heels. "I tell you, the man said he was my brother and he made me think he was," Nancy told her husband for the tenth time. "I don't even have a brother." Martin Laughton sighed. "I can't understand why you believed him. It's just—just plain nuts, Nancy!" "Don't you think I know it?" Nancy said tearfully. "I feel like I'm going crazy. I can't say I dreamt it because there was Reggie with his bleeding knees, squalling for all he was worth on the grass—Oh, I don't even want to think about it." "We haven't lost Reggie, Nancy, remember that. Now why don't you try to get some rest?" "You—you don't believe me at all, do you, Martin?" When her husband did not answer, her head sank to her arms on the table and she sobbed. "Nancy, for heaven's sake, of course I believe you. I'm trying to think it out, that's all. We should have called the police." Nancy shook her head in her arms. "They'd—never—believe me either," she moaned. "I'd better go and make sure Reggie's all right." Martin got up out of his chair and went to the stairs. "I'm going with you," Nancy said, hurriedly rising and coming over to him. "We'll go up and look at him together." They found Reggie peacefully asleep in his crib in his room upstairs. They checked the windows and tucked in the blankets. They paused in the room for a moment and then Martin stole his arm around his wife and led her to the door. "As I've said, sergeant, this fellow hypnotized my wife. He made her think he was her brother. She doesn't even have a brother. Then he tried to get away with the baby." Martin leaned down and patted the dog. "It was Tiger here who scared him off." The police sergeant looked at the father, at Nancy and then at the dog. He scribbled notes in his book. "Are you a rich man, Mr. Laughton?" he asked. "Not at all. The bank still owns most of the house. I have a few hundred dollars, that's all." "What do you do?" "Office work, mostly. I'm a junior executive in an insurance company." "Any enemies?" "No ... Oh, I suppose I have a few people I don't get along with, like anybody else. Nobody who'd do anything like this, though." The sergeant flipped his notebook closed. "You'd better keep your dog inside and around the kid as much as possible. Keep your doors and windows locked. I'll see that the prowl car keeps an eye on the house. Call us if anything seems unusual or out of the way." Nancy had taken a sedative and was asleep by the time Martin finished cleaning the .30-.30 rifle he used for deer hunting. He put it by the stairs, ready for use, fully loaded, leaning it against the wall next to the telephone stand. The front door bell rang. He answered it. It was Dr. Stuart and another man. "I came as soon as I could, Martin," the young doctor said, stepping inside with the other man. "This is my new assistant, Dr. Tompkins." Martin and Tompkins shook hands. "The baby—?" Dr. Stuart asked. "Upstairs," Martin said. "You'd better get him, Dr. Tompkins, if we're to take him to the hospital. I'll stay here with Mr. Laughton. How've you been, Martin?" "Fine." "How's everything at the office?" "Fine." "And your wife?" "She's fine, too." "Glad to hear it, Martin. Mighty glad. Say, by the way, there's that bill you owe me. I think it's $32, isn't that right?" "Yes, I'd almost forgotten about it." "Why don't you be a good fellow and write a check for it? It's been over a year, you know." "That's right. I'll get right at it." Martin went over to his desk, opened it and started looking for his checkbook. Dr. Stuart stood by him, making idle comment until Dr. Tompkins came down the stairs with the sleeping baby cuddled against his shoulder. "Never mind the check, now, Martin. I see we're ready to go." He went over to his assistant and took the baby. Together they walked out the front door. "Good-bye," Martin said, going to the door. Then he was nearly bowled over by the discharge of the .30-.30. Dr. Stuart crumpled to the ground, the baby falling to the lawn. Dr. Tompkins whirled and there was a second shot. Dr. Tompkins pitched forward on his face. The figure of a woman ran from the house, retrieved the now squalling infant and ran back into the house. Once inside, Nancy slammed the door, gave the baby to the stunned Martin and headed for the telephone. "One of them was the same man!" she cried. Martin gasped, sinking into a chair with the baby. "I believed them," he said slowly and uncomprehendingly. "They made me believe them!" "Those bodies," the sergeant said. "Would you mind pointing them out to me, please?" "Aren't they—aren't they on the walk?" Mrs. Laughton asked. "There is nothing on the walk, Mrs. Laughton." "But there must be! I tell you I shot these men who posed as doctors. One of them was the same man who tried to take the baby this afternoon. They hypnotized my husband—" "Yes, I know, Mrs. Laughton. We've been through that." The sergeant went to the door and opened it. "Say, Homer, take another look around the walk and the bushes. There's supposed to be two of them. Shot with a .30-.30." He turned and picked up the gun and examined it again. "Ever shoot a gun before, Mrs. Laughton?" "Many times. Martin and I used to go hunting together before we had Reggie." The sergeant nodded. "You were taking an awful chance, shooting at a guy carrying your baby, don't you think?" "I shot him in the legs. The other—the other turned and I shot him in the chest. I could even see his eyes when he turned around. If I hadn't pulled the trigger then ... I don't want to remember it." The patrolman pushed the door open. "There's no bodies out here but there's some blood. Quite a lot of blood. A little to one side of the walk." The policemen went out. "Thank God you woke up, Nancy," Martin said. "I'd have let them have the baby." He reached over and smoothed the sleeping Reggie's hair. Nancy, who was rocking the boy, narrowed her eyes. "I wonder why they want our baby? He's just like any other baby. We don't have any money. We couldn't pay a ransom." "Reggie's pretty cute, though," Martin said. "You will have to admit that." Nancy smiled. Then she suddenly stopped rocking. "Martin!" He sat up quickly. "Where's Tiger?" Together they rose and walked around the room. They found him in a corner, eyes open, tongue protruding. He was dead. If we keep Reggie in the house much longer he'll turn out to be a hermit," Martin said at breakfast a month later. "He needs fresh air and sunshine." "I'm not going to sit on the lawn alone with him, Martin. I just can't, that's all. I'd be able to think of nothing but that day." "Still thinking about it? I think we'd have heard from them again if they were coming back. They probably got somebody else's baby by this time." Martin finished his coffee and rose to kiss her good-bye. "But for safety's sake I guess you'd better keep that gun handy." The morning turned into a brilliant, sunshiny day. Puffs of clouds moved slowly across the summer sky and a warm breeze rustled the trees. It would be a crime to keep Reggie inside on a day like this, Nancy thought. So she called Mrs. MacDougal, the next door neighbor. Mrs. MacDougal was familiar with what had happened to the Laughtons and she agreed to keep an eye on Nancy and Reggie and to call the police at the first sign of trouble. With a fearful but determined heart Nancy moved the play pen and set it up in the front yard. She spread a blanket for herself and put Reggie in the pen. Her heart pounded all the while and she watched the street for any strangers, ready to flee inside if need be. Reggie just gurgled with delight at the change in environment. This peaceful scene was disturbed by a speeding car in which two men were riding. The car roared up the street, swerved toward the parkway, tires screaming, bounced over the curb and sidewalk, straight toward the child and mother. Reggie, attracted by the sudden noise, looked up to see the approaching vehicle. His mother stood up, set her palms against her cheeks and shrieked. The car came on, crunched over the play pen, killing the child. The mother was hit and instantly killed, force of the blow snapping her spine and tossing her against the house. The car plunged on into a tree, hitting it a terrible blow, crumbling the car's forward end so it looked like an accordion. The men were thrown from the machine. "We'll never be able to prosecute in this case," the states attorney said. "At least not on a drunken driving basis." "I can't get over it," the chief of police said. "I've got at least six men who will swear the man was drunk. He staggered, reeled and gave the usual drunk talk. He reeked of whiskey." The prosecutor handed the report over the desk. "Here's the analysis. Not a trace of alcohol. He couldn't have even had a smell of near beer. Here's another report. This is his physical exam made not long afterwards. The man was in perfect health. Only variations are he had a scar on his leg where something, probably a dog, bit him once. And then a scar on his chest. It looked like an old gunshot wound, they said. Must have happened years ago." "That's odd. The man who accosted Mrs. Laughton in the afternoon was bitten by their dog. Later that night she said she shot the same man in the chest. Since the scars are healed it obviously couldn't be the same man. But there's a real coincidence for you. And speaking of the dogbite, the Laughton dog died that night. His menu evidently didn't agree with him. Never did figure what killed him, actually." "Any record of treatment on the man she shot?" "The men . You'll remember, there were two. No, we never found a trace of either. No doctor ever made a report of a gunshot wound that night. No hospital had a case either—at least not within several hundred miles—that night or several nights afterwards. Ever been shot with .30-.30?" The state attorney shook his head. "I wouldn't be here if I had." "I'll say you wouldn't. The pair must have crawled away to die God knows where." "Getting back to the man who ran over the child and killed Mrs. Laughton. Why did he pretend to be drunk?" It was the chief's turn to shake his head. "Your guess is as good as mine. There are a lot of angles to this case none of us understand. It looks deliberate, but where's the motive?" "What does the man have to say?" "I was afraid you'd get to him," the chief said, his neck reddening. "It's all been rather embarrassing to the department." He coughed self-consciously. "He's proved a strange one, all right. He says his name is John Smith and he's got cards to prove it, too—for example, a social security card. It looks authentic, yet there's no such number on file in Washington, so we've discovered. We've had him in jail for a week and we've all taken turns questioning him. He laughs and admits his guilt—in fact, he seems amused by most everything. Sometimes all alone in his cell he'll start laughing for no apparent reason. It gives you the creeps." The states attorney leaned back in his chair. "Maybe it's a case for an alienist." "One jump ahead of you. Dr. Stone thinks he's normal, but won't put down any I.Q. Actually, he can't figure him out himself. Smith seems to take delight in answering questions—sort of anticipates them and has the answer ready before you're half through asking." "Well, if Dr. Stone says he's normal, that's enough for me." The prosecutor was silent for a moment. Then, "How about the husband?" "Laughton? We're afraid to let him see him. All broken up. No telling what kind of a rumpus he'd start—especially if Smith started his funny business." "Guess you're right. Well, Mr. Smith won't think it's so funny when we hang criminal negligence or manslaughter on him. By the way, you've checked possible family connections?" "Nobody ever saw John Smith before. Even at the address on his driver's license. And there's no duplicate of that in Springfield, in case you're interested." The man who had laughingly told police his name was John Smith lay on his cot in the county jail, his eyes closed, his arms folded across his chest. This gave him the appearance of being alert despite reclining. Even as he lay, his mouth held a hint of a smile. Arvid 6—for John Smith was Arvid 6—had lain in that position for more than four hours, when suddenly he snapped his eyes open and appeared to be listening. For a moment a look of concern crossed his face and he swung his legs to the floor and sat there expectantly. Arvid 6 knew Tendal 13 had materialized and was somewhere in the building. Eventually there were some sounds from beyond the steel cell and doorway. There was a clang when the outer doorway was opened and Arvid 6 rose from his cot. "Your lawyer's here to see you," the jailer said, indicating the man with the brief case. "Ring the buzzer when you're through." The jailer let the man in, locked the cell door and walked away. The man threw the brief case on the jail cot and stood glaring. "Your damned foolishness has gone far enough. I'm sick and tired of it," he declared. "If you carry on any more we'll never get back to the Ultroom!" "I'm sorry, Tendal," the man on the cot said. "I didn't think—" "You're absolutely right. You didn't think. Crashing that car into that tree and killing that woman—that was the last straw. You don't even deserve to get back to our era. You ought to be made to rot here." "I'm really sorry about that," Arvid 6 said. You know the instructions. Just because you work in the Ultroom don't get to thinking human life doesn't have any value. We wouldn't be here if it hadn't. But to unnecessarily kill—" The older man shook his head. "You could have killed yourself as well and we'd never get the job done. As it is, you almost totally obliterated me." Tendal 13 paced the length of the cell and back again, gesturing as he talked. "It was only with the greatest effort I pulled myself back together again. I doubt that you could have done it. And then all the while you've been sitting here, probably enjoying yourself with your special brand of humor I have grown to despise." "You didn't have to come along at all, you know," Arvid 6 said. "How well I know! How sorry I am that I ever did! It was only because I was sorry for you, because someone older and more experienced than you was needed. I volunteered. Imagine that! I volunteered! Tendal 13 reaches the height of stupidity and volunteers to help Arvid 6 go back 6,000 years to bring Kanad back, to correct a mistake Arvid 6 made!" He snorted. "I still can't believe I was ever that stupid. I only prove it when I pinch myself and here I am. "Oh, you've been a joy to be with! First it was that hunt in ancient Mycenae when you let the lion escape the hunters' quaint spears and we were partly eaten by the lion in the bargain, although you dazzled the hunters, deflecting their spears. And then your zest for drink when we were with Octavian in Alexandria that led to everybody's amusement but ours when we were ambushed by Anthony's men. And worst of all, that English barmaid you became engrossed with at our last stop in 1609, when her husband mistook me for you and you let him take me apart piece by piece—" "All right, all right," Arvid 6 said. "I'll admit I've made some mistakes. You're just not adventurous, that's all." "Shut up! For once you're going to listen to me. Our instructions specifically stated we were to have as little as possible to do with these people. But at every turn you've got us more and more enmeshed with them. If that's adventure, you can have it." Tendal 13 sat down wearily and sank his head in his hands. "It was you who conceived the idea of taking Reggie right out of his play pen. 'Watch me take that child right out from under its mother's nose' were your exact words. And before I could stop you, you did. Only you forgot an important factor in the equation—the dog, Tiger. And you nursed a dogbite most of the afternoon before it healed. And then you took your spite out on the poor thing by suggesting suffocation to it that night. "And speaking of that night, you remember we agreed I was to do the talking. But no, you pulled a switch and captured Martin Laughton's attention. 'I came as soon as I could, Martin,' you said. And suddenly I played a very minor role. 'This is my new assistant, Dr. Tompkins,' you said. And then what happened? I get shot in the legs and you get a hole in your back. We were both nearly obliterated that time and we didn't even come close to getting the child. "Still you wanted to run the whole show. 'I'm younger than you,' you said. 'I'll take the wheel.' And the next thing I know I'm floating in space halfway to nowhere with two broken legs, a spinal injury, concussion and some of the finest bruises you ever saw." These twentieth century machines aren't what they ought to be," Arvid 6 said. "You never run out of excuses, do you, Arvid? Remember what you said in the Ultroom when you pushed the lever clear over and transferred Kanad back 6,000 years? 'My hand slipped.' As simple as that. 'My hand slipped.' It was so simple everyone believed you. You were given no real punishment. In a way it was a reward—at least to you—getting to go back and rescue the life germ of Kanad out of each era he'd be born in." Tendal 13 turned and looked steadily and directly at Arvid 6. "Do you know what I think? I think you deliberately pushed the lever over as far as it would go just to see what would happen . That's how simple I think it was." Arvid 6 flushed, turned away and looked at the floor. "What crazy things have you been doing since I've been gone?" Tendal 13 asked. Arvid 6 sighed. "After what you just said I guess it wouldn't amuse you, although it has me. They got to me right after the accident before I had a chance to collect my wits, dematerialize or anything—you said we shouldn't dematerialize in front of anybody." "That's right." "Well, I didn't know what to do. I could see they thought I was drunk, so I was. But they had a blood sample before I could manufacture any alcohol in my blood, although I implanted a memory in them that I reeked of it." He laughed. "I fancy they're thoroughly confused." "And you're thoroughly amused, no doubt. Have they questioned you?" "At great length. They had a psychiatrist in to see me. He was a queer fellow with the most stupid set of questions and tests I ever saw." "And you amused yourself with him." "I suppose you'd think so." "Who do you tell them you are?" "John Smith. A rather prevalent name here, I understand. I manufactured a pasteboard called a social security card and a driver's license—" "Never mind. It's easy to see you've been your own inimitable self. Believe me, if I ever get back to the Ultroom I hope I never see you again. And I hope I'll never leave there again though I'm rejuvenated through a million years." "Was Kanad's life germ transferred all right this time?" Tendal 13 shook his head. "I haven't heard. The transfers are getting more difficult all the time. In 1609, you'll remember, it was a case of pneumonia for the two-year-old. A simple procedure. It wouldn't work here. Medicine's too far along." He produced a notebook. "The last jump was 342 years, a little more than average. The next ought to be around 2250. Things will be more difficult than ever there, probably." "Do you think Kanad will be angry about all this?" "How would you like to have to go through all those birth processes, to have your life germ knocked from one era to the next?" "Frankly, I didn't think he'd go back so far." "If it had been anybody but Kanad nobody'd ever have thought of going back after it. The life germ of the head of the whole galactic system who came to the Ultroom to be transplanted to a younger body—and then sending him back beyond his original birth date—" Tendal 13 got up and commenced his pacing again. "Oh, I suppose Kanad's partly to blame, wanting rejuvenating at only 300 years. Some have waited a thousand or more or until their bones are like paper." "I just wonder how angry Kanad will be," Arvid muttered. HB92167. Ultroom Error. Tendal 13. Arvid 6. Kanad transfer out of 1951 complete. Next Kanad transfer ready. 2267. Phullam 19, son of Orla 39 and Rhoda R, 22H Level M, Hemisphere B, Quadrant 3, Sector I. Arrive his 329th Day. TB92167 Arvid 6 rose from the cot and the two men faced each other. "Before we leave, Arvid," Tendal 13 started to say. "I know, I know. You want me to let you handle everything." "Exactly. Is that too much to ask after all you've done?" "I guess I have made mistakes. From now on you be the boss. I'll do whatever you say." "I hope I can count on that." Tendal 13 rang the jail buzzer. The jailer unlocked the cell door. "You remember the chief said it's all right to take him with me, Matthews," Tendal 13 told the jailer. "Yes, I remember," the jailer said mechanically, letting them both out of the cell. They walked together down the jail corridor. When they came to another barred door the jailer fumbled with the keys and clumsily tried several with no luck. Arvid 6, an amused set to his mouth and devilment in his eyes, watched the jailer's expression as he walked through the bars of the door. He laughed as he saw the jailer's eyes bulge. "Arvid!" Tendal 13 walked briskly through the door, snatched Arvid 6 by the shoulders and shook him. The jailer watched stupified as the two men vanished in the middle of a violent argument.
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C. She is hypnotized by Arvid 6, who is posing as her nonexistent brother.
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Which treatment was administered to Mr. Williams in the period 03/15 - 06/15?
Choose the correct answer from the following options:
A. Cyclophosphamide–bortezomib–dexamethasone
B. Carfilzomib/Lenolidomide/Dexamethasone
C. Stem cell mobilization with cyclophosphamide
D. Darzalex 16mg/kg
E. Cyclosporine 200mg daily
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### Patient Report 0
**Dear colleague, **
Herewith we report on Mr. John Williams, born 08/08/1956, inpatient from
10/03/2015 to 10/06/2015.
**Diagnosis:**
Multiple Myeloma IgG kappa.
**Staging and Initial Diagnosis:**
Date: 03/2015
Stage: IIA based on the Salmon and Durie scale, ISS II.
- CT whole body 03/11/2015: Osteolysis detected in the seventh
thoracic vertebra (T7); pathologic fracture observed in the first
lumbar vertebra (L1).
- Bone marrow infiltration: Initial histological evaluation showed
22%; cytomorphological assessment revealed 28%.
**Histological Findings:**
Date: 03/2015
**FISH (Fluorescence In Situ Hybridization) Results:** Detected an
additional signal for both CCND1 and CCND3. Presence of one trisomy or
tetrasomy 9. Additional signals observed for 5p15- and 5q31- as well as
19p13- and 19q13-. 46, XY with a detected ASxL1 mutation.
**Treatment Timeline:**
**01-02/15:** Administered 2 cycles of
Cyclophosphamide-Bortezomib-Dexamethasone (CyBorD). Resulted in stable
disease but caused prolonged pancytopenia.
**03/15 - 06/15:** Administered 3 cycles of a combination treatment
including Carfilzomib, Lenalidomide, and Dexamethasone.
**07/15:** Underwent stem cell mobilization using cyclophosphamide.
**07-08/15:** Experienced extended pancytopenia and regeneration. Bone
marrow puncture showed progressive disease with a significant increase
in plasma cell infiltration, reaching 92%.
**09/02/15:** Received the first dosage of daratumumab at 16mg/kg.
Subsequently developed thrombocytopenia. Treatment did not include
Revlimid.
**Histopathological report: **
Multiple myeloma, IgG kappa. The evaluation is for myelodysplastic
syndrome in the presence of tricytopenia and an ASXL1 mutation.
**Methods:** Hematoxylin and eosin (HE), periodic acid-Schiff (PAS),
iron, Giemsa, Gomori, chloroacetate esterase, step sections,
decalcification, and 1 block.
**Microscopic Examination:**
The sample is a 2 cm long bone marrow biopsy core that contains more
than ten medullary canals. The cellularity is around 20-30%, which is
considered normocellular for the patient\'s age. There is evidence of
bone marrow edema and heightened hemosiderosis. Recent stromal
hemorrhages are also observed. There is a relative increase in
erythropoiesis with a ratio of erythropoiesis to granulopoiesis being
approximately 2:1. Erythropoiesis is present in well-defined zones with
regular maturation. Only minimal nuclear rounding is observed.
Granulopoiesis matures into segmented granulocytes. PAS staining reveals
some morphologically normal megakaryocytes. Occasionally there are bare
nuclei and possible microforms. Scattered mature plasma cells are
observed with no signs of atypical proliferation. The argyrophilic
fibrous network is fine, and no fibrosis is detected.
**Preliminary Findings:**
The bone marrow biopsy is normocellular for the age with a relative
increase in erythropoiesis that shows only minimal cytological atypia.
Granulopoiesis is slightly reduced, while megakaryopoiesis is
normocellular with a few cells that are hypolobulated.There is bone
marrow edema and enhanced hemosiderosis. Scattered mature plasma cells
are also noted.
Based solely on histomorphologic observations, it is not enough to
confirm a diagnosis of myelodysplastic syndrome (MDS), which is the
suspected clinical diagnosis. For a more thorough evaluation of
potential atypicalities in the megakaryopoiesis (like
micromegakaryocytes), further immunohistochemical examination is
recommended. Assessing the blast content is also advised. There is no
evidence currently of manifest infiltrates from the previously diagnosed
multiple myeloma.
**Immunohistochemical Additional Findings (Dated 10/04/2015):**
**Immunohistochemistry Stains Used:** CD3, CD79a, CD34, CD117, MUM-1,
Kappa, lambda, CyclinD1, CD61.
Blast cells positive for CD34 and CD117 are below 5% of the total. CD3
stains scattered T lymphocytes, and CD79a identifies sporadic B
lymphocytes and some plasma cells. Plasma cells are also positive for
MUM-1 and exhibit polytypic expression of kappa and lambda light chains.
There is no co-expression with CyclinD1. CD61 highlights the previously
described megakaryocytes, and no micromegakaryocytes are observed.
**Final Report:**
The bone marrow biopsy is representative and normocellular for the
patient\'s age. There is a relative increase in erythropoiesis that
shows only minor cytological atypia. Granulopoiesis appears slightly
reduced, while megakaryopoiesis presents with a few hypolobulated cell
forms. Evidence of bone marrow edema and increased hemosiderosis is
noted, along with scattered mature plasma cells.
### Patient Report 1
**Dear colleague, **
We hereby report on Mr. Williams, John, born 08/08/1956, inpatient from
11/30/2015 to 12/28/2015.
**Oncological Diagnosis**:
Multiple myeloma IgG kappa.
Initial diagnosis 03/15: Stage IIA (Salmon and Durie), ISS II.
**Sites**:
Osteolysis in T7 vertebra, fracture in T1 vertebra.
Bone marrow: 22% histological, 28% cytomorphologic infiltration.
**Histology**:
Bone marrow biopsy 11/16: FISH: Additional signals for CCND1, CCND3;
Trisomy 3, 9; Additional signals on chromosomes 5 and 19. Chromosomal
analysis: 46, XY with ASxL1 mutation.
**Treatment**:
01-02/15: 2 cycles Cyclophosphamide-Bortezomib-Dexamethasone -\>
Stable disease, prolonged low blood counts.
03/15 - 06/15: 3 cycles Carfilzomib/Lenolidomide/Dexamethasone.
07/15: Stem cell mobilization with Cyclophosphamide.
07-08/15: Extended low blood count. Bone marrow biopsy: 92% plasma cell
infiltration.
09/02/15: Darzalex 16mg/kg initial dose, with platelet count drop. No
Lenalidomide.
09/04/15: 10 cycles of Darzalex, 1 cycle with Lenalidomide due to
renewed low platelet and white blood cell counts.
11-12/15: Conditioning chemo with Fludarabine/Treosulfan, then
allogeneic stem cell transplant from HLA-matched unrelated donor.
Immunosuppression with ATG, cyclosporine, Mycophenolate Mofetil.
**Complications**:
Mucositis, central line infection, gastrointestinal symptoms, urinary
infections with E. faecium and E.coli, JC virus bladder infection.
**Secondary Diagnoses**:
Dry eye syndrome, Type 2 diabetes managed with oral meds, Hypertension.
**Treatment Plan**:
Gradual reduction of immunosuppression based on graft vs. host disease
signs.
**Radiology**:
CT Whole Body: 12/01/15: Various areas of bone osteolysis. Degeneration
of spine.
CT Chest 12/02/15 and 12/03/15: Changes in lungs and some fluid
accumulation.
**Medication**:
**Medication** **Dosage** **Frequency**
------------------------------ ------------- ---------------
Mycophenolic Acid (Myfortic) 360 mg Twice Daily
Cyclosporine (Sandimmune) 200 mg Daily
Artificial Tears As directed 3x Daily
Candesartan (Atacand) 8 mg Daily
Tamsulosin (Flomax) 0.4 mg Daily
Pantoprazole (Protonix) 40 mg Daily
Amlodipine (Norvasc) 5 mg Twice Daily
Cotrimoxazole (Bactrim) 960 mg Mon/Wed/Fri
Valacyclovir (Valtrex) 500 mg Twice Daily
**Summary**:
Mr. Williams was admitted on 11/30/2015 for treatment related to his
Multiple Myeloma. He underwent conditioning chemotherapy,
immunosuppressive therapy, and stem cell transplantation. He experienced
complications, including infections and symptoms affecting multiple
systems. Close monitoring of blood pressure and glucose is recommended.
He was discharged on 12/28/2015 in good condition and will be followed
up in the outpatient clinic. If there are worsening symptoms, he should
visit the emergency department immediately.
**Dear Mr. Williams,**
We report on your outpatient treatment on 02/15/2016.
**Diagnoses:**
1. **Multiple Myeloma** IgG kappa, diagnosed 03/2015.
Stage IIA as per Salmon and Durie, stage II as per ISS.
Osteolysis at T7 vertebra, fracture at T1 vertebra.
Bone marrow infiltration: 22% histologically, 28% cytologically.
FISH: Indications of additional CCND1 and CCND3 signals; Trisomy 3,
additional signals at various chromosomes.
Chromosome analysis: 46, XY \[20\].
**Secondary diagnoses:**
Type 2 diabetes mellitus
Hypertension
Cataract (surgery 06/2018)
Nodular goiter
RSV pneumonia (03/2018)
**Summary:**
Mr. Williams presents in good general health to our bone marrow
transplant (BMT) outpatient clinic. There are no signs of infection or
chronic graft rejection. He has shown significant improvement in
resilience and does not have any complaints. Vital signs are stable.
Blood tests showed ongoing regeneration with normal light chains and
persistent positive immunofixation. There is no need for
myeloma-specific therapy at present, but close monitoring of the
paraprotein is required.
**Medication:**
**Medication** **Dosage** **Frequency**
----------------------------- ---------------------- -------------------------------------------------------
Tamsulosin (Flomax) 0.4 mg Daily in the morning
Candesartan (Atacand) 8 mg Twice Daily
Metformin (Glucophage) 1000 mg 0.5 tablet in the morning, 1.5 tablets in the evening
Pantoprazole (Protonix) 20 mg Daily in the morning
Vitamin D3 (various brands) 20,000 IU Once a week
Allopurinol (Zyloprim) 100 mg Daily in the morning
Insulin (various types) As per sliding scale As per sliding scale
With kind regards
### Patient Report 2
**Dear colleague, **
We are providing an update on our shared patient, Mr. John Williams, who
consulted with us on June 15, 2018.
**Consultation Summary:**
8. **Multiple Myeloma**
**Kidney biopsy scheduled for tomorrow.**
**Prostate cancer**
**Current Status:**
Acute renal failure accompanied by proteinuria due to the recent
diagnosis of multiple myeloma.
Multiple osteolytic lesions, including at the T4, T7, L1 vertebra and
the ribs.
**Diagnosis:**
Multiple myeloma.
Prostate cancer
**Clinical Presentation:**
Osteolytic lesion presenting as thoracic pain.
**Imaging Findings:**
Osteolytic lesion at T4 vertebra with involvement of the posterior edge.
**Planned Procedures:**
Restricted bed rest.
Whole spine MRI with STIR sequences, to be presented in the upcoming
tumor board meeting for deciding further course of action.
**Previous Diagnoses:**
May, 2018, Nephrology: Enlarged kidneys noted bilaterally.
January, 2018, Urology: Prostate cancer
December, 2015, Internal Medicine: Multiple myeloma without evidence of
complete remission.
**Previous Procedures:**
Transrectal biopsy of the prostate.
**Histology Report, Date: June 13, 2018:**
Suspected plasmacytoma with paraproteinemia.
WBC 6.47; Hb 10.8; Platelets 251,000.
Bone marrow biopsy: Cellularity approximated at 48%, indicating slightly
increased cellularity. Amidst reduced hematopoiesis, there is
proliferation of plasmacytoid cells with certain features.
**Preliminary Report:**
The bone marrow sample indicates possible infiltration due to plasma
cell myeloma. Additional tests will be conducted to confirm and further
elucidate this finding.
**Supplementary Findings:**
Immunohistochemical staining: CD138, Kappa, Lambda, CD20.
Microscopic findings confirm the presence of nodular infiltrates with
certain features.
**Final Report:**
Bone marrow sample indicates infiltration by a plasma cell myeloma with
kappa light chain restriction. Additionally, regular trilinear
hematopoiesis is significantly reduced.
### Patient Report 3
**Dear colleague, **
I wish to provide an update on our mutual patient, Mr. John Williams,
born 08/08/1956, who presented at our clinic at 08/20/2018.
**Diagnosis:**
Present condition: Multiple Myeloma IgG type, coded under ICD-10.
Stage: II B based on Durie and Salmon criteria; determined from Hb 9.1,
Creatinine 4.5 mg/dL.
**Histology:**
Bone marrow biopsy presents a strong indication of interstitial and
focal nodular invasion of the marrow space by plasma cell myeloma,
predominantly of high to intermediate maturity.
**Immunohistochemistry:**
The nodular infiltrates were found positive for CD138 with a kappa-light
chain restriction (infiltration rate at 62%).
Cytological findings align with high-grade bone marrow infiltration by
multiple myeloma.
**Tumor Localization:**
MRI of the entire spine conducted on 06/20/2018 reveals disseminated
bone lesions throughout the spine without any soft tissue involvement.
There is noted anterior vertebral body involvement at T4.
**Secondary Diagnoses:**
Cysts in the right kidney.
As of 01/2018, a diagnosis of Prostate cancer with a Gleason score of 8
and a PSA reading of 10.02.
Previous rib fracture, which may be associated with the multiple
myeloma.
Chronic renal failure, with ongoing dialysis treatment.
Documented mitral valve surgery in 2015.
History of Deep Vein Thrombosis in 1999.
**Prior Treatments:**
Initial diagnosis of multiple myeloma IgG kappa in 2015.
Prostate cancer was diagnosed in 01/2018 following spontaneous rib
fractures, Gleason score of 8.
A PSMA-PET-CT scan in 05/18 showed multiple bone lesions, notably
pronounced at Th4.
Tumor board review in 06/2018 concluded treatment strategies for
urological tumors, encompassing radiation therapy targeting Th4 and
antiandrogen therapy for the identified prostate cancer, using a GnRH
analog.
The progression of multiple myeloma required the commencement of
systemic treatment with Velcade and Dexamethasone.
**Study**: PSMA-PET-CT Scan
**Date of Study**: 05/2018
**Clinical Information**: Prostate cancer diagnosed in 01/2018 following
spontaneous rib fractures. Gleason score of 8.
**Technique**:
Whole body positron emission tomography/computed tomography (PET/CT) was
performed following the intravenous administration of PSMA-radiotracer.
Coronal, sagittal, and axial images were acquired and reviewed.
**Findings**:
Bone: Notably increased PSMA uptake is seen at the level of T4 vertebral
body consistent with metastatic involvement. The lesion has caused
cortical erosion and expansion with potential involvement of the
anterior spinal canal. Multiple rib lesions are identified,
corresponding with the clinical history of spontaneous rib fractures.
These lesions exhibit no increased PSMA uptake. No other foci of
increased PSMA uptake throughout the axial and appendicular skeleton.
**Prostate**:
12. The prostate gland demonstrates diffusely increased uptake, which is
consistent with primary prostate malignancy, especially given the
known clinical history.
**Thorax/Abdomen: **
13. No abnormal PSMA avid soft tissue masses or lymphadenopathies were
noted in the visualized fields. No pulmonary nodules or masses
suggestive of metastatic disease were identified. Liver, spleen,
kidneys, and adrenal glands appear unremarkable with no evidence of
metastatic lesions.
**Impression**:
Osseous metastasis from prostate cancer with involvement of the T4
vertebral body. No evidence of soft tissue, lymph node, or pulmonary
metastases in the visualized fields. Prostate gland showing evidence
consistent with primary malignancy.
**Current Radiation Therapy:**
**Indication:** Radiotherapy became a consideration due to a sizable
osteolytic lesion at T4, both for pain alleviation and stabilization.
Concurrent treatment of the aching ribs on the right side (7th-9th) was
also performed.
**Technique:** 6 MeV photons from a linear accelerator, administering a
cumulative dose of 30 Gy to thoracic vertebra 4 and 20 Gy to the ribs
with respective daily doses.
1. **Treatment Duration:**
Th4: 08/21/2018 to 08/27/2018
Rib area: 08/21/2018 to 08/27/2018
**Clinical Update:**
Throughout the therapy period, Mr. Williams remained admitted to our
Oncology ward for ongoing reduced dosage chemotherapy using Velcade. He
has reported a decline in pain sensations during this timeframe. The
overall health status appeared satisfactory, with no skin irritation
observed at the irradiated sites.
**Subsequent Actions:**
Guidance on skincare and potential adverse effects have been provided to
Mr. Williams. The intensity of the chemotherapy will soon be escalated.
A radio-oncological assessment has been scheduled in our outpatient
facility for 09/05/2018 at 12:00 PM. I kindly request the most recent
test results by this date.
**Note:** In compliance with the Radiation Protection Act, we shall
undertake regular evaluations and request updates on the patient\'s
condition. Mr. Williams has been apprised of the necessity for
consistent oncological check-ups.
Warm regards,
### Patient Report 4
**Dear colleague, **
We wish to update you on our mutual patient, Mr. John Williams.
**Diagnosis:**
Current multiple myeloma IgG type
**Tumor Localization:**
Based on a whole spine MRI dated June 20, 2018:
Multiple intraosseous lesions throughout the spine without soft tissue
involvement.
Known intrusion of the T4 cover plate.
**Secondary Diagnoses:**
Right kidney cysts
Diagnosed prostate carcinoma in January 2018, Gleason score 8, initial
PSA at 10.02.
History of a spontaneous rib fracture related to the multiple myeloma.
Chronic renal insufficiency; he remains on dialysis.
History of mitral valve reconstruction in 2015.
History of deep vein thrombosis in 1999.
**Treatment Overview:**
Diagnosed with multiple myeloma type kappa in 2015 with initially normal
renal function.
Diagnosed with prostate carcinoma in January 2018 due to spontaneous rib
fractures, Gleason score 8.
Treatment decisions in 2018 included radiation for vertebral lesions and
hormone therapy for prostate cancer using a GnRH analogue.
Systemic therapy with Velcade and Dexamethasone initiated due to
progressive myeloma.
Radiation therapy in August 2018 for vertebral and rib lesions.
**Summary:**
Mr. Williams had a radio-oncological follow-up on September 29, 2018.
His general health has improved. He remains on thrice-weekly dialysis.
Recent CT scans show extensive osteolysis of the spine with several
vertebral collapses. Currently, we see no urgent fracture risk or need
for additional radiation therapy. We have planned regular clinical
check-ups with Mr. Williams. His next follow-up is scheduled in three
months.
**Oncologic treatment: **
Daratumumab/lenalidomide/dexamethasone regimen:
Daratumumab 16mg/kg: Days 1, 8, 15, 22 for cycles 1 & 2 (every 28 days
for 8 weeks).
Days 1, 15 for cycles 3-6 (every 28 days for 16 weeks).
Day 1 for subsequent cycles (every 28 days).
Dexamethasone 20mg on Daratumumab days, with an additional 20mg the day
after (totaling 40mg/week).
Lenalidomide 5mg from day 1-21 (every 28 days).
Bondronate every 4 weeks (last administered on 12/13/2016).
Re-evaluation of hemodialysis and autologous peripheral blood stem cell
transplant (PBSCT) after 2 cycles of daratumumab.
**CT Spine scan (09/30/2018): **
**Technique**: Contrast-enhanced computed tomography (Omnipaque 240) of
the thoracic and lumbar spine was performed with axial slices, and
multiplanar reconstructions in sagittal and coronal orientations.
**Findings**:
**Thoracic Spine**:
Extensive osteolytic lesions are identified in multiple thoracic
vertebrae. Specifically, vertebral collapses are noted at T4, T7, T9,
T11. No significant bony destruction of pedicles, lamina and spinous
processes. No evidence of paravertebral or epidural soft tissue masses.
**Lumbar Spine**:
Prominent osteolytic changes are seen in L1 (with fracture) and L4
vertebral bodies. However, there is no significant vertebral collapse.
Preserved pedicles, lamina, and spinous Processes without significant
osteolysis. No evidence of abnormal masses or lymphadenopathy.
No significant central canal stenosis or neural foraminal narrowing. The
intervertebral discs are preserved without significant discopathies.
**Impression**:
Extensive osteolysis in multiple vertebral bodies, specifically in the
thoracic and lumbar spine, with vertebral collapses at levels T4, T7,
T9, and T11 as well as L1. Also, osteolytic changes in L4 of the lumbar
spine.
Currently, based on imaging, there does not appear to be an urgent
fracture risk, and no radiologic signs suggesting a need for imminent
radiation therapy. No soft tissue abnormalities identified in the
examined regions.
**Medication: **
**Medication** **Dosage** **Frequency**
---------------------------- ------------ ----------------------------------------
Fentanyl Patch (Duragesic) 25 μg Changed every 72 hours
Enoxaparin (Lovenox) 0.2 mL Nightly (dialysis dose)
Dexamethasone (Decadron) 8 mg In the morning (day after Daratumumab)
Pantoprazole (Protonix) 40 mg Daily in the morning
Cotrimoxazole (Bactrim) 480 mg Thrice weekly (Mon, Wed, Fri)
Valacyclovir (Valtrex) 500 mg Daily in the morning
Acetaminophen (Tylenol) 500 mg Orally, three times daily
Ibandronate (Boniva) 2 mg Every 4 weeks
Leuprorelin (Lupron Depot) 3.75 mg Monthly (4-week depot) subcutaneously
Pregabalin (Lyrica) 25 mg Twice a day
Amlodipine (Norvasc) 5 mg Daily in the morning
Bisoprolol (Zebeta) 5 mg Daily in the morning
Lenalidomide (Revlimid) 5 mg Nightly
Ondansetron (Zofran) 8 mg As needed, up to twice daily
### Patient Report 5
**Dear colleague, **
We are updating you on Mr. John Williams\' outpatient visit on December
13, 2018.
**Diagnosis:**
Febrile respiratory infection.
**Underlying Conditions:**
Multiple myeloma, kappa light chain, stage IIIB as classified by Salmon
and Durie.
Chronic kidney disease requiring hemodialysis.
Prostate cancer.
**Summary:**
Mr. Williams came to the emergency room with fever and dry cough during
his multiple myeloma treatment with Darzalex, Revlimid, and
Dexamethasone. His vital signs were recorded, and laboratory tests
showed signs of infection and confirmed chronic kidney disease. Chest
X-ray indicated possible inflammation. Given these findings, Mr.
Williams was admitted for antibiotic therapy. Further observations and
treatments were documented.
### Patient Report 6
**Dear colleague, **
This letter pertains to Mr. John Williams, who was hospitalized from
December 14 to 21st, 2018.
**Oncological Diagnosis:**
Multiple myeloma, kappa light chain, initially diagnosed in June 2018 as
stage IIIB per Durie and Salmon criteria.
**Treatment Details:**
He underwent various treatment regimens for multiple myeloma over the
course of the year. His current condition indicates an
influenza-positive pneumonia, likely with a bacterial superinfection. He
continues hemodialysis thrice a week.
**Secondary Diagnoses:**
Several renal complications were documented in June 2018.
**Plan of Care:**
Mr. Williams\' therapy plan was discussed in a tumor board meeting. He
remains on a regimen of Darzalex, Revlimid, and Dexamethasone.
**Summary:**
Mr. Williams came to the emergency room on December 13, 2018, with cough
and fever. Further details about his history can be found in previous
communications. On admission, he showed signs of a respiratory
infection, confirmed by a chest X-ray. He was treated with antibiotics,
which were later escalated. He also tested positive for influenza A and
was given Tamiflu. After a short in-patient stay, he has shown
improvement. He is scheduled to continue his therapy in our clinic on
December 22, 2018. In case of any complications, he has been advised to
return to our emergency room immediately.
For future consultations, please provide a referral slip for each new
quarter.
Warm regards
### Patient Report 7
**Dear colleague, **
We are writing to inform you about Mr. John Williams, who was an
inpatient in our clinic from March 1, 2019, to March 3, 2019.
Oncological diagnosis:
Mr. Williams was diagnosed with Multiple Myeloma light chain kappa. He
received his follow-up diagnosis in June 2018, which was at stage IIIB
per the Durie and Salmon staging system.
Treatment:
In June 2018, he was given VelDex due to impaired renal function.
Subsequently, he received Carfilzomib (15mg/m2 on days 1-2, 8-9, 15-16),
Lenalidomide (5 mg, on days 1-21), and Dexamethasone (40mg, on days 1,
8, 15-16, 22). In addition, he was treated with Pomalidomide (4mg on
days 1-21), Doxorubicin (9mg/m2 on days 1, 4), and Dexamethasone (40mg,
on days 1, 8, 15, 22). He underwent radiation therapy to T4 of the rib
thorax in August. Between August to October 2018, he had three cycles of
Pomalidomide, Doxorubicin, and Dexamethasone, after which the disease
progressed. From November 2018 to February 2019, he had four cycles of
Daratumumab, Lenalidomide, and Dexamethasone.
**Outcome:**
The response to the treatment was very good partial remission (VGPR).
**Present Treatment:**
He underwent mobilization chemotherapy with cyclophosphamide, with a
dosage adjusted due to his requirement for dialysis (1500mg/m^2^ on day
1 and 1000mg/m^2^ on day 2). He received dialysis on March 2 in our
nephrology department.
**Secondary diagnoses:**
In March 2018, he developed renal insufficiency requiring thrice-weekly
dialysis. In January 2018, he was diagnosed with prostate carcinoma and
was treated with an androgen blockade using Enantone.
**Future Therapy Plan:**
The tumor board\'s decision from March 3, 2019 was to continue with
Daratumumab, Revlimid, and Dexamethasone due to the good response. He
will undergo stem cell mobilization and high-dose therapy with
autologous stem cell transplant. Monitoring is scheduled for March 14,
2019, followed by dialysis at our dialysis center on Mondays,
Wednesdays, and Fridays.
**Medications:**
His current medications include:
**Medication** **Dosage** **Frequency**
------------------------------ ------------------ ---------------------------------------------------
Fentanyl Patch (Duragesic) 25 μg Changed every 72 hours
Enoxaparin (Lovenox) 0.2 mL For dialysis
Dexamethasone (Decadron) 8 mg On March 4 and 5
Pantoprazole (Protonix) 40 mg
Cotrimoxazole (Bactrim) 480 mg Thrice weekly on Mondays, Wednesdays, and Fridays
Valacyclovir (Valtrex) 500 mg
Ibandronate (Boniva) 2 mg Every four weeks
Leuprorelin (Lupron Depot) 3.75 mg Every four weeks
Pregabalin (Lyrica) 25 mg
Amlodipine (Norvasc) Currently paused Currently paused
Bisoprolol (Zebeta) 2.5 mg
Filgrastim (Neupogen/Granix) 48 million IU
**Summary:**
Mr. Williams was admitted on March 1, 2019, for mobilization
chemotherapy with cyclophosphamide. Please refer to our previous letters
for a detailed history. His last treatment was with daratumumab,
Revlimid, and dexamethasone. Fortunately, this treatment showed a very
good response. He is dialyzed three times a week at our clinic due to
chronic renal insufficiency. He was discharged on March 3, 2019, and we
request the administration of filgrastim as per the medication plan
starting March 6, 2019. CD34+ monitoring is scheduled for March 14,
2019. Depending on the CD34+ count, stem cell collection may need to be
scheduled on a dialysis-free day. We have coordinated with our
colleagues at the dialysis center for the collection via the atrial
catheter. A follow-up for blood count and Ibandronate administration has
been scheduled for March 10, 2017. If his condition deteriorates or if
he shows signs of infection, bleeding, or any other complications, he
should immediately be brought to our emergency department. Please
remember to bring a referral form during your initial visit each
quarter.
Therapy recommendation based on Transthoracic echocardiography findings:
Mr. Williams has a normally sized left ventricle with standard global
function. There\'s no evidence of any regional wall motion
abnormalities. The right ventricle is also of normal size with standard
function. The left atrium is not dilated. There\'s marked concentric
left ventricular hypertrophy. His aortic valve shows insufficiency of I°
(PHT 520 ms), while the mitral and tricuspid valves appear normal. There
is no significant pericardial effusion. Overall, he has a standard left
ventricular function with no significant valvular diseases or pulmonary
hypertension.
**Surgery Report:**
Diagnosis: Terminal renal failure.
Procedure: Creation of a right upper arm brachialis-basilica fistula
with the anterior movement of the right basilic vein.
**Report:**
Mr. Williams required dialysis due to terminal renal insufficiency. For
this purpose, an arteriovenous (AV) fistula was created as a dialysis
access. Previously, dialysis was performed using a right atrial
catheter. After mapping, only the basilic vein on the right arm seemed
suitable. Hence, a brachialis-basilica fistula was created with anterior
transposition of the basilica vein. A partial mobilization of the
basilica vein was performed. Afterward, a brachialis-basilica
anastomosis was carried out. The operation was uncomplicated.
Your collaboration has been instrumental in managing this patient
effectively. If you have any further queries or require additional
details, please do not hesitate to contact our office.
**Medication:**
**Medication** **Dosage** **Frequency**
------------------------------- ------------------ ------------------------------------
Fentanyl Patch (Duragesic) 25 μg Change every 72 hours
Enoxaparin (Lovenox) 0.2 mL Nightly (dialysis dose)
Dexamethasone (Decadron) 8 mg Morning on 03/05 & 03/06
Pantoprazole (Protonix) 40 mg Morning
Cotrimoxazole (Bactrim Forte) 480 mg Morning 3x weekly on Mon, Wed, Fri
Valacyclovir (Valtrex) 500 mg Half tablet in the morning
Ibandronate (Boniva) 2 mg Every 4 weeks
Leuprorelin (Lupron Depot) 3.75 mg Monthly subcutaneous (Morning)
Pregabalin (Lyrica) 25 mg Morning and Evening
Amlodipine (Norvasc) Currently paused Currently paused
Bisoprolol (Zebeta) 2.5 mg Morning and Evening
Filgrastim (Neupogen/Granix) 48 million IU Morning and Evening
Best regards,
### Patient Report 8
**Dear colleague, **
I am writing to provide you with a detailed report on Mr. John Williams,
who was admitted to our facility from May 8, 2020, to May 28, 2020.
**Diagnoses:**
History of acute mitral valve endocarditis in March 2020.
Subsequent re-operation entailing mitral valve replacement using a
Bioprosthesis (29 mm) coupled with the resection of all infected tissue
from the mitral valve\'s supporting apparatus on March 24, 2020.
The origin remains uncertain, but potential associations include Demers
catheter infection and port catheter infection (confirmed presence of
Staphylococcus epidermidis).
Surgical removal was conducted on March 21, 2020, with no findings at
the catheter tips.
14. Antibiotic regimen included:
Meropenem from April 2, 2020, to April 23, 2020.
Linezolid 600 mg from April 3, 2020, to April 19, 2020.
Daptomycin from April 3, 2020, to May 27, 2020.
Fosfomycin from April 19, 2020, to May 28, 2020.
History of mitral valve reconstruction via minithoracotomy in 2015.
Right-side vision loss due to septic-embolic central retinal artery
occlusion.
Left hemispheric ischemia in the caput nuclei caudati/lenticular nuclei
on April 5, 2020, possibly embolic in origin from mitral valve
endocarditis.
History of brainstem transient ischemic attack (TIA) on March 11, 2020,
potentially embolic in relation to mitral valve endocarditis.
Jugular vein thrombosis.
20. Hematological/oncological diagnoses comprise:
Multiple myeloma with lambda light chains, stage IIIB according to
the Salmon and Durie criteria, first diagnosed in 2015. This was
accompanied by multiple osteolysis occurrences, history of radiation
to Th4 and rib thorax, and treatment with Daratumumab. Current
treatment has been paused due to remission.
A prostate carcinoma diagnosis in January 2018
**Other medical conditions include:**
-Chronic kidney failure necessitating dialysis since 2018, history of a
Demer catheter with explantation on March 2020, and angioplasty on the
right V. basilica and V. brachialis due to stenosis-related shunt
dysfunction.
-History of brainstem TIA in April 2019.
-Sensations of tingling paresthesias in both lower legs.
-History of bilateral deep vein thrombosis.
-Frequent calf muscle cramps.
**Medical History Overview:**
Mr. Williams\'s latest admission on May 8, 2020, was to assess remission
status and determine if continuation of treatment for his known multiple
myeloma was necessary. Previously, until March 2020 he was under a
Daratumumab monotherapy (as he could not tolerate Revlimid), which
showed stable disease progression. Prior to this, he was treated at our
local hospital for mitral valve endocarditis which had a complex
trajectory. At the time of admission, Mr. Williams felt generally weak
but was otherwise in stable condition. Upon discontinuation of the
fentanyl patch, his back pain increased. He exhibited no fevers and had
no known allergies. His appetite was low, and he reported no nausea.
Since his heart surgery, he has experienced numbness in his left heel
and toes. His residual urine output was about 190 mL per day, and he was
undergoing regular dialysis.
**Physical Examination:**
The patient was alert, responsive, and fully oriented. The examination
of the head, neck, and lungs was unremarkable. Cardiac auscultation
revealed clear and rhythmic heart sounds without any abnormal findings.
There was a non-irritated sternotomy scar. Examination of his back
revealed decubitus ulcers. Abdominal examination showed a soft,
non-tender abdomen with normal bowel sounds. Extremity examination
revealed minor edema.
**Diagnostic Imaging and Tests:**
A series of diagnostic tests, including sonography, whole body CT scan,
ophthalmological exams, and histology were conducted. The results are
detailed within this report. In summary, the findings indicate:
-Limited abnormalities in the heart\'s echocardiography, with potential
mitral valve issues to monitor.
-Bone scans revealed extensive osteopenia and other abnormalities
related to his known multiple myeloma, but no evidence of new
osteolysis.
-Eye examinations confirmed the previously noted vision issues,
potentially stemming from the mitral valve endocarditis, but provided no
clear solutions.
-Histological evaluation of bone marrow samples indicates largely
regular hematopoiesis but confirms infiltration from the known multiple
myeloma.
**Summary and Recommendations:**
Mr. John Williams is a 63-year-old male with a complex medical history
involving multiple organ systems. His most recent admission was in
relation to his multiple myeloma, for which he has been in remission and
will be monitored closely. His mitral valve endocarditis from earlier
this year has been resolved and treated appropriately. Due to the
multiple comorbidities, it is crucial for any treating facility or
physician to be fully aware of his history to provide optimal care.
Continual monitoring of his cardiovascular and renal systems is
essential. The importance of maintaining strict adherence to his
dialysis regimen and potential antibiotic prophylaxis is emphasized.
Given his weakened general condition and chronic pain, palliative care
might also be a suitable approach to consider, focusing on enhancing his
quality of life and addressing his pain management needs.
Please refer to the attached files for further details and a complete
breakdown of tests and findings. I trust this report will help guide the
appropriate medical care for Mr. John Williams.
Sincerely,
**Medication:**
**Medication** **Dosage** **Frequency**
----------------------------------------- -------------------- -----------------------------------------------------------------
Clopidogrel (Plavix) 75 mg Morning
Enoxaparin (Lovenox) 0.2 mL s.c. Evening, only on days when not receiving dialysis
Dronabinol (Marinol) Drops 3 drops Morning and Evening
Leuprorelin (Lupron Depot) Monthly depot Every 4 weeks via subcutaneous injection
Fentanyl Transdermal System 12 μg/hour Changed every 3 days
Pantoprazole (Protonix) 40 mg Morning
Sevelamer (Renagel) 800 mg Morning
Multivitamin One tablet Morning
Torsemide (Torem) 200 mg Morning
Vitamin D3 20,000 IU Once weekly
Sodium bicarbonate (Bicanorm) One tablet Morning
Calcitriol (Rocaltrol) 0.25 μg Morning
Valacyclovir (Valtrex) 500 mg half-tablet Morning
Trimethoprim/Sulfamethoxazole (Bactrim) 480 mg Morning on Mondays, Wednesdays, and Fridays
Dexamethasone (Decadron) 4 mg Morning on day 1 and day 2 following daratumumab administration
### Patient Report 9
**Dear colleague, **
I am writing to provide an update on the medical condition and treatment
of Mr. John Williams, who has been undergoing inpatient treatment in our
facility since September 30, 2021.
**Diagnoses**:
**Present**: Acute impairment of the visual field.
**Oncological Diagnosis**:
1. Diagnosis of Multiple Myeloma with kappa light chains, staged at
IIIB as per the Salmon and Durie criteria
Observable multiple osteolyses.
History of radiation to the T4 and thoracic rib.
Starting from 2018, he required dialysis due to renal insufficiency,
scheduled on Mondays, Wednesdays, and Fridays in our local clinic.
2018: Treatment involved Bortezomib and Dexamethasone, but he was
refractory to this combination. The regimen of Carfilzomib,
Lenalidomide, and Dexamethasone was also found to be ineffective.
Radiation was administered to the T4 (totaling 30 Gy) and the
thoracic rib (totaling 20 Gy) in August 2018.
Between August and October 2018: Mr. Williams underwent three cycles
of Pomalidomide, Doxorubicin, and Dexamethasone, but the disease
showed progression.
November 2018 to February 2019: He received four treatments of
Daratumumab, Lenalidomide, and Dexamethasone, which led to a very
good partial response (VGPR).
In March 2019, he underwent stem cell mobilization due to RSV
pneumonia complications and then started on Daratumumab monotherapy
(VGPR was last noted in May 2018).
He continued with Daratumumab treatment until November 2019, after
which there was a pause until March 2020 due to remission (VGPR) and
a diagnosis of endocarditis.
A whole body CT scan conducted in March 2020 did not show any new
osteolyses.
By May 2020, there was an increase in LK values, prompting the
resumption of Daratumumab, which led to a decrease in free light
chains.
As of June 2020, there was a noted increase in light chain kappa
values to 102 mg/L.
In July 2020, therapy was escalated to include Daratumumab, Revlimid
(5 mg), and Dexamethasone.
By September 2020, a further increase in light chains was observed,
prompting a planned switch to Elotuzumab, Pomalidomide, and
Dexamethasone.
**For his heart condition:**
Acute mitral valve endocarditis was diagnosed in March 2020. He
underwent a re-operation for mitral valve replacement with a
bioprosthesis (29 mm). This procedure, performed in March, 2020,
involved the resection of all infected tissue from the mitral valve\'s
holding apparatus. The cause is presumed to be associated with a Demers
catheter infection or possibly related to a port catheter infection
(Staphylococcus epidermidis was found). The catheter was surgically
removed in March 2020. He was on a series of antibiotics, including
Meropenem, Linezolid, Daptomycin, and Fosfomycin.
**Other pertinent medical events include:**
A history of radiation treatment using a minithoracotomy technique for
mitral valve reconstruction in 2015.
Right eye amaurosis due to septic-embolic central retinal artery
occlusion.
Left hemispheric ischemia diagnosed in April 2020, possibly due to
emboli from the mitral valve endocarditis.
A transient ischemic attack (TIA) in the brainstem observed on in March
2020, which could be related to emboli from the mitral valve
endocarditis.
Jugular vein thrombosis.
Prostate cancer diagnosed in 2018.
Chronic renal failure necessitating dialysis since 2018.
Previous procedures include Demers catheter placement (removed on March
2020) and angioplasty on the right basilic vein and brachial vein due to
stenosis causing shunt dysfunction.
History of transient ischemic attacks.
Bilateral tingling paresthesias in the lower legs, history of deep vein
thrombosis, recurrent calf cramps, and hypothyroidism.
Please let me know if you require any further information on Mr.
Williams. I am confident that this detailed account will assist you in
understanding his medical history and ensuring optimal care.
**Therapy: **
Therapy schedule: Daratumumab s.c. 1800mg abs. weekly in week 1-8,
2-weekly in week 9-24, every 4 weeks from week 25. Continuation of
Bondronat. Regular monitoring and optimal adjustment of cardiovascular
risk factors.
Medication:
Plavix (Clopidogrel) 75 mg; once daily in the morning
Lovenox (Enoxaparin) 0.2 ml subcutaneously; once daily in the evening on
non-dialysis days
Marinol (Dronabinol) drops; four drops in the morning and four drops in
the evening
Duragesic (Fentanyl transdermal patch) 12 μg/hour; change every 3 days
Protonix (Pantoprazole) 40 mg; dosing: Once daily in the morning and
once daily in the evening for 2 weeks, then once daily in the morning
Renvela 800 mg; dosing: Once daily in the morning
Torem 200 mg; once daily in the morning
Vitamin D3 20,000 IU; once weekly
Calcijex (Calcitriol) 0.25 mcg; once daily in the morning
Valtrex (Valacyclovir) 500 mg; dosing: Half a tablet (250 mg) once daily
in the morning
Bactrim (Cotrimoxazole or trimethoprim/sulfamethoxazole) 480 mg, once
daily
Warm regards,
**Clinical Update, 11/12/2022**
Mr. John Williams, a 66-year-old male with a known history of multiple
myeloma and associated complications, presented again to our facility
with worsening symptoms over the past three weeks.
**Symptoms**:
Persistent fatigue
Shortness of breath on minimal exertion
Bilateral pitting edema in the lower extremities up to the mid-calf
**Preliminary Findings**:
**Physical Examination**:
1. Jugular venous distention
Decreased breath sounds bilaterally with mild basilar crackles
S3 gallop on cardiac auscultation
**Chest X-ray**:
4. Cardiomegaly with an enlarged cardiac silhouette. Mild pulmonary
edema evident.
**Echocardiogram**:
5. Reduced left ventricular ejection fraction (LVEF) of 35% (normal \>
55%)
Mild mitral regurgitation
**Lab Results**:
7. B-type natriuretic peptide (BNP): 890 pg/mL (Normal: \<100 pg/mL)
Serum Sodium: 130 mEq/L (Normal: 135-145 mEq/L)
Serum Potassium: 5.8 mEq/L (Normal: 3.5-5.1 mEq/L)
Blood Urea Nitrogen (BUN): 38 mg/dL (Normal: 7-20 mg/dL)
Creatinine: 2.1 mg/dL (Normal: 0.8-1.3 mg/dL)
GFR: 35 mL/min (Reduced)
**Diagnosis**:
Congestive Heart Failure (CHF) with reduced ejection fraction
Renal insufficiency
Multiple Myeloma (primary diagnosis 2015)
Prostate cancer
**Treatment Administered**:
Intravenous furosemide was administered to relieve fluid overload,
resulting in a significant reduction in edema and improvement in
breathlessness over the subsequent 48 hours. Lisinopril was initiated
cautiously to manage CHF and to potentially provide renal protection.
Metoprolol was started at a low dose, with close monitoring of blood
pressure and heart rate. Potassium levels were closely monitored given
initial hyperkalemia; diet and medications were adjusted accordingly.
Dietary consult emphasized a low-sodium, moderate protein, and
potassium-restricted diet. Close monitoring of fluid balance
(input-output) was maintained throughout the stay.
**Progress**:
Mr. Williams showed consistent improvement over his two-week admission.
Serial echocardiograms indicated a slight improvement in LVEF to 39%.
The edema receded notably, and his shortness of breath on exertion
reduced significantly. Labs before discharge showed:
Serum Sodium: 134 mEq/L
Serum Potassium: 4.9 mEq/L
BUN: 32 mg/dL
Creatinine: 1.9 mg/dL
BNP: 550 pg/mL
**Discharge Recommendations**:
Outpatient cardiology follow-up in two weeks and then monthly to monitor
LVEF and adjust medications. Nephrology consultation to keep an eye on
renal function, given his increased susceptibility to kidney damage.
Continue with dietary restrictions and modifications as advised.
Commence an outpatient cardiac rehabilitation program for supervised
exercise and lifestyle modifications. Weekly blood tests for the first
month to monitor electrolytes and kidney function.
Mr. Williams remains at risk due to multiple comorbidities. It is
essential to address each condition holistically while ensuring no
single treatment exacerbates another condition. A collaborative and
vigilant approach is imperative for his ongoing health management.
Warm regards,
--------------------------- ---------------- ---------------------
**Parameter** **Value** **Reference Range**
**Blood Count**
White Blood Cells (WBC) 5.8 x 10^9^/L 4-11 x 10^9^/L
Red Blood Cells (RBC) 3.9 x 10^12^/L 4.5-5.5 x 10^12^/L
Hemoglobin (Hb) 9.8 g/dL 13-18 g/dL for men
Platelets (Plt) 150 x 10^9^/L 150-450 x 10^9^/L
**Biochemistry**
Creatinine 2.8 mg/dL 0.6-1.3 mg/dL
Blood Urea Nitrogen (BUN) 40 mg/dL 7-20 mg/dL
Glucose 98 mg/dL 70-100 mg/dL
**Electrolytes**
Sodium (Na) 137 mEq/L 135-145 mEq/L
Potassium (K) 5.1 mEq/L 3.5-5.0 mEq/L
Calcium 8.6 mg/dL 8.5-10.5 mg/dL
Phosphate 4.5 mg/dL 2.5-4.5 mg/dL
**Oncologic Markers**
Free light chain kappa 692 mg/L 3.3-19.4 mg/L
Free light chain lambda 12 mg/L 5.7-26.3 mg/L
**Other Values**
LDL cholesterol 80 mg/dL \<100 mg/dL
HbA1c 6.2% \<5.7%
--------------------------- ---------------- ---------------------
|
Carfilzomib/Lenolidomide/Dexamethasone
|
What can be inferred about the thyroid function from Mr. Romero's lab results of March 2016 and June 2016?
Choose the correct answer from the following options:
A. Overactive thyroid, as indicated by elevated TSH levels
B. Underactive thyroid, as indicated by low T4 levels
C. Normal thyroid function, as indicated by T3 and T4 within reference range
D. Inconclusive due to conflicting T3 and T4 levels
E. Overactive thyroid, as indicated by low TSH levels
|
### Patient Report 0
**Dear colleague, **
We would like to report to you about our patient, Mr. David Romero, born
on 02/16/1942, who was under our inpatient care from 03/25/2016 to
03/30/2016.
**Diagnoses:**
- Suspected myocarditis
- Uncomplicated biopsy, pending results
- LifeVest has been adjusted
- Left ventricular ejection fraction of 28%
- Chronic hepatitis C
- Status post hepatitis A
- Post-antiviral therapy
- Exclusion of relevant coronary artery disease
**Medical History:** The patient was admitted with suspected myocarditis
due to a significantly impaired pump function noticed during outpatient
visits. Anamnestically, the patient reported experiencing fatigue and
exertional dyspnea since mid-December, with no recollection of a
preceding infection. Antiviral therapy with Interferon/Ribavirin for
chronic Hepatitis C had been ongoing since November. An outpatient
evaluation had excluded relevant coronary artery disease.
**Current Presentation:** Suspected inflammatory/dilated cardiomyopathy,
Indication for biopsy
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without guarding, spleen
and liver not palpable. Normal bowel sounds.
**Coronary Angiography**: Globally significantly impaired left
ventricular function (EF: 28%)
[Myocardial biopsy:]{.underline} Uncomplicated retrieval of LV
endomyocardial biopsies
[Recommendation]{.underline}: A conservative medical approach is
recommended, and further therapeutic decisions will depend on the
histological, immunohistological, and molecular biological examination
results of the now-retrieved myocardial biopsies.
[Procedure]{.underline}: Femoral closure system is applied, 6 hours of
bed rest, administration of 100 mg/day of Aspirin for 4 weeks following
left ventricular heart biopsy.
**Echocardiography before Heart Catheterization**:
Performed in sinus rhythm. Satisfactory ultrasound condition.
[Findings]{.underline}: Moderately dilated left ventricle (LVDd 64mm).
Markedly reduced systolic LV function (EF 28%). Global longitudinal
strain (2D speckle tracking): -8.6%.
Regional wall motion abnormalities: despite global hypokinesia, the
posterolateral wall (basal) contracts best. Diastolic dysfunction Grade
1 (LV relaxation disorder) (E/A 0.7) (E/E\' mean 13.8). No LV
hypertrophy. Morphologically age-appropriate heart valves. Moderately
dilated left atrium (LA Vol. 71ml). Mild mitral valve insufficiency
(Grade 1 on a 3-grade scale). Normal-sized right ventricle. Moderately
reduced RV function Normal-sized right atrium. Minimal tricuspid valve
insufficiency (Grade 0-1 on a 3-grade scale). Systolic pulmonary artery
pressure in the normal range (systolic PAP 27mmHg).
No thrombus detected. Minimal pericardial effusion, circular, maximum
2mm, no hemodynamic relevance.
**Echocardiography after Heart Catheterization:**
[Indication]{.underline}: Follow-up on pericardial effusion.
[Examination]{.underline}: TTE at rest, including duplex and
quantitative determination of parameters. [Echocardiographic
Finding:]{.underline} Regarding pericardial effusion, the status is the
same. Circular effusion, maximum 2mm.
**ECG after Heart Catheterization:**
76/min, sinus rhythm, complete left bundle branch block.
**Summary:** On 03/26/2016, biopsy and left heart catheterization were
successfully performed without complications. Here, too, the patient
exhibited a significantly impaired pump function, currently at 28%.
**Therapy and Progression:**
Throughout the inpatient stay, the patient remained cardiorespiratorily
stable at all times. Malignant arrhythmias were ruled out via telemetry.
After the intervention, echocardiography showed no pericardial effusion.
The results of the endomyocardial biopsies are still pending. An
appointment for results discussion and evaluation of further procedures
at our facility should be scheduled in 3 weeks. Following the biopsy,
Aspirin 100 as specified should be given for 4 weeks. We intensified the
ongoing heart failure therapy and added Spironolactone to the
medication, recommending further escalation based on hemodynamic
tolerability.
**Current Recommendations:** Close cardiological follow-up examinations,
electrolyte monitoring, and echocardiography are advised. Depending on
the left ventricular ejection fraction\'s course, the implantation of an
ICD or ICD/CRT system should be considered after 3 months. On the day of
discharge, we initiated the adjustment of a Life Vest, allowing the
patient to return home in good general condition.
**Medication upon Discharge: **
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torasemide (Torem) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
**Lab results upon Discharge:**
**Parameter** **Results** **Reference Range**
------------------------ ------------- ---------------------
Absolute Erythroblasts 0.01/nL \< 0.01/nL
Sodium 134 mEq/L 136-145 mEq/L
Potassium 4.5 mEq/L 3.5-4.5 mEq/L
Creatinine (Jaffé) 1.25 mg/dL 0.70-1.20 mg/dL
Urea 50 mg/dL 17-48 mg/dL
Total Bilirubin 1.9 mg/dL \< 1.20 mg/dL
CRP 4.1 mg/L \< 5.0 mg/L
Troponin-T 78 ng/L \< 14 ng/L
ALT 67 U/L \< 41 U/L
AST 78 U/L \< 50 U/L
Alkaline Phosphatase 151 U/L 40-130 U/L
gamma-GT 200 U/L 8-61 U/L
Free Triiodothyronine 2.3 ng/L 2.00-4.40 ng/L
Free Thyroxine 14.2 ng/L 9.30-17.00 ng/L
TSH 4.1 mU/L 0.27-4.20 mU/L
Hemoglobin 11.6 g/dL 13.5-17.0 g/dL
Hematocrit 34.5% 39.5-50.5%
Erythrocytes 3.7 /pL 4.3-5.8/pL
Leukocytes 9.56/nL 3.90-10.50/nL
MCV 92.5 fL 80.0-99.0 fL
MCH 31.1 pg 27.0-33.5 pg
MCHC 33.6 g/dL 31.5-36.0 g/dL
MPV 8.9 fL 7.0-12.0 fL
RDW-CV 14.0% 11.5-15.0%
Quick 89% 78-123%
INR 1.09 0.90-1.25
PTT Actin-FS 25.3 sec. 22.0-29.0 sec.
### Patient Report 1
**Dear colleague, **
We are reporting on the pending findings of the myocardial biopsies
taken from Mr. David Romero, born on 02/16/1942 on 03/26/2016 due to the
deterioration of LV function from 40% to 28% after interferon therapy
for HCV infection.
**Diagnoses:**
- Suspected myocarditis
- LifeVest
- Left ventricular ejection fraction of 28%
- Chronic hepatitis C
- Status post hepatitis A
- Post-antiviral therapy
- Exclusion of relevant coronary artery disease
**Current Medication:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torasemide (Torem) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
**Myocardial Biopsy on 01/27/2014:**
[Molecular Biology:]{.underline}
PCR examinations performed under the question of myocardial infection
with cardiotropic pathogens yielded a positive detection of HCV-specific
RNA in myocardial tissue without quantification possibility
(methodically determined). Otherwise, there was no evidence of
myocardial infection with enteroviruses, adenoviruses, Epstein-Barr
virus, Human Herpes Virus Type 6 A/B, or Erythrovirus genotypes 1/2 in
the myocardium.
[Assessment]{.underline}: Positive HCV-mRNA detection in myocardial
tissue. This positive test result does not unequivocally prove an
infection of myocardial cells, as contamination of the tissue sample
with HCV-infected peripheral blood cells cannot be ruled out in chronic
hepatitis.
**Histology and Immunohistochemistry**:
Unremarkable endocardium, normal cell content of the interstitium with
only isolated lymphocytes and histiocytes in the histologically examined
samples. Quantitatively, immunohistochemically examined native
preparations showed borderline high CD3-positive lymphocytes with a
diffuse distribution pattern at 10.2 cells/mm2. No increased
perforin-positive cytotoxic T cells. The expression of cell adhesion
molecules is discreetly elevated. Otherwise, only slight perivascular
but no interstitial fibrosis. Cardiomyocytes are properly arranged and
slightly hypertrophied (average diameter around 23 µm), the surrounding
capillaries are unremarkable. No evidence of acute
inflammation-associated myocardial cell necrosis (no active myocarditis)
and no interstitial scars from previous myocyte loss. No lipomatosis.
[Assessment:]{.underline} Based on the myocardial biopsy findings, there
is positive detection of HCV-RNA in the myocardial tissue samples, with
the possibility of tissue contamination with HCV-infected peripheral
blood cells. Significant myocardial inflammatory reaction cannot be
documented histologically and immunohistochemically. In the endocardial
samples, apart from mild hypertrophy of properly arranged
cardiomyocytes, there are no significant signs of myocardial damage
(interstitial fibrosis or scars from previous myocyte loss). Therefore,
the present findings do not indicate the need for specific further
antiviral or anti-inflammatory therapy, and the existing heart failure
medication can be continued unchanged. If LV function impairment
persists for an extended period, there is an indication for
antiarrhythmic protection of the patient using an ICD.
### Patient Report 2
**Dear colleague, **
We thank you for referring your patient Mr. David Romero, born on
02/16/1942, to us for echocardiographic follow-up on 05/04/2016.
**Diagnoses:**
- Dilatated cardiomyopathy
- LifeVest
- Left ventricular ejection fraction of 28%
- Chronic Hepatitis C
- Status post Hepatitis A
- Post-antiviral therapy
- Exclusion of relevant coronary artery disease
- Type 2 diabetes mellitus
- Hypothyroidism
**Current Medication:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torem (Torasemide) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without pressure pain,
spleen and liver not palpable. Normal bowel sounds.
**Echocardiography: M-mode and 2-dimensional.**
The left ventricle measures approximately 65/56 mm (normal up to 56 mm).
The right atrium and right ventricle are of normal dimensions.
Global progressive reduction in contractility, morphologically
unremarkable.
In Doppler echocardiography, normal heart valves are observed.
Mitral valve insufficiency Grade I.
[Assessment]{.underline}: Dilated cardiomyopathy with slightly reduced
left ventricular function. MI I TII °, PAP 23 mm Hg + CVP. No more
pulmonary embolism detectable.
**Summary:**
Currently, the cardiac situation is stable, LVEDD slightly decreasing.
### Patient Report 3
**Dear colleague, **
We thank you for referring your patient, Mr. David Romero, born on
02/16/1942 to us for echocardiographic follow-up on 06/15/2016.
**Diagnoses:**
- Dilatated cardiomyopathy
- LifeVest
- Left ventricular ejection fraction of 28%
- Chronic Hepatitis C
- Status post Hepatitis A
- Post-antiviral therapy
- Exclusion of relevant coronary artery disease
- Type 2 diabetes mellitus
- Hypothyroidism
**Medication upon Admission:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torasemide (Torem) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without guarding, spleen
and liver not palpable. Normal bowel sounds.
**Echocardiography from 06/15/2016**: Good ultrasound conditions.
The left ventricle is dilated to approximately 65/57 mm (normal up to 56
mm). The left atrium is dilated to 48 mm. Normal thickness of the left
ventricular myocardium. Ejection fraction is around 28%. Heart valves
show normal flow velocities.
**Summary:**
Currently, the cardiac situation is stable, LVEDD slightly decreasing,
potassium and creatinine levels were obtained. If EF remains this low,
an ICD may be indicated.
**Lab results from 06/15/2016:**
**Parameter** **Result** **Reference Range**
----------------------------------- ------------ ---------------------
Reticulocytes 0.01/nL \< 0.01/nL
Sodium 135 mEq/L 136-145 mEq/L
Potassium 4.8 mEq/L 3.5-4.5 mEq/L
Creatinine 1.34 mg/dL 0.70-1.20 mg/dL
BUN 49 mg/dL 17-48 mg/dL
Total Bilirubin 1.9 mg/dL \< 1.20 mg/dL
C-reactive Protein 4.1 mg/L \< 5.0 mg/L
Troponin-T 78 ng/L \< 14 ng/L
ALT 67 U/L \< 41 U/L
AST 78 U/L \< 50 U/L
Alkaline Phosphatase 151 U/L 40-130 U/L
gamma-GT 200 U/L 8-61 U/L
Free Triiodothyronine (T3) 2.3 ng/L 2.00-4.40 ng/L
Free Thyroxine (T4) 14.2 ng/L 9.30-17.00 ng/L
Thyroid Stimulating Hormone (TSH) 4.1 mU/L 0.27-4.20 mU/L
Hemoglobin 11.6 g/dL 13.5-17.0 g/dL
Hematocrit 34.5% 39.5-50.5%
Red Blood Cell Count 3.7 M/µL 4.3-5.8 M/µL
White Blood Cell Count 9.56 K/µL 3.90-10.50 K/µL
Platelet Count 280 K/µL 150-370 K/µL
MC 92.5 fL 80.0-99.0 fL
MCH 31.1 pg 27.0-33.5 pg
MCHC 33.6 g/dL 31.5-36.0 g/dL
MPV 8.9 fL 7.0-12.0 fL
RDW-CV 14.0% 11.5-15.0%
Quick 89% 78-123%
INR 1.09 0.90-1.25
Partial Thromboplastin Time 25.3 sec. 22.0-29.0 sec.
### Patient Report 4
**Dear colleague, **
We are reporting to you about Mr. David Romero, born on 02/16/1942, who
presented himself at our Cardiology University Outpatient Clinic on
06/30/2016.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function (ejection fraction
around 30%)
- LifeVest
- Planned CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Current Medication:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ---------------- ---------------
Aspirin 100 mg/tablet 1-0-0
Ramipril (Altace) 2.5 mg/tablet 1-0-1
Carvedilol (Coreg) 12.5 mg/tablet 1-0-1
Torasemide (Torem) 5 mg/tablet 1-0-0
Spironolactone (Aldactone) 25 mg/tablet 1-0-0
L-Thyroxine (Synthroid) 50 µg/tablet 1-0-0
**Echocardiography on 06/30/2016:** In sinus rhythm. Adequate ultrasound
window.
Moderately dilated left ventricle (LVDd 63mm). Significantly reduced
systolic LV function (EF biplane 29%). No LV hypertrophy.
**ECG on 06/30/2016:** Sinus rhythm, regular tracing, heart rate 69/min,
complete left bundle branch block, QRS 135 ms, ERBS with left bundle
branch block.
**Assessment**: Mr. Romero presents himself for the follow-up assessment
of known dilated cardiomyopathy. He currently reports minimal dyspnea.
Coronary heart disease has been ruled out. No virus was detected
bioptically. However, the recent echocardiography still shows severely
impaired LV function.
**Current Recommendations:** Given the presence of left bundle branch
block, there is an indication for CRT-D implantation. For this purpose,
we have scheduled a pre-admission appointment, with the implantation
planned for 07/04/2016. We kindly request a referral letter. The
LifeVest should continue to be worn until the implantation, despite the
pressure sores on the thorax.
### Patient Report 5
**Dear colleague, **
We would like to report to you about our patient, Mr. David Romero, born
on 02/16/1942, who was in our inpatient care from 07/04/2016 to
07/06/2016.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function (ejection fraction
around 30%)
- LifeVest
- Planned CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Medication upon Admission:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torem (Torasemide) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
Sitagliptin (Januvia) 100 mg 1-0-0
Insulin glargine (Lantus) 0-0-20IE
**Current Presentation:** The current admission was elective for CRT-D
implantation in dilated cardiomyopathy with severely impaired LV
function despite full heart failure medication and complete left bundle
branch block. Please refer to previous medical records for a detailed
history. On 07/05/2016, a CRT-ICD system was successfully implanted. The
peri- and post-interventional course was uncomplicated. Pneumothorax was
ruled out post-interventionally. The wound conditions are
irritation-free. The ICD card was given to the patient. We request
outpatient follow-up on the above-mentioned date for wound inspection
and CRT follow-up. Please adjust the known cardiovascular risk factors.
**Findings:**
**ECG upon Admission:** Sinus rhythm 66/min, PQ 176ms, QRS 126ms, QTc
432ms, Complete left bundle branch block with corresponding excitation
regression disorder.
**Procedure**: Implantation of a CRT-D with left ventricular multipoint
pacing left pectoral. Smooth triple puncture of the lateral left
subclavian vein and implantation of an active single-coil electrode in
the RV apex with very good electrical values. Trouble-free probing of
the CS and direct venography using a balloon occlusion catheter.
Identification of a suitable lateral vein and implantation of a
quadripolar electrode (Quartet, St. Jude Medical) with very good
electrical values. No phrenic stimulation up to 10 volts in all
polarities. Finally, implantation of an active P/S electrode in the
right atrial roof with equally very good electrical values. Connection
to the device and submuscular implantation. Wound irrigation and layered
wound closure with absorbable suture material. Finally, extensive
testing of all polarities of the LV electrode and activation of
multipoint pacing. Final setting of the ICD.
**Chest X-ray on 07/05/2016:**
[Clinical status, question, justifying indication:]{.underline} History
of CRT-D implantation. Question about lead position, pneumothorax?
**Findings**: New CRT-D unit left pectoral with leads projected onto the
right ventricle, the right atrium, and the sinus coronarius. No
pneumothorax.
Normal heart size. No pulmonary congestion. No diffuse infiltrates. No
pleural effusions.
**ECG at Discharge:** Continuous ventricular PM stimulation, HR: 66/min.
**Current Recommendations:**
- We request a follow-up appointment in our Pacemaker Clinic. Please
provide a referral slip.
- We ask for the protection of the left arm and avoidance of
elevations \> 90 degrees. Self-absorbing sutures have been used.
- We request regular wound checks.
### Patient Report 6
**Dear colleague, **
We thank you for referring your patient, Mr. David Romero, born on
02/16/1942, who presented to our Cardiological University Outpatient
Clinic on 08/26/2016.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Current Medication:**
**Medication ** **Dosage ** **Frequency**
---------------------------- ------------- ---------------
Aspirin 100 mg 1-0-0
Ramipril (Altace) 2.5 mg 1-0-1
Carvedilol (Coreg) 12.5 mg 1-0-1
Torem (Torasemide) 5 mg 1-0-0
Spironolactone (Aldactone) 25 mg 1-0-0
L-Thyroxine (Synthroid) 50 µg 1-0-0
Sitagliptin (Januvia) 100 mg 1-0-0
Insulin glargine (Lantus) 0-0-20IE
**Current Presentation**: Slightly increasing exertional dyspnea, no
coronary heart disease.
**Cardiovascular Risk Factors:**
- Family history: No
- Smoking: No
- Hypertension: No
- Diabetes: Yes
- Dyslipidemia: Yes
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without pressure pain,
spleen and liver not palpable. Normal bowel sounds.
**Findings**:
**Resting ECG:** Sinus rhythm, 83 bpm. Blood pressure: 120/70 mmHg.
**Echocardiography: M-mode and 2-dimensional**
Left ventricle dimensions: Approximately 57/45 mm (normal up to 56 mm),
moderately dilated
- Right atrium and right ventricle: Normal dimensions
- Normal thickness of left ventricular muscle
- Globally, mild reduction in contractility
- Heart valves: Morphologically normal
- Doppler-Echocardiography: No significant valve regurgitation
**Assessment**: Mildly dilated cardiomyopathy with slightly reduced left
ventricular function. Ejection fraction at 45 - 50%. Mild diastolic
dysfunction. Mild tricuspid regurgitation, pulmonary artery pressure 22
mm Hg, and left ventricular filling pressure slightly increased.
**Stress Echocardiography: Stress echocardiography with exercise test**
- Stress test protocol: Treadmill exercise test
- Reason for stress test: Exertional dyspnea
- Quality of the ultrasound: Good
- Initial workload: 50 watts
- Maximum workload achieved: 150 Watt
- Blood pressure response: Systolic BP increased from 112/80 mmHg to
175/90 mmHg
- Heart rate response: Increased from 71bpm to 124bpm
- Exercise terminated due to leg pain
**Resting ECG:** Sinus rhythm**.** No significant changes during
exercise
**Echocardiography at rest:** Normokinesis of all left ventricular
segments EF: 45 - 50%
**Echocardiography during exercise:** Increased contractility and wall
thickening of all segments
[Summary]{.underline}: No dynamic wall motion abnormalities. No evidence
of exercise-induced myocardial ischemia
**Carotid Doppler Ultrasound:** Both common carotid arteries are
smooth-walled**.** Intima-media thickness: 0.8 mm**.** Small plaque in
the carotid bulb on both sides**.** Normal flow in the internal and
external carotid arteries**.** Normal dimensions and flow in the
vertebral arteries
**Summary:** Non-obstructive carotid plaques**.** Indicated to lower LDL
to below 1.8 mmol/L
**Summary:**
- Stress echocardiography shows no evidence of ischemia, EF \>45-50%
- Carotid duplex shows minimal non-obstructive plaques
- Increase Simvastatin to 20 mg, target LDL-C \< 1.8 mmol/L
### Patient Report 7
**Dear colleague, **
We would like to inform you about the results of the cardiac
catheterization of Mr. David Romero, born on 02/16/1942 performed by us
on 08/10/2022.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Procedure:** Right femoral artery puncture. Left ventriculography with
a 5F pigtail catheter in the right anterior oblique projection. Coronary
angiography with 5F JL4.0 and 5F JR 4.0 catheters. End-diastolic
pressure in the left ventricle within the normal range, measured in
mmHg. No pathological pressure gradient across the aortic valve.
**Coronary angiography:**
- Unremarkable left main stem.
- The left anterior descending (LAD) artery shows mild wall changes,
with a maximum stenosis of 20-\<30%.
- The robust right coronary artery (RCA) is stenosed proximally by
30-40%, subsequently ectatic and then stenosed to 40-\<50% distally.
Slow contrast clearance. The right coronary artery is also stenosed
up to 30%.
- Left-dominant coronary circulation.
**Assessment**: Diffuse coronary atherosclerosis with less than 50%
stenosis in the RCA and evidence of endothelial dysfunction.
**Current Recommendations:**
- Initiation of Ranolazine
- Additional stress myocardial perfusion scintigraphy
### Patient Report 8
**Dear colleague, **
We would like to inform you about the results of the Myocardial
Perfusion Scintigraphy performed on our patient, Mr. David Romero, born
on 02/16/1942, on 09/23/2022.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function (ejection fraction
around 30%)
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without guarding, spleen
and liver not palpable. Normal bowel sounds.
**Myocardial Perfusion Scintigraphy:**
The myocardial perfusion scintigraphy was conducted using 365 MBq of
99m-Technetium MIBI during pharmacological stress and 383 MBq of
99m-Technetium MIBI at rest.
[Technique]{.underline}: Initially, the patient was pharmacologically
stressed with the intravenous administration of 400 µg of Regadenoson
over 20 seconds, accompanied by ergometer exercise at 50 W.
Subsequently, the intravenous injection of the radiopharmaceutical was
performed. The maximum blood pressure achieved during the stress phase
was 143/84 mm Hg, and the maximum heart rate reached was 102 beats per
minute.
Approximately 60 minutes later, ECG-triggered acquisition of a
360-degree SPECT study was conducted with reconstructions of short and
long-axis slices.
Due to inhomogeneities in the myocardial wall segments during stress,
rest images were acquired on another examination day. Following the
intravenous injection of the radiopharmaceutical, ECG-triggered
acquisition of a 360-degree SPECT study was performed, including
short-axis and long-axis slices, approximately 60 minutes later.
[Clinical Information:]{.underline} Known coronary heart disease (RCA
50%). ICD/CRT pacemaker.
[Findings]{.underline}: No clear perfusion defects are seen in the
scintigraphic images acquired after pharmacologic exposure to
Regadenoson. This finding remains unchanged in the scintigraphic images
acquired at rest.
Quantitative analysis shows a normal-sized ventricle with a normal left
ventricular ejection fraction (LVEF) of 53% under exercise conditions
and 47% at rest (EDV 81 mL). There are no clear wall motion
abnormalities. In the gated SPECT analysis, there are no definite wall
motion abnormalities observed in both stress and rest conditions.
**Quantitative Scoring:**
- SSS (Summed Stress Score): 3 (4.4%)
- SRS (Summed Rest Score): 0 (0.0%)
- SDS (Summed Difference Score): 3 (4.4%)
**Assessment**: No evidence of myocardial perfusion defects with
Regadenoson stress or at rest. Normal ventricular size and function with
no significant wall motion abnormalities.
### Patient Report 9
**Dear colleague, **
We would like to report on our patient, Mr. David Romero, born on
02/16/1942, who was under our inpatient care from 05/20/2023 to
05/21/2023.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Medical History:** The patient was admitted for device replacement due
and upgrading to a CRT-P pacemaker. At admission, the patient reported
no complaints of fever, cough, dyspnea, chest pain, or melena.
**Physical Examination:** The patient is fully oriented with good
general condition and normal mental state. Dry skin and mucous
membranes, normal breathing, no cyanosis. Cranial nerves are grossly
intact, no focal neurological deficits, good muscle strength and
sensitivity all around. Clear, rhythmic heart sounds, with a 2/6
systolic murmur at the apex. Lungs are evenly ventilated without rales.
Resonant percussion. Soft and supple abdomen without guarding, spleen
and liver not palpable. Normal bowel sounds.
**Medication upon Admission**
**Medication** **Dosage** **Frequency**
--------------------------- -------------- ----------------------
Insulin glargine (Lantus) 450 E/1.5 ml 0-0-0-6-8 IU
Insulin lispro (Humalog) 300 E/3 ml 5-8 IU-5-8 IU-5-8 IU
Levothyroxine (Synthroid) 100 mcg 1-0-0-0
Colecalciferol 12.5 mcg 2-0-0-0
Atorvastatin (Lipitor) 21.7 mg 0-0-1-0
Amlodipine (Norvasc) 6.94 mg 1-0-0-0
Ramipril (Altace) 5 mg 1-0-0-0
Torasemide (Torem) 5 mg 0-0-0.5-0
Carvedilol (Coreg) 25 mg 0.5-0-0.5-0
Simvastatin (Zocor) 40 mg 0-0-0.5-0
Aspirin 100 mg 1-0-0-0
**Therapy and Progression:** The patient\'s current admission was
elective for the implantation of a 3-chamber CRT-D device due to device
depletion. The procedure was performed without complications on
05/20/2023. The post-interventional course was uneventful. The
implantation site showed no irritation or significant hematoma at the
time of discharge, and no pneumothorax was detected on X-ray.
To protect the surgical wound, we request dry wound dressing for the
next 10 days and clinical wound checks. Suture removal is not necessary
with absorbable suture material. We advise against arm elevation for the
next 4 weeks, avoiding heavy lifting on the side of the device pocket
and gradual, pain-adapted full range of motion after 4 weeks.
**Current Recommendations:** We kindly request an outpatient follow-up
appointment in our Pacemaker Clinic.
**Medication upon Discharge:**
**Medication ** **Dosage ** **Frequency**
----------------------------- --------------- -----------------------
Insulin glargine (Lantus) 450 E./1.5 ml 0-0-0-/6-8 IU
Insulin lispro (Humalog) 300 E./3 ml 5-8 IU/-5-8 IU/5-8 IU
Levothyroxine (Synthroid) 100 µg 1-0-0-0
Colecalciferol (Vitamin D3) 12.5 µg 2-0-0-0
Atorvastatin (Lipitor) 21.7 mg 0-0-1-0
Amlodipine (Norvasc) 6.94 mg 1-0-0-0
Ramipril (Altace) 5 mg 1-0-0-0
Torasemide (Torem) 5 mg 0-0-0.5-0
Carvedilol (Coreg) 25 mg 0.5-0-0.5-0
Simvastatin (Zocor) 40 mg 0-0-0.5-0
Aspirin 100 mg 1-0-0-0
Colecalciferol 12.5 µg 2-0-0-0
**Addition: Findings:**
**ECG at Discharge:** Sinus rhythm, ventricular pacing, QRS 122ms, QTc
472ms
**Rhythm Examination on 05/20/2023:**
[Results:]{.underline} Replacement of a 3-chamber CRT-D device (new:
SJM/Abbott Quadra Assura) due to impending battery depletion:
Uncomplicated replacement. Tedious freeing of the submuscular device and
proximal lead portions using a plasma blade. Extraction of the old
device. Connection to the new device. Avoidance of device fixation in
the submuscular position. Hemostasis by electrocauterization. Layered
wound closure. Skin closure with absorbable intracutaneous sutures. End
adjustment of the CRT-D device is complete. [Procedure]{.underline}:
Compression of the wound with a sandbag and local cooling. First
outpatient follow-up in 8 weeks through our pacemaker clinic (please
schedule an appointment before discharge). Postoperative chest X-ray is
not necessary. Cefuroxime 1.5 mg again tonight.
**Transthoracic Echocardiography on 05/18/2023**
**Results:** Globally mildly impaired systolic LV function. Diastolic
dysfunction Grade 1 (LV relaxation disorder).
- Right Ventricle: Normal-sized right ventricle. Normal RV function.
Pulmonary arterial pressure is normal.
- Left Atrium: Slightly dilated left atrium.
- Right Atrium: Normal-sized right atrium.
- Mitral Valve: Morphologically unremarkable. Minimal mitral valve
regurgitation.
- Aortic Valve: Mildly sclerotic aortic valve cusps. No aortic valve
insufficiency. No aortic valve stenosis (AV PGmax 7 mmHg).
- Tricuspid Valve: Delicate tricuspid valve leaflets. Minimal
tricuspid valve regurgitation (TR Pmax 26 mmHg).
- Pulmonary Valve: No pulmonary valve insufficiency. Pericardium: No
pericardial effusion.
**Assessment**: Examination in sinus rhythm with bundle branch block.
Moderate ultrasound windows. Normal-sized left ventricle (LVED 54 mm)
with mildly reduced systolic LV function (EF biplan 55%) with mildly
reduced contractility without regional emphasis. Mild LV hypertrophy,
predominantly septal, without obstruction. Diastolic dysfunction Grade 1
(E/A 0.47) with a normal LV filling index (E/E\' mean 3.5). Slightly
sclerotic aortic valve without stenosis, no AI. Slightly dilated left
atrium (LAVI 31 ml/m²). Minimal MI. Normal-sized right ventricle with
normal function. Normal-sized right atrium (RAVI 21 ml/m²). Minimal TI.
As far as assessable, systolic PA pressure is within the normal range.
The IVC cannot be viewed from the subcostal angle. No thrombi are
visible. As far as assessable, no pericardial effusion is visible.
**Chest X-ray in two planes on 05/20/2023: **
[Clinical Information, Question, Justification:]{.underline} Post CRT
device replacement. Inquiry about position, pneumothorax.
[Findings]{.underline}: No pneumothorax following CRT device
replacement.
### Patient Report 0
**Dear colleague, **
We are writing to provide an update on Mr. David Romero, born on
02/16/1942, who presented at our Rhythm Clinic on 09/29/2023.
**Diagnoses:**
- Dilated cardiomyopathy
- Exclusion of coronary heart diseases
- Myocardial biopsy showed no inflammation
- Left bundle branch block
- Severely impaired left ventricular (LV) function
- LifeVest
- CRT-D implantation
- Chronic Hepatitis C
- Type 2 diabetes
**Current Medication:**
**Medication** **Dosage** **Frequency**
----------------------------- ------------------ ---------------
Lantus (Insulin glargine) 450 Units/1.5 mL 0-0-0-/6-8
Humalog (Insulin lispro) 300 Units/3 mL 5-8/0/5-8/5-8
Levothyroxine (Synthroid) 100 mcg 1-0-0-0
Vitamin D3 (Colecalciferol) 12.5 mcg 2-0-0-0
Lipitor (Atorvastatin) 21.7 mg 0-0-1-0
Norvasc (Amlodipine) 6.94 mg 1-0-0-0
Altace (Ramipril) 5 mg 1-0-0-0
Demadex (Torasemide) 5 mg 0-0-0.5-0
Coreg (Carvedilol) 25 mg 0.5-0-0.5-0
Zocor (Simvastatin) 40 mg 0-0-0.5-0
Aspirin 100 mg 1-0-0-0
Vitamin D3 (Colecalciferol) 12.5 mcg 2-0-0-0
**Measurement Results:**
Battery/Capacitor: Status: OK, Voltage: 8.4V
- Right Atrial: 375 Ohms 3.80 mV 0.375 V 0.50 ms
- Right Ventricular: 388 Ohms 11.80 mV 0.750 V 0.50 ms
- Left Ventricular: 350 Ohms 0.625 V 0.50 ms
- Defibrillation Impedance: Right Ventricular: 48 Ohms
**Implant Settings:**
- Bradycardia Setting: Mode: DDD
- Tachycardia Settings: Zone Detection Interval (ms) Detection Beats
ATP Shocks Details Status
- VFVF 260 ms 30 /
- VTVT1 330 ms 55 /
<!-- -->
- Probe Settings: Lead Sensitivity Sensing Polarity/Vector
Amplification/Pulse Width Stimulation Polarity/Vector Auto Amplitude
Control
- Right Atrial: 0.30 mV Bipolar/ 1.375 V/0.50 ms Bipolar/
- Right Ventricular: Bipolar/ 2.000 V/0.50 ms Bipolar/
- Left Ventricular: 2.000 V/0.50 ms tip 1 - RV Coil
**Assessment:**
- Routine visit with normal device function.
- Normal sinus rhythm with a heart rate of 65/min.
- Balanced heart rate histogram with a plateau at 60-70 bpm.
- Wound conditions are unremarkable.
- Battery status: OK.
- Atrial probe: Intact
- Right ventricular probe: Intact
- Left ventricular probe: Intact
- A follow-up appointment for the patient is requested in 6 months.
**Lab results:**
**Parameter** **Result** **Reference Range**
----------------------------------- ------------ ---------------------
Reticulocytes 0.01/nL \< 0.01/nL
Sodium 137 mEq/L 136-145 mEq/L
Potassium 4.2 mEq/L 3.5-4.5 mEq/L
Creatinine 1.34 mg/dL 0.70-1.20 mg/dL
BUN 49 mg/dL 17-48 mg/dL
Total Bilirubin 1.8 mg/dL \< 1.20 mg/dL
C-reactive Protein 5.9 mg/L \< 5.0 mg/L
ALT 67 U/L \< 41 U/L
AST 78 U/L \< 50 U/L
Alkaline Phosphatase 151 U/L 40-130 U/L
Gamma-Glutamyl Transferase 200 U/L 8-61 U/L
Free Triiodothyronine (T3) 2.3 ng/L 2.00-4.40 ng/L
Free Thyroxine (T4) 14.2 ng/L 9.30-17.00 ng/L
Thyroid Stimulating Hormone (TSH) 4.1 mU/L 0.27-4.20 mU/L
Hemoglobin 11.6 g/dL 13.5-17.0 g/dL
Hematocrit 34.5% 39.5-50.5%
Red Blood Cell Count 3.7 M/µL 4.3-5.8 M/µL
White Blood Cell Count 9.56 K/µL 3.90-10.50 K/µL
MCV 92.7 fL 80.0-99.0 fL
MCH 31.8 pg 27.0-33.5 pg
MCHC 33.9 g/dL 31.5-36.0 g/dL
MPV 8.9 fL 7.0-12.0 fL
RDW-CV 14.2% 11.5-15.0%
Quick 89% 78-123%
INR 1.09 0.90-1.25
Partial Thromboplastin Time 25.3 sec. 22.0-29.0 sec.
|
Normal thyroid function, as indicated by T3 and T4 within reference range
|
What would have happened had the captain not married Wanda?
A. Jane would have been upset with Harry for ruining her plan
B. The priest would have been happy that Wanda remained unmarried
C. The priest would not have been able to eventually end up with Jane
D. Wanda would have had to marry Harry instead
|
VOYAGE TO FAR N'JURD By KRIS NEVILLE Illustrated by MACK [Transcriber's Note: This etext was produced from Galaxy Magazine April 1963. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] They would never live to see the trip's end. So they made a few changes in their way of life—and many in their way of death! I "I don't see why we have to be here," a crewman said. "He ain't liable to say anything." "He shore better," the man in front of him said loudly. "Be still," his wife said. "People's lookin' at ya." "I don't care a smidgen," he said, "if en they ayre." "Please," she said. "Joanne Marie," he said, "you know that when I aims ta do somethin', I'm jest natcher'lly bound to do hit. An' iffen I aims ta talk...." "Here comes the priest. Now, be still." The man looked up. "So he do; an' I'll tell ya, hit shore is time he's a-gittin' hyere. I ain't got no all night fer ta sit." The crewman to his left bent over and whispered, "I'll bet he's gonna tell us it's gonna be another postponement." "Iffen he does, I'm jest a-gonna stand up an' yell right out that I ain't gonna stand fer hit no longer." "Now, dear," said Joanne Marie, "the captain can hear ya, if you're gonna talk so loud." "I hope he does; I jest hope he does. He's th' one that's a-keepin' us all from our Reward, an' I jest hope he does heyar me, so he'll know I'm a-gittin' mighty tyird uv waitin'." "You tell 'im!" someone said from two rows behind him. The captain, in the officer's section, sat very straight and tall. He was studiously ignoring the crew. This confined his field of vision to the left half of the recreation area. While the priest stood before the speaker's rostrum waiting for silence, the captain reached back with great dignity and scratched his right shoulder blade. Nestir, the priest, was dressed out in the full ceremonial costume of office. His high, strapless boots glistened with polish. His fez perched jauntily on his shiny, shaven head. The baldness was symbolic of diligent mental application to abstruse points of doctrine. Cotian exentiati pablum re overum est : "Grass grows not in the middle of a busy thoroughfare." The baldness was the result of the diligent application of an effective depilatory. His blood-red cloak had been freshly cleaned for the occasion, and it rustled around him in silky sibilants. "Men," he said. And then, more loudly, "Men!" The hiss and sputter of conversation guttered away. "Men," he said. "The other evening," he said, "—Gelday it was, to be exact—one of the crew came to me with a complaint." "Well, I'll be damned," Joanne Marie's husband said loudly. Nestir cleared his throat. "It was about the Casting Off. That's why I called you all together today." He stared away, at a point over the head and to the rear of the audience. "It puts me in mind of the parable of the six Vergios." Joanne Marie's husband sighed deeply. "Three, you will recall, were wise. When Prophet was at Meizque, they came to him and said, 'Prophet, we are afflicted. We have great sores upon our bodies.' The Prophet looked at them and did see that it was true. Then he blessed them and took out His knife and lay open their sores. For which the three wise Vergios were passing grateful. And within the last week, they were dead of infection. But three were foolish and hid their sores; and these three did live." The captain rubbed his nose. " Calex i pundendem hoy , my children. 'Secrecy makes for a long life,' as it says in the Jarcon ." Nestir tugged behind him at his cloak. "I want you all to remember that little story. I want you all to take it away from here with you and think about it, tonight, in the privacy of your cabins. "And like the three wise Vergios who went to the Prophet, one of the crewmen came to me. He came to me, and he said: 'Father, I am weary of sailing.' "Yes, he said, 'I am weary of sailing.' "Now, don't you think I don't know that. Every one of you—every blessed one of you—is weary of sailing. I know that as well as I know my own name, yes. "But because he came to me and said, 'Father, I am weary of sailing,' I went to the captain, and I said, 'Captain, the men are weary of sailing.' "And then the captain said: 'All right, Father,' he said, 'I will set the day for the Festival of the Casting Off!'" The little fellow was pleased by the rustle of approval from the audience. "God damn, hit's about time!" Joanne Marie's husband said. Nestir cleared his throat again. "Hummm. Uh. And the day is not very far distant," said Nestir. "I knowed there was a catch to hit," Joanne Marie's husband said. "I know you will have many questions; yes, I know you will have—ah, ah—well, many questions. You are thinking: 'What kind of a Festival can we have here on this ship?' You are thinking: 'What a fine thing—ah, what a good thing, that is—ah, how nice it would be to have the Casting Off at home, among friends.'" Nestir waved his hands. "Well, I just want to tell you: I come from Koltah. And you know that Koltah never let any city state outdo her in a Festival, uh-huh. "The arena in Koltah is the greatest arena in the whole system. We have as many as sixty thousand accepted applicants. All of them together in the arena is a—uh, uh, well—a sight to behold. People come from all over to behold it. I never will forget the Festival at which my father was accepted. He.... "Well, the point I want to make is this: I just wanted to tell you that I know what a Festival should be, and the captain and I will do everything in our power to make our Casting Off as wonderful as any anywhere. "And I want to tell you that if you'll come to me with your suggestions, I'll do all I can to see that we do this thing just the way you want it done. I want you to be proud of this Casting Off Festival, so you can look back on it and say, uh, uh—this day was the real high point of your whole life!" Everyone but Joanne Marie's husband cheered. He sat glumly muttering to himself. Nestir bobbed his shiny head at them and beamed his cherubic smile. And noticed that there was a little blonde, one of the crewmen's wives, in the front row that had very cute ankles. While they were still cheering and stomping and otherwise expressing their enthusiasm and approval, Nestir walked off the speaker's platform and into the officer's corridor. He wiped his forehead indecorously on the hem of his cloak and felt quite relieved that the announcement was over with and the public speaking done. II Dinner that evening was a gala occasion aboard the ship. The steward ordered the holiday feast prepared in celebration of Nestir's announcement. And, for the officers, he broke out of the special cellar the last case allotment for Crew One of the delicate Colta Barauche ('94). He ordered the messman to put a bottle of it to the right of each plate. The captain came down from his stateroom after the meal had begun. He nodded curtly to the officers when he entered the mess hall, walked directly to his place at the head of the table, sat down and morosely began to work the cork out of his wine bottle with his teeth. "You'll spoil the flavor, shaking it that way," the third mate cautioned. He was particularly fond of that year. The captain twisted the bottle savagely, and the cork came free with a little pop. He removed the cork from between his teeth, placed it very carefully beside his fork, and poured himself a full glass of the wine. "Very probably," he said sadly. "I don't think hit'll do hit," the first mate said. "He hain't shook hard enough to matter." The captain picked up the glass, brought it toward his lips—then, suddenly having thought of something, he put it back down and turned to Nestir. "I say. Have you decided on this Carstar thing yet, Father?" The little priest looked up. He laid his knife across the rim of his plate. "It has ramifications," he said. When the third mate saw that his opinion on the wine was not immediately to be justified, he settled back in his chair with a little sigh of disapproval. "Well, what do you think your decision will be, Father?" the steward asked. Nestir picked up his knife and fork and cut off a piece of meat. "Hummmm," he said. "It's hard to say. The whole issue involves, as a core point, the principle of casta cum mae stotiti ." The first mate nodded sagely. "The intent, of course, could actually be—ah— sub mailloux ; and in that event, naturally, the decision would be even more difficult. I wish I could talk to higher authority about it; but of course I haven't the time. I'll have to decide something." "He had a very pretty wife," the third mate said. "Yes, very." Nestir agreed. "But as I was saying, if it could be proven that the culstem fell due to no negligence on his part, either consciously or subconsciously, then the obvious conclusion would be that no stigma would be attached." He speared his meat and chewed it thoughtfully. "But it wasn't at all bloody," the wife of the second mate said. "I scarcely think he felt it at all. It happened too fast." Nestir swallowed the mouthful of food and washed it down with a gulp of wine. "The problem, my dear Helen," he said, "is one of intent. To raise the issue of concomitant agonies is to confuse the whole matter. For instance. Take Wilson, in my home state of Koltah. Certainly he died as miserable a death as anyone could desire." "Yes," said the second mate's wife. "I remember that. I read about it in the newspapers." "But it was a case of obvious intent ," continued Nestir, "and therefore constituted a clear out attempt to avoid his duty by hastening to his Reward." Upon hearing the word duty, the captain brightened. "That," he said to Nestir, "my dear Father, is the cardinal point of the whole game, y'know." He scratched the back of his left hand. "Duty. And I must say, I think you're being quite short-sighted about the Casting Off date. After all, it's not only a question of how we go, but also a question of leaving only after having done our duty. And that's equally important." "The Synod of Cathau—" Nestir began. "Plague take it, Father! Really, now, I must say. The Synod of Cathau! Certainly you've misinterpreted that. Anticipation can be a joy, y'know: almost equal to the very Reward. Anticipation should spur man in duty. It's all noble and self sacrificing." He scratched the back of his right hand. The second mate had been trying to get a word in edgewise for several minutes; he finally succeeded by utilizing the temporary silence following the captain's outburst. "You don't need to worry about your Casting Off, Captain. You can leave that to me. I assure you, I have in mind a most ingenious method." The captain was not visibly cheered; he was still brooding about the sad absence of a sense of duty on the part of Nestir. "I will welcome it," he said, "at the proper time, sir. And I certainly hope—" His eyes swept the table. "I certainly hope to be Cast Off by an officer. It would be very humiliating, y'know, to have a crew member do it." "Oh, very," said the steward. "I don't know," the second mate's wife said, "whether you better count on my husband or not. I have my own plans for him." "This problem of Carstar interests me," the third mate said. "Did I ever tell you about my wife? She strangled our second baby." "He was a very annoying child," his wife said. "He probably wouldn't have lived, anyway," the third mate said. "Puny baby." "That," said Nestir, "is not at all like the Carstar case. Not at all. Yours is a question of saliex y cuminzund ." The first mate nodded. "It seems to me that the whole thing would depend on the intent of the strangler." "Captain," the steward said, "you really must let me give you some of that salve." "That's very kind of you, but I...." "No bother at all," the steward said. "As I see it," Nestir said, "if the intent was the natural maternal instinct of the mother to release her child from its duty, then...." "Oh, not at all," the third mate's wife said. "I did it to make him stop crying." "Well, in that case, I see no reason why he shouldn't get his Reward." "I certainly hope so," the third mate said. "Jane worries about it all the time." "I do not," Jane contradicted. "Now, honey, you know you do so." At that moment, he lost interest in his wife and leaned across the table toward the captain, "Well?" he asked. The captain rolled the wine over his tongue. "You were right, of course." The third mate turned triumphantly to the first mate. "There, I told you so." The first mate shrugged. "I never do say nothin' right," he said. "I hain't got no luck. I've spent more years un all ya, carpenterin' up a duty log that's better un even th' captain's. An' hit's Martha an' me that gotta wait an' help th' next crew. Lord above knows how long time hit'll be afore we uns'll got ta have a Festival." "Oh, really, now. Now. Duty, duty," the captain reprimanded him mildly. "Duty! Duty! Duty! You all ur in a conspiracy. You all want me ta die uv old age." "Nonsense," said the steward. "We don't want anything of the sort. After all, someone has to orient the new crew." "Quite right," said the captain. "You ought to be proud." The first mate slammed his napkin in the middle of his food and stalked out of the mess hall. "Quite touchy today," Nestir observed. "By the way," the third mate said. "Wanda gave me a petition to give to you, Father." "Wanda?" "Yes. She's sixteen, now." "Wanda who?" the steward asked. "Wanda Miller, the bosun's daughter." "I know her," Helen said. "She's the oldest child on the ship, and she wants you to sign her adult petition so she can be in the Festival, Father." "She's so young...." "Sixteen, Father." "After all, one must have done some duty," the captain said. "He wants you to sign it so he can take her in the Changing of the Wives," Jane said. Nestir fidgeted uncomfortably. "Well, I'll look at her record," he said. "It's an idea," the second mate said. "Otherwise, we'll be short one woman." "There wouldn't be one short if he had brought a wife," the first mate's wife said, looking squarely at the captain. "Now, Martha. I place duty above pleasure. You're just angry, y'know, because you have to stay with your husband." "All right, so I am. But it's true. And if Carstar hadn't been killed, there would have been two short." She shot a wicked glance at Nestir. "Why don't you and him share a woman—" "Martha!" "Although the Prophet knows what woman in her right mind would consent to...." "Well," said Nestir hesitantly. "Listen," the third mate said, "the second's right. If you don't sign it, someone will have to do without a woman." Nestir blushed. "I'll look it over very carefully, but you must realize that the priestcraft...." "Actually, in a way, it would be her duty to, you see. Think of it like that: as her way to do her duty." "She's too young for you, dear," Jane said to her husband. "Oh, I don't know," the steward said. "Sometimes they're the best, I hear." III The third mate, whose name was Harry, stood before the mirror combing his hair. He had been combing his hair for the last fifteen minutes. "I suppose the crew is celebrating?" his wife said. "I suppose." She stood up and walked over to the dresser. Absently she began to finger the articles on it. "You really shouldn't have told them about little Glenn tonight." "Pish-tush." "No, Harry. I mean it. Helen looked at me strangely all through dinner. She has three children, you know." "You're imagining things." "But she does have three children." "I mean about her looking at you." "Oh." Harry fiddled with his tie without speaking. "I mean, as much as to say: 'Well, I raised all of mine.'" "But honey, about little Glenn. That was an accident, almost. You didn't really mean to choke him that hard." "But still ... it ... I mean, there was Helen, looking at me like I wasn't doing my duty. You know." "No," he said. "That's nonsense, Jane. Sheer nonsense. You know what the priest said." He polished one of his brass buttons with the sleeve of his coat. "Harry?" "Yes?" "I don't think all that is necessary just to go on duty." "Probably not." She walked to the bed and sat down. "Harry?" "Yes, dear?" "Don't you really think she's awful young?" "Huh-uh." "I mean, why don't you pick someone else? Like Mary? She's awful sweet. I'll bet she'd be better." "Probably." "She's a lot of fun." He brushed at his hair again. "Who do you want, Jane?" "Oh, I don't know." She looked down at her legs, raised them up from the floor and held them out in front of her. "I think I'd kind of like Nestir. With his funny bald head. I hope he asks me." "I'll mention it to him." "Would you really, Harry? That would be sweet." "Sure, honey." He looked down at his watch. "Harry? Are you going to meet Wanda in the control room?" "Uh-huh." "I thought so. Well, remember this, dear: It isn't the day of the Changing of the Wives yet. Don't forget." "Honey! You don't think for a minute that...." "No, dear. I know you wouldn't. But just don't , I mean." He walked over and kissed her forehead and patted her cheek. "Course not," he said, comfortingly. He left her sitting on the bed and strolled down the officers' corridor, whistling. He made a mental note to have the bosun send some of the crew in tomorrow to wash down these bulkheads. They needed it. In one corner a spider spun its silver web. He jogged up the companionway, turned left and felt the air as fresh as spring when he stepped under the great ventilator. And beneath it lay one of the crew. He kicked the man several times in the ribs until he came to consciousness. "Can't sleep here, my man," Harry explained. "Awww. Go way an' le' me 'lone, huh?" "Here. Here." He pulled the fellow erect and slapped him in the face briskly. "This is the officers' corridor." "Oh? Ish it? Schorry. Shore schorry, shir. So schorry." Harry assisted him to the crew's corridor where he sank to the floor and relapsed once more into a profound slumber. Harry continued on to the control room. When he entered it, the second mate was yawning. "Hi, John. Sleepy?" "Uh-huh. You're early." "Don't mind, do you?" "No ... Quiet tonight. Had to cut the motors an hour ago. Control technician passed out." "Oh?" The second mate took out a cigarette and lit it. "Can't blow the ship up, you know. Look like hell on the record. Hope the captain don't find out about it, though. He'll figure the man was neglecting his duty." He blew a smoke ring. "Might even bar him from the Festival." "Yeah," said Harry, "the captain's funny that way." The second mate blew another smoke ring. "Well," Harry said. "Uh. Harry? Are you really going to take that Wanda girl?" "If Nestir lets me." "Say. Harry. Do you suppose your wife would...?" Harry crossed to the second mate and put a hand on his shoulder. "Sorry, old fellow. She's got it in her head to take Nestir." He shrugged. "I don't exactly approve, of course, but ... I'm sure if he doesn't want her, she'd be glad to hear your offer." "Aw, that's all right," John said. "Don't really matter. Say. By the way. Have I told you what I intend to do to the captain? I've got it all thought out. You know that saber I picked up on Queglat? Well...." "Look. How about telling me another time?" "Uh, Sure. If you say so. Uh?" "I'm kind of expecting Wanda." "Oh. Sure. I should have known you weren't here early for nothing. In that case, I better be shoving off. Luck." "Thanks. See you at breakfast." "Right-o." After the second mate left, Harry walked over to the control panel. The jet lights were dead. He picked up the intercom and switched over the engine call bell. "'Lo," he said into the microphone. "This is the bridge.... Oh, hi, Barney. Harry.... Have you got a sober control technician down there yet...? Fine. We'll start the jets again. If the captain comes in now—well, you know how he is.... Okay, thanks. Night." He replaced the microphone. He reached over and threw the forward firing lever. The jet lights came on and the ship began to brake acceleration again. Having done that, he switched on the space viewer. The steady buzz of the equipment warming sounded in his ears. Wanda would be sure to want to look at the stars. She was simple minded. "Hello." He swiveled around. "Oh, hello, Wanda, honey." "Hello, Haireee. Are you glad little ol' me could come, huh?" "Sure am." "Me, too. Can I look at the—oh. It's already on." "Uh-huh. Look. Wanda." "Hum?" "I talked to Nestir today." "Goody. What did he say, huh? I can be an adult and get to play in the Festival, can I?" "I don't know, yet. He's thinking about it. That's why I want to see you. He's going to check your record. And Wanda?" "Them stars shore are purty." "Wanda, listen to me." "I'm a-listenin', Haireee." "You're simply going to have to stop carrying that doll around with you if you want to be an adult." In Nestir's cabin the next morning, the captain and the priest held a conference. "No, Captain. I'm afraid I can't agree to that," Nestir said. The captain said, "Oh, don't be unreasonable, Father. After all, this is a ship, y'know. And I am, after all, the captain." Nestir shook his head. "The crew and the officers will participate together in the Festival. I will not put the officers' corridor off limits, and—Oh! Yes? Come in!" The door opened. "Father?" "Yes, my son? Come in." "Thank you, Father. Good morning, Captain, sir." "Sit down, my son. Now, Captain, as I was saying: no segregation. It's contrary to the spirit, if not the wording, of the Jarcon ." "But Father! A crewman! In the officers' corridor! Think!" "Before the Prophet, we are all equal. I'm sorry, Captain. Now on Koltah, we practiced it with very good results, and...." "I say, really—" "Father?" said the crewman who had just entered. "Yes, my son. In one moment. Now, Captain. As I have been explaining: The arena method has advantages. In Koltah we always used it. But here—due to the—ah—exigencies of deep space—I feel convinced that a departure from normal procedure is warranted. It is not without precedent. Such things were fairly common, in astoli tavoro , up until centralization, three hundred years before Allth. Indeed, in my home city—Koltah—in the year of the seventh plague, a most unusual expedient was adopted. It seems...." "You're perfectly correct, of course," the captain said. "That's just what I wanted to see you about, Father," the crewman said. "Now, in my city state of Ni, for the Festivals, we...." "Shut up," said the captain softly. "Yes, sir." "Now, as I was saying, Captain, when the methods used in...." "If you'll excuse me, Father, I really should return to duty," said the crewman. "Quite all right, my son. Close the door after you." "I must say, fellow, your sense of duty is commendable." "Well, uh, thank you, sir. And thank you, Father, for your time." "Quite all right, my son. That's what I'm here for. Come in as often as you like." The crewman closed the door after him. He had been gone only a moment, scarcely time for Nestir to get properly launched on his account, when Harry, the third mate, knocked on the door and was admitted. "Oh? Good morning, Captain. I didn't know you were here." Then, to the priest: "I'll come back later, Father." "Nonsense," said the captain. "Come in." "Well, I had hoped to see the Father for a minute on ... private business." "I have to be toddling along," said the captain. "But Captain! I haven't finished telling you about...." "I'll just go down and get a cup of coffee," the captain said. "I'll call you when I'm through," said Harry. The captain left the room. "It's about Wanda, Father," said the third mate. The priest studied the table top. He rearranged some papers. "Ah, yes. The young girl." "Well, I mean, it's not only about Wanda," said Harry. "You see, my wife, Jane, that is...." "Yes?" said the priest. He took his pen out of the holder. "I think, with the proper ... ah ... you know. What I mean is, I think she might look with favor on you in the Changing of the Wives, if I said a few well chosen words in your behalf." "That is very flattering, my son." He returned the pen to the holder. "Such bounty, as it says in the Jarcon , is cull tensio ." "And with your permission, Father...." "Ah...." "She's a very pretty woman." "Ah.... Quite so." "Well, about Wanda. I really shouldn't mention this. But Father, if we are short one woman...." "Hummmm." "I mean, the girls might think a man gets rusty." "I see what you mean." Nestir blinked his eyes. "It wouldn't be fair, all things considered." He stood up. "I may tell you, my son, that, in thinking this matter over last night, I decided that Wanda—ah—Miller, yes, has had sufficient duty to merit participation in the Festival." "Justice is a priestly virtue," Harry said. "And you really think your wife would...?" "Oh, yes, Father." "Well, ahem. But...." "Yes, Father?" " Ad dulce verboten. " "Uh?" "That is to say, in order for a woman to join in the ritual of the Changing of the Wives, she must, ahem, be married." "I never thought of that," said the third mate disconsolately. "I think that can be arranged, however," said Nestir. "If you go by the mess hall on your way out, please tell the captain we can continue our discussion at his pleasure." IV "Sit down, Captain," said Nestir, when the captain entered. "No. Over there, in the comfortable chair. There. Are you comfortable, Captain?" "Of course I am." "Good. I have a question to ask you, Captain." "I say?" Nestir rubbed his bald head. "Sir," he said by way of preamble, "I know you have the greatest sensibility in questions of duty." "That's quite so, y'know. I pride myself upon it, if I do say so." "Exactly. Argot y calpex. No sacrifice is too great." "True; true." "Well, then, say the first day of Wenslaus, that would be—ah, a Zentahday—I may depend upon you to wed Wanda Miller, the bosun's daughter, yes?" "No," said the captain. "Come now, sir. I realize she is the daughter of a crewman, but—" "Father," said the captain, "did I ever tell you about the time I led an expeditionary force against Zelthalta?" "I don't believe you have." "Then I will tell you. Came about this way. I was given command of fifty-three thousand Barains. Savage devils. Uncivilized, but fine fighters. I was to march them ninety-seven miles across the desert that...." "Captain! I fear I must be very severe with you. I will be forced to announce in the mess hall this evening that you have refused to do your duty when it was plainly and properly called to your attention." "Very well, Father," the captain said after several minutes. "I will do it." He was trembling slightly. That morning was to be the time of the captain's wedding. He had insisted that it be done in privacy. For the ceremony, he refused to make the slightest change in his everyday uniform; nor would he consent to Nestir's suggestion that he carry a nosegay of hydroponic flowers. He had intended, after the ceremony, to go about his duty as if nothing out of the ordinary had happened; but after it was done with, the vast indignity of it came home to him even more poignantly than he had imagined it would. Without a word, he left the priest's stateroom and walked slowly, ponderously, with great dignity, to his own. It was a very fine stateroom. The finest, but for Nestir's, in the whole ship. The velvet and gold drapes (his single esthetic joy) were scented with exotic perfume. The carpet was an inch and a half thick. He walked through his office without breaking his stride. The bed was large and fluffy. An unbroken expanse of white coverlette jutting out from the far bulkhead. It looked as soft as feather down. Without even a sigh, he threw himself upon the bed and lay very, very quiet. His left leg was suspended in the air, intersecting, at the thigh, the plane of the coverlet at forty-five degrees; the number of degrees remained stiffly, unrelaxingly forty-five. Only after a long, long time did he roll over on his back and then it was merely to stare fixedly at the ceiling. It is entirely possible that he would have lain there until Doomsday had not his introspection been, around noon, interrupted by an apologetic tap on the door. "Come in," he whispered, hoping she would not hear him and go away. But she heard him. "Husband," Wanda said simply. She closed the door behind her and stood staring at him. "Madam," he said, "I hope you will have the kindness not to refer to me by that indecent appelation a second time." "Gee. You say the cutest things. I'm awful glad you had to marry me, huh." The captain stood up, adjusted his coat and his shoulders, and walked across the room to the dressing table. He opened the left-hand drawer, removed a bottle, poured himself half a water-glass full and drank it off. "Ah," he said. He returned to the bed and sat down. "Can'tcha even say hello ta little ol' me, huh?" she asked. "Hello," he said. "Madam, sit down. I intend to give you an instructive lecture in the natural order of...." "Huh?" "Ah," he said. "Quite true, of course." She walked over to the chair and sat down. "I don't like them," she said. "Them cloth things over there." "Those, Madam," he said, "are priceless drapes I had imported from the province of San Xalthan. They have a long, strange history. "About three thousand years ago, a family by the name of Soong was forced to flee from the city of Xan because the eldest son of the family had become involved in a conspiracy against the illustrious King Fod. As the Soong family was traveling...." "I don't like 'em anyway," said Wanda. "Madam," said the captain, "kindly bring me that." "This?" "Yes. Thank you." He took the doll from her. He got up again, walked to the chest of drawers, searched around for a penknife. Finally he located it under a stack of socks.
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C. The priest would not have been able to eventually end up with Jane
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Which dialogue acts are more suited to the twitter domain?
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### Introduction
The need for real-time, efficient, and reliable customer service has grown in recent years. Twitter has emerged as a popular medium for customer service dialogue, allowing customers to make inquiries and receive instant live support in the public domain. In order to provide useful information to customers, agents must first understand the requirements of the conversation, and offer customers the appropriate feedback. While this may be feasible at the level of a single conversation for a human agent, automatic analysis of conversations is essential for data-driven approaches towards the design of automated customer support agents and systems. Analyzing the dialogic structure of a conversation in terms of the "dialogue acts" used, such as statements or questions, can give important meta-information about conversation flow and content, and can be used as a first step to developing automated agents. Traditional dialogue act taxonomies used to label turns in a conversation are very generic, in order to allow for broad coverage of the majority of dialogue acts possible in a conversation BIBREF0 , BIBREF1 , BIBREF2 . However, for the purpose of understanding and analyzing customer service conversations, generic taxonomies fall short. Table TABREF1 shows a sample customer service conversation between a human agent and customer on Twitter, where the customer and agent take alternating "turns" to discuss the problem. As shown from the dialogue acts used at each turn, simply knowing that a turn is a Statement or Request, as is possible with generic taxonomies, is not enough information to allow for automated handling or response to a problem. We need more fine-grained dialogue acts, such as Informative Statement, Complaint, or Request for Information to capture the speaker's intent, and act accordingly. Likewise, turns often include multiple overlapping dialogue acts, such that a multi-label approach to classification is often more informative than a single-label approach. Dialogue act prediction can be used to guide automatic response generation, and to develop diagnostic tools for the fine-tuning of automatic agents. For example, in Table TABREF1 , the customer's first turn (Turn 1) is categorized as a Complaint, Negative Expressive Statement, and Sarcasm, and the agent's response (Turn 2) is tagged as a Request for Information, Yes-No Question, and Apology. Prediction of these dialogue acts in a real-time setting can be leveraged to generate appropriate automated agent responses to similar situations. Additionally, important patterns can emerge from analysis of the fine-grained acts in a dialogue in a post-prediction setting. For example, if an agent does not follow-up with certain actions in response to a customer's question dialogue act, this could be found to be a violation of a best practice pattern. By analyzing large numbers of dialogue act sequences correlated with specific outcomes, various rules can be derived, i.e. "Continuing to request information late in a conversation often leads to customer dissatisfaction." This can then be codified into a best practice pattern rules for automated systems, such as "A request for information act should be issued early in a conversation, followed by an answer, informative statement, or apology towards the end of the conversation." In this work, we are motivated to predict the dialogue acts in conversations with the intent of identifying problem spots that can be addressed in real-time, and to allow for post-conversation analysis to derive rules about conversation outcomes indicating successful/unsuccessful interactions, namely, customer satisfaction, customer frustration, and problem resolution. We focus on analysis of the dialogue acts used in customer service conversations as a first step to fully automating the interaction. We address various different challenges: dialogue act annotated data is not available for customer service on Twitter, the task of dialogue act annotation is subjective, existing taxonomies do not capture the fine-grained information we believe is valuable to our task, and tweets, although concise in nature, often consist of overlapping dialogue acts to characterize their full intent. The novelty of our work comes from the development of our fine-grained dialogue act taxonomy and multi-label approach for act prediction, as well as our analysis of the customer service domain on Twitter. Our goal is to offer useful analytics to improve outcome-oriented conversational systems. We first expand upon previous work and generic dialogue act taxonomies, developing a fine-grained set of dialogue acts for customer service, and conducting a systematic user study to identify these acts in a dataset of 800 conversations from four Twitter customer service accounts (i.e. four different companies in the telecommunication, electronics, and insurance industries). We then aim to understand the conversation flow between customers and agents using our taxonomy, so we develop a real-time sequential SVM-HMM model to predict our fine-grained dialogue acts while a conversation is in progress, using a novel multi-label scheme to classify each turn. Finally, using our dialogue act predictions, we classify conversations based on the outcomes of customer satisfaction, frustration, and overall problem resolution, then provide actionable guidelines for the development of automated customer service systems and intelligent agents aimed at desired customer outcomes BIBREF3 , BIBREF4 . We begin with a discussion of related work, followed by an overview of our methodology. Next, we describe our conversation modeling framework, and explain our outcome analysis experiments, to show how we derive useful patterns for designing automated customer service agents. Finally, we present conclusions and directions for future work. ### Related Work
Developing computational speech and dialogue act models has long been a topic of interest BIBREF5 , BIBREF6 , BIBREF7 , BIBREF8 , with researchers from many different backgrounds studying human conversations and developing theories around conversational analysis and interpretation on intent. Modern intelligent conversational BIBREF3 , BIBREF4 and dialogue systems draw principles from many disciplines, including philosophy, linguistics, computer science, and sociology. In this section, we describe relevant previous work on speech and dialogue act modeling, general conversation modeling on Twitter, and speech and dialogue act modeling of customer service in other data sources. Previous work has explored speech act modeling in different domains (as a predecessor to dialogue act modeling). Zhang et al. present work on recognition of speech acts on Twitter, following up with a study on scalable speech act recognition given the difficulty of obtaining labeled training data BIBREF9 . They use a simple taxonomy of four main speech acts (Statement, Question, Suggestion, Comment, and a Miscellaneous category). More recently, Vosoughi et al. develop BIBREF10 a speech act classifier for Twitter, using a modification of the taxonomy defined by Searle in 1975, including six acts they observe to commonly occur on Twitter: Assertion, Recommendation Expression, Question, Request, again plus a Miscellaneous category. They describe good features for speech act classification and the application of such a system to detect stories on social media BIBREF11 . In this work, we are interested in the dialogic characteristics of Twitter conversations, rather than speech acts in stand-alone tweets. Different dialogue act taxonomies have been developed to characterize conversational acts. Core and Allen present the Dialogue Act Marking in Several Layers (DAMSL), a standard for discourse annotation that was developed in 1997 BIBREF0 . The taxonomy contains a total of 220 tags, divided into four main categories: communicative status, information level, forward-looking function, and backward-looking function. Jurafsky, Shriberg, and Biasca develop a less fine-grained taxonomy of 42 tags based on DAMSL BIBREF1 . Stolcke et al. employ a similar set for general conversation BIBREF2 , citing that "content- and task-related distinctions will always play an important role in effective DA [Dialogue Act] labeling." Many researchers have tackled the task of developing different speech and dialogue act taxonomies and coding schemes BIBREF12 , BIBREF13 , BIBREF14 , BIBREF15 . For the purposes of our own research, we require a set of dialogue acts that is more closely representative of customer service domain interactions - thus we expand upon previously defined taxonomies and develop a more fine-grained set. Modeling general conversation on Twitter has also been a topic of interest in previous work. Honeycutt and Herring study conversation and collaboration on Twitter using individual tweets containing "@" mentions BIBREF16 . Ritter et al. explore unsupervised modeling of Twitter conversations, using clustering methods on a corpus of 1.3 million Twitter conversations to define a model of transitional flow between in a general Twitter dialogue BIBREF17 . While these approaches are relevant to understanding the nature of interactions on Twitter, we find that the customer service domain presents its own interesting characteristics that are worth exploring further. The most related previous work has explored speech and dialogue act modeling in customer service, however, no previous work has focused on Twitter as a data source. In 2005, Ivanovic uses an abridged set of 12 course-grained dialogue acts (detailed in the Taxonomy section) to describe interactions between customers and agents in instant messaging chats BIBREF18 , BIBREF19 , leading to a proposal on response suggestion using the proposed dialogue acts BIBREF20 . Follow-up work using the taxonomy selected by Ivanovic comes from Kim et al., where they focus on classifying dialogue acts in both one-on-one and multi-party live instant messaging chats BIBREF21 , BIBREF22 . These works are similar to ours in the nature of the problem addressed, but we use a much more fine-grained taxonomy to define the interactions possible in the customer service domain, and focus on Twitter conversations, which are unique in their brevity and the nature of the public interactions. The most similar work to our own is that of Herzig et al. on classifying emotions in customer support dialogues on Twitter BIBREF23 . They explore how agent responses should be tailored to the detected emotional response in customers, in order to improve the quality of service agents can provide. Rather than focusing on emotional response, we seek to model the dialogic structure and intents of the speakers using dialogue acts, with emotion included as features in our model, to characterize the emotional intent within each act. ### Methodology
The underlying goal of this work is to show how a well-defined taxonomy of dialogue acts can be used to summarize semantic information in real-time about the flow of a conversation to derive meaningful insights into the success/failure of the interaction, and then to develop actionable rules to be used in automating customer service interactions. We focus on the customer service domain on Twitter, which has not previously been explored in the context of dialogue act classification. In this new domain, we can provide meaningful recommendations about good communicative practices, based on real data. Our methodology pipeline is shown in Figure FIGREF2 . ### Taxonomy Definition
As described in the related work, the taxonomy of 12 acts to classify dialogue acts in an instant-messaging scenario, developed by Ivanovic in 2005, has been used by previous work when approaching the task of dialogue act classification for customer service BIBREF18 , BIBREF20 , BIBREF19 , BIBREF21 , BIBREF22 . The dataset used consisted of eight conversations from chat logs in the MSN Shopping Service (around 550 turns spanning around 4,500 words) BIBREF19 . The conversations were gathered by asking five volunteers to use the platform to inquire for help regarding various hypothetical situations (i.e. buying an item for someone) BIBREF19 . The process of selection of tags to develop the taxonomy, beginning with the 42 tags from the DAMSL set BIBREF0 , involved removing tags inappropriate for written text, and collapsing sets of tags into a more coarse-grained label BIBREF18 . The final taxonomy consists of the following 12 dialogue acts (sorted by frequency in the dataset): Statement (36%), Thanking (14.7%), Yes-No Question (13.9%), Response-Acknowledgement (7.2%), Request (5.9%), Open-Question (5.3%), Yes-Answer (5.1%), Conventional-Closing (2.9%), No-Answer (2.5%), Conventional-Opening (2.3%), Expressive (2.3%) and Downplayer (1.9%). For the purposes of our own research, focused on customer service on Twitter, we found that the course-grained nature of the taxonomy presented a natural shortcoming in terms of what information could be learned by performing classification at this level. We observe that while having a smaller set of dialogue acts may be helpful for achieving good agreement between annotators (Ivanovic cites kappas of 0.87 between the three expert annotators using this tag set on his data BIBREF18 ), it is unable to offer deeper semantic insight into the specific intent behind each act for many of the categories. For example, the Statement act, which comprises the largest percentage (36% of turns), is an extremely broad category that fails to provide useful information from an analytical perspective. Likewise, the Request category also does not specify any intent behind the act, and leaves much room for improvement. For this reason, and motivated by previous work seeking to develop dialogue act taxonomies appropriate for different domains BIBREF19 , BIBREF21 , we convert the list of dialogue acts presented by the literature into a hierarchical taxonomy, shown in Figure FIGREF6 . We first organize the taxonomy into six high-level dialogue acts: Greeting, Statement, Request, Question, Answer, and Social Act. Then, we update the taxonomy using two main steps: restructuring and adding additional fine-grained acts. We base our changes upon the taxonomy used by Ivanovic and Kim et al. in their work on instant messaging chat dialogues BIBREF19 , BIBREF21 , but also on general dialogue acts observed in the customer service domain, including complaints and suggestions. Our taxonomy does not make any specific restrictions on which party in the dialogue may perform each act, but we do observe that some acts are far more frequent (and sometimes non-existent) in usage, depending on whether the customer or agent is the speaker (for example, the Statement Complaint category never shows up in Agent turns). In order to account for gaps in available act selections for annotators, we include an Other act in the broadest categories. While our taxonomy fills in many gaps from previous work in our domain, we do not claim to have handled coverage of all possible acts in this domain. Our taxonomy allows us to more closely specify the intent and motivation behind each turn, and ultimately how to address different situations. ### Data Collection
Given our taxonomy of fine-grained dialogue acts that expands upon previous work, we set out to gather annotations for Twitter customer service conversations. For our data collection phase, we begin with conversations from the Twitter customer service pages of four different companies, from the electronics, telecommunications, and insurance industries. We perform several forms of pre-processing to the conversations. We filter out conversations if they contain more than one customer or agent speaker, do not have alternating customer/agent speaking turns (single turn per speaker), have less than 5 or more than 10 turns, have less than 70 words in total, and if any turn in the conversation ends in an ellipses followed by a link (indicating that the turn has been cut off due to length, and spans another tweet). Additionally, we remove any references to the company names (substituting with "Agent"), any references to customer usernames (substituting with "Customer"), and replacing and links or image references with INLINEFORM0 link INLINEFORM1 and INLINEFORM2 img INLINEFORM3 tokens. Using these filters as pre-processing methods, we end up with a set of 800 conversations, spanning 5,327 turns. We conduct our annotation study on Amazon Mechanical Turk, presenting Turkers with Human Intelligence Tasks (henceforth, HITs) consisting of a single conversation between a customer and an agent. In each HIT, we present Turkers with a definition of each dialogue act, as well as a sample annotated dialogue for reference. For each turn in the conversation, we allow Turkers to select as many labels from our taxonomy as required to fully characterize the intent of the turn. Additionally, annotators are asked three questions at the end of each conversation HIT, to which they could respond that they agreed, disagreed, or could not tell: We ask 5 Turkers to annotate each conversation HIT, and pay $0.20 per HIT. We find the list of "majority dialogue acts" for each tweet by finding any acts that have received majority-vote labels (at least 3 out of 5 judgements). It is important to note at this point that we make an important choice as to how we will handle dialogue act tagging for each turn. We note that each turn may contain more than one dialogue act vital to carry its full meaning. Thus, we choose not to carry out a specific segmentation task on our tweets, contrary to previous work BIBREF24 , BIBREF25 , opting to characterize each tweet as a single unit composed of different, often overlapping, dialogue acts. Table TABREF16 shows examples of tweets that receive majority vote on more than one label, where the act boundaries are overlapping and not necessarily distinguishable. It is clear that the lines differentiating these acts are not very well defined, and that segmentation would not necessarily aid in clearly separating out each intent. For these reasons, and due to the overall brevity of tweets in general, we choose to avoid the overhead of requiring annotators to provide segment boundaries, and instead ask for all appropriate dialogue acts. ### Annotation Results
Figure FIGREF17 shows the distribution of the number of times each dialogue act in our taxonomy is selected a majority act by the annotators (recall that each turn is annotated by 5 annotators). From the distribution, we see that the largest class is Statement Info which is part of the majority vote list for 2,152 of the 5,327 total turns, followed by Request Info, which appears in 1,088 of the total turns. Although Statement Informative comprises the largest set of majority labels in the data (as did Statement in Ivanovic's distribution), we do observe that other fine-grained categories of Statement occur in the most frequent labels as well, including Statement Complaint, Statement Expressive Negative, and Statement Suggestion – giving more useful information as to what form of statement is most frequently occurring. We find that 147 tweets receive no majority label (i.e. no single act received 3 or more votes out of 5). At the tail of the distribution, we see less frequent acts, such as Statement Sarcasm, Social Act Downplayer, Statement Promise, Greeting Closing, and Request Other. It is also interesting to note that both opening and closing greetings occur infrequently in the data – which is understandable given the nature of Twitter conversation, where formal greeting is not generally required. Table TABREF19 shows a more detailed summary of the distribution of our top 12 dialogue acts according to the annotation experiments, as presented by Ivanovic BIBREF18 . Since each turn has an overlapping set of labels, the column % of Turns (5,327) represents what fraction of the total 5,327 turns contain that dialogue act label (these values do not sum to 1, since there is overlap). To give a better sense of the percentage appearance of each dialogue act class in terms of the total number of annotated labels given, we also present column % of Annotations (10,343) (these values are percentages). We measure agreement in our annotations using a few different techniques. Since each item in our annotation experiments allows for multiple labels, we first design an agreement measure that accounts for how frequently each annotator selects the acts that agree with the majority-selected labels for the turns they annotated. To calculate this for each annotator, we find the number of majority-selected acts for each conversation they annotated (call this MAJ), and the number of subset those acts that they selected (call this SUBS), and find the ratio (SUBS/MAJ). We use this ratio to systematically fine-tune our set of annotators by running our annotation in four batches, restricting our pool of annotators to those that have above a 0.60 ratio of agreement with the majority from the previous batch, as a sort of quality assurance test. We also measure Fleiss' Kappa BIBREF26 agreement between annotators in two ways: first by normalizing our annotation results into binary-valued items indicating annotators' votes for each label contain within each turn. We find an average Fleiss- INLINEFORM0 for the full dataset, including all turn-and-label items, representing moderate agreement on the 24-label problem. We also calculate the Fleiss- INLINEFORM0 values for each label, and use the categories defined by Landis and Koch to bin our speech acts based on agreement BIBREF27 . As shown in Table TABREF18 , we find that the per-label agreement varies from "almost perfect" agreement of INLINEFORM1 for lexically defined categories such as Apology and Thanks, with only slight agreement of INLINEFORM2 for less clearly-defined categories, such as Statement (Other), Answer Response Acknowledgement and Request (Other). For the conversation-level questions, we calculate the agreement across the "Agree" label for all annotators, finding an average Fleiss- INLINEFORM3 , with question-level results of INLINEFORM4 for customer satisfaction, INLINEFORM5 for problem resolution, and INLINEFORM6 for customer frustration. These results suggest room for improvement for further development of the taxonomy, to address problem areas for annotators and remedy areas of lower agreement. ### Motivation for Multi-Label Classification
We test our hypothesis that tweet turns are often characterized by more than one distinct dialogue act label by measuring the percentage overlap between frequent pairs of labels. Of the 5,327 turns annotated, across the 800 conversations, we find that 3,593 of those turns (67.4%) contained more than one majority-act label. Table TABREF22 shows the distribution percentage of the most frequent pairs. For example, we observe that answering with informative statements is the most frequent pair, followed by complaints coupled with negative sentiment or informative statements. We also observe that requests are usually formed as questions, but also co-occur frequently with apologies. This experiment validates our intuition that the majority of turns do contain more than a single label, and motivates our use of a multi-label classification method for characterizing each turn in the conversation modeling experiments we present in the next section. ### Conversation Modeling
In this section, we describe the setup and results of our conversational modeling experiments on the data we collected using our fine-grained taxonomy of customer service dialogue acts. We begin with an overview of the features and classes used, followed by our experimental setup and results for each experiment performed. ### Features
The following list describes the set of features used for our dialogue act classification tasks: Word/Punctuation: binary bag-of-word unigrams, binary existence of a question mark, binary existence of an exclamation mark in a turn Temporal: response time of a turn (time in seconds elapsed between the posting time of the previous turn and that of the current turn) Second-Person Reference: existence of an explicit second-person reference in the turn (you, your, you're) Emotion: count of words in each of the 8 emotion classes from the NRC emotion lexicon BIBREF28 (anger, anticipation, disgust, fear, joy, negative, positive, sadness, surprise, and trust) Dialogue: lexical indicators in the turn: opening greetings (hi, hello, greetings, etc), closing greetings (bye, goodbye), yes-no questions (turns with questions starting with do, did, can, could, etc), wh- questions (turns with questions starting with who, what, where, etc), thanking (thank*), apology (sorry, apolog*), yes-answer, and no-answer ### Classes
Table TABREF30 shows the division of classes we use for each of our experiments. We select our classes using the distribution of annotations we observe in our data collection phase (see Table TABREF19 ), selecting the top 12 classes as candidates. While iteratively selecting the most frequently-occurring classes helps to ensure that classes with the most data are represented in our experiments, it also introduces the problem of including classes that are very well-defined lexically, and may not require learning for classification, such as Social Act Apology and Social Act Thanking in the first 10-Class set. For this reason, we call this set 10-Class (Easy), and also experiment using a 10-Class (Hard) set, where we add in the next two less-defined and more semantically rich labels, such as Statement Offer and Question Open. When using each set of classes, a turn is either classified as one of the classes in the set, or it is classified as "other" (i.e. any of the other classes). We discuss our experiments in more detail and comment on performance differences in the experiment section. ### Experiments
Following previous work on conversation modeling BIBREF23 , we use a sequential SVM-HMM (using the INLINEFORM0 toolkit BIBREF29 ) for our conversation modeling experiments. We hypothesize that a sequential model is most suited to our dialogic data, and that we will be able to concisely capture conversational attributes such as the order in which dialogue acts often occur (i.e. some Answer act after Question a question act, or Apology acts after Complaints). We note that with default settings for a sequence of length INLINEFORM0 , an SVM-HMM model will be able to refine its answers for any turn INLINEFORM1 as information becomes available for turns INLINEFORM2 . However, we opt to design our classifier under a real-time setting, where turn-by-turn classification is required without future knowledge or adaptation of prediction at any given stage. In our setup, turns are predicted in a real-time setting to fairly model conversation available to an intelligent agent in a conversational system. At any point, a turn INLINEFORM3 is predicted using information from turns INLINEFORM4 , and where a prediction is not changed when new information is available. We test our hypothesis by comparing our real-time sequential SVM-HMM model to non-sequential baselines from the NLTK BIBREF30 and Scikit-Learn BIBREF31 toolkits. We use our selected feature set (described above) to be generic enough to apply to both our sequential and non-sequential models, in order to allow us to fairly compare performance. We shuffle and divide our data into 70% for training and development (560 conversations, using 10-fold cross-validation for parameter tuning), and hold out 30% of the data (240 conversations) for test. Motivated by the prevalent overlap of dialogue acts, we conduct our learning experiments using a multi-label setup. For each of the sets of classes, we conduct binary classification task for each label: for each INLINEFORM0 -class classification task, a turn is labeled as either belonging to the current label, or not (i.e. "other"). In this setup, each turn is assigned a binary value for each label (i.e. for the 6-class experiment, each turn receives a value of 0/1 for each indicating whether the classifier predicts it to be relevant to the each of the 6 labels). Thus, for each INLINEFORM1 -class experiment, we end up with INLINEFORM2 binary labels, for example, whether the turn is a Statement Informative or Other, Request Information or Other, etc. We aggregate the INLINEFORM3 binary predictions for each turn, then compare the resultant prediction matrix for all turns to our majority-vote ground-truth labels, where at least 3 out of 5 annotators have selected a label to be true for a given turn. The difficulty of the task increases as the number of classes INLINEFORM4 increases, as there are more classifications done for each turn (i.e., for the 6-class problem, there are 6 classification tasks per turn, while for the 8-class problem, there are 8, etc). Due to the inherent imbalance of label-distribution in the data (shown in Figure FIGREF17 ), we use weighted F-macro to calculate our final scores for each feature set (which finds the average of the metrics for each label, weighted by the number of true instances for that label) BIBREF31 . Our first experiment sets out to compare the use of a non-sequential classification algorithm versus a sequential model for dialogue act classification on our dataset. We experiment with the default Naive Bayes (NB) and Linear SVC algorithms from Scikit-Learn BIBREF31 , comparing with our sequential SVM-HMM model. We test each classifier on each of our four class sets, reporting weighted F-macro for each experiment. Figure FIGREF33 shows the results of the experiments. From this experiment, we observe that our sequential SVM-HMM outperforms each non-sequential baseline, for each of the four class sets. We select the sequential SVM-HMM model for our preferred model for subsequent experiments. We observe that while performance may be expected to drop as the number of classes increases, we instead get a spike in performance for the 10-Class (Easy) setting. This increase occurs due to the addition of the lexically well-defined classes of Statement Apology and Statement Thanks, which are much simpler for our model to predict. Their addition results in a performance boost, comparable to that of the simpler 6-Class problem. When we remove the two well-defined classes and add in the next two broader dialogue act classes of Statement Offer and Question Open (as defined by the 10-Class (Hard) set), we observe a drop in performance, and an overall result comparable to our 8-Class problem. This result is still strong, since the number of classes has increased, but the overall performance does not drop. We also observe that while NB and LinearSVC have the same performance trend for the smaller number of classes, Linear SVC rapidly improves in performance as the number of classes increases, following the same trend as SVM-HMM. The smallest margin of difference between SVM-HMM and Linear SVC also occurs at the 10-Class (Easy) setting, where the addition of highly-lexical classes makes for a more differentiable set of turns. Our next experiment tests the differences in performance when training and testing our real-time sequential SVM-HMM model using only a single type of speaker's turns (i.e. only Customer or only Agent turns). Figure FIGREF35 shows the relative performance of using only speaker-specific turns, versus our standard results using all turns. We observe that using Customer-only turns gives us lower prediction performance than using both speakers' turns, but that Agent-only turns actually gives us higher performance. Since agents are put through training on how to interact with customers (often using templates), agent behavior is significantly more predictable than customer behavior, and it is easier to predict agent turns even without utilizing any customer turn information (which is more varied, and thus more difficult to predict). We again observe a boost in performance at out 10-Class (Easy) set, due to the inclusion of lexically well-defined classes. Notably, we achieve best performance for the 10-Class (Easy) set using only agent turns, where the use of the Apology and Thanks classes are both prevalent and predictable. In our final experiment, we explore the changes in performance we get by splitting the training and test data based on company domain. We compare this performance with our standard setup for SVM-HMM from our baseline experiments (Figure FIGREF33 ), where our train-test data splitting is company-independent (i.e. all conversations are randomized, and no information is used to differentiate different companies or domains). To recap, our data consists of conversations from four companies from three different industrial domains (one from the telecommunication domain, two from the electronics domain, and one from the insurance domain). We create four different versions of our 6-class real-time sequential SVM-HMM, where we train on the data from three of the companies, and test on the remaining company. We present our findings in Table TABREF37 . From the table, we see that our real-time model achieves best prediction results when we use one of the electronics companies in the test fold, even though the number of training samples is smallest in these cases. On the other hand, when we assign insurance company in the test fold, our model's prediction performance is comparatively low. Upon further investigation, we find that customer-agent conversations in the telecommunication and electronics domains are more similar than those in the insurance domain. Our findings show that our model is robust to different domains as our test set size increases, and that our more generic, company-independent experiment gives us better performance than any domain-specific experiments. ### Conversation Outcome Analysis
Given our observation that Agent turns are more predictable, and that we achieve best performance in a company-independent setting, we question whether the training that agents receive is actually reliable in terms of resulting in overall "satisfied customers", regardless of company domain. Ultimately, our goal is to discover whether we can use the insight we derive from our predicted dialogue acts to better inform conversational systems aimed at offering customer support. Our next set of experiments aims to show the utility of our real-time dialogue act classification as a method for summarizing semantic intent in a conversation into rules that can be used to guide automated systems. ### Classifying Problem Outcomes
We conduct three supervised classification experiments to better understand full conversation outcome, using the default Linear SVC classifier in Scikit-Learn BIBREF31 (which gave us our best baseline for the dialogue classification task). Each classification experiments centers around one of three problem outcomes: customer satisfaction, problem resolution, and customer frustration. For each outcome, we remove any conversation that did not receive majority consensus for a label, or received majority vote of "can't tell". Our final conversation sets consist of 216 satisfied and 500 unsatisfied customer conversations, 271 resolved and 425 unresolved problem conversations, and 534 frustrated and 229 not frustrated customer conversations. We retain the inherent imbalance in the data to match the natural distribution observed. The clear excess of consensus of responses that indicate negative outcomes further motivates us to understand what sorts of dialogic patterns results in such outcomes. We run the experiment for each conversation outcome using 10-fold cross-validation, under each of our four class settings: 6-Class, 8-Class, 10-Class (Easy), and 10-Class (Hard). The first feature set we use is Best_Features (from the original dialogue act classification experiments), which we run as a baseline. Our second feature set is our Dialogue_Acts predictions for each turn – we choose the most probable dialogue act prediction for each turn using our dialogue act classification framework to avoid sparsity. In this way, for each class size INLINEFORM0 , each conversation is converted into a vector of INLINEFORM1 (up to 10) features that describe the most strongly associated dialogue act from the dialogue act classification experiments for each turn, and the corresponding turn number. For example, a conversation feature vector may look as follows: INLINEFORM2 Thus, our classifier can then learn patterns based on these features (for example, that specific acts appearing at the end of a conversation are strong indicators of customer satisfaction) that allow us to derive rules about successful/unsuccessful interactions. Figure FIGREF38 shows the results of our binary classification experiments for each outcome. For each experiment, the Best_Features set is constant over each class size, while the Dialogue_Act features are affected by class size (since the predicted act for each turn will change based on the set of acts available for that class size). Our first observation is that we achieve high performance on the binary classification task, reaching F-measures of 0.70, 0.65, and 0.83 for the satisfaction, resolution, and frustration outcomes, respectively. Also, we observe that the performance of our predicted dialogue act features is comparable to that of the much larger set of best features for each label (almost identical in the case of frustration). In more detail, we note interesting differences comparing the performance of the small set of dialogue act features that "summarize" the large, sparse set of best features for each label, as a form of data-driven feature selection. For satisfaction, we see that the best feature set outperforms the dialogue acts for each class set except for 10-Class (Easy), where the dialogue acts are more effective. The existence of the very lexically well-defined Social Act Thanking and Social Act Apology classes makes the dialogue acts ideal for summarization. In the case of problem resolution, we see that the performance of the dialogue acts approaches that of the best feature set as the number of classes increases, showing that the dialogue features are able to express the full intent of the turns well, even at more difficult class settings. Finally, for the frustration experiment, we observe negligible different between the best features and dialogue act features, and very high classification results overall. ### Actionable Rules for Automated Customer Support
While these experiments highlight how we can use dialogue act predictions as a means to greatly reduce feature sparsity and predict conversation outcome, our main aim is to gain good insight from the use of the dialogue acts to inform and automate customer service interactions. We conduct deeper analysis by taking a closer look at the most informative dialogue act features in each experiment. Table TABREF44 shows the most informative features and weights for each of our three conversation outcomes. To help guide our analysis, we divide the features into positions based on where they occur in the conversation: start (turns 1-3), middle (turns 4-6), and end (turns 7-10). Desirable outcomes (customers that are satisfied/not frustrated and resolved problems) are shown at the top rows of the table, and undesirable outcomes (unsatisfied/frustrated customers and unresolved problems) are shown at the bottom rows. Our analysis helps zone in on how the use of certain dialogue acts may be likely to result in different outcomes. The weights we observe vary in the amount of insight provided: for example, offering extra help at the end of a conversation, or thanking the customer yields more satisfied customers, and more resolved problems (with ratios of above 6:1). However, some outcomes are much more subtle: for example, asking yes-no questions early-on in a conversation is highly associated with problem resolution (ratio 3:1), but asking them at the end of a conversation has as similarly strong association with unsatisfied customers. Giving elaborate answers that are not a simple affirmative, negative, or response acknowledgement (i.e. Answer (Other)) towards the middle of a conversation leads to satisfied customers that are not frustrated. Likewise, requesting information towards the end of a conversation (implying that more information is still necessary at the termination of the dialogue) leads to unsatisfied and unresolved customers, with ratios of at least 4:1. By using the feature weights we derive from using our predicted dialogue acts in our outcome classification experiments, we can thus derive data-driven patterns that offer useful insight into good/bad practices. Our goal is to then use these rules as guidelines, serving as a basis for automated response planning in the customer service domain. For example, these rules can be used to recommend certain dialogue act responses given the position in a conversation, and based previous turns. This information, derived from correlation with conversation outcomes, gives a valuable addition to conversational flow for intelligent agents, and is more useful than canned responses. ### Conclusions
In this paper, we explore how we can analyze dialogic trends in customer service conversations on Twitter to offer insight into good/bad practices with respect to conversation outcomes. We design a novel taxonomy of fine-grained dialogue acts, tailored for the customer service domain, and gather annotations for 800 Twitter conversations. We show that dialogue acts are often semantically overlapping, and conduct multi-label supervised learning experiments to predict multiple appropriate dialogue act labels for each turn in real-time, under varying class sizes. We show that our sequential SVM-HMM model outperforms all non-sequential baselines, and plan to continue our exploration of other sequential models including Conditional Random Fields (CRF) BIBREF32 and Long Short-Term Memory (LSTM) BIBREF33 , as well as of dialogue modeling using different Markov Decision Process (MDP) BIBREF34 models such as the Partially-Observed MDP (POMDP) BIBREF35 . We establish that agents are more predictable than customers in terms of the dialogue acts they utilize, and set out to understand whether the conversation strategies agents employ are well-correlated with desirable conversation outcomes. We conduct binary classification experiments to analyze how our predicted dialogue acts can be used to classify conversations as ending in customer satisfaction, customer frustration, and problem resolution. We observe interesting correlations between the dialogue acts agents use and the outcomes, offering insights into good/bad practices that are more useful for creating context-aware automated customer service systems than generating canned response templates. Future directions for this work revolve around the integration of the insights derived in the design of automated customer service systems. To this end, we aim to improve the taxonomy and annotation design by consulting domain-experts and using annotator feedback and agreement information, derive more powerful features for dialogue act prediction, and automate ranking and selection of best-practice rules based on domain requirements for automated customer service system design. Table 1: Example Twitter Customer Service Conversation Figure 1: Methodology Pipeline Figure 2: Proposed Fine-Grained Dialogue Act Taxonomy for Customer Service Table 3: Dialogue Act Agreement in Fleiss-κ Bins (from Landis and Koch, 1977) Figure 3: Distribution of Annotated Dialogue Act Labels Table 4: Detailed Distribution of Top 12 Fine-Grained Dialogue Acts Derived From Annotations Table 5: Distribution of the 10 Most Frequent Dialogue Act Pairs for Turns with More Than 1 Label (3,593) Table 6: Dialogue Acts Used in Each Set of Experiments Figure 4: Plot of Non-Sequential Baselines vs. Sequential SVM-HMM Model Figure 5: Plot of Both Speaker Turns vs. Only Customer/Agent Turns for Sequential SVM-HMM Table 7: Company-Wise vs Company-Independent Evaluation for 6-Class Sequential SVM-HMM Figure 6: Plot of Dialogue Act Features vs. Best Feature Sets for Satisfaction, Resolution, and Frustration Outcomes Table 8: Most Informative Dialogue Act Features and Derivative Actionable Insights, by Conversation Outcome
|
overlapping dialogue acts
|
What significant change in Mr. Harder's bone metastasis was reported in the PSMA-PET-CT scan in July 2023 compared to earlier scans?
Choose the correct answer from the following options:
A. Decrease in metabolic activity
B. New extensive metastasis in the sacrum
C. New small metastasis in the sacrum
D. Remission of iliac metastases
E. Increase in the size of known iliac metastases
|
### Patient Report 0
**Dear colleague, **
We are reporting on Mr. Ben Harder, born on 08/02/1940, who was admitted
to our hospital from 12/17/2015 to 12/27/2015.
**Diagnoses:**
- Prostate carcinoma pT3b pN1 R1 L0 V0, Gleason: 4 + 5 = 9
- Urine extravasation
- Persistent lymphatic leakage
**Other Diagnoses:**
- Arterial hypertension
- Status post excision on the nose with suspicion of basal cell
carcinoma
- Status post laparoscopic cholecystectomy
- Retropubic radical prostatectomy without nerve preservation and with
bilateral pelvic lymphadenectomy was performed on 12/17/2015.
**Medication upon Admission:**
**Medication** **Dosage** **Frequency**
------------------------- ------------- ---------------------------------------------------
Valsartan (Diovan) 160 mg 1-0-1
Aspirin 100 mg 1-0-1
Simvastatin (Zocor) 15 mg 0-0-1
Doxazosin (Cardura) 1 mg 0-0-1
Enoxaparin (Lovenox) 0.6 mL s.c. Administer subcutaneously for a total of 4 weeks.
Acetaminophen (Tylenol) 500 mg 1-1-1 (for 4 days)
**Histopathology:**
1. 2 adenocarcinoma metastases in 2 out of 4 lymph nodes, left external
iliac region.
2. 3 adenocarcinoma metastases in 3 out of 6 lymph nodes, right pelvic
region.
3. 7 adenocarcinoma metastases in 7 out of 7 lymph nodes, right lumbar
para-aortic region.
4. Acinar adenocarcinoma of the prostate is observed bilaterally, with
a Gleason score of 4 (70%) + 5 (25%) = 9 and a tertiary Gleason
grade of 3 (5%) according to the modified Gleason grading of the
ISUP 2005. The tumor is multifocal and encompasses the entire
prostate with a maximum extrapolated tumor extension of 60 mm. There
is extracapsular tumor growth, with focal involvement at the dorsal
right base. Vascular invasion is not noted, but perineural invasion
is extensive. Both seminal vesicles are heavily infiltrated, and the
resection margin of the left seminal vesicle is involved. Before
tissue embedding, the margins of the specimen show focal
infiltration by the tumor, in the right anterior region near the
base (section 7) with a total contact area of 2 mm wide, and the
primary Gleason grade at the positive margin is 4. In addition to
the carcinoma, other prostatic tissue shows features of myoglandular
hyperplasia and high-grade prostatic intraepithelial neoplasia
(HGPIN). The prostatic urethra is free of tumors or dysplasia.
5. **Tumor classification:** pT3bpN1(12/17), R1L0V0, Gleason: 4 + 5 = 9
**Medical History:** Mr. Harder was admitted for open prostatectomy due
to biopsy-confirmed prostate carcinoma.
Initial PSA value: 5.42 ng/ml. Gleason score of biopsy: 4+5=9 in 11 out
of 12 biopsy samples. Clinical tumor stage: cT2c PSMA PET-CT + MRI from
12/23/2015: Left capsular penetration without rectal infiltration.
Seminal vesicles are infiltrated on both sides. Evidence of multiple
lymph nodes; intrapelvic locoregional and two lymph nodes on the right
parailiacal and lumbar interaortocaval region.
TRUS: 88 cc Digital Rectal Examination: Abnormal findings on the left
side
**Physical Examination:** The patient is in good general condition, has
a lean nutritional status, and reports feeling well. The abdomen is
soft, with no tenderness, masses, resistance, or guarding, and the
external genitalia are unremarkable.
**Ultrasound upon admission:** Both kidneys are not dilated and show no
space-occupying lesions. The bladder is minimally filled and appears
unremarkable to the extent assessable.
**Pretherapeutic Tumor Conference:** The findings were discussed
interdisciplinary, and the possible treatment options were explained.
The patient opted for radical prostatectomy.
**Therapy and Progression:** The above-mentioned procedure was performed
without complications. The postoperative course was uneventful. Blood
transfusions were not required. Unfortunately, a cystogram on revealed
extravasation, requiring the indwelling catheter to be retained. The
wound drain was lifted once with serum-identical creatinine values and
retained with persistent output (approximately 400 ml daily). Both
kidneys were not dilated, and there were no signs of lymphocele or
hematoma in the pelvic region on ultrasound. A follow-up rehabilitation
treatment has been organized through our social services. We discharged
the patient with absorbable intracutaneous sutures for further
outpatient care.
**Current Recommendations:** The patient was discharged with a permanent
catheter and will present on 01/03/2016 for cystogram and possibly
catheter removal. If catheter removal is indicated, we recommend
considering a trial of voiding with subsequent admission if the
cystogram is normal. The wound drain was also retained, and we request
documentation of output. If output regresses and remains persistently \<
30-40 ml, and there is no ultrasound evidence of lymphocele, it could be
removed on an outpatient basis or during the follow-up appointment.
We recommend the first PSA check 6 -- 8 weeks postoperatively, followed
by quarterly intervals. If the PSA level does not reach the zero range
or rises again from the zero range, the patient can be offered
radiotherapy of the prostatic bed and lymphatic drainage pathways in
combination with a 2-year hormonal ablative therapy as an individual
therapeutic trial. Alternatively, primary hormonal ablative therapy is
an option. If the PSA level reaches the zero range, the patient may be
offered adjuvant hormonal ablative therapy for 2 years, possibly
combined with radiotherapy. Additional findings will be discussed in our
post-therapeutic conference. In case of changes in the recommended
procedure mentioned above, we will inform you again.
**Course of the lab results:**
**Parameter** **12/18/15** **12/19/15** **12/20/15** **12/23/15** **Reference Range**
--------------------------- --------------- ---------------- --------------- -------------- ---------------------
Sodium 135 mEq/L 138 mEq/L 136-145 mEq/L
Potassium 5.1 mEq/L 4.4 mEq/L 3.4-4.5 mEq/L
Creatinine (Jaffe method) 0.93 mg/dL 1.05 mg/dL 0.70-1.20 mg/dL
Estimated GFR (eGFR) 83 65
Hemoglobin 11.4 g/dL 12.4 g/dL 12.5-17.2 g/dL
Hematocrit 0.323 L/L 0.361 L/L 0.370-0.490 L/L
Red Blood Cells 3.8 x10\^12/L 4.3 x10\^12/L 4.2 x10\^12/L 4.0-5.7 x10\^12/L
White Blood Cells 9.57 x10\^9/L 11.51 x10\^9/L 9.65 x10\^9/L 3.90-10.50 x10\^9/L
Platelets 216 x10\^9/L 239 x10\^9/L 285 x10\^9/L 150-370 x10\^9/L
MCV 88.1 fL 86.0 fL 88.3 fL 80.0-101.0 fL
MCH 30.2 pg 30.1 pg 29.5 pg 27.0-34.0 pg
MCHC 34.5 g/dL 35.3 g/dL 33.8 g/dL 31.5-36.0 g/dL
MPV 10.2 fL 10.4 fL 10.3 fL 7.0-12.0 fL
RDW-CV 12.1% 12.2% 12.8% 11.6-14.4%
### Patient Report 1
**Dear colleague, **
We report to you about Mr. Ben Harder, born on 08/02/1940 who received
inpatient treatment from 01/13/2016 to 01/19/2016.
**Diagnosis:** Urinary Tract Infection in Patient with indwelling
catheter
**Other Diagnoses:**
- Prostate carcinoma pT3b pN1 R1 L0 V0, Gleason: 4 + 5 = 9
- Urine extravasation
- Persistent lymphatic leakage
- Arterial hypertension
- History of excision on the nose with suspicion of basal cell
carcinoma
- History of laparoscopic cholecystectomy
**Medication upon Admission: **
**Medication (Brand)** **Dosage** **Frequency**
------------------------------ ------------ ---------------
Aspirin 100 mg 1-0-0-0
Candesartan (Atacand) 16 mg 1-0-1-0
Chlorthalidone (Hygroton) 25 mg 0.5-0-0-0
Multivitamin \- 1-1-0-0
Hawthorn Herb 450 mg 1-1-1-0
Selenium 999 mcg 0-0-1-0
Zinc 157 mg 0-1-0-0
Vitamin D3 (Cholecalciferol) 20 mg 0-1-0-0
Vitamin B complex 0.5 mg 1-0-0-0
Vitamin E 200 IU 1-0-1-0
Vitamin A \- 0-2-0-0
Lercanidipine 10 mg 0.5-0-0.5-0
Thiamine 200 mg 1x/Week
Pyridoxine 25 mg 2-3x/Week
**Current presentation:** Mr. Harder returned to our clinic on
01/13/2016, complaining of new-onset symptoms including increased
urgency and frequency of urination, discomfort, lower abdominal pain,
and fever. Given his recent surgery and indwelling catheter, concerns
were raised about a possible urinary tract infection.
**Clinical Examination:** On physical examination, Mr. Harder appeared
unwell. He had a temperature of 38.8°C, elevated heart rate
(tachycardia), and mild lower abdominal tenderness on palpation. The
indwelling urinary catheter was in situ, and no signs of catheter
dislodgment or leakage were observed.
**Ultrasound of the Abdomen upon admission:** Bilateral, no urinary
transport obstruction, approximately 4x2 cm-sized fluid collection noted
in the right inguinal area, suggestive of possible lymphocele.
**CT Scan Abdomen/Pelvic from 01/13/2016:** The liver displays a smooth
contour, with homogeneous parenchymal contrast enhancement, and no
evidence of focal intrahepatic lesions. There is no indication of
intrahepatic or extrahepatic cholestasis. History of previous
cholecystectomy with an accentuated common hepatic duct. Spleen,
pancreas, and adrenal glands appear unremarkable. Both orthotopically
located kidneys exhibit simultaneous and equal contrast enhancement. No
intrarenal structural abnormalities or signs of urinary obstruction are
observed. The colonic frame and small intestine show adequate perfusion,
without focal wall thickening. The stomach is distended. The urinary
bladder contains a catheter. Two intraluminal air pockets are seen.
Known circumferential, uniform bladder wall thickening from previous
examinations. No free intrabdominal air is detected. No evidence of
ascites. Bilateral iliac and inguinal operative clips from prior
lymphadenectomy. Right iliac region shows a serous fluid collection
measuring approximately 3 x 2 cm. Para-aortic lymph nodes, up to 14 mm
in size, are consistent with findings from previous evaluations. No
suspicious malignancy-related bone destruction is noted. A drainage tube
has been placed through the right lower abdominal wall, with its tip
located in the left pelvic area.
**Assessment:** No evidence of abscess formation. A lymphocele measuring
approximately 3 x 2 cm is noted in the right iliac region, without signs
of acute inflammation.
**Microbiological Examination**
**Material**: Catheter Urine Examination Request: Identification of
Pathogens and Resistance Results: Organism 1: Growth of 100,000 CFU/mL
Enterococcus faecalis Possible ICD-10 Coding Suggestion: Enterococci as
Pathogen.
- Acute Cystitis
- Pyelonephritis
- Urinary Tract Infection related to Catheter/Implant
- Urinary Tract Infection, Unspecified Location
**Antibiogram**
- Gentamicin HL: S
- Levofloxacin: R 1
- Teicoplanin: S \<=0.5
- Ampicillin: S \<=2
- Piperacillin: S
- Ampicillin/Sulbactam: S \<=2
- Piperacillin/Tazobactam: S
- Imipenem: S \<=1
- Cefuroxim: R \>=64
- Gentamicin: R
- Cotrimoxazole: R \<=10
- Ciprofloxacin: R \<=0.5
- Vancomycin: S 2
- Linezolid: S 2
- Tigecyclin: S \<=0.12
**Therapy and Progression:** After CT morphological exclusion of an
abscess formation or retention, the wound drainage was removed under
antibiotic coverage. Initially, empirical antibiotic therapy with
Cefuroxim was administered, followed by targeted treatment with oral
Unacid based on resistance testing. The drainage insertion site healed
primarily. The bladder catheter was removed, after which urination was
free of residual urine. The patient has primary continence. We
discharged the patient to further outpatient treatment, with the patient
reporting subjective well-being.
Mr. Harder showed gradual clinical improvement after initiating
antibiotic therapy. His fever subsided, and lower abdominal tenderness
diminished. The IV fluids were discontinued, and he remained on oral
antibiotics.
**Urine Culture Results:** The urine culture results returned positive
for Escherichia coli (E. coli), a common uropathogen. The sensitivity
profile indicated susceptibility to ciprofloxacin.
**Follow-Up:** Mr. Harder was closely monitored for the duration of his
antibiotic course. He was advised to complete the full course of
antibiotics and maintain adequate hydration. The urinary catheter was
removed on the fifth day of hospitalization after demonstrating improved
urine output and resolution of symptoms. No further complications
related to the catheter removal were observed.
**Current Recommendations:**
1. Please refer to the previous discharge letter for the procedure
regarding prostate cancer.
2. He was educated on the signs and symptoms of UTIs and instructed to
seek prompt medical attention if symptoms recurred.
**\
**
### Patient Report 2
**Dear colleague, **
Thank you for assigning Mr. Ben Harder, born on 08/02/1940 to the PET/CT
combination scanner examination on 12/11/2022.
**Diagnoses:**
- Initial diagnosis of prostate cancer in December 2015, confirmed by
prostate biopsy.
- Tumor detected in 11 out of 12 biopsy samples
- Maximum Gleason score of 9
- Preoperative PSA level: 5.42 ng/ml
- In the initial PET/CT examination (preoperative) on 12/23/2015
evidence of prostate cancer extending beyond the capsule in both
prostatic lobes was found.
- Infiltration of the left seminal vesicles and beginning infiltration
of the right seminal vesicles
- Multiple retroperitoneal lymph node metastases and bilateral pelvic
lymph nodes.
- Radical prostatectomy
- Current PSA level: 1.23 ng/ml
- Radiation therapy planned at our facility
**Technique**: To expedite renal-urinary activity elimination, the
patient was adequately hydrated. The examination was conducted using the
PET/CT combination scanner BIOGRAPH 64 with CT parameters set at 120 kV
and 1 mm slice thickness. PET emission data were acquired with 5 bed
positions on a radiation therapy-compatible table for whole-body
examination in the caudocranial direction with transverse slices at 3.0
mm intervals over the same axial range as the CT scan. Iterative
reconstruction was performed. A whole-body scan was conducted 90 minutes
after the administration of 278 MBq Ga-68-PSMA (prostate-specific
membrane antigen). Transmissions-corrected and non-corrected PET scans,
CT scans, fusion images, and the determination of the SUV value
(standard uptake value, a measure of activity uptake per volume) were
used for evaluation.
**PET Findings:** The 3D whole-body images documented in 3 planes using
PET and PET/CT technology showed the following changes compared to the
prior examination on 12/23/2015:
- Post-radical prostatectomy, there is diffuse activity accumulation
in the region dorsal to the bladder, on the left side.
- Regarding the known retroperitoneal lymph node metastases, the
following changes were observed: New retrocrural nodule on the
right. SUV 6.6, diameter: 6 mm.
- Known interaortocaval lymph node, dorsally at the level of L3/4,
showed increased metabolic activity from SUV 4.7 to 11.5. Slightly
increased in size, measuring 7 to 8 mm. Additionally, two new
metabolically active nodules cranially, up to the level of L2/3.
- Slightly increased metabolic activity in the known right iliaca
communis lymph node, located between the fifth lumbar vertebra and
the psoas muscle, from 4.0 to 4.6, with the same size of 5 mm.
- Progressive enlargement of the known confluent lymph nodes on the
right parailiacal externa proximal side, now having a combined size
of 10 x 26 mm (width x height), previously individual nodules of 10
and 12 mm. SUV 18.2, previously max 11.5.
- New paraaortic lymph nodes on the left, mostly small, SUV 11.2.
- Newly added lymph nodes in both biiliac communal areas. Maximum size
on the left is 15 mm, SUV 17.2.
- New retrocrural lymph node on the right, measuring 6 mm, SUV 6.6.
- Known lymph node on the right perirectal, slightly progressive from
8 to 10 mm. SUV 6.9, previously 6.4.
- Known lymph node on the left iliaca externa not currently
verifiable, possibly postoperative scarring.
- Newly added focus in the bone at the level of the spinous
process/dorsal arch of the fifth lumbar vertebra. In CT, a 7 mm
focal sclerosis is noted. Normal activity accumulation in the soft
tissues of the neck, axillae, and chest. Physiological accumulation
in the parenchymal upper abdominal organs. Kidneys and urinary tract
appear functionally normal. Whole-body CT following bolus-like
peripheral venous machine injection of 100 ml of Optiray 350: No
suspicious lymph nodes in the cervical, axillary, or mediastinal
regions. Normal-sized thyroid gland. No pleuropulmonary infiltrates
or round lesions. Scarred changes in the left lower lobe.
Normal-sized liver without focal lesions. Spleen, pancreas, adrenal
glands, and kidneys appear regular. No urinary obstruction..
**Results**: In the postoperative PET/CT compared to the preoperative
examination on, there is now malignancy-typical PSMA receptor binding in
the former prostate lodge, indicating a local recurrence. Progression of
retroperitoneal lymph node metastases, with further extension cranially,
extending to the interaortocaval region up to the level of L2/3. Newly
added metastases on the left paraaortic and biiliac communal areas.
Progression of known right iliaca externa lymph node metastases. The
left iliaca externa nodule is not verifiable, likely removed. New small
retrocrural nodule on the right. New osteosclerotic metastasis in the
dorsal arch of LWK 5. Minimal activity accumulation in the 8th rib on
the right lateral aspect. A developing metastasis cannot be conclusively
ruled out here. We kindly request information on the patient\'s further
clinical course (submission of medical reports, etc.).
**Lab results**
**Parameter** **Results** **Reference Range**
---------------------- ------------- ---------------------
Glucose (Plasma) 91 mg/dL 55-100 mg/dL
Alkaline Phosphatase 93 U/L \< 130 U/L
Total Cholesterol 152 mg/dL \< 200 mg/dL
LDL-Cholesterol 89 mg/dL \< 130 mg/dL
HDL-Cholesterol 50 mg/dL 40-60 mg/dL
Non-HDL Cholesterol 101.8 mg/dL \< 200 mg/dL
Triglycerides 64 mg/dL \< 150 mg/dL
White Blood Cells 4.1 K/uL 4.5-11 K/uL
Red Blood Cells 4.68 M/uL 4.0-5.5 M/uL
Hemoglobin 13.6 g/dL 12.5-17.2 g/dL
Hematocrit 39.5% 37.0-49.0%
MCH 29.1 pg 27.0-34.0 pg
MCHC 34.4 g/dL 31.5-36.0 g/dL
MCV 84.4 fL 80.0-101.0 fL
RDW 13.0% 11.6-14.4%
Platelets 238 K/uL 150-370 K/uL
**\
**
### Patient Report 3
**Dear colleague, **
We are writing to provide an update on Mr. Ben Harder, born on
08/02/1940, who received inpatient treatment at our facility from
06/23/2023 to 06/26/2023.
**Diagnosis:**
Prostate Cancer pT3b pN1 R1 L0 V0 Gleason Score: 4 + 5 = 9 (Initial
diagnosis in December 2015)
- History of Retropubic Radical Prostatectomy without nerve
preservation and with bilateral pelvic lymph node dissection on
November 16, 2015. Currently, lymph node and bone metastasis
**Other Diagnoses:**
- History of Retropubic Radical Prostatectomy without nerve
preservation and with bilateral pelvic lymph node dissection on
November 16, 2015.
- Prostate Cancer pT3b pN1 R1 L0 V0, Gleason Score: 4 + 5 = 9
- Initial PSA (Prostate-Specific Antigen) level of 4.8 ng/ml
- Subsequent treatments included Docetaxel, Cabazitaxel, and 4 cycles
of Lutetium-Radioligand Therapy.
- 12/2022, a subdiaphragmatic lymph node was punctured at Sea Clinic,
followed by radiation therapy of the lymph node metastasis.
Radiation was discontinued after 11 sessions due to dyspnea and
Grade 3 esophagitis.
- Notable PSA levels include 5.42 ng/ml in 10/2015, PSA undetectable
in 07/2019 (PSA 0.01 ng/ml, Testosterone 0.00 ng/ml), PSA rising in
11/2019 (PSA \> 0.03 ng/ml), PSA 0.16 ng/ml in 01/2020, PSA 0.06
ng/ml in 02/ 2020 (with undetectable Testosterone and Ostease 31),
and various other PSA values during the course of treatment.
- Imaging studies confirmed bone metastasis in the ilium and sacrum in
03/2020. A CT scan of the pelvis revealed these metastases, as well
as sclerosis of the sacrum and dorsal vertebral arches of L5.
- Further treatments included Zometa, Trenantone, and radiotherapy.
- An MRI of the lumbar spine in 02/2021 showed intraspinal soft tissue
structures with compression of the dural sac, along with extensive
predominantly sclerotic bone metastasis from L4 to S1.
- Surgical intervention included a decompressive hemilaminectomy with
microsurgical tumor resection from the epidural space in 02/2021,
followed by postoperative radiation therapy to the lumbar spine in
04/2021.
- Cabazitaxel therapy commenced in 07/2021, and a CT scan in 09/2021
showed morphologically progressive bone metastasis in the lumbar
spine.
- The patient received Lutetium PSMA-Therapy cycles in 04/2022,
06/2022, 08/2022, and 10/2022. A PSMA-PET-CT scan in 11/2022
indicated a very good partial remission in bone metastases but
progressive mediastinal lymph node metastasis.
- Radiotherapy was administered to the mediastinal lymph nodes but
discontinued after 11 sessions due to side effects
- In 04/2023, the patient underwent a re-challenge with Cabazitaxel
for one cycle but had to discontinue chemotherapy due to
polyneuropathy and cramps.
- A CT scan of the chest and abdomen in 04/2023 showed similar
findings, including two new sclerosis sites in the thoracic spine
(thora 11 and 12) with possible post-radiation changes.
- PSA level in 05/2023 was 0.48 ng/ml.
- Genetic sequencing revealed no therapeutic consequences.
- A PSMA-PET-CT in 06/2023 scan indicated new extensive metastasis in
the sacrum and diffuse lung metastases, accompanied by a PSA level
of 1.35 ng/ml.
- Arterial Hypertension
- Chronic Kidney Insufficiency
**Medications on Admission:**
**Medication ** **Dosage** **Frequency**
---------------------------- ------------ ---------------
Candesartan (Atacand) 16 mg 1-0-1-0
Aspirin 100 mg 1-0-0-0
Chlorthalidone (Thalitone) 25 mg 1-0-0-0
**Physical Examination:** The patient was in good general condition and
had normal orientation to all qualities. There were no edemas, dyspnea,
fever, or cough.
**Medical History:** Mr. Hader presents himself for the 1st cycle of RLT
with Ac-225-PSMA/Lu-177-I&T-PSMA for lymph node and bone metastatic
prostate cancer on an inpatient basis. In the presence of progressive
imaging findings under guideline-compliant therapy, the indication for
RLT tandem therapy was confirmed according to the tumor conference on.
Upon admission, the patient reports feeling well, denies any B-symptoms.
There is no fever or nausea, and the weight is currently stable. There
has been a tendency to fall for some time. The rest of the medical
history is assumed to be known.
**Neurological Consultation on 06/25/2023: **
Clinically neurological examination revealed a polyneuropathy syndrome
of the lower extremities, predominantly on the right side, as well as a
known right-sided foot drop. In summary, we consider the falls to be
multifactorial due to foot weakness as well as polyneuropathy syndrome
with impaired proprioception as the cause of the balance disorder.
Recommended further procedure: In the presence of a known PNP syndrome
that has occurred during chemotherapy, consider outpatient neurological
evaluation and objectification by means of Electromyography and
polyneuropathy laboratory tests.
**Salivary Gland Scintigraphy on 06/26/2023**
**Assessment**: Normal function of the submandibular and parotid glands
bilaterally.
Post-therapeutic imaging with Lu-177-PSMA imaging using
SPECT/low-dose-CT
**Assessment:** Consistent with the PET-CT, there is no tracer uptake in
the area of the prostate. Intensive accumulation of the therapeutic
agent in the area of lymph node metastases, especially mediastinal.
Corresponding to the PET/CT, there are clear focal tracer accumulations
in the left upper lobe of the lung in the area of nodular or diffuse
tissue condensations, possibly metastases or, secondarily,
post-inflammatory. Intensive tracer uptake in the area of known bone
metastases from the previous examination. No newly appearing
tracer-enhancing lesions. In addition, physiological accumulation in the
organ systems involved in tracer metabolism and excretion. NB: Small
pleural effusions on both sides. Known pronounced peribronchial cuffs in
the upper lobes on both sides, possibly scarred, or indicative of
pulmonary venous congestion. Known atrophic kidney on the right.
**Current Recommendations:**
- Blood count checks and determination of kidney and liver parameters
1, 2, 4, and 8 weeks after therapy
- Outpatient neurologic assessment for the evaluation of
polyneuropathy
- PSA determination 6-8 weeks after therapy
- Appointment for a 2nd cycle of radioligand therapy
(Ac-225-/Lu-177-PSMA)
**Lab results upon Discharge**
**Parameter** **Results** **Reference Range**
---------------------------------- ------------- ---------------------
Neutrophils (%) 72.2 % 42.0-77.0 %
Lymphocytes (%) 8.6 % 20.0-44.0 %
Monocytes (%) 11.6 % 2.0-9.5 %
Basophils (%) 1.4 % 0.0-1.8 %
Eosinophils (%) 6.0 % 0.5-5.5 %
Immature Granulocytes (%) 0.2 % 0.0-1.0 %
Sodium 137 mEq/L 136-145 mEq/L
Potassium 4.2 mEq/L 3.5-4.5 mEq/L
Calcium 2.31 mEq/L 2.20-2.55 mEq/L
Chloride 100 mEq/L 98-107 mEq/L
Creatinine 1.27 mg/dL 0.70-1.20 mg/dL
BUN 48 mg/dL 17-48 mg/dL
Uric Acid 5.2 mg/dL 3.6-8.2 mg/dL
C-reactive Protein 0.8 mg/L \< 5.0 mg/L
PSA 2.31 µg/L \< 4.40 µg/L
ALT 12 U/L \< 41 U/L
AST 38 U/L \< 50 U/L
Alkaline Phosphatase 115 U/L 40-130 U/L
Gamma-GT 20 U/L 8-61 U/L
LDH 335 U/L 135-250 U/L
Testosterone \<0.03 µg/L 1.32-8.92 µg/L
TSH 1.42 mU/L 0.27-4.20 mU/L
Hemoglobin 10.1 g/dL 12.5-17.2 g/dL
Hematocrit 0.285 L/L 0.370-0.490 L/L
RBC 3.3 /pL 4.0-5.6 /pL
WBC 4.98 /nL 3.90-10.50 /nL
Platelets 281 /nL 150-370 /nL
MCV 85.6 fL 80.0-101.0 fL
MCH 30.3 pg 27.0-34.0 pg
MCHC 35.4 g/dL 31.5-36.0 g/dL
MPV 9.2 fL 7.0-12.0 fL
RDW 13.4 % 11.5-15.0 %
Neutrophils (Absolute) 3.59 /nL 1.50-7.70 /nL
Immature Granulocytes (Absolute) 0.010 /nL \< 0.050 /nL
Lymphocytes (Absolute) 0.43 /nL 1.10-4.50 /nL
Monocytes (Absolute) 0.58 /nL 0.10-0.90 /nL
Eosinophils (Absolute) 0.30 /nL 0.02-0.50 /nL
Basophils (Absolute) 0.07 /nL 0.00-0.20 /nL
Reticulocytes 31.3 /nL 25.0-105.0 /nL
Reticulocyte (%) 0.94 % 0.50-2.00 %
Reticulocyte Production Index 0.3 \-
Ret-Hb 33.9 pg 28.5-34.
### Patient Report 4
**Dear colleague, **
We would like to report on our mutual patient, Mr. Ben Harder, born on
08/02/1940, who presented himself to our outpatient clinic on 1/8/2023.
**Diagnoses:**
- Prostate cancer pT3b pN1 R1 L0 V0, Gleason: 4 + 5 = 9 (initial
diagnosis in 11/2015)
- History of retropubic radical prostatectomy without nerve
preservation and with pelvic lymphadenectomy bilaterally on
11/16/2015
- Currently, there are lymph node and bone metastases
- History of retropubic radical prostatectomy without nerve
preservation and with pelvic lymphadenectomy bilaterally
- Prostate cancer pT3b pN1 R1 L0 V0, Gleason: 4 + 5 = 9
- Initial PSA level was 4.8 ng/ml
- History of Docetaxel therapy
- History of Cabazitaxel therapy
- History of 4 cycles of Lutetium-Radioligand therapy
- Subsequently, radiation therapy was initiated for the lymph node
metastasis but discontinued after 11 sessions due to dyspnea and G3
esophagitis.
- Arterial hypertension
- Chronic renal insufficiency
- Type 2 diabetes mellitus
**Treatment and Progression:** The patient presents for a second opinion
on his prostate cancer, which has metastasized to the bones and lymph
nodes and has become castration-resistant. He recently received
Lutetium-Radioligand therapy. Genetic sequencing from the tissue biopsy
did not reveal any significant gene mutations. The patient wishes to
undergo further evaluation for the diagnosis of relevant genetic
mutations. A previously punctured subdiaphragmatic lymph node metastasis
has not yet undergone genetic testing, which may be justified based on
the available data and publications in specific cases. A chemotherapy
session with Cabazitaxel is planned for the end of January in the
treating urological practice. In cases of DNA repair gene alterations, a
platinum combination could also be considered. Further possible
diagnostic and therapeutic steps were discussed with the patient. An
application for a repeat genetic sequencing will be submitted by our
colleagues from the genetics department.
**Current Recommendations:**
- Application for genetic sequencing for the punctured lymph node
metastasis through the genetics department and DNA-med
- Subsequent re-genetic sequencing of the subdiaphragmatic lymph node
metastasis for relevant mutations
- After receiving the results, a follow-up appointment can be
scheduled in our uro-oncology outpatient clinic.
.
**\
**
### Patient Report 5
**Dear colleague, **
We are reporting to you regarding the inpatient stay of our patient Mr.
Ben Harder, born on 08/02/1940. He was under our care from 09/16/2023 to
09/23/2023.
**Diagnosis**: Prostate Cancer pT3b pN1 R1 L0 V0
- Gleason Score: 4 + 5 = 9
- Postoperative status following retropubic radical prostatectomy
without nerve preservation and with pelvic lymphadenectomy.
- Currently presenting with lymph node and bone metastases, mCRPC
(metastatic castration-resistant prostate cancer)
- Initial PSA level: 4.8 ng/ml
**Previous Treatment and Course:**
- History of Retropubic Radical Prostatectomy without nerve
preservation and with bilateral pelvic lymph node dissection on
- Prostate Cancer pT3b pN1 R1 L0 V0, Gleason Score: 4 + 5 = 9
- Initial PSA (Prostate-Specific Antigen) level of 4.8 ng/ml
- Subsequent treatments included Docetaxel, Cabazitaxel, and 4 cycles
of Lutetium-Radioligand Therapy.
- 12/2022, a subdiaphragmatic lymph node was punctured at Sea Clinic,
followed by radiation therapy of the lymph node metastasis.
Radiation was discontinued after 11 sessions due to dyspnea and
Grade 3 esophagitis.
- Notable PSA levels include 5.42 ng/ml in 10/2015, PSA undetectable
in 07/2019 (PSA 0.01 ng/ml, Testosterone 0.00 ng/ml), PSA rising in
11/2019 (PSA \> 0.03 ng/ml), PSA 0.16 ng/ml in 01/2020, PSA 0.06
ng/ml in 02/ 2020 (with undetectable Testosterone and Ostease 31),
and various other PSA values during the course of treatment.
- Imaging studies confirmed bone metastasis in the ilium and sacrum in
03/2020. A CT scan of the pelvis revealed these metastases, as well
as sclerosis of the sacrum and dorsal vertebral arches of L5.
- Further treatments included Zometa, Trenantone, and radiotherapy.
- An MRI of the lumbar spine in 02/2021 showed intraspinal soft tissue
structures with compression of the dural sac, along with extensive
predominantly sclerotic bone metastasis from L4 to S1.
- Surgical intervention included a decompressive hemilaminectomy with
microsurgical tumor resection from the epidural space in 02/2021,
followed by postoperative radiation therapy to the lumbar spine in
04/2021.
- Cabazitaxel therapy commenced in 07/2021, and a CT scan in 09/2021
showed morphologically progressive bone metastasis in the lumbar
spine.
- The patient received Lutetium PSMA-Therapy cycles in 04/2022,
06/2022, 08/2022, and 10/2022. A PSMA-PET-CT scan in 11/2022
indicated a very good partial remission in bone metastases but
progressive mediastinal lymph node metastasis.
- Radiotherapy was administered to the mediastinal lymph nodes but
discontinued after 11 sessions due to side effects in 01/2023.
- In 04/2023, the patient underwent a re-challenge with Cabazitaxel
for one cycle but had to discontinue chemotherapy due to
polyneuropathy and cramps.
- A CT scan of the chest and abdomen in 04/2023 showed similar
findings, including two new sclerosis sites in the thoracic spine
with possible post-radiation changes.
- PSA level in 05/2023 was 0.48 ng/ml.
- Genetic sequencing revealed no therapeutic consequences.
- A PSMA-PET-CT scan indicated new extensive metastasis in the sacrum
and diffuse lung metastases, accompanied by a PSA level of 1.35
ng/ml.
- Current PET-CT not available. Recommendations for further treatment
options are as follows, based on externally described
image-morphological progression in the recent CT:
1. Actinium-225-PSMA Therapy (Lu-177 Tandem Therapy), provided that
all vital metastases are PSMA-positive (mandatory exclusion of
post-renal urinary flow obstruction)
2. Alternatively, consider initiating therapy with Abiraterone +
Prednisolone or a Cabazitaxel re-challenge (if there was a
favorable response to the last 2 cycles of Cabazitaxel
3. Evaluation of pre-screening for CAR-T cell studies in oncology
at CBF (contact will be made)
**Other Diagnoses:**
- Arterial Hypertension
- Chronic Kidney Insufficiency
- Type 2 Diabetes Mellitus
**Current Presentation:** Mr. Ben Harder is presenting for his 2nd cycle
of Radioligand Therapy (RLT) with Ac-225-PSMA/Lu-177-I&T-PSMA for lymph
node and bone metastatic prostate cancer. In light of progressive
image-morphological findings despite guideline-compliant treatment, the
indication for RLT tandem therapy was determined in the tumor
conference.
**Medical History:** Mr. Harder reports that after the last treatment
cycle, he experienced pronounced fatigue symptoms. He particularly
struggled with climbing stairs and walking longer distances. However, he
managed to fully recover from these symptoms through targeted training.
Additionally, he developed pain in the area of the right ribcage
following the last treatment cycle. The pain occurs intermittently and
is accompanied by increased salivation and nausea, sometimes leading to
vomiting. Mr. Ben Harder also reports newly developed swallowing
difficulties. He feels that food gets stuck in his throat after
swallowing.
**Therapy and Progression:**
In the case of Mr. Ben Harder, due to metastatic prostate cancer with
radiographic progression despite previous guideline-recommended therapy,
according to the recommendations, there was an indication for the 2nd
radioligand therapy with Ac-225-PSMA/Lu-177-I&T-PSMA. The
post-therapeutic imaging showed targeted accumulation of the therapeutic
agent within the tumor. The therapy was administered due to elevated
renal retention parameters with reduced activity of Lu-177-PSMA. The
course of therapy and the entire hospital stay were uncomplicated, so we
can now transition the patient to your outpatient care. We recommend
close laboratory monitoring (blood count, liver and kidney parameters)
at 1, 2, 4, and 8 weeks, as well as a PSA determination 6-8 weeks after
therapy.
In the case of significant fatigue symptoms after the 1st cycle of
tandem RLT, if there are blood count changes indicating a decrease in
hemoglobin levels and recurrent fatigue symptoms, the administration of
erythropoietin or the indication for blood product transfusion should be
considered. Depending on the PSA value 6 weeks post-therapy and the
findings of the PSMA-PET/CT, the further course of action will be
determined in the interdisciplinary Tumor Conference.
If the patient desires, they can seek a second opinion on further
therapeutic procedures in the specialized clinic of the Uro-Oncology
colleagues. In case of pronounced rib pain, if requested by the patient,
the possibility of undergoing radiation therapy can be evaluated. To do
so, Mr. Harder can schedule an appointment at the Radio-Oncology clinic.
Psycho-oncological counseling has been offered to the patient.
**Medication upon Discharge:**
**Medication ** **Dosage** **Frequency**
-------------------------------- ------------ ---------------
Aspirin 100 mg 1-0-0-0
Candesartan Cilexetil (Atacan) 16 mg 1-0-1-0
Chlorthalidone (Hygroton) 25 mg 0.5-0-0-0
Multi-Vitamin \- 1-1-0-0
Hawthorn Herb 450 mg 1-1-1-0
Sodium Selenite 999 µg 0-0-1-0
Zinc 157 mg 0-1-0-0
Vitamin D3 (Cholecalciferol) 20 mg 0-1-0-0
Vitamin B Complex 0.5 mg 1-0-0-0
Vitamin E 200 IU 1-0-1-0
Vitamin A \- 0-2-0-0
Lercanidipine 10 mg 0.5-0-0.5-0
Vitamin B1 200 mg 1x/Week
Vitamin B6 25 mg 2-3x/Week
**Lab results upon Discharge:**
**Parameter** **Results** **Reference Range**
-------------------------------- -------------------- ---------------------
Neutrophils % 80.3 % 42.0-77.0 %
Lymphocytes % 6.7 % 20.0-44.0 %
Monocytes % 8.9 % 2.0-9.5 %
Basophils % 1.3 % 0.0-1.8 %
Eosinophils % 2.4 % 0.5-5.5 %
Immature Granulocytes % 0.4 % 0.0-1.0 %
I:T Ratio 0.005
HFLC Absolute 0.0 /µL
Sodium 140 mEq/L 136-145 mEq/L
Potassium 3.9 mEq/L 3.5-4.5 mEq/L
Calcium 9.36 mg/dL 8.8-10.2 mg/dL
Chloride 102 mEq/L 98-107 mEq/L
Creatinine 1.25 P+ mg/dL 0.70-1.20 mg/dL
Estimated GFR 52 mL/min/1.73m\^2
BUN (Urea) 44 mg/dL 17-48 mg/dL
Uric Acid 3.8 mg/dL 3.6-8.2 mg/dL
CRP 1.3 mg/L \< 5.0 mg/L
PSA 2.98 ng/mL \< 4.4 ng/mL
ALT (GPT) 22 U/L \< 41 U/L
AST (GOT) 49 U/L \< 50 U/L
Alkaline Phosphatase 114 U/L 40-130 U/L
Gamma-GT 19 U/L 8-61 U/L
LDH 404 P+ U/L 135-250 U/L
Testosterone \<0.03 P- ng/mL 1.32-8.92 ng/mL
TSH 1.14 mIU/L 0.27-4.20 mIU/L
Complete Blood Count
Differential Count
Hemoglobin 10.6 g/dL 12.5-17.2 g/dL
Hematocrit 30.5 % 37.0-49.0 %
RBC 3.4 M/µL 4.0-5.6 M/µL
WBC 5.49 K/µL 3.90-10.50 K/µL
Platelets 279 K/µL 150-370 K/µL
MCV 88.7 fL 80.0-101.0 fL
MCH 30.8 pg 27.0-34.0 pg
MCHC 34.8 g/dL 31.5-36.0 g/dL
MPV 10.1 fL 7.0-12.0 fL
RDW-CV 14.1 % 11.5-15.0 %
Absolute Neutrophils 4.41 K/µL 1.50-7.70 K/µL
Absolute Immature Granulocytes 0.020 K/µL \< 0.050 K/µL
Absolute Lymphocytes 0.37 K/µL 1.10-4.50 K/µL
Absolute Monocytes 0.49 K/µL 0.10-0.90 K/µL
Absolute Eosinophils 0.13 K/µL 0.02-0.50 K/µL
Absolute Basophils 0.07 K/µL 0.00-0.20 K/µL
Reticulocytes 37.8 K/µL 25.0-105.0 K/µL
Reticulocyte Percentage 1.10 % 0.50-2.00 %
Reticulocyte Production Index 0.4
Ret-Hb 35.0 pg 28.5-34.5 pg
Prothrombin Time 117 % \> 78 %
INR 0.94 \< 1.25
aPTT 30.2 sec 25.0-38.0 sec
|
New extensive metastasis in the sacrum
|
How does the scoring model work?
|
### Introduction
Electronic health records (EHRs) systematically collect patients' clinical information, such as health profiles, histories of present illness, past medical histories, examination results and treatment plans BIBREF0 . By analyzing EHRs, many useful information, closely related to patients, can be discovered BIBREF1 . Since Chinese EHRs are recorded without explicit word delimiters (e.g., “UTF8gkai糖尿病酮症酸中毒” (diabetic ketoacidosis)), Chinese word segmentation (CWS) is a prerequisite for processing EHRs. Currently, state-of-the-art CWS methods usually require large amounts of manually-labeled data to reach their full potential. However, there are many challenges inherent in labeling EHRs. First, EHRs have many medical terminologies, such as “UTF8gkai高血压性心脏病” (hypertensive heart disease) and “UTF8gkai罗氏芬” (Rocephin), so only annotators with medical backgrounds can be qualified to label EHRs. Second, EHRs may involve personal privacies of patients. Therefore, they cannot be openly published on a large scale for labeling. The above two problems lead to the high annotation cost and insufficient training corpus in the research of CWS in medical text. CWS was usually formulated as a sequence labeling task BIBREF2 , which can be solved by supervised learning approaches, such as hidden markov model (HMM) BIBREF3 and conditional random field (CRF) BIBREF4 . However, these methods rely heavily on handcrafted features. To relieve the efforts of feature engineering, neural network-based methods are beginning to thrive BIBREF5 , BIBREF6 , BIBREF7 . However, due to insufficient annotated training data, conventional models for CWS trained on open corpus often suffer from significant performance degradation when transferred to a domain-specific text. Moreover, the task in medical domain is rarely dabbled, and only one related work on transfer learning is found in recent literatures BIBREF8 . However, researches related to transfer learning mostly remain in general domains, causing a major problem that a considerable amount of manually annotated data is required, when introducing the models into specific domains. One of the solutions for this obstacle is to use active learning, where only a small scale of samples are selected and labeled in an active manner. Active learning methods are favored by the researchers in many natural language processing (NLP) tasks, such as text classification BIBREF9 and named entity recognition (NER) BIBREF10 . However, only a handful of works are conducted on CWS BIBREF2 , and few focuses on medical domain tasks. Given the aforementioned challenges and current researches, we propose a word segmentation method based on active learning. To model the segmentation history, we incorporate a sampling strategy consisting of word score, link score and sequence score, which effectively evaluates the segmentation decisions. Specifically, we combine information branch and gated neural network to determine if the segment is a legal word, i.e., word score. Meanwhile, we use the hidden layer output of the long short-term memory (LSTM) BIBREF11 to find out how the word is linked to its surroundings, i.e., link score. The final decision on the selection of labeling samples is made by calculating the average of word and link scores on the whole segmented sentence, i.e., sequence score. Besides, to capture coherence over characters, we additionally add K-means clustering features to the input of CRF-based word segmenter. To sum up, the main contributions of our work are summarized as follows: The rest of this paper is organized as follows. Section SECREF2 briefly reviews the related work on CWS and active learning. Section SECREF3 presents an active learning method for CWS. We experimentally evaluate our proposed method in Section SECREF4 . Finally, Section SECREF5 concludes the paper and envisions on future work. ### Chinese Word Segmentation
In past decades, researches on CWS have a long history and various methods have been proposed BIBREF13 , BIBREF14 , BIBREF15 , which is an important task for Chinese NLP BIBREF7 . These methods are mainly focus on two categories: supervised learning and deep learning BIBREF2 . Supervised Learning Methods. Initially, supervised learning methods were widely-used in CWS. Xue BIBREF13 employed a maximum entropy tagger to automatically assign Chinese characters. Zhao et al. BIBREF16 used a conditional random field for tag decoding and considered both feature template selection and tag set selection. However, these methods greatly rely on manual feature engineering BIBREF17 , while handcrafted features are difficult to design, and the size of these features is usually very large BIBREF6 . Deep Learning Methods. Recently, neural networks have been applied in CWS tasks. To name a few, Zheng et al. BIBREF14 used deep layers of neural networks to learn feature representations of characters. Chen et al. BIBREF6 adopted LSTM to capture the previous important information. Chen et al. BIBREF18 proposed a gated recursive neural network (GRNN), which contains reset and update gates to incorporate the complicated combinations of characters. Jiang and Tang BIBREF19 proposed a sequence-to-sequence transformer model to avoid overfitting and capture character information at the distant site of a sentence. Yang et al. BIBREF20 investigated subword information for CWS and integrated subword embeddings into a Lattice LSTM (LaLSTM) network. However, general word segmentation models do not work well in specific field due to lack of annotated training data. Currently, a handful of domain-specific CWS approaches have been studied, but they focused on decentralized domains. In the metallurgical field, Shao et al. BIBREF15 proposed a domain-specific CWS method based on Bi-LSTM model. In the medical field, Xing et al. BIBREF8 proposed an adaptive multi-task transfer learning framework to fully leverage domain-invariant knowledge from high resource domain to medical domain. Meanwhile, transfer learning still greatly focuses on the corpus in general domain. When it comes to the specific domain, large amounts of manually-annotated data is necessary. Active learning can solve this problem to a certain extent. However, due to the challenges faced by performing active learning on CWS, only a few studies have been conducted. On judgements, Yan et al. BIBREF21 adopted the local annotation strategy, which selects substrings around the informative characters in active learning. However, their method still stays at the statistical level. Unlike the above method, we propose an active learning approach for CWS in medical text, which combines information entropy with neural network to effectively reduce annotation cost. ### Active Learning
Active learning BIBREF22 mainly aims to ease the data collection process by automatically deciding which instances should be labeled by annotators to train a model as quickly and effectively as possible BIBREF23 . The sampling strategy plays a key role in active learning. In the past decade, the rapid development of active learning has resulted in various sampling strategies, such as uncertainty sampling BIBREF24 , query-by-committee BIBREF25 and information gain BIBREF26 . Currently, the most mainstream sampling strategy is uncertainty sampling. It focuses its selection on samples closest to the decision boundary of the classifier and then chooses these samples for annotators to relabel BIBREF27 . The formal definition of uncertainty sampling is to select a sample INLINEFORM0 that maximizes the entropy INLINEFORM1 over the probability of predicted classes: DISPLAYFORM0 where INLINEFORM0 is a multi-dimensional feature vector, INLINEFORM1 is its binary label, and INLINEFORM2 is the predicted probability, through which a classifier trained on training sets can map features to labels. However, in some complicated tasks, such as CWS and NER, only considering the uncertainty of classifier is obviously not enough. ### Active Learning for Chinese Word Segmentation
Active learning methods can generally be described into two parts: a learning engine and a selection engine BIBREF28 . The learning engine is essentially a classifier, which is mainly used for training of classification problems. The selection engine is based on the sampling strategy, which chooses samples that need to be relabeled by annotators from unlabeled data. Then, relabeled samples are added to training set for classifier to re-train, thus continuously improving the accuracy of the classifier. In this paper, a CRF-based segmenter and a scoring model are employed as learning engine and selection engine, respectively. Fig. FIGREF7 and Algorithm SECREF3 demonstrate the procedure of CWS based on active learning. First, we train a CRF-based segmenter by train set. Then, the segmenter is employed to annotate the unlabeled set roughly. Subsequently, information entropy based scoring model picks INLINEFORM0 -lowest ranking samples for annotators to relabel. Meanwhile, the train sets and unlabeled sets are updated. Finally, we re-train the segmenter. The above steps iterate until the desired accuracy is achieved or the number of iterations has reached a predefined threshold. [!ht] Active Learning for Chinese Word Segmentation labeled data INLINEFORM1 , unlabeled data INLINEFORM2 , the number of iterations INLINEFORM3 , the number of samples selected per iteration INLINEFORM4 , partitioning function INLINEFORM5 , size INLINEFORM6 a word segmentation model INLINEFORM7 with the smallest test set loss INLINEFORM8 Initialize: INLINEFORM9 train a word segmenter INLINEFORM0 estimate the test set loss INLINEFORM0 label INLINEFORM0 by INLINEFORM1 INLINEFORM0 to INLINEFORM1 INLINEFORM2 compute INLINEFORM3 by branch information entropy based scoring model select INLINEFORM0 -lowest ranking samples INLINEFORM1 relabel INLINEFORM0 by annotators form a new labeled dataset INLINEFORM0 form a new unlabeled dataset INLINEFORM0 train a word segmenter INLINEFORM0 estimate the new test loss INLINEFORM0 compute the loss reduction INLINEFORM0 INLINEFORM0 INLINEFORM1 INLINEFORM0 INLINEFORM0 INLINEFORM1 with the smallest test set loss INLINEFORM2 INLINEFORM3 ### CRF-based Word Segmenter
CWS can be formalized as a sequence labeling problem with character position tags, which are (`B', `M', `E', `S'). So, we convert the labeled data into the `BMES' format, in which each character in the sequence is assigned into a label as follows one by one: B=beginning of a word, M=middle of a word, E=end of a word and S=single word. In this paper, we use CRF as a training model for CWS task. Given the observed sequence, CRF has a single exponential model for the joint probability of the entire sequence of labels, while maximum entropy markov model (MEMM) BIBREF29 uses per-state exponential models for the conditional probabilities of next states BIBREF4 . Therefore, it can solve the label bias problem effectively. Compared with neural networks, it has less dependency on the corpus size. First, we pre-process EHRs at the character-level, separating each character of raw EHRs. For instance, given a sentence INLINEFORM0 , where INLINEFORM1 represents the INLINEFORM2 -th character, the separated form is INLINEFORM3 . Then, we employ Word2Vec BIBREF30 to train pre-processed EHRs to get character embeddings. To capture interactions between adjacent characters, K-means clustering algorithm BIBREF31 is utilized to feature the coherence over characters. In general, K-means divides INLINEFORM4 EHR characters into INLINEFORM5 groups of clusters and the similarity of EHR characters in the same cluster is higher. With each iteration, K-means can classify EHR characters into the nearest cluster based on distance to the mean vector. Then, recalculating and adjusting the mean vectors of these clusters until the mean vector converges. K-means features explicitly show the difference between two adjacent characters and even multiple characters. Finally, we additionally add K-means clustering features to the input of CRF-based segmenter. The segmenter makes positional tagging decisions over individual characters. For example, a Chinese segmented sentence UTF8gkai“病人/长期/于/我院/肾病科/住院/治疗/。/" (The patient was hospitalized for a long time in the nephrology department of our hospital.) is labeled as `BEBESBEBMEBEBES'. ### Information Entropy Based Scoring Model
To select the most appropriate sentences in a large number of unlabeled corpora, we propose a scoring model based on information entropy and neural network as the sampling strategy of active learning, which is inspired by Cai and Zhao BIBREF32 . The score of a segmented sentence is computed as follows. First, mapping the segmented sentence to a sequence of candidate word embeddings. Then, the scoring model takes the word embedding sequence as input, scoring over each individual candidate word from two perspectives: (1) the possibility that the candidate word itself can be regarded as a legal word; (2) the rationality of the link that the candidate word directly follows previous segmentation history. Fig. FIGREF10 illustrates the entire scoring model. A gated neural network is employed over character embeddings to generate distributed representations of candidate words, which are sent to a LSTM model. We use gated neural network and information entropy to capture the likelihood of the segment being a legal word. The architecture of word score model is depicted in Fig. FIGREF12 . Gated Combination Neural Network (GCNN) To effectively learn word representations through character embeddings, we use GCNN BIBREF32 . The architecture of GCNN is demonstrated in Fig. FIGREF13 , which includes update gate and reset gate. The gated mechanism not only captures the characteristics of the characters themselves, but also utilizes the interaction between the characters. There are two types of gates in this network structure: reset gates and update gates. These two gated vectors determine the final output of the gated recurrent neural network, where the update gate helps the model determine what to be passed, and the reset gate primarily helps the model decide what to be cleared. In particular, the word embedding of a word with INLINEFORM0 characters can be computed as: DISPLAYFORM0 where INLINEFORM0 and INLINEFORM1 are update gates for new combination vector INLINEFORM2 and the i-th character INLINEFORM3 respectively, the combination vector INLINEFORM4 is formalized as: DISPLAYFORM0 where INLINEFORM0 and INLINEFORM1 are reset gates for characters. Left and Right Branch Information Entropy In general, each string in a sentence may be a word. However, compared with a string which is not a word, the string of a word is significantly more independent. The branch information entropy is usually used to judge whether each character in a string is tightly linked through the statistical characteristics of the string, which reflects the likelihood of a string being a word. The left and right branch information entropy can be formalized as follows: DISPLAYFORM0 DISPLAYFORM1 where INLINEFORM0 denotes the INLINEFORM1 -th candidate word, INLINEFORM2 denotes the character set, INLINEFORM3 denotes the probability that character INLINEFORM4 is on the left of word INLINEFORM5 and INLINEFORM6 denotes the probability that character INLINEFORM7 is on the right of word INLINEFORM8 . INLINEFORM9 and INLINEFORM10 respectively represent the left and right branch information entropy of the candidate word INLINEFORM11 . If the left and right branch information entropy of a candidate word is relatively high, the probability that the candidate word can be combined with the surrounded characters to form a word is low, thus the candidate word is likely to be a legal word. To judge whether the candidate words in a segmented sentence are legal words, we compute the left and right entropy of each candidate word, then take average as the measurement standard: DISPLAYFORM0 We represent a segmented sentence with INLINEFORM0 candidate words as [ INLINEFORM1 , INLINEFORM2 ,..., INLINEFORM3 ], so the INLINEFORM4 ( INLINEFORM5 ) of the INLINEFORM6 -th candidate word is computed by its average entropy: DISPLAYFORM0 In this paper, we use LSTM to capture the coherence between words in a segmented sentence. This neural network is mainly an optimization for traditional RNN. RNN is widely used to deal with time-series prediction problems. The result of its current hidden layer is determined by the input of the current layer and the output of the previous hidden layer BIBREF33 . Therefore, RNN can remember historical results. However, traditional RNN has problems of vanishing gradient and exploding gradient when training long sequences BIBREF34 . By adding a gated mechanism to RNN, LSTM effectively solves these problems, which motivates us to get the link score with LSTM. Formally, the LSTM unit performs the following operations at time step INLINEFORM0 : DISPLAYFORM0 DISPLAYFORM1 where INLINEFORM0 , INLINEFORM1 , INLINEFORM2 are the inputs of LSTM, all INLINEFORM3 and INLINEFORM4 are a set of parameter matrices to be trained, and INLINEFORM5 is a set of bias parameter matrices to be trained. INLINEFORM6 and INLINEFORM7 operation respectively represent matrix element-wise multiplication and sigmoid function. In the LSTM unit, there are two hidden layers ( INLINEFORM8 , INLINEFORM9 ), where INLINEFORM10 is the internal memory cell for dealing with vanishing gradient, while INLINEFORM11 is the main output of the LSTM unit for complex operations in subsequent layers. We denotes INLINEFORM0 as the word embedding of time step INLINEFORM1 , a prediction INLINEFORM2 of next word embedding INLINEFORM3 can be computed by hidden layer INLINEFORM4 : DISPLAYFORM0 Therefore, link score of next word embedding INLINEFORM0 can be computed as: DISPLAYFORM0 Due to the structure of LSTM, vector INLINEFORM0 contains important information of entire segmentation decisions. In this way, the link score gets the result of the sequence-level word segmentation, not just word-level. Intuitively, we can compute the score of a segmented sequence by summing up word scores and link scores. However, we find that a sequence with more candidate words tends to have higher sequence scores. Therefore, to alleviate the impact of the number of candidate words on sequence scores, we calculate final scores as follows: DISPLAYFORM0 where INLINEFORM0 denotes the INLINEFORM1 -th segmented sequence with INLINEFORM2 candidate words, and INLINEFORM3 represents the INLINEFORM4 -th candidate words in the segmented sequence. When training the model, we seek to minimize the sequence score of the corrected segmented sentence and the predicted segmented sentence. DISPLAYFORM0 where INLINEFORM0 is the loss function. ### Datasets
We collect 204 EHRs with cardiovascular diseases from the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and each contains 27 types of records. We choose 4 different types with a total of 3868 records from them, which are first course reports, medical records, chief ward round records and discharge records. The detailed information of EHRs are listed in Table TABREF32 . We split our datasets as follows. First, we randomly select 3200 records from 3868 records as unlabeled set. Then, we manually annotate remaining 668 records as labeled set, which contains 1170 sentences. Finally, we divide labeled set into train set and test set with the ratio of 7:3 randomly. Statistics of datasets are listed in Table TABREF33 . ### Parameter Settings
To determine suitable parameters, we divide training set into two sets, the first 80% sentences as training set and the rest 20% sentences as validation set. Character embedding dimensions and K-means clusters are two main parameters in the CRF-based word segmenter. In this paper, we choose character-based CRF without any features as baseline. First, we use Word2Vec to train character embeddings with dimensions of [`50', `100', `150', `200', `300', `400'] respectively, thus we obtain 6 different dimensional character embeddings. Second, these six types of character embeddings are used as the input to K-means algorithm with the number of clusters [`50', `100', `200', `300', `400', `500', `600'] respectively to capture the corresponding features of character embeddings. Then, we add K-means clustering features to baseline for training. As can be seen from Fig. FIGREF36 , when the character embedding dimension INLINEFORM0 = 150 and the number of clusters INLINEFORM1 = 400, CRF-based word segmenter performs best, so these two parameters are used in subsequent experiments. Hyper-parameters of neural network have a great impact on the performance. The hyper-parameters we choose are listed in Table TABREF38 . The dimension of character embeddings is set as same as the parameter used in CRF-based word segmenter and the number of hidden units is also set to be the same as it. Maximum word length is ralated to the number of parameters in GCNN unit. Since there are many long medical terminologies in EHRs, we set the maximum word length as 6. In addition, dropout is an effective way to prevent neural networks from overfitting BIBREF35 . To avoid overfitting, we drop the input layer of the scoring model with the rate of 20%. ### Experimental Results
Our work experimentally compares two mainstream CWS tools (LTP and Jieba) on training and testing sets. These two tools are widely used and recognized due to their high INLINEFORM0 -score of word segmentation in general fields. However, in specific fields, there are many terminologies and uncommon words, which lead to the unsatisfactory performance of segmentation results. To solve the problem of word segmentation in specific fields, these two tools provide a custom dictionary for users. In the experiments, we also conduct a comparative experiment on whether external domain dictionary has an effect on the experimental results. We manually construct the dictionary when labeling EHRs. From the results in Table TABREF41 , we find that Jieba benefits a lot from the external dictionary. However, the Recall of LTP decreases when joining the domain dictionary. Generally speaking, since these two tools are trained by general domain corpus, the results are not ideal enough to cater to the needs of subsequent NLP of EHRs when applied to specific fields. To investigate the effectiveness of K-means features in CRF-based segmenter, we also compare K-means with 3 different clustering features, including MeanShift BIBREF36 , SpectralClustering BIBREF37 and DBSCAN BIBREF38 on training and testing sets. From the results in Table TABREF43 , by adding additional clustering features in CRF-based segmenter, there is a significant improvement of INLINEFORM0 -score, which indicates that clustering features can effectively capture the semantic coherence between characters. Among these clustering features, K-means performs best, so we utlize K-means results as additional features for CRF-based segmenter. In this experiment, since uncertainty sampling is the most popular strategy in real applications for its simpleness and effectiveness BIBREF27 , we compare our proposed strategy with uncertainty sampling in active learning. We conduct our experiments as follows. First, we employ CRF-based segmenter to annotate the unlabeled set. Then, sampling strategy in active learning selects a part of samples for annotators to relabel. Finally, the relabeled samples are added to train set for segmenter to re-train. Our proposed scoring strategy selects samples according to the sequence scores of the segmented sentences, while uncertainty sampling suggests relabeling samples that are closest to the segmenter’s decision boundary. Generally, two main parameters in active learning are the numbers of iterations and samples selected per iteration. To fairly investigate the influence of two parameters, we compare our proposed strategy with uncertainty sampling on the same parameter. We find that though the number of iterations is large enough, it has a limited impact on the performance of segmenter. Therefore, we choose 30 as the number of iterations, which is a good trade-off between speed and performance. As for the number of samples selected per iteration, there are 6078 sentences in unlabeled set, considering the high cost of relabeling, we set four sizes of samples selected per iteration, which are 2%, 5%, 8% and 11%. The experimental results of two sampling strategies with 30 iterations on four different proportions of relabeled data are shown in Fig. FIGREF45 , where x-axis represents the number of iterations and y-axis denotes the INLINEFORM0 -score of the segmenter. Scoring strategy shows consistent improvements over uncertainty sampling in the early iterations, indicating that scoring strategy is more capable of selecting representative samples. Furthermore, we also investigate the relations between the best INLINEFORM0 -score and corresponding number of iteration on two sampling strategies, which is depicted in Fig. FIGREF46 . It is observed that in our proposed scoring model, with the proportion of relabeled data increasing, the iteration number of reaching the optimal word segmentation result is decreasing, but the INLINEFORM0 -score of CRF-based word segmenter is also gradually decreasing. When the proportion is 2%, the segmenter reaches the highest INLINEFORM1 -score: 90.62%. Obviously, our proposed strategy outperforms uncertainty sampling by a large margin. Our proposed method needs only 2% relabeled samples to obtain INLINEFORM2 -score of 90.62%, while uncertainty sampling requires 8% samples to reach its best INLINEFORM3 -score of 88.98%, which indicates that with our proposed method, we only need to manually relabel a small number of samples to achieve a desired segmentation result. ### Conclusion and Future Work
To relieve the efforts of EHRs annotation, we propose an effective word segmentation method based on active learning, in which the sampling strategy is a scoring model combining information entropy with neural network. Compared with the mainstream uncertainty sampling, our strategy selects samples from statistical perspective and deep learning level. In addition, to capture coherence between characters, we add K-means clustering features to CRF-based word segmenter. Based on EHRs collected from the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, we evaluate our method on CWS task. Compared with uncertainty sampling, our method requires 6% less relabeled samples to achieve better performance, which proves that our method can save the cost of manual annotation to a certain extent. In future, we plan to employ other widely-used deep neural networks, such as convolutional neural network and attention mechanism, in the research of EHRs segmentation. Then, we believe that our method can be applied to other tasks as well, so we will fully investigate the application of our method in other tasks, such as NER and relation extraction. ### Acknowledgment
The authors would like to appreciate any suggestions or comments from the anonymous reviewers. This work was supported by the National Natural Science Foundation of China (No. 61772201) and the National Key R&D Program of China for “Precision medical research" (No. 2018YFC0910550). Fig. 1. The diagram of active learning for the Chinese word segmentation. Fig. 2. The architecture of the information entropy based scoring model, where ‘/’ represents candidate word separator, xi represents the one-hot encoding of the i-th character, cj represents the j-th character embedding learned by Word2Vec, wm represents the distributed representation of the mth candidate word and pn represents the prediction of the (n+1)-th candidate word. Fig. 3. The architecture of word score, where ‘/’ represents candidate word separator, ci represents the i-th character embedding, wj represents the j-th candidate word embedding and ScoreWord(wk) represents the word score of the k-th candidate word. Fig. 4. The architecture of GCNN. TABLE I DETAILED INFORMATION OF EHRS TABLE III HYPER-PARAMETER SETTING. TABLE IV EXPERIMENTAL RESULTS WITH DIFFERENT WORD SEGMENTATION TOOLS. Fig. 5. The relation between F1-score and K-means class with different character embedding dimensions. TABLE II STATISTICS OF DATASETS TABLE V COMPARISON WITH DIFFERENT CLUSTERING FEATURES. Fig. 7. The relations between the best F1-score and corresponding iteration on two sampling strategies with different relabeled sample sizes. Fig. 6. The results of two sampling strategies with different relabeled sample sizes.
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the scoring model takes the word embedding sequence as input, scoring over each individual candidate word from two perspectives: (1) the possibility that the candidate word itself can be regarded as a legal word; (2) the rationality of the link that the candidate word directly follows previous segmentation history
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what were the baselines?
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### Introduction
Let us consider the goal of building machine reasoning systems based on knowledge from fulltext data like encyclopedic articles, scientific papers or news articles. Such machine reasoning systems, like humans researching a problem, must be able to recover evidence from large amounts of retrieved but mostly irrelevant information and judge the evidence to decide the answer to the question at hand. A typical approach, used implicitly in information retrieval (and its extensions, like IR-based Question Answering systems BIBREF0 ), is to determine evidence relevancy by a keyword overlap feature (like tf-idf or BM-25 BIBREF1 ) and prune the evidence by the relevancy score. On the other hand, textual entailment systems that seek to confirm hypotheses based on evidence BIBREF2 BIBREF3 BIBREF4 are typically provided with only a single piece of evidence or only evidence pre-determined as relevant, and are often restricted to short and simple sentences without open-domain named entity occurences. In this work, we seek to fuse information retrieval and textual entaiment recognition by defining the Hypothesis Evaluation task as deciding the truth value of a hypothesis by integrating numerous pieces of evidence, not all of it equally relevant. As a specific instance, we introduce the Argus Yes/No Question Answering task. The problem is, given a real-world event binary question like Did Donald Trump announce he is running for president? and numerous retrieved news article fragments as evidence, to determine the answer for the question. Our research is motivated by the Argus automatic reporting system for the Augur prediction market platform. BIBREF5 Therefore, we consider the question answering task within the constraints of a practical scenario that has limited available dataset and only minimum supervision. Hence, authentic news sentences are the evidence (with noise like segmentation errors, irrelevant participial phrases, etc.), and whereas we have gold standard for the correct answers, the model must do without explicit supervision on which individual evidence snippets are relevant and what do they entail. To this end, we introduce an open dataset of questions and newspaper evidence, and a neural model within the Sentence Pair Scoring framework BIBREF6 that (A) learns sentence embeddings for the question and evidence, (B) the embeddings represent both relevance and entailment characteristics as linear classifier inputs, and (C) the model aggregates all available evidence to produce a binary signal as the answer, which is the only training supervision. We also evaluate our model on a related task that concerns ranking answers of multiple-choice questions given a set of evidencing sentences. We consider the MCTest dataset and the AI2-8grade/CK12 dataset that we introduce below. The paper is structured as follows. In Sec. SECREF2 , we formally outline the Argus question answering task, describe the question-evidence dataset, and describe the multiple-choice questions task and datasets. In Sec. SECREF3 , we briefly survey the related work on similar problems, whereas in Sec. SECREF4 we propose our neural models for joint learning of sentence relevance and entailment. We present the results in Sec. SECREF5 and conclude with a summary, model usage recommendations and future work directions in Sec. SECREF6 . ### The Hypothesis Evaluation Task
Formally, the Hypothesis Evaluation task is to build a function INLINEFORM0 , where INLINEFORM1 is a binary label (no towards yes) and INLINEFORM2 is a hypothesis instance in the form of question text INLINEFORM3 and a set of INLINEFORM4 evidence texts INLINEFORM5 as extracted from an evidence-carrying corpus. ### Argus Dataset
Our main aim is to propose a solution to the Argus Task, where the Argus system BIBREF7 BIBREF5 is to automatically analyze and answer questions in the context of the Augur prediction market platform. In a prediction market, users pose questions about future events whereas others bet on the yes or no answer, with the assumption that the bet price reflects the real probability of the event. At a specified moment (e.g. after the date of a to-be-predicted sports match), the correct answer is retroactively determined and the bets are paid off. At a larger volume of questions, determining the bet results may present a significant overhead for running of the market. This motivates the Argus system, which should partially automate this determination — deciding questions related to recent events based on open news sources. To train a machine learning model for the INLINEFORM0 function, we have created a dataset of questions with gold labels, and produced sets of evidence texts from a variety of news paper using a pre-existing IR (information retrieval) component of the Argus system. We release this dataset openly. To pose a reproducible task for the IR component, the time domain of questions was restricted from September 1, 2014 to September 1, 2015, and topic domain was focused to politics, sports and the stock market. To build the question dataset, we have used several sources: We asked Amazon Mechanical Turk users to pose questions, together with a golden label and a news article reference. This seeded the dataset with initial, somewhat redundant 250 questions. We manually extended this dataset by derived questions with reversed polarity (to obtain an opposite answer). We extended the data with questions autogenerated from 26 templates, pertaining top sporting event winners and US senate or gubernatorial elections. To build the evidence dataset, we used the Syphon preprocessing component BIBREF5 of the Argus implementation to identify semantic roles of all question tokens and produce the search keywords if a role was assigned to each token. We then used the IR component to query a corpus of newspaper articles, and kept sentences that contained at least 2/3 of all the keywords. Our corpus of articles contained articles from The Guardian (all articles) and from the New York Times (Sports, Politics and Business sections). Furthermore, we scraped partial archive.org historical data out of 35 RSS feeds from CNN, Reuters, BBC International, CBS News, ABC News, c|net, Financial Times, Skynews and the Washington Post. For the final dataset, we kept only questions where at least a single evidence was found (i.e. we successfuly assigned a role to each token, found some news stories and found at least one sentence with 2/3 of question keywords within). The final size of the dataset is outlined in Fig. FIGREF8 and some examples are shown in Fig. FIGREF9 . ### AI2-8grade/CK12 Dataset
The AI2 Elementary School Science Questions (no-diagrams variant) released by the Allen Institute cover 855 basic four-choice questions regarding high school science and follows up to the Allen AI Science Kaggle challenge. The vocabulary includes scientific jargon and named entities, and many questions are not factoid, requiring real-world reasoning or thought experiments. We have combined each answer with the respective question (by substituting the wh-word in the question by each answer) and retrieved evidence sentences for each hypothesis using Solr search in a collection of CK-12 “Concepts B” textbooks. 525 questions attained any supporting evidence, examples are shown in Fig. FIGREF10 . We consider this dataset as preliminary since it was not reviewed by a human and many hypotheses are apparently unprovable by the evidence we have gathered (i.e. the theoretical top accuracy is much lower than 1.0). However, we released it to the public and still included it in the comparison as these qualities reflect many realistic datasets of unknown qualities, so we find relative performances of models on such datasets instructive. ### MCTest Dataset
The Machine Comprehension Test BIBREF8 dataset has been introduced to provide a challenge for researchers to come up with models that approach human-level reading comprehension, and serve as a higher-level alternative to semantic parsing tasks that enforce a specific knowledge representation. The dataset consists of a set of 660 stories spanning multiple sentences, written in simple and clean language (but with less restricted vocabulary than e.g. the bAbI dataset BIBREF9 ). Each story is accompanied by four questions and each of these lists four possible answers; the questions are tagged as based on just one in-story sentence, or requiring multiple sentence inference. We use an official extension of the dataset for RTE evaluation that again textually merges questions and answers. The dataset is split in two parts, MC-160 and MC-500, based on provenance but similar in quality. We train all models on a joined training set. The practical setting differs from the Argus task as the MCTest dataset contains relatively restricted vocabulary and well-formed sentences. Furthermore, the goal is to find the single key point in the story to focus on, while in the Argus setting we may have many pieces of evidence supporting an answer; another specific characteristics of MCTest is that it consists of stories where the ordering and proximity of evidence sentences matters. ### Related Work
Our primary concern when integrating natural language query with textual evidence is to find sentence-level representations suitable both for relevance weighing and answer prediction. Sentence-level representations in the retrieval + inference context have been popularly proposed within the Memory Network framework BIBREF10 , but explored just in the form of averaged word embeddings; the task includes only very simple sentences and a small vocabulary. Much more realistic setting is introduced in the Answer Sentence Selection context BIBREF11 BIBREF6 , with state-of-art models using complex deep neural architectures with attention BIBREF12 , but the selection task consists of only retrieval and no inference (answer prediction). A more indirect retrieval task regarding news summarization was investigated by BIBREF13 . In the entailment context, BIBREF4 introduced a large dataset with single-evidence sentence pairs (Stanford Natural Language Inference, SNLI), but a larger vocabulary and slightly more complicated (but still conservatively formed) sentences. They also proposed baseline recurrent neural model for modeling sentence representations, while word-level attention based models are being studied more recently BIBREF14 BIBREF15 . In the MCTest text comprehension challenge BIBREF8 , the leading models use complex engineered features ensembling multiple traditional semantic NLP approaches BIBREF16 . The best deep model so far BIBREF17 uses convolutional neural networks for sentence representations, and attention on multiple levels to pick evidencing sentences. ### Neural Model
Our approach is to use a sequence of word embeddings to build sentence embeddings for each hypothesis and respective evidence, then use the sentence embeddings to estimate relevance and entailment of each evidence with regard to the respective hypothesis, and finally integrate the evidence to a single answer. ### Sentence Embeddings
To produce sentence embeddings, we investigated the neural models proposed in the dataset-sts framework for deep learning of sentence pair scoring functions. BIBREF6 We refer the reader to BIBREF6 and its references for detailed model descriptions. We evaluate an RNN model which uses bidirectionally summed GRU memory cells BIBREF18 and uses the final states as embeddings; a CNN model which uses sentence-max-pooled convolutional filters as embeddings BIBREF19 ; an RNN-CNN model which puts the CNN on top of per-token GRU outputs rather than the word embeddings BIBREF20 ; and an attn1511 model inspired by BIBREF20 that integrates the RNN-CNN model with per-word attention to build hypothesis-specific evidence embeddings. We also report the baseline results of avg mean of word embeddings in the sentence with projection matrix and DAN Deep Averaging Network model that employs word-level dropout and adds multiple nonlinear transformations on top of the averaged embeddings BIBREF21 . The original attn1511 model BIBREF6 (as tuned for the Answer Sentence Selection task) used a softmax attention mechanism that would effectively select only a few key words of the evidence to focus on — for a hypothesis-evidence token INLINEFORM0 scalar attention score INLINEFORM1 , the focus INLINEFORM2 is: INLINEFORM3 A different focus mechanism exhibited better performance in the Hypothesis Evaluation task, modelling per-token attention more independently: INLINEFORM0 We also use relu instead of tanh in the CNNs. As model input, we use the standard GloVe embeddings BIBREF22 extended with binary inputs denoting token type and overlap with token or bigram in the paired sentence, as described in BIBREF6 . However, we introduce two changes to the word embedding model — we use 50-dimensional embeddings instead of 300-dimensional, and rather than building an adaptable embedding matrix from the training set words preinitialized by GloVe, we use only the top 100 most frequent tokens in the adaptable embedding matrix and use fixed GloVe vectors for all other tokens (including tokens not found in the training set). In preliminary experiments, this improved generalization for highly vocabulary-rich tasks like Argus, while still allowing the high-frequency tokens (like interpunction or conjunctions) to learn semantic operator representations. As an additional method for producing sentence embeddings, we consider the Ubu. RNN transfer learning method proposed by BIBREF6 where an RNN model (as described above) is trained on the Ubuntu Dialogue task BIBREF23 . The pretrained model weights are used to initialize an RNN model which is then fine-tuned on the Hypothesis Evaluation task. We use the same model as originally proposed (except the aforementioned vocabulary handling modification), with the dot-product scoring used for Ubuntu Dialogue training replaced by MLP point-scores described below. ### Evidence Integration
Our main proposed schema for evidence integration is Evidence Weighing. From each pair of hypothesis and evidence embeddings, we produce two INLINEFORM0 predictions using a pair of MLP point-scorers of dataset-sts BIBREF6 with sigmoid activation function. The predictions are interpreted as INLINEFORM1 entailment (0 to 1 as no to yes) and relevance INLINEFORM2 . To integrate the predictions across multiple pieces of evidence, we propose a weighed average model: INLINEFORM3 We do not have access to any explicit labels for the evidence, but we train the model end-to-end with just INLINEFORM0 labels and the formula for INLINEFORM1 is differentiable, carrying over the gradient to the sentence embedding model. This can be thought of as a simple passage-wide attention model. As a baseline strategy, we also consider Evidence Averaging, where we simply produce a single scalar prediction per hypothesis-evidence pair (using the same strategy as above) and decide the hypothesis simply based on the mean prediction across available evidence. Finally, following success reported in the Answer Sentence Selection task BIBREF6 , we consider a BM25 Feature combined with Evidence Averaging, where the MLP scorer that produces the pair scalar prediction as above takes an additional BM25 word overlap score input BIBREF1 besides the elementwise embedding comparisons. ### Experimental Setup
We implement the differentiable model in the Keras framework BIBREF24 and train the whole network from word embeddings to output evidence-integrated hypothesis label using the binary cross-entropy loss as an objective and the Adam optimization algorithm BIBREF25 . We apply INLINEFORM0 regularization and a INLINEFORM1 dropout. Following the recommendation of BIBREF6 , we report expected test set question accuracy as determined by average accuracy in 16 independent trainings and with 95% confidence intervals based on the Student's t-distribution. ### Evaluation
In Fig. FIGREF26 , we report the model performance on the Argus task, showing that the Ubuntu Dialogue transfer RNN outperforms other proposed models by a large margin. However, a comparison of evidence integration approaches in Fig. FIGREF27 shows that evidence integration is not the major deciding factor and there are no staticially meaningful differences between the evaluated approaches. We measured high correlation between classification and relevance scores with Pearson's INLINEFORM0 , showing that our model does not learn a separate evidence weighing function on this task. In Fig. FIGREF28 , we look at the model performance on the AI2-8grade/CK12 task, repeating the story of Ubuntu Dialogue transfer RNN dominating other models. However, on this task our proposed evidence weighing scheme improves over simpler approaches — but just on the best model, as shown in Fig. FIGREF29 . On the other hand, the simplest averaging model benefits from at least BM25 information to select relevant evidence, apparently. For the MCTest dataset, Fig. FIGREF30 compares our proposed models with the current state-of-art ensemble of hand-crafted syntactic and frame-semantic features BIBREF16 , as well as past neural models from the literature, all using attention mechanisms — the Attentive Reader of BIBREF26 , Neural Reasoner of BIBREF27 and the HABCNN model family of BIBREF17 . We see that averaging-based models are surprisingly effective on this task, and in particular on the MC-500 dataset it can beat even the best so far reported model of HABCNN-TE. Our proposed transfer model is statistically equivalent to the best model on both datasets (furthermore, previous work did not include confidence intervals, even though their models should also be stochastically initialized). As expected, our models did badly on the multiple-evidence class of questions — we made no attempt to model information flow across adjacent sentences in our models as this aspect is unique to MCTest in the context of our work. Interestingly, evidence weighing does play an important role on the MCTest task as shown in Fig. FIGREF31 , significantly boosting model accuracy. This confirms that a mechanism to allocate attention to different sentences is indeed crucial for this task. ### Analysis
While we can universally proclaim Ubu. RNN as the best model, we observe many aspects of the Hypothesis Evaluation problem that are shared by the AI2-8grade/CK12 and MCTest tasks, but not by the Argus task. Our largest surprise lies in the ineffectivity of evidence weighing on the Argus task, since observations of irrelevant passages initially led us to investigate this model. We may also see that non-pretrained RNN does very well on the Argus task while CNN is a better model otherwise. An aspect that could explain this rift is that the latter two tasks are primarily retrieval based, where we seek to judge each evidence as irrelevant or essentially a paraphrase of the hypothesis. On the other hand, the Argus task is highly semantic and compositional, with the questions often differing just by a presence of negation — recurrent model that can capture long-term dependencies and alter sentence representations based on the presence of negation may represent an essential improvement over an n-gram-like convolutional scheme. We might also attribute the lack of success of evidence weighing in the Argus task to a more conservative scheme of passage retrieval employed in the IR pipeline that produced the dataset. Given the large vocabulary and noise levels in the data, we may also simply require more data to train the evidence weighing properly. We see from the training vs. test accuracies that RNN-based models (including the word-level attention model) have a strong tendency to overfit on our small datasets, while CNN is much more resilient. While word-level attention seems appealing for such a task, we speculate that we simply might not have enough training data to properly train it. Investigating attention transfer is a point for future work — by our preliminary experiments on multiple datasets, attention models appear more task specific than the basic text comprehension models of memory based RNNs. One concrete limitation of our models in case of the Argus task is a problem of reconciling particular named entity instances. The more obvious form of this issue is Had Roger Federer beat Martin Cilic in US OPEN 2014? versus an opposite Had Martin Cilic beat Roger Federer in US OPEN 2014? — another form of this problem is reconciling a hypothesis like Will the Royals win the World Series? with evidence Giants Win World Series With Game 7 Victory Over Royals. An abstract embedding of the sentence will not carry over the required information — it is important to explicitly pass and reconcile the roles of multiple named entities which cannot be meaningfully embedded in a GloVe-like semantic vector space. ### Conclusion
We have established a general Hypothesis Evaluation task with three datasets of various properties, and shown that neural models can exhibit strong performance (with less hand-crafting effort than non-neural classifiers). We propose an evidence weighing model that is never harmful and improves performance on some tasks. We also demonstrate that simple models can outperform or closely match performance of complex architectures; all the models we consider are task-independent and were successfully used in different contexts than Hypothesis Evaluation BIBREF6 . Our results empirically show that a basic RNN text comprehension model well trained on a large dataset (even if the task is unrelated and vocabulary characteristics are very different) outperforms or matches more complex architectures trained only on the dataset of the task at hand. Finally, on the MCTest dataset, our best proposed model is better or statistically indistinguishable from the best neural model reported so far BIBREF17 , even though it has a simpler architecture and only a naive attention mechanism. We would like to draw several recommendations for future research from our findings: (A) encourage usage of basic neural architectures as evaluation baselines; (B) suggest that future research includes models pretrained on large data as baselines; (C) validate complex architectures on tasks with large datasets if they cannot beat baselines on small datasets; and (D) for randomized machine comprehension models (e.g. neural networks with random weight initialization, batch shuffling or probabilistic dropout), report expected test set performance based on multiple independent training runs. As a general advice for solving complex tasks with small datasets, besides the point (B) above our analysis suggests convolutional networks as the best models regarding the tendency to overfit, unless semantic composionality plays a crucial role in the task; in this scenario, simple averaging-based models are a great start as well. Preinitializing a model also helps against overfitting. We release our implementation of the Argus task, evidence integration models and processing of all the evaluated datasets as open source. We believe the next step towards machine comprehension NLP models (based on deep learning but capable of dealing with real-world, large-vocabulary data) will involve research into a better way to deal with entities without available embeddings. When distinguishing specific entities, simple word-level attention mechanisms will not do. A promising approach could extend the flexibility of the final sentence representation, moving from attention mechanism to a memory mechanism by allowing the network to remember a set of “facts” derived from each sentence; related work has been done for example on end-to-end differentiable shift-reduce parsers with LSTM as stack cells BIBREF28 . ### Acknowledgments
This work was co-funded by the Augur Project of the Forecast Foundation and financially supported by the Grant Agency of the Czech Technical University in Prague, grant No. SGS16/ 084/OHK3/1T/13. Computational resources were provided by the CESNET LM2015042 and the CERIT Scientific Cloud LM2015085, provided under the programme “Projects of Large Research, Development, and Innovations Infrastructures.” We'd like to thank Peronet Despeignes of the Augur Project for his support. Carl Burke has provided instructions for searching CK-12 ebooks within the Kaggle challenge. Figure 51.14 In a pedigree, squares symbolize males, and circles represent females. energy pyramid model is used to show the pattern of traits that are passed from one generation to the next in a family? Energy is passed up a food chain or web from lower to higher trophic levels. Each step of the food chain in the energy pyramid is called a trophic level.
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RNN model, CNN model , RNN-CNN model, attn1511 model, Deep Averaging Network model, avg mean of word embeddings in the sentence with projection matrix
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What different approaches of encoding syntactic information authors present?
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### Introduction
The task of semantic role labeling (SRL) is to recognize arguments for a given predicate in one sentence and assign labels to them, including “who” did “what” to “whom”, “when”, “where”, etc. Figure FIGREF1 is an example sentence with both semantic roles and syntactic dependencies. Since the nature of semantic roles is more abstract than the syntactic dependencies, SRL has a wide range of applications in different areas, e.g., text classification BIBREF0, text summarization BIBREF1, BIBREF2, recognizing textual entailment BIBREF3, BIBREF4, information extraction BIBREF5, question answering BIBREF6, BIBREF7, and so on. UTF8gbsn Traditionally, syntax is the bridge to reach semantics. However, along with the popularity of the end-to-end models in the NLP community, various recent studies have been discussing the necessity of syntax in the context of SRL. For instance, BIBREF8 have observed that only good syntax helps with the SRL performance. BIBREF9 have explored what kind of syntactic information or structure is better suited for the SRL model. BIBREF10 have compared syntax-agnostic and syntax-aware approaches and claim that the syntax-agnostic model surpasses the syntax-aware ones. In this paper, we focus on analyzing the relationship between the syntactic dependency information and the SRL performance. In particular, we investigate the following four aspects: 1) Quality of the syntactic information: whether the performance of the syntactic parser output affects the SRL performance; 2) Representation of the syntactic information: how to represent the syntactic dependencies to better preserve the original structural information; 3) Incorporation of the syntactic information: at which layer of the SRL model and how to incorporate the syntactic information; and 4) the Relationship with other external resources: when we append other external resources into the SRL model, whether their contributions are orthogonal to the syntactic dependencies. For the main architecture of the SRL model, many neural-network-based models use BiLSTM as the encoder (e.g., BIBREF10, BIBREF11, BIBREF12), while recently self-attention-based encoder becomes popular due to both the effectiveness and the efficiency BIBREF13, BIBREF14, BIBREF15. By its nature, the self-attention-based model directly captures the relation between words in the sentence, which is convenient to incorporate syntactic dependency information. BIBREF15 replace one attention head with pre-trained syntactic dependency information, which can be viewed as a hard way to inject syntax into the neural model. Enlightened by the machine translation model proposed by BIBREF16, we introduce the Relation-Aware method to incorporate syntactic dependencies, which is a softer way to encode richer structural information. Various experiments for the Chinese SRL on the CoNLL-2009 dataset are conducted to evaluate our hypotheses. From the empirical results, we observe that: 1) The quality of the syntactic information is essential when we incorporate structural information into the SRL model; 2) Deeper integration of the syntactic information achieves better results than the simple concatenation to the inputs; 3) External pre-trained contextualized word representations help to boost the SRL performance further, which is not entirely overlapping with the syntactic information. In summary, the contributions of our work are: We present detailed experiments on different aspects of incorporating syntactic information into the SRL model, in what quality, in which representation and how to integrate. We introduce the relation-aware approach to employ syntactic dependencies into the self-attention-based SRL model. We compare our approach with previous studies, and achieve state-of-the-art results with and without external resources, i.e., in the so-called closed and open settings. ### Related work
Traditional semantic role labeling task BIBREF17 presumes that the syntactic structure of the sentence is given, either being a constituent tree or a dependency tree, like in the CoNLL shared tasks BIBREF18, BIBREF19, BIBREF20. Recent neural-network-based approaches can be roughly categorized into two classes: 1) making use of the syntactic information BIBREF21, BIBREF22, BIBREF23, BIBREF24, and 2) pure end-to-end learning from tokens to semantic labels, e.g., BIBREF25, BIBREF26. BIBREF22 utilize an LSTM model to obtain embeddings from the syntactic dependency paths; while BIBREF24 construct Graph Convolutional Networks to encode the dependency structure. Although BIBREF8's approach is a pure end-to-end learning, they have included an analysis of adding syntactic dependency information into English SRL in the discussion section. BIBREF10 have compared syntax-agnostic and syntax-aware approaches and BIBREF9 have compared different ways to represent and encode the syntactic knowledge. In another line of research, BIBREF14 utilize the Transformer network for the encoder instead of the BiLSTM. BIBREF15 present a novel and effective multi-head self-attention model to incorporate syntax, which is called LISA (Linguistically-Informed Self-Attention). We follow their approach of replacing one attention head with the dependency head information, but use a softer way to capture the pairwise relationship between input elements BIBREF16. For the datasets and annotations of the SRL task, most of the previous research focuses on 1) PropBank BIBREF27 and NomBank BIBREF28 annotations, i.e., the CoNLL 2005 BIBREF18 and CoNLL 2009 BIBREF20 shared tasks; 2) OntoNotes annotations BIBREF29, i.e., the CoNLL 2005 and CoNLL 2012 datasets and more; 3) and FrameNet BIBREF30 annotations. For the non-English languages, not all of them are widely available. Apart from these, in the broad range of semantic processing, other formalisms non-exhaustively include abstract meaning representation BIBREF31, universal decompositional semantics BIBREF32, and semantic dependency parsing BIBREF33. BIBREF34 give a better overview of various semantic representations. In this paper, we primarily work on the Chinese and English datasets from the CoNLL-2009 shared task and focus on the effectiveness of incorporating syntax into the Chinese SRL task. ### Approaches
In this section, we first introduce the basic architecture of our self-attention-based SRL model, and then present two different ways to encode the syntactic dependency information. Afterwards, we compare three approaches to incorporate the syntax into the base model, concatenation to the input embedding, LISA, and our proposed relation-aware method. ### Approaches ::: The Basic Architecture
Our basic model is a multi-head self-attention-based model, which is effective in SRL task as previous work proves BIBREF35. The model consists of three layers: the input layer, the encoder layer and the prediction layer as shown in Figure FIGREF5. ### Approaches ::: The Basic Architecture ::: Input Layer
The input layer contains three types of embeddings: token embedding, predicate embedding, and positional embedding. Token Embedding includes word embedding, part-of-speech (POS) tag embedding. Predicate Embedding has been proposed by BIBREF8, and its binary embedding is used to indicate the predicates indices in each sentence. Positional Embedding encodes the order of the input word sequence. We follow BIBREF13 to use time positional embedding, which is formulated as follows: where $t$ is the position, $i$ means the dimension, and $d$ is the dimension of the model input embedding. ### Approaches ::: The Basic Architecture ::: Encoder Layer
The self-attention block is almost the same as Transformer encoder proposed by BIBREF13. Specifically the Transformer encoder contains a feed-forward network (FFN) and a multi-head attention network. The former is followed by the latter. In this work, we exchange their order, so that the multi-head attention module is moved behind the FFN module as Figure FIGREF5 shows. FFN The FFN module consists of two affine layers with a ReLU activation in the middle. Formally, we have the following equation: Multi-Head Attention The basic attention mechanism used in the multi-head attention function is called “Scaled Dot-Product Attention”, which is formulated as follows: where $Q$ is queries, $K$ is keys, and $V$ is values. In the multi-head attention setting, it first maps the input matrix $X$ into queries, keys and values matrices by using $h$ different learned linear projections. Taking queries $Q$ as an example: where $0 \le i < h$. Keys and values use similar projections. On each of these projections, we perform the scaled dot-product attention in parallel. These parallel output values are concatenated and once again projected into the final values. Equation DISPLAY_FORM14 depicts the above operations. where More details about multi-head attention can be found in BIBREF13. Add & Norm We employ a residual connection to each module, followed by a layer normalization BIBREF36 operation. The output of each module is formulated as where $f(x)$ is implemented by each above module. ### Approaches ::: Representation of the Syntactic Dependencies ::: Dependency Head & Relation
The most intuitive way to represent syntactic information is to use individual dependency relations directly, like dependency head and dependency relation label, denoted as Dep and Rel for short. Except for LISA, where Dep is a one-hot matrix of dependency head word index described in SECREF25, in other cases, we use the corresponding head word. Rel is the dependency relation between the word and its syntactic head. We take both Dep and Rel as common strings and map them into dense vectors in the similar way of word embedding. ### Approaches ::: Representation of the Syntactic Dependencies ::: Dependency Path & Relation Path
In order to preserve the structural information of dependency trees as much as possible, we take the syntactic path between candidate arguments and predicates in dependency trees as linguistic knowledge. Referring to BIBREF9, we use the Tree-based Position Feature (TPF) as Dependency Path (DepPath) and use the Shortest Dependency Path (SDP) as Relation Path (RelPath). To generate DepPath & RelPath between candidate argument and predicate, we firstly find their lowest common ancestor. Then we get two sub-paths, one is from the ancestor to the predicate and the other is from the ancestor to the argument. For DepPath, we compute distance from ancestor to predicate and argument respectively and then concatenate two distances with the separator `,'. For RelPath, we concatenate the labels appearing in each sub-path with the separator “_" respectively to get two label paths, and then concatenate the two label paths with the separator `,'. UTF8gbsn As shown in Figure FIGREF21, the lowest common ancestor of the predicate “鼓励 (encourage)" and the candidate argument “农业 (agriculture)" is “鼓励 (encourage)", so their DepPath is “2,0" and its RelPath is “COMP_COMP,". We take both DepPath and RelPath as common strings and map them into dense vectors in the similar way of Dep and Rel. UTF8gbsn ### Approaches ::: Incorporation Methods ::: Input Embedding Concatenation
To incorporate syntactic knowledge, one simple method is to take it as part of the neural network input, denoted as Input. We represent the syntactic information with dense vectors, and concatenate it with other information like word embedding: where $\oplus $ means concatenation; $E_W$ means the original inputs of the neural model and $E_S$ means the embedding of syntax information, such as Dep/Rel or DepPath/RelPath. ### Approaches ::: Incorporation Methods ::: LISA
BIBREF15 propose the linguistically-informed self-attention model (LISA for short) to combine SRL and dependency parsing as multi-task learning in a subtle way. Based on the multi-head self-attention model, LISA uses one attention head to predict the dependency results and it can also directly use pre-trained dependency head results to replace the attention matrix during testing. Being different from their multi-task learning, we make the replacement of one attention head during both training and testing. Instead of the original $softmax$ attention matrix, we use a one-hot matrix, generated by mapping the dependency head index of each word into a 0-1 vector of the sentence length as Figure FIGREF27 shows. We add the dependency relation information with $V$ in the replaced head so that we can make full use of the syntactic knowledge. The replaced attention head is formulated as follows: where $M_D$ is the one-hot dependency head matrix and $E_R$ means the embedding of dependency relation information, such as Rel or RelPath. ### Approaches ::: Incorporation Methods ::: Relation-Aware Self-Attention
Relation-aware self-attention model (RelAwe for brevity) incorporates external information into the attention. By this way, the model considers the pairwise relationships between input elements, which highly agrees with the task of SRL, i.e., aiming to find the semantic relations between the candidate argument and predicate in one sentence. Compared to the standard attention, in this paper, we add the dependency information into $Q$ and $V$ in each attention head, like equation (DISPLAY_FORM15) shows: where $E_D$ and $E_R$ mean the syntactic dependency head and relation information respectively. For our multi-layer multi-head self-attention model, we make this change to each head of the first $N$ self-attention layers. ### Experiment ::: Settings
Datasets & Evaluation Metrics Our experiments are conducted on the CoNLL-2009 shared task dataset BIBREF20. We use the official evaluation script to compare the output of different system configurations, and report the labeled precision (P), labeled recall (R) and labeled f-score (F1) for the semantic dependencies. Word Representations Most of our experiments are conducted in the closed setting without any external word embeddings or data resources than those provided by the CoNLL-2009 datasets. In the closed setting, word embedding is initialized by a Gaussian distribution with mean 0 and variance $\frac{1}{\sqrt{d}}$, where $d$ is the dimension of embedding size of each layer. For the experiments with external resources in the open setting, we utilize 1) word embeddings pre-trained with GloVe BIBREF37 on the Gigaword corpus for Chinese and the published embeddings with 100 dimensions pre-trained on Wikipedia and Gigaword for English; and 2) ELMo BIBREF38 and BERT BIBREF39, two recently proposed effective deep contextualized word representations. Other embeddings, i.e., POS embedding, linguistic knowledge embedding, and so on are initialized in same way as random word embedding no matter in closed or open setting. Syntactic Parsers In Table TABREF30, both Auto and Gold syntactic dependencies are provided by the dataset. Since the performance of the Auto is far behind the state-of-the-art BiaffineParser BIBREF40, we generate more dependency results by training BiaffineParser with different external knowledge, including pre-trained word embedding and BERT. Performance for different parsers is listed in Table TABREF30. Parameters In this work, we set word embedding size $d_w=100$, POS embedding size $d_t=50$. The predicate embedding size is set as $d_p=100$. The syntax-related embedding size varies along with different configurations, so as the feature embedding size $d_f$. To facilitate residual connections, all sub-layers in the model produce outputs of dimension $d_{model}=d_f+d_p$. The hidden dimension $d_{ff}=800$ is applied for all the experiments. We set the number of shared self-attention blocks $N=10$. The number of heads varies with $d_{model}$, but dimension of each head is 25. Besides, LISA incorporates syntax knowledge in the 5-th self-attention layer while RelAwe incorporates in the first 5 layers. We apply the similar dropout strategy as BIBREF13, i.e., the attention and residual dropout values are $0.2$ and $0.3$ respectively. The dropout is also applied in the middle layer of FFN with value $0.2$. We also employ label smoothing BIBREF41 of value $0.1$ during training. We use softmax-cross-entropy as our loss function, and use the Adadelta optimizer BIBREF42 with $\epsilon =10^{-6}$ and $\rho =0.95$. For all experiments, we train the model $200,000$ steps with learning rate $lr=1.0$, and each batch has 4096 words. All the hyper-parameters are tuned on the development set. Configurations We use different abbreviations to represent the parsing results, syntactic dependency representations, and incorporation methods. All the system configurations in our experiments are listed in Table TABREF36. ### Experiment ::: Quality of the Syntactic Dependencies
We use the above-mentioned dependency trees of different quality for comparison, with Dep&Rel representation on our RelAwe model. In addition, we generate one more data AutoDel by deleting all the erroneous dependency heads and relations from the provided Auto data according to the gold heads and relations, and we do not replace them with any alternative heads and relations. We take this setting as another reference (along with GOLD) to indicate that erroneous syntax information may hurt the performance of the SRL model. We take the Gold as the upperbound reference of our task setting. Experiment results in Table TABREF37 demonstrate that, incorporating syntactic knowledge into the SRL model can achieve better performance and overall, the better the quality is, the better the SRL model performs. This is consistent with the previous study by BIBREF8 on the English dataset. Closer observation reveals two additional interesting phenomena. Firstly, SRL performance improvement is not proportionate to the improvement of dependency quality. When switching syntactic dependency trees from Auto to Biaffine, SRL performance improves 0.5%, although syntactic dependency improves about 8%. In contrast, the difference between Biaffine and BiaffineBert shows more significant improvement of 1.5%. The possible reason is that BiaffineBert provides key dependency information which is missing in other configurations. Secondly, the SRL performance gap between AutoDel and Auto is large though they provide the same correct syntactic information. This may indicate that incorporating erroneous syntactic knowledge hurts the SRL model, and even providing more correct dependencies cannot make up for the harm (cf. BiaffineBert). ### Experiment ::: Representation of the Syntactic Dependencies
Apart from Dep and Rel, we also use DepPath and RelPath to encode the syntactic knowledge. In this subsection, we conduct experiments to compare different syntactic encoding in our SRL model. We base the experiments on our RelAwe model, since it is easier to incorporate different representations for comparison. When generating the RelPath, we filter the paths 1) when the dependency distance between the predicate and the candidate argument is more than 4, and 2) when the RelPath's frequency is less than 10. No matter in which representation, dependency label information is more important than the head and the combination of the two achieves better performance as our experiment results in Table TABREF41 show. Furthermore, using Biaffine dependency trees, DepPath and RelPath perform better than Dep and Rel. This is because of the capability of DepPath and RelPath to capture more structural information of the dependency trees. Comparing Table TABREF37 and TABREF41, when using gold dependencies, DepPath&RelPath can achieve much better result than Dep&Rel. But with the Auto trees, DepPath&RelPath is much worse. Therefore, structural information is much more sensitive to the quality of dependency trees due to error propagation. ### Experiment ::: Incorporation Methods
[9]From the mechanism of LISA, we can find that the replaced attention head can't copy the syntactic dependency heads from DepPath. This subsection discusses the effectiveness of different incorporation methods of the syntactic knowledge. We take Biaffine's output as our dependency information for the comparison. Firstly, results in Table TABREF44 show that with little dependency information (Dep), LISA performs better, while incorporating richer syntactic knowledge (Dep&Rel or Dep&RelPath), three methods achieve similar performance. Overall, RelAwe achieves best results given enough syntactic knowledge. Secondly, Input and LISA achieve much better performance when we combine the dependency head information and the relation, while BIBREF15 have not introduced relation information to the LISA model and BIBREF9 have not combined the head and relation information either. Our proposed RelAwe method with DepPath&RelPath representation performs the best, which encodes the richest syntactic knowledge. Lastly, under the same settings, LISA and RelAwe perform better than Input, which indicates the importance of the location where the model incorporates the syntax, the input layer vs. the encoder layer. ### Experiment ::: External Resources
Apart from the experiments with syntactic knowledge itself, we also compare different external resources to discover their relationship with the syntax, including pre-trained word embeddings, ELMo, and BERT. We conduct experiments with our best setting, the RelAwe model with DepPath & RelPath and the results are listed in Table TABREF45. The plain word embedding improves a little in such settings with syntactic information, while for the newly proposed Elmo and Bert, both of them can boost the models further. ### Experiment ::: Final Results on the Chinese Test Data
Based on the above experiments and analyses, we present the overall results of our model in this subsection. We train the three models (Input, LISA, and RelAwe) with their best settings without any external knowledge as Closed, and we take the same models with Bert as Open. The DepPath&RelPath from Gold without external knowledge serves as the Gold for reference. Since we have been focusing on the task of argument identification and labeling, for both Closed and Open, we follow BIBREF22 to use existing systems' predicate senses BIBREF43 to exclude them from comparison. Table TABREF46 shows that our Open model achieves more than 3 points of f1-score than the state-of-the-art result, and RelAwe with DepPath&RelPath achieves the best in both Closed and Open settings. Notice that our best Closed model can almost perform as well as the state-of-the-art model while the latter utilizes pre-trained word embeddings. Besides, performance gap between three models under Open setting is very small. It indicates that the representation ability of BERT is so powerful and may contains rich syntactic information. At last, the Gold result is much higher than the other models, indicating that there is still large space for improvement for this task. ### Experiment ::: Results on the English Data
We also conduct several experiments on the English dataset to validate the effectiveness of our approaches on other languages than Chinese and the results are in Table TABREF49. Although both configurations are not exactly the same as their original papers, we tried our best to reproduce their methods on the CoNLL2009 dataset for our comparison. Overall, the results are consistent with the Chinese experiments, while the improvement is not as large as the Chinese counterparts. The RelAwe model with DepPath&RelPath still achieves the best performance. Applying our syntax-enhanced model to more languages will be an interesting research direction to work on in the future. [10]We reimplement LISA in BIBREF15 as LISA(Dep), and BIBREF9's best DepPath approach as Input(DepPath). Therefore, we can compare with their work as fairly as possible. Other settings are the best configurations for their corresponding methods. ### Conclusion and Future Work
This paper investigates how to incorporate syntactic dependency information into semantic role labeling in depth. Firstly, we confirm that dependency trees of better quality are more helpful for the SRL task. Secondly, we present different ways to encode the trees and the experiments show that keeping more (correct) structural information during encoding improves the SRL performance. Thirdly, we compare three incorporation methods and discover that our proposed relation-aware self-attention-based model is the most effective one. Although our experiments are primarily on the Chinese dataset, the approach is largely language independent. Apart from our tentative experiments on the English dataset, applying the approach to other languages will be an interesting research direction to work on in the future. Figure 1: An example of one sentence with its syntactic dependency tree and semantic roles. Arcs above the sentence are semantic role annotations for the predicate “鼓励 (encourage)” and below the sentence are syntactic dependency annotations of the whole sentence. The meaning of this sentence is “China encourages foreign merchants to invest in agriculture”. Figure 2: Architecture of our syntax-enhanced selfattention-based SRL model. Red dotted arrows indicate different locations where we incorporate linguistic knowledge in different forms. The dotted box on the upper right is the detailed composition of the selfattention block. Figure 3: The syntactic dependency tree of the sentence “中国鼓励外商投资农业” (China encourages foreign merchants to invest in agriculture). Numbers in brackets are the DEPPATH for each candidate argument with the predicate “鼓励 (encourage)”. Light grey labels on the arcs are the syntactic dependency labels. Table 1: Syntactic dependency performance for different parsers. AUTO indicates the automatic dependency trees provided by the CoNLL-09 Chinese dataset. BIAFFINE means the trees are generated by BiaffineParser with pre-trained word embedding on the Gigaword corpus while BIAFFINEBERT is the same parser with BERT. We use the labeled accuracy score (LAS) and unlabeled accuracy score (UAS) to measure the quality of syntactic dependency trees. Figure 4: Attention matrix of the replaced attention head in the LISA model. The left matrix is the original softmax attention, and the right is a one-hot matrix copied from the syntactic dependency head results. Table 2: A glossary of abbreviations for different system configurations in our experiments. Table 3: SRL results with dependency trees of different quality on the Chinese dev set. These experiments are conducted on the RELAWE model with DEP&REL representations. Table 4: SRL results with different syntactic representations on the Chinese dev set. Experiments are conducted on the RELAWE method. Table 5: SRL results with different incorporation methods of the syntactic information on the Chinese dev set. Experiments are conducted on the BIAFFINE parsing results. Table 6: SRL results with different external knowledge on the Chinese dev set. We use the RELAWE model and DEPPATH&RELPATH syntax representation. Table 7: SRL results on the Chinese test set. We choose the best settings for each configuration of our model. Table 8: SRL results on the English test set. We use syntactic dependency results generated by BiaffineParser (On test set, syntactic performance is: UAS = 94.35%, and LAS = 92.54%, which improves about 6% compared to automatic trees in CoNLL2009.).
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dependency head and dependency relation label, denoted as Dep and Rel for short, Tree-based Position Feature (TPF) as Dependency Path (DepPath), Shortest Dependency Path (SDP) as Relation Path (RelPath)
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What is the FY2019 - FY2020 total revenue growth rate for Block (formerly known as Square)? Answer in units of percents and round to one decimal place. Approach the question asked by assuming the standpoint of an investment banking analyst who only has access to the statement of income.
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Evidence 0:
SQUARE, INC.
CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except per share data)
Year Ended December 31,
2020
2019
2018
Revenue:
Transaction-basedrevenue
$
3,294,978
$
3,081,074
$
2,471,451
Subscriptionandservices-basedrevenue
1,539,403
1,031,456
591,706
Hardwarerevenue
91,654
84,505
68,503
Bitcoinrevenue
4,571,543
516,465
166,517
Totalnetrevenue
9,497,578
4,713,500
3,298,177
Costofrevenue:
Transaction-basedcosts
1,911,848
1,937,971
1,558,562
Subscriptionandservices-basedcosts
222,712
234,270
169,884
Hardwarecosts
143,901
136,385
94,114
Bitcoincosts
4,474,534
508,239
164,827
Amortizationofacquiredtechnology
11,174
6,950
7,090
Totalcostofrevenue
6,764,169
2,823,815
1,994,477
Grossprofit
2,733,409
1,889,685
1,303,700
Operatingexpenses:
Productdevelopment
881,826
670,606
497,479
Salesandmarketing
1,109,670
624,832
411,151
Generalandadministrative
579,203
436,250
339,245
Transactionandloanlosses
177,670
126,959
88,077
Amortizationofacquiredcustomerassets
3,855
4,481
4,362
Totaloperatingexpenses
2,752,224
1,863,128
1,340,314
Operatingincome(loss)
(18,815)
26,557
(36,614)
Gainonsaleofassetgroup
(373,445)
Interestexpense,net
56,943
21,516
17,982
Otherexpense(income),net
(291,725)
273
(18,469)
Income(loss)beforeincometax
215,967
378,213
(36,127)
Provisionforincometaxes
2,862
2,767
2,326
Netincome(loss)
$
213,105
$
375,446
$
(38,453)
Netincome(loss)pershare:
Basic
$
0.48
$
0.88
$
(0.09)
Diluted
$
0.44
$
0.81
$
(0.09)
Weighted-averagesharesusedtocomputenetincome(loss)pershare:
Basic
443,126
424,999
405,731
Diluted
482,167
466,076
405,731
Seeaccompanyingnotestoconsolidatedfinancialstatements.
85
|
101.5%
|
Why had the children never seen Earth?
A. The ship didn’t have enough fuel to return to Earth.
B. Earth was destroyed before they were born.
C. They weren’t able to see through the portholes.
D. They were born while on Quest III.
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THE GIANTS RETURN By ROBERT ABERNATHY Earth set itself grimly to meet them with corrosive fire, determined to blast them back to the stars. But they erred in thinking the Old Ones were too big to be clever. [Transcriber's Note: This etext was produced from Planet Stories Fall 1949. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] In the last hours the star ahead had grown brighter by many magnitudes, and had changed its color from a dazzling blue through white to the normal yellow, of a GO sun. That was the Doppler effect as the star's radial velocity changed relative to the Quest III , as for forty hours the ship had decelerated. They had seen many such stars come near out of the galaxy's glittering backdrop, and had seen them dwindle, turn red and go out as the Quest III drove on its way once more, lashed by despair toward the speed of light, leaving behind the mockery of yet another solitary and lifeless luminary unaccompanied by worlds where men might dwell. They had grown sated with the sight of wonders—of multiple systems of giant stars, of nebulae that sprawled in empty flame across light years. But now unwonted excitement possessed the hundred-odd members of the Quest III's crew. It was a subdued excitement; men and women, they came and stood quietly gazing into the big vision screens that showed the oncoming star, and there were wide-eyed children who had been born in the ship and had never seen a planet. The grownups talked in low voices, in tones of mingled eagerness and apprehension, of what might lie at the long journey's end. For the Quest III was coming home; the sun ahead was the Sun, whose rays had warmed their lives' beginning. Knof Llud, the Quest III's captain, came slowly down the narrow stair from the observatory, into the big rotunda that was now the main recreation room, where most of the people gathered. The great chamber, a full cross-section of the vessel, had been at first a fuel hold. At the voyage's beginning eighty per cent of the fifteen-hundred-foot cylinder had been engines and fuel; but as the immense stores were spent and the holds became radioactively safe, the crew had spread out from its original cramped quarters. Now the interstellar ship was little more than a hollow shell. Eyes lifted from the vision screens to interrogate Knof Llud; he met them with an impassive countenance, and announced quietly, "We've sighted Earth." A feverish buzz arose; the captain gestured for silence and went on, "It is still only a featureless disk to the telescope. Zost Relyul has identified it—no more." But this time the clamor was not to be settled. People pressed round the screens, peering into them as if with the naked eye they could pick out the atom of reflected light that was Earth, home. They wrung each other's hands, kissed, shouted, wept. For the present their fears were forgotten and exaltation prevailed. Knof Llud smiled wryly. The rest of the little speech he had been about to make didn't matter anyway, and it might have spoiled this moment. He turned to go, and was halted by the sight of his wife, standing at his elbow. His wry smile took on warmth; he asked, "How do you feel, Lesra?" She drew an uncertain breath and released it in a faint sigh. "I don't know. It's good that Earth's still there." She was thinking, he judged shrewdly, of Knof Jr. and Delza, who save from pictures could not remember sunlit skies or grassy fields or woods in summer.... He said, with a touch of tolerant amusement, "What did you think might have happened to Earth? After all, it's only been nine hundred years." "That's just it," said Lesra shakily. "Nine hundred years have gone by— there —and nothing will be the same. It won't be the same world we left, the world we knew and fitted in...." The captain put an arm round her with comforting pressure. "Don't worry. Things may have changed—but we'll manage." But his face had hardened against registering the gnawing of that same doubtful fear within him. He let his arm fall. "I'd better get up to the bridge. There's a new course to be set now—for Earth." He left her and began to climb the stairway again. Someone switched off the lights, and a charmed whisper ran through the big room as the people saw each other's faces by the pale golden light of Earth's own Sun, mirrored and multiplied by the screens. In that light Lesra's eyes gleamed with unshed tears. Captain Llud found Navigator Gwar Den looking as smug as the cat that ate the canary. Gwar Den was finding that the actual observed positions of the planets thus far located agreed quite closely with his extrapolations from long unused charts of the Solar System. He had already set up on the calculator a course that would carry them to Earth. Llud nodded curt approval, remarking, "Probably we'll be intercepted before we get that far." Den was jolted out of his happy abstraction. "Uh, Captain," he said hesitantly. "What kind of a reception do you suppose we'll get?" Llud shook his head slowly. "Who knows? We don't know whether any of the other Quests returned successful, or if they returned at all. And we don't know what changes have taken place on Earth. It's possible—not likely, though—that something has happened to break civilization's continuity to the point where our expedition has been forgotten altogether." He turned away grim-lipped and left the bridge. From his private office-cabin, he sent a message to Chief Astronomer Zost Relyul to notify him as soon as Earth's surface features became clear; then he sat idle, alone with his thoughts. The ship's automatic mechanisms had scant need of tending; Knof Llud found himself wishing that he could find some back-breaking task for everyone on board, himself included, to fill up the hours that remained. There was an extensive and well-chosen film library in the cabin, but he couldn't persuade himself to kill time that way. He could go down and watch the screens, or to the family apartment where he might find Lesra and the children—but somehow he didn't want to do that either. He felt empty, drained—like his ship. As the Quest III's fuel stores and the hope of success in man's mightiest venture had dwindled, so the strength had gone out of him. Now the last fuel compartment was almost empty and Captain Knof Llud felt tired and old. Perhaps, he thought, he was feeling the weight of his nine hundred Earth years—though physically he was only forty now, ten years older than when the voyage had begun. That was the foreshortening along the time axis of a space ship approaching the speed of light. Weeks and months had passed for the Quest III in interstellar flight while years and decades had raced by on the home world. Bemusedly Llud got to his feet and stood surveying a cabinet with built-in voice recorder and pigeonholes for records. There were about three dozen film spools there—his personal memoirs of the great expedition, a segment of his life and of history. He might add that to the ship's official log and its collections of scientific data, as a report to whatever powers might be on Earth now—if such powers were still interested. Llud selected a spool from among the earliest. It was one he had made shortly after leaving Procyon, end of the first leg of the trip. He slid it onto the reproducer. His own voice came from the speaker, fresher, more vibrant and confident than he knew it was now. "One light-day out from Procyon, the thirty-third day by ship's time since leaving Earth. "Our visit to Procyon drew a blank. There is only one huge planet, twice the size of Jupiter, and like Jupiter utterly unfit to support a colony. "Our hopes were dashed—and I think all of us, even remembering the Centaurus Expedition's failure, hoped more than we cared to admit. If Procyon had possessed a habitable planet, we could have returned after an absence of not much over twenty years Earth time. "It is cheering to note that the crew seems only more resolute. We go on to Capella; its spectrum, so like our own Sun's, beckons. If success comes there, a century will have passed before we can return to Earth; friends, relatives, all the generation that launched the Quest ships will be long since dead. Nevertheless we go on. Our generation's dream, humanity's dream, lives in us and in the ship forever...." Presently Knof Llud switched off that younger voice of his and leaned back, an ironic smile touching his lips. That fervent idealism seemed remote and foreign to him now. The fanfares of departure must still have been ringing in his ears. He rose, slipped the record back in its niche and picked out another, later, one. "One week since we passed close enough to Aldebaran to ascertain that that system, too, is devoid of planets. "We face the unpleasant realization that what was feared is probably true—that worlds such as the Sun's are a rare accident, and that we may complete our search without finding even one new Earth. "It makes no difference, of course; we cannot betray the plan.... This may be man's last chance of escaping his pitiful limitation to one world in all the Universe. Certainly the building of this ship and its two sisters, the immense expenditure of time and labor and energy stores that went into them, left Earth's economy drained and exhausted. Only once in a long age does mankind rise to such a selfless and transcendent effort—the effort of Egypt that built the pyramids, or the war efforts of the nations in the last great conflicts of the twentieth century. "Looked at historically, such super-human outbursts of energy are the result of a population's outgrowing its room and resources, and therefore signalize the beginning of the end. Population can be limited, but the price is a deadly frustration, because growth alone is life.... In our day the end of man's room for growth on the Earth was in sight—so we launched the Quests . Perhaps our effort will prove as futile as pyramid-building, less practical than orgies of slaughter to reduce pressure.... In any case, it would be impossible to transport very many people to other stars; but Earth could at least go into its decline with the knowledge that its race went onward and upward, expanding limitlessly into the Universe.... "Hopeless, unless we find planets!" Knof Llud shook his head sorrowfully and took off the spool. That was from the time when he had grown philosophical after the first disappointments. He frowned thoughtfully, choosing one more spool that was only four years old. The recorded voice sounded weary, yet alive with a strange longing.... "We are in the heart of Pleiades; a hundred stars show brilliant on the screens, each star encircled by a misty halo like lights glowing through fog, for we are traversing a vast diffuse nebula. "According to plan, the Quest III has reached its furthest point from Earth. Now we turn back along a curve that will take us past many more stars and stellar systems—but hope is small that any of those will prove a home for man, as have none of the thousands of stars examined already. "But what are a few thousand stars in a galaxy of billions? We have only, as it were, visited a handful of the outlying villages of the Universe, while the lights of its great cities still blaze far ahead along the Milky Way. "On flimsy excuses I have had Zost Relyul make observations of the globular cluster Omega Centauri. There are a hundred thousand stars there in a volume of space where one finds a few dozen in the Sun's neighborhood; there if anywhere must circle the planets we seek! But Omega Centauri is twenty thousand light years away.... "Even so—by expending its remaining fuel freely, the Quest III could achieve a velocity that would take us there without dying of senility of aging too greatly. It would be a one-way journey—even if enough fuel remained, there would be little point in returning to Earth after more than forty thousand years. By then our civilization certainly, and perhaps the human race itself, would have perished from memory. "That was why the planners limited our voyage, and those of the other Quests , to less than a thousand years Earth time. Even now, according to the sociodynamic predictions made then, our civilization—if the other expeditions failed also—will have reached a dangerously unstable phase, and before we can get back it may have collapsed completely from overpopulation. "Why go back, then with the news of our failure? Why not forget about Earth and go on to Omega Centauri? What use is quixotic loyalty to a decree five thousand years old, whose makers are dead and which may be forgotten back there? "Would the crew be willing? I don't know—some of them still show signs of homesickness, though they know with their minds that everything that was once 'home' has probably been swept away.... "It doesn't matter. Today I gave orders to swing the ship." Savagely Knof Llud stabbed the button that shut off the speaker. Then he sat for a time with head resting in his hands, staring into nothing. The memory of that fierce impulse to go on still had power to shake him. A couple of lines of poetry came into his head, as he read them once in translation from the ancient English.... ... for my purpose holds To sail beyond the sunset, and the baths Of all the western stars, until I die. Llud sighed. He still couldn't say just why he had given the order to turn back. The stars had claimed his heart—but he was still a part of Earth, and not even nine hundred years of space and time had been able to alter that. He wondered if there would still be a quiet stream and a green shady place beside it where a death-weary man, relieved at last of responsibility, could rest and dream no more.... Those things went on, if men didn't change them. And a pine forest where he and young Knof could go camping, and lie on their backs at night and gaze at the glittering constellations, far away, out of reach.... He wasn't sure he would want to do that, though. Suddenly a faint cushioned jar went through the great ship; it seemed to falter one moment in flight. The captain was on his feet instantly, but then his movements became unhurried. Whatever it had been was past, and he had a good idea what it had been—a meteoroid, nothing unusual in the vicinity of the Sun, though in interstellar space and around planetless stars such collisions were rare to the vanishing point. No harm could have been done. The Quest III's collision armor was nonmaterial and for practical purposes invulnerable. Just as he took his finger off the button that opened the door, the intercommunication phone shrilled imperatively. Knof Llud wheeled, frowning—surely a meteoroid impact wasn't that serious. Coincidence, maybe—it might be Zost Relyul calling as instructed. He reached the phone at the moment when another, heavier jolt shook the vessel. Llud snatched up the receiver with the speed of a scalded cat. "Captain?" It was Gwar Den's voice, stammering a little. "Captain, we're being attacked!" "Sound the alarm. Emergency stations." He had said it automatically, then felt a curious detached relief at the knowledge that after all these years he could still respond quickly and smoothly to a crisis. There was a moment's silence, and he heard the alarm start—three short buzzes and repeat, ringing through all the great length of the interstellar ship. Knowing that Gwar Den was still there, he said, "Now—attacked by what?" "Ships," said Gwar Den helplessly. "Five of them so far. No, there's a sixth now." Repeated blows quivered the Quest III's framework. The navigator said, obviously striving for calm, "They're light craft, not fifty feet long, but they move fast. The detectors hardly had time to show them before they opened up. Can't get a telescope beam on them long enough to tell much." "If they're that small," said Knof Llud deliberately, "they can't carry anything heavy enough to hurt us. Hold to course. I'll be right up." In the open doorway he almost fell over his son. Young Knof's eyes were big; he had heard his father's words. "Something's happened," he judged with deadly twelve-year-old seriousness and, without wasting time on questions, "Can I go with you, huh, Dad?" Llud hesitated, said, "All right. Come along and keep out of the way." He headed for the bridge with strides that the boy could not match. There were people running in the corridors, heading for their posts. Their faces were set, scared, uncomprehending. The Quest III shuddered, again and again, under blows that must have had millions of horsepower behind them; but it plunged on toward Earth, its mighty engines still steadily braking its interstellar velocity. To a man, the ship's responsible officers were already on the bridge, most of them breathless. To a man they looked appeal at Captain Knof Llud. "Well?" he snapped. "What are they doing?" Gwar Den spoke. "There are thirteen of them out there now, sir, and they're all banging away at us." The captain stared into the black star-strewn depths of a vision screen where occasional blue points of light winked ominously, never twice from the same position. Knof Jr. flattened himself against the metal wall and watched silently. His young face was less anxious than his elders'; he had confidence in his father. "If they had anything heavier," surmised the captain, "they'd have unlimbered it by now. They're out to get us. But at this rate, they can't touch us as long as our power lasts—or until they bring up some bigger stuff." The mild shocks went on—whether from projectiles or energy-charges, would be hard to find out and it didn't matter; whatever was hitting the Quest III's shell was doing it at velocities where the distinction between matter and radiation practically ceases to exist. But that shell was tough. It was an extension of the gravitic drive field which transmitted the engines' power equally to every atom of the ship; forces impinging on the outside of the field were similarly transmitted and rendered harmless. The effect was as if the vessel and all space inside its field were a single perfectly elastic body. A meteoroid, for example, on striking it rebounded—usually vaporized by the impact—and the ship, in obedience to the law of equal and opposite forces, rebounded too, but since its mass was so much greater, its deflection was negligible. The people in the Quest III would have felt nothing at all of the vicious onslaught being hurled against them, save that their inertialess drive, at its normal thrust of two hundred gravities, was intentionally operated at one half of one per cent efficiency to provide the illusion of Earthly gravitation. One of the officers said shakily, "It's as if they've been lying in wait for us. But why on Earth—" "That," said the captain grimly, "is what we have to find out. Why—on Earth. At least, I suspect the answer's there." The Quest III bored steadily on through space, decelerating. Even if one were no fatalist, there seemed no reason to stop decelerating or change course. There was nowhere else to go and too little fuel left if there had been; come what might, this was journey's end—perhaps in a more violent and final way than had been anticipated. All around wheeled the pigmy enemies, circling, maneuvering, and attacking, always attacking, with the senseless fury of maddened hornets. The interstellar ship bore no offensive weapons—but suddenly on one of the vision screens a speck of light flared into nova-brilliance, dazzling the watchers for the brief moment in which its very atoms were torn apart. Knof Jr. whooped ecstatically and then subsided warily, but no one was paying attention to him. The men on the Quest III's bridge looked questions at each other, as the thought of help from outside flashed into many minds at once. But Captain Llud said soberly, "It must have caught one of their own shots, reflected. Maybe its own, if it scored too direct a hit." He studied the data so far gathered. A few blurred pictures had been got, which showed cylindrical space ships much like the Quest III , except that they were rocket-propelled and of far lesser size. Their size was hard to ascertain, because you needed to know their distance and speed—but detector-beam echoes gave the distance, and likewise, by the Doppler method, the velocity of directly receding or approaching ships. It was apparent that the enemy vessels were even smaller than Gwar Den had at first supposed—not large enough to hold even one man. Tiny, deadly hornets with a colossal sting. "Robot craft, no doubt," said Knof Llud, but a chill ran down his spine as it occurred to him that perhaps the attackers weren't of human origin. They had seen no recognizable life in the part of the galaxy they had explored, but one of the other Quests might have encountered and been traced home by some unhuman race that was greedy and able to conquer. It became evident, too, that the bombardment was being kept up by a constant arrival of fresh attackers, while others raced away into space, presumably returning to base to replenish their ammunition. That argued a planned and prepared interception with virulent hatred behind it. Elsuz Llug, the gravitic engineer, calculated dismally, "At the rate we're having to shed energy, the fuel will be gone in six or eight hours." "We'll have reached Earth before then," Gwar Den said hopefully. "If they don't bring out the heavy artillery first." "We're under the psychological disadvantage," said the captain, "of not knowing why we're being attacked." Knof Jr. burst out, spluttering slightly with the violence of a thought too important to suppress, "But we're under a ps-psychological advantage, too!" His father raised an eyebrow. "What's that? I don't seem to have noticed it." "They're mad and we aren't, yet," said the boy. Then, seeing that he hadn't made himself clear, "In a fight, if a guy gets mad he starts swinging wild and then you nail him." Smiles splintered the ice of tension. Captain Llud said, "Maybe you've got something there. They seem to be mad, all right. But we're not in a position to throw any punches." He turned back to the others. "As I was going to say—I think we'd better try to parley with the enemy. At least we may find out who he is and why he's determined to smash us." And now instead of tight-beam detectors the ship was broadcasting on an audio carrier wave that shifted through a wide range of frequencies, repeating on each the same brief recorded message: "Who are you? What do you want? We are the interstellar expedition Quest III ...." And so on, identifying themselves and protesting that they were unarmed and peaceful, that there must be some mistake, and querying again, "Who are you ?" There was no answer. The ship drove on, its fuel trickling away under multiplied demands. Those outside were squandering vastly greater amounts of energy in the effort to batter down its defenses, but converting that energy into harmless gravitic impulses was costing the Quest III too. Once more Knof Llud had the insidious sense of his own nerves and muscles and will weakening along with the power-sinews of his ship. Zost Relyul approached him apologetically. "If you have time, Captain—I've got some data on Earth now." Eagerly Llud took the sheaf of photographs made with the telescope. But they told him nothing; only the continental outlines were clear, and those were as they had been nine hundred years ago.... He looked up inquiringly at Zost Relyul. "There are some strange features," said the astronomer carefully. "First of all—there are no lights on the night side. And on the daylight face, our highest magnification should already reveal traces of cities, canals, and the like—but it does not. "The prevailing color of the land masses, you see, is the normal green vegetation. But the diffraction spectrum is queer. It indicates reflecting surfaces less than one-tenth millimeter wide—so the vegetation there can't be trees or grass, but must be more like a fine moss or even a coarse mold." "Is that all?" demanded Llud. "Isn't it enough?" said Zost Relyul blankly. "Well—we tried photography by invisible light, of course. The infra-red shows nothing and likewise the ultraviolet up to the point where the atmosphere is opaque to it." The captain sighed wearily. "Good work," he said. "Keep it up; perhaps you can answer some of these riddles before—" " We know who you are ," interrupted a harshly crackling voice with a strange accent, " and pleading will do you no good. " Knof Llud whirled to the radio apparatus, his weariness dropping from him once more. He snapped, "But who are you?" and the words blended absurdly with the same words in his own voice on the still repeating tape. He snapped off the record; as he did so the speaker, still crackling with space static, said, "It may interest you to know that you are the last. The two other interstellar expeditions that went out have already returned and been destroyed, as you will soon be—the sooner, if you continue toward Earth." Knof Llud's mind was clicking again. The voice—which must be coming from Earth, relayed by one of the midget ships—was not very smart; it had already involuntarily told him a couple of things—that it was not as sure of itself as it sounded he deduced from the fact it had deigned to speak at all, and from its last remark he gathered that the Quest III's ponderous and unswerving progress toward Earth had somehow frightened it. So it was trying to frighten them. He shoved those facts back for future use. Just now he had to know something, so vitally that he asked it as a bald question, " Are you human? " The voice chuckled sourly. "We are human," it answered, "but you are not." The captain was momentarily silent, groping for an adequate reply. Behind him somebody made a choked noise, the only sound in the stunned hush, and the ship jarred slightly as a thunderbolt slammed vengefully into its field. "Suppose we settle this argument about humanity," said Knof Llud woodenly. He named a vision frequency. "Very well." The tone was like a shrug. The voice went on in its language that was quite intelligible, but alien-sounding with the changes that nine hundred years had wrought. "Perhaps, if you realize your position, you will follow the intelligent example of the Quest I's commander." Knof Llud stiffened. The Quest I , launched toward Arcturus and the star cloud called Berenice's Hair, had been after the Quest III the most hopeful of the expeditions—and its captain had been a good friend of Llud's, nine hundred years ago.... He growled, "What happened to him?" "He fought off our interceptors, which are around you now, for some time," said the voice lightly. "When he saw that it was hopeless, he preferred suicide to defeat, and took his ship into the Sun." A short pause. "The vision connection is ready." Knof Llud switched on the screen at the named wavelength, and a picture formed there. The face and figure that appeared were ugly, but undeniably a man's. His features and his light-brown skin showed the same racial characteristics possessed by those aboard the Quest III , but he had an elusive look of deformity. Most obviously, his head seemed too big for his body, and his eyes in turn too big for his head. He grinned nastily at Knof Llud. "Have you any other last wishes?" "Yes," said Llud with icy control. "You haven't answered one question. Why do you want to kill us? You can see we're as human as you are." The big-headed man eyed him with a speculative look in his great eyes, behind which the captain glimpsed the flickering raw fire of a poisonous hatred. "It is enough for you to know that you must die."
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D. They were born while on Quest III.
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What does the film reviewer respect the most about the director of "The Limey"?
A. His use of flashback and dialogue
B. His simultaneous implication and omission of violence
C. His ability to pack a lot of action into a short film
D. His ability to evolve as a filmmaker
|
Machines in the Garden In the animated ecological epic Princess Mononoke , the camera travels over landscapes with a clear, steady gaze, like a Zen hang glider. The images have none of the comin'-at-ya pop-surrealism of American cartoons, many of which have characters that spring out of the frame like jack-in-the-boxes. The Japanese director, Hayao Miyazaki, who spent three years on Princess Mononoke and is reported to have done 70 percent of its paintings himself, seems to work from the outside in: to begin with the curve of the earth, then the mossy hills, the watercolor foliage, the nubby stones, the whorls on the wood, the meticulous carvings on a teacup. He captures the texture of light and the currents of air. You could almost settle down in this landscape. A view of nature that some would call "tree-hugging" doesn't feel softheaded when the trees are rendered in such brilliant and robust detail. But then, "soft" is not a word you can apply to Princess Mononoke , however pantheistic its worldview. The film, which is rated PG-13, is full of splattery carnage. If Miyazaki in long shot is contemplative, in close-up he's ferocious. He's both inside and outside the action: He knows when to rock your world and when to induce a state of sorrowful detachment. According to the New York Times , Toy Story animators screened reels of his work when their imaginations flagged, and writers for Star Trek named an alien species after one of his features. Watching Princess Mononoke --which has been dubbed to Disney/Miramax specifications by American and English stars but retains its two-hour-plus length, its gory beheadings, and its grim, near-apocalyptic finale--you can understand their worship. It isn't that Miyazaki's work is technically so dazzling in this age of digitized miracles; it's that everything is sublimely in proportion. The movie has a scope that makes Hollywood's homiletic, follow-your-dream fables look even more solipsistic. Miyazaki is after nothing less than the moment in our history (the film is set in the 14 th and 15 th centuries) when the power shifted from a "natural" world to one shaped by human technology. It's the beginning of what Bill McKibben called "the end of nature"--that is, when nature became no longer an autonomous, self-regulating force but one touched (and, in Miyazaki's view, poisoned) by human industry. The hero, Ashitaka, a warrior from the isolationist Emishi clan, is forced in the first scene to kill a marauding boar--a god turned into a demon (covered in roiling, corrosive worms) by an iron ball lodged in its body. Infected, destined to be consumed by--and to die of--rage, Ashitaka leaves his village in search of the iron ball's source. He discovers a fortress-cum-arms-manufacturing plant called Irontown, presided over by one of the most complex villains in modern film: the regal Lady Eboshi. On one hand, she's a benevolent industrialist who presides over a warmly matriarchal society; on the other, she wants to destroy the forest, harness its resources, and exterminate its animal deities--chiefly the Spirit of the Forest, a magnificent deer god whose touch brings instant life or death, and who transforms at dusk into the towering Night Walker. P rincess Mononoke builds to a full-scale war between humans and the animal kingdom--which does not, by the way, consist of your father's cartoon critters. In fact, the boars and apes have little patience with Ashitaka's call for nature and mankind to live together in harmony; they'd like to eat him. The wolf god, Moro, is slightly more sympathetic, but that's because her adopted "daughter," San (a k a Princess Mononoke), is human. San is first seen sucking a wound of her huge wolf mother, then, as the gore drips from her mouth, training her dark eyes on Ashitaka with feral hatred. Her second appearance--a lone attack on Irontown to assassinate Lady Eboshi--is one of the movie's high points. It's Miyazaki's use of sound--and silence--that takes your breath away: the determined tap of the wolf princess's shoes as she scuttles over the fortress's rooftops; the silence of Eboshi and her army as they stare at this tiny yet formidable tomboy against the black sky. Their battle is so furious that the blades streak and lose definition--it's almost subliminal. It's a shame that the wolf princess warms up to Ashitaka and spends the rest of the film either saving him or being saved by him. She loses that punk-bitch allure. The voice of Claire Danes doesn't help. When Danes says, "I'd do anything to get you humans out of my forest," she sounds like a Valley Girl peeved over lack of parking spaces at the mall. (San needs a more ragged voice--I'd be interested to hear the original Japanese actress.) Billy Crudup is just as Disneyfied (Miramaxed?), but that doesn't hurt as much because Ashitaka is conceived from the start as a rather bland ingénu. Gillian Anderson's growling Moro sounds silly (she doesn't have the breath control), and the fey-hick tones of Billy Bob Thornton are too recognizable as the Akim Tamiroff-like mercenary, Jigo. But Minnie Driver--coming off a triumphantly dizzy Jane in Tarzan --once again provides a voice that the animators deserve. "Bring the strange-ah to me late-ah," she commands in sexy Martian Queen cadences that will stir the loins of Flash Gordon fans everywhere. "I would like to thank him puh-sonally." The overfamiliar voices nudge Princess Mononoke closer to its American counterparts--but not by a lot. There's always something wondrously strange. The "kodamas" are little tree spirits on doughboy bodies. They cock their trapezoidal dice heads and emit a series of clicks; then their heads pop back with a conclusive rattle. Something about them seems just right; I could watch them for hours. (Miyazaki limits their appearances to seconds--he doesn't wear out their mystery the way that, say, George Lucas would.) And no Hollywood animated feature would end with such a powerful vision of apocalypse, as the land is bestridden by a colossus dropping a thick, caustic, tarlike gel that recalls the post-Hiroshima "black rain." Can you take the kids? I think so. As Miyazaki said at a New York Film Festival press conference, "Children understand intuitively that the world they have been born into is not a blessed world." Princess Mononoke , at least, can tell them why. "A special smile ... a certain touch ..." So begins the elevator-music theme song of Music of the Heart ... "I never had a lot that I loved so much." The credits had just started and I was already looking for a barf bag. Did Miramax and director Wes Craven have to work so hard to schlockify the story of Roberta Guaspari (played here by Meryl Streep), whose violin courses in East Harlem elementary schools have become a beacon for such programs nationwide? A fabled taskmaster (her story was told in the 1996 documentary Small Wonders ), Guaspari used music as a way to teach self-discipline--along with the healthy self-respect that follows in its wake. When the New York school board cut the funding for her program, she proved a marvel of self-promotion, attracting features in all the major dailies and ending up along with her best students at Carnegie Hall for a benefit "Fiddlefest"--along with Itzhak Perlman, Isaac Stern, and other legendary "fiddlers." Streep has said that she spent so much of the time on the set learning the violin (she doesn't play any instruments) that she didn't bring the full force of her acting technique to bear on Roberta. Maybe that's why the performance seems so natural. Let her always learn an instrument on the set! Still, she doesn't make much sense of Guaspari. The script, by Pamela Gray ( A Walk on the Moon ), has her students complain of her nastiness and perfectionism, but Streep--who has made herself look dumpy, thick-waisted, and bedraggled--is so busy telegraphing her vulnerability that all we get is dippy niceness. Instead of a monument to an individual's iron will, Music of the Heart becomes the story of a woman so helpless that she arouses the kindness of strangers. Directors of violent genre pieces like Craven (who got this mainstream gig in return for doing the Scream sequels) or Carl Franklin or Sam Raimi sometimes want so badly to belong to Establishment Hollywood--to go to the Academy Awards--that they neuter themselves. Bending over backward to show how sensitive they can be, they forget that violence--even if it's just emotional violence--belongs in "ordinary" dramas, too. Craven does good work with the young actors in the classroom scenes, but the film has a reticence common to most biopics and a mushy, TV-movie humanism that blands out its texture. OK, I was a puddle after some scenes, like the one where Guaspari pushes a student to get her to improve her posture and discovers that the girl is wearing a leg brace. But how much more emotional the Carnegie Hall climax would have been if instead of suddenly seeing these East Harlem kids on stage with Perlman, Stern, Joshua Bell, etc., we'd seen them rehearsing first and struggling to keep up. There's too much music of the heart and not enough music of the callused fingers. In outline, The Limey is a lean little B-movie revenge melodrama about a felonious Brit (Terence Stamp) who's newly sprung from prison and flies to Southern California to get to the bottom of his beautiful daughter's death: "My name's Wilson ... Who dunnit?" The film, directed by Steven Soderbergh, would be worth seeing just for Stamp's performance, at once rock-hard and goofily blinkered, and for Peter Fonda's wittily self-parodic turn as the suspected killer, a music producer who coasts on '60s counterculture easiness while his lackeys do the dirty work. ("Oh, man," he says, the fear finally seeping through the ether. "This is getting all too close to me.") But the picture's glory is its layered and intricate syntax. The dialogue moves ahead--there are great gobs of exposition--but the images continually double back: to Stamp and Lesley Ann Warren, as his daughter's acting teacher, simply gazing at each other; or to Stamp sitting on a plane, remembering his daughter as a girl on the beach, the lens of his home movie camera creating an eerily bright--almost supernatural--spot that dances over her face. The film's most violent act happens well off screen. (You hear the distant "pop-pop-pop-pop-pop" of the hero's gun.) The rest is only half-glimpsed, fantasized, or saturated by memory--or is the present the memory? Is all of The Limey a temporal hiccup? Some, including the critic at Time , have questioned Soderbergh's sanity. (But of course--Soderbergh flouts time!) I see a method to his madness. Less grandiosely than Harmony Korine in Julien Donkey-Boy , Soderbergh pores over every scene in search of its essential dramatic gesture. He's saying: This --not all that other stuff--is what's important. He telegraphs the ending--you know the Limey will somehow be at the root of his daughter's death--but it's still an emotional wow. The climax justifies the technique. It says the point of this odyssey isn't revenge but regret--for irredeemably blown chances and a tragic waste of love. Soderbergh is one of those rare filmmakers who learn on the job. Working within a tight genre structure, he's discovering hundreds of ways of editing a given scene that can give it the richness of a novel. Is he totally successful? No; he misses now and then, which is why the technique sticks out. But what a fantastic effort. See it and weep for what's missing in most other movies.
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D. His ability to evolve as a filmmaker
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What did the Nahali people do in side-shows as their talent?
A. Performed with the dangerous Vapor snakes
B. Performed tricks with the electric power the held in their bodies
C. Swallowed electricty and performed with currents
D. Their appearance alone was their performance, as they had triangular mouths and scaled hides
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The Blue Behemoth By LEIGH BRACKETT Shannon's Imperial Circus was a jinxed space-carny leased for a mysterious tour of the inner worlds. It made a one-night pitch on a Venusian swamp-town—to find that death stalked it from the jungle in a tiny ball of flame. [Transcriber's Note: This etext was produced from Planet Stories May 1943. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Bucky Shannon leaned forward across the little hexagonal table. He knocked over the pitcher of thil , but it didn't matter. The pitcher was empty. He jabbed me in the breastbone with his forefinger, not very hard. Not hard enough to jar the ribs clean loose, just enough to spring them. "We," he said, "are broke. We are finished, through. Washed up and down the drain." He added, as an afterthought, "Destitute." I looked at him. I said sourly, "You're kidding!" "Kidding." Shannon put his elbows on the table and peered at me through a curtain of very blond hair that was trying hard to be red. "He says I'm kidding! With Shannon's Imperial Circus, the Greatest Show in Space, plastered so thick with attachments...." "It's no more plastered than you are." I was sore because he'd been a lot quicker grabbing the pitcher. "The Greatest Show in Space. Phooey! I've wet-nursed Shannon's Imperial Circus around the Triangle for eleven years, and I know. It's lousy, it's mangy, it's broken-down! Nothing works, from the ship to the roustabouts. In short, it stinks!" I must have had the pitcher oftener than I thought. Nobody insults Buckhalter Shannon's Imperial Circus to Buckhalter Shannon's face unless he's tired and wants a long rest in a comfy fracture-frame. Shannon got up. He got up slowly. I had plenty of time to see his grey-green eyes get sleepy, and hear the quarter-Earth-blood Martian girl wailing about love over by the battered piano, and watch the slanting cat-eyes of the little dark people at the tables swing round toward us, pleased and kind of hungry. I had plenty of time to think how I only weigh one-thirty-seven to Shannon's one-seventy-five, and how I'm not as young as I used to be. I said, "Bucky. Hold on, fella. I...." Somebody said, "Excuse me, gentlemen. Is one of you Mister Buckhalter Shannon?" Shannon put his hands down on his belt. He closed his eyes and smiled pleasantly and said, very gently: "Would you be collecting for the feed bill, or the fuel?" I shot a glance at the newcomer. He'd saved me from a beating, even if he was a lousy bill-collecter; and I felt sorry for him. Bucky Shannon settled his shoulders and hips like a dancer. The stranger was a little guy. He even made me look big. He was dressed in dark-green synthesilk, very conservative. There was a powdering of grey in his hair and his skin was pink, soft, and shaved painfully clean. He had the kind of a face that nice maiden-ladies will trust with their last dime. I looked for his strong-arm squad. There didn't seem to be any. The little guy looked at Shannon with pale blue eyes like a baby, and his voice was softer than Bucky's. He said, "I don't think you understand." I felt cold, suddenly, between the shoulders. Somebody scraped a chair back. It sounded like he'd ripped the floor open, it was so quiet. I got my brassies on, and my hands were sweating. Bucky Shannon sighed, and let his fist start traveling, a long, deceptive arc. Then I saw what the little guy was holding in his hand. I yelled and knocked the table over into Bucky. It made a lot of noise. It knocked him sideways and down, and the little dark men jumped up, quivering and showing their teeth. The Martian girl screamed. Bucky heaved the table off his lap and cursed me. "What's eating you, Jig? I'm not going to hurt him." "Shut up," I said. "Look what he's got there. Money!" The little guy looked at me. He hadn't turned a hair. "Yes," he said. "Money. Quite a lot of it. Would you gentlemen permit me to join you?" Bucky Shannon got up. He grinned his pleasantest grin. "Delighted. I'm Shannon. This is Jig Bentley, my business manager." He looked down at the table. "I'm sorry about that. Mistaken identity." The little guy smiled. He did it with his lips. The rest of his face stayed placid and babyish, almost transparent. I realized with a start that it wasn't transparent at all. It was the most complete dead-pan I ever met, and you couldn't see into those innocent blue eyes any more than you could see through sheet metal. I didn't like him. I didn't like him at all. But he had money. I said, "Howdy. Let's go find a booth. These Marshies make me nervous, looking like hungry cats at a mouse-hole." The little guy nodded. "Excellent idea. My name is Beamish. Simon Beamish. I wish to—ah—charter your circus." I looked at Bucky. He looked hungrier than the Marshies did. We didn't say anything until we got Beamish into a curtained booth with a fresh pitcher of thil on the table. Then I cleared my throat. "What exactly did you have in mind, Mr. Beamish?" Beamish sipped his drink, made a polite face, and put it down. "I have independent means, gentlemen. It has always been my desire to lighten the burden of life for those less fortunate...." Bucky got red around the ears. "Just a minute," he murmured, and started to get up. I kicked him under the table. "Shut up, you lug. Let Mister Beamish finish." He sat down, looking like a mean dog waiting for the postman. Beamish ignored him. He went on, quietly, "I have always held that entertainment, of the right sort, is the most valuable aid humanity can have in its search for the alleviation of toil and boredom...." I said, "Sure, sure. But what was your idea?" "There are many towns along the Venusian frontiers where no entertainment of the— proper sort has been available. I propose to remedy that. I propose to charter your circus, Mister Shannon, to make a tour of several settlements along the Tehara Belt." Bucky had relaxed. His grey-green eyes began to gleam. He started to speak, and I kicked him again. "That would be expensive, Mister Beamish," I said. "We'd have to cancel several engagements...." He looked at me. I was lying, and he knew it. But he said, "I quite understand that. I would be prepared...." The curtains were yanked back suddenly. Beamish shut up. Bucky and I glared at the head and shoulders poking in between the drapes. It was Gow, our zoo-man—a big, ugly son-of-a-gun from a Terran colony on Mercury. I was there once. Gow looks a lot like the scenery—scowling, unapproachable, and tough. His hands, holding the curtains apart, had thick black hair on them and were not much larger than the hams of a Venusian swamp-rhino. He said, "Boss, Gertrude's actin' up again." "Gertrude be blowed," growled Bucky. "Can't you see I'm busy?" Gow's black eyes were unpleasant. "I'm tellin' you, Boss, Gertrude ain't happy. She ain't had the right food. If something...." I said, "That'll all be taken care of, Gow. Run along now." He looked at me like he was thinking it wouldn't take much timber to fit me for a coffin. "Okay! But Gertrude's unhappy. She's lonesome, see? And if she don't get happier pretty soon I ain't sure your tin-pot ship'll hold her." He pulled the curtains to and departed. Bucky Shannon groaned. Beamish cleared his throat and said, rather stiffly, "Gertrude?" "Yeah. She's kind of temperamental." Bucky took a quick drink. I finished for him. "She's the star attraction of our show, Mr. Beamish. A real blue-swamp Venusian cansin . The only other one on the Triangle belongs to Savitt Brothers, and she's much smaller than Gertrude." She was also much younger, but I didn't go into that. Gertrude may be a little creaky, but she's still pretty impressive. I only hoped she wouldn't die on us, because without her we'd have a sicker-looking circus than even I could stand. Beamish looked impressed. "A cansin . Well, well! The mystery surrounding the origin and species of the cansin is a fascinating subject. The extreme rarity of the animal...." We were getting off the subject. I said tactfully, "We'd have to have at least a hundred U.C.'s." It was twice what we had any right to ask. I was prepared to dicker. Beamish looked at me with that innocent dead pan. For a fraction of a second I thought I saw something back of his round blue eyes, and my stomach jumped like it was shot. Beamish smiled sweetly. "I'm not much of a bargainer. One hundred Universal Credits will be agreeable to me." He dragged out a roll as big as my two fists, peeled off half a dozen credit slips, and laid them on the table. "By way of a retainer, gentleman. My attorney and I will call on you in the morning with a contract and itinerary. Good night." We said good night, trying not to drool. Beamish went away. Bucky made grab for the money, but I beat him to it. "Scram," I said. "There are guys waiting for this. Big guys with clubs. Here." I gave him a small-denomination slip I'd been holding out. "We can get lushed enough on this." Shannon has a good vocabulary. He used it. When he got his breath back he said suddenly, "Beamish is pulling some kind of a game." "Yeah." "It may be crooked." "Sure. And he may be screwball and on the level. For Pete's sake!" I yelled. "You want to sit here till we all dry up and blow away?" Shannon looked at me, kind of funny. He looked at the bulge in my tunic where the roll was. He raked back his thick light hair. "Yeah," he said. "I hope there'll be enough left to bribe the jury." He poked his head outside. "Hey, boy! More thildatum !" It was pretty late when we got back to the broken-down spaceport where Shannon's Imperial Circus was crouching beneath its attachments. Late as it was, they were waiting for us. About twenty of them, sitting around and smoking and looking very ugly. It was awfully lonesome out there, with the desert cold and restless under the two moons. There's a smell to Mars, like something dead and dried long past decay, but still waiting. An unhappy smell. The blown red dust gritted in my teeth. Bucky Shannon walked out into the glare of the light at the entrance to the roped-off space around the main lock. He was pretty steady on his feet. He waved and said, "Hiya, boys." They got up off the steps, and the packing cases, and came toward us. I grinned and got into my brassies. We felt we owed those boys a lot more than money. It grates on a man's pride to have to sneak in and out of his own property through the sewage lock. This was the first time in weeks we'd come in at the front door. I waved the money in their faces. That stopped them. Very solemnly, Bucky and I checked the bills, paid them, and pocketed the receipts. Bucky yawned and stretched sleepily. "Now?" he said. "Now," I said. We had a lot of fun. Some of the boys inside the ship came out to join in. We raised a lot of dust and nobody got killed, quite. We all went home happy. They had their money, and we had their blood. The news was all over the ship before we got inside. The freaks and the green girl from Tethys who could roll herself like a hoop, and Zurt the muscle man from Jupiter, and all the other assorted geeks and kinkers and joeys that make up the usual corny carnie were doing nip-ups in the passageways and drooling over the thought of steer and toppings. Bucky Shannon regarded them possessively, wiping blood from his nose. "They're good guys, Jig. Swell people. They stuck by me, and I've rewarded them." I said, "Sure," rather sourly. Bucky hiccoughed. "Let's go see Gertrude." I didn't want to see Gertrude. I never got over feeling funny going into the brute tank, especially at night or out in space. I'm a city guy, myself. The smell and sound of wildness gives me goose bumps. But Bucky was looking stubborn, so I shrugged. "Okay. But just for a minute. Then we go beddy-bye." "You're a pal, Jif. Bes' li'l' guy inna worl'...." The fight had just put the topper on him. I was afraid he'd fall down the ladder and break his neck. That's why I went along. If I hadn't.... Oh, well, what's a few nightmares among friends? It was dark down there in the tank. Way off at the other end, there was a dim glow. Gow was evidently holding Gertrude's hand. We started down the long passageway between the rows of cages and glassed-in tanks and compression units. Our footsteps sounded loud and empty on the iron floor. I wasn't near as happy as Shannon, and my skin began to crawl a little. It's the smell, I think; rank and sour and wild. And the sound of them, breathing and rustling in the dark, with the patient hatred walled around them as strong as the cage bars. Bucky Shannon lurched against me suddenly. I choked back a yell, and then wiped the sweat off my forehead and cursed. The scream came again. A high, ragged, whistling screech like nothing this side of hell, ripping through the musty darkness. Gertrude, on the wailing wall. It had been quiet. Now every brute in the place let go at the same time. My stomach turned clear over. I called Gertrude every name I could think of, and I couldn't hear myself doing it. Presently a great metallic clash nearly burst my eardrums, and the beasts shut up. Gow had them nicely conditioned to that gong. But they didn't quiet down. Not really. They were uneasy. You can feel them inside you when they're uneasy. I think that's why I'm scared of them. They make me feel like I'm not human as I thought—like I wanted to put my back-hair up and snarl. Yeah. They were uneasy that night, all of a sudden.... Gow glared at us as we came up into the lantern light. "She's gettin' worse," he said. "She's lonesome." "That's tough," said Bucky Shannon. His grey-green eyes looked like an owl's. He swayed slightly. "That's sure tough." He sniffled. I looked at Gertrude. Her cage is the biggest and strongest in the tank and even so she looked as though she could break it open just taking a deep breath. I don't know if you've ever seen a cansin . There's only two of them on the Triangle. If you haven't, nothing I can say will make much difference. They're what the brain gang calls an "end of evolution." Seems old Dame Nature had an idea that didn't jell. The cansins were pretty successful for a while, it seems, but something gummed up the works and now there's only a few left, way in the deep-swamp country, where even the Venusians hardly ever go. Living fossils. I wouldn't know, of course, but Gertrude looks to me like she got stuck some place between a dinosaur and a grizzly bear, with maybe a little bird blood thrown in. Anyway, she's big. I couldn't help feeling sorry for her. She was crouched in the cage with her hands—yeah, hands—hanging over her knees and her snaky head sunk into her shoulders, looking out. Just looking. Not at anything. Her eyes were way back in deep horny pits, like cold green fire. The lantern light was yellow on her blue-black skin, but it made the mane, or crest, of coarse wide scales that ran from between her eyes clear down to her flat, short tail, burn all colors. She looked like old Mother Misery herself, from way back before time began. Gow said softly, "She wants a mate. And somebody better get her one." Bucky Shannon sniffled again. I said irritably, "Be reasonable, Gow! Nobody's ever seen a male cansin . There may not even be any." Gertrude screamed again. She didn't move, not even to raise her head. The sadness just built up inside her until it had to come out. That close, the screech was deafening, and it turned me all limp and cold inside. The loneliness, the sheer stark, simple pain.... Bucky Shannon began to cry. I snarled, "You'll have to snap her out of this, Gow. She's driving the rest of 'em nuts." He hammered on his gong, and things quieted down again. Gow stood looking out over the tank, sniffing a little, like a hound. Then he turned to Gertrude. "I saved her life," he said. "When we bought her out of Hanak's wreck and everybody thought she was too hurt to live, I saved her. I know her. I can do things with her. But this time...." He shrugged. He was huge and tough and ugly, and his voice was like a woman's talking about a sick child. "This time," he said, "I ain't sure." "Well for Pete's sake, do what you can. We got a charter, and we need her." I took Shannon's arm. "Come to bed, Bucky darlin'." He draped himself over my shoulder and we went off. Gow didn't look at us. Bucky sobbed. "You were right, Jig," he mumbled. "Circus is no good. I know it. But it's all I got. I love it, Jig. Unnerstan' me? Like Gow there with Gertrude. She's ugly and no good, but he loves her. I love...." "Sure, sure," I told him. "Stop crying down my neck." We were a long way from the light, then. The cages and tanks loomed high and black over us. It was still. The secret, uneasy motion all around us and the scruffing of our feet only made it stiller. Bucky was almost asleep on me. I started to slap him. And then the mist rose up out of the darkness in little lazy coils, sparkling faintly with blue, cold fire. I yelled, "Gow! Gow, the Vapor snakes! Gow—for God's sake!" I started to run, back along the passageway. Bucky weighed on me, limp and heavy. The noise burst suddenly in a deafening hell of moans and roars and shrieks, packed in tight by the metal walls, and above it all I could hear Gertrude's lonely, whistling scream. I thought, " Somebody's down here. Somebody let 'em out. Somebody wants to kill us! " I tried to yell again. It strangled in my throat. I sobbed, and the sweat was thick and cold on me. One of Bucky's dragging, stumbling feet got between mine. We fell. I rolled on top of him, covering his face, and buried my own face in the hollow of his shoulder. The first snake touched me. It was like a live wire, sliding along the back of my neck. I screamed. It came down along my cheek, hunting my mouth. There were more of them, burning me through my clothes. Bucky moaned and kicked under me. I remember hanging on and thinking, "This is it. This is it, and oh God, I'm scared!" Then I went out. II Kanza the Martian croaker, was bending over me when I woke up. His little brown face was crinkled with laughter. He'd lost most of his teeth, and he gummed thak -weed. It smelt. "You pretty, Mis' Jig," he giggled. "You funny like hell." He slapped some cold greasy stuff on my face. It hurt. I cursed him and said, "Where's Shannon? How is he?" "Mis' Bucky okay. You save life. You big hero, Mis' Jig. Mis' Gow come nickuhtime get snakes. You hero. Haw! You funny like hell!" I said, "Yeah," and pushed him away and got up. I almost fell down a couple of times, but presently I made it to the mirror over the washstand—I was in my own cell—and I saw what Kanza meant. The damned snakes had done a good job. I looked like I was upholstered in Scotch plaid. I felt sick. Bucky Shannon opened the door. He looked white and grim, and there was a big burn across his neck. He said: "Beamish is here with his lawyer." I picked up my shirt. "Right with you." Kanza went out, still giggling. Bucky closed the door. "Jig," he said, "those vapor worms were all right when we went in. Somebody followed us down and let them out. On purpose." I hurt all over. I growled, "With that brain, son, you should go far. Nobody saw anything, of course?" Bucky shook his head. "Question is, Jig, who wants to kill us, and why?" "Beamish. He realizes he's been gypped." "One hundred U.C.'s," said Bucky softly, "for a few lousy swampedge mining camps. It stinks, Jig. You think we should back out?" I shrugged. "You're the boss man. I'm only the guy that beats off the creditors." "Yeah," Bucky said reflectively. "And I hear starvation isn't a comfortable death. Okay, Jig. Let's go sign." He put his hand on the latch and looked at my feet. "And—uh—Jig, I...." I said, "Skip it. The next time, just don't trip me up, that's all!" We had a nasty trip to Venus. Gertrude kept the brute tank on edge, and Gow, on the rare occasions he came up for air, went around looking like a disaster hoping to happen. To make it worse, Zurt the Jovian strong-man got hurt during the take-off, and the Mercurian cave-cat had kittens. Nobody would have minded that, only one of 'em had only four legs. It lived just long enough to scare that bunch of superstitious dopes out of their pants. Circus people are funny that way. Shannon and I did a little quiet sleuthing, but it was a waste of time. Anybody in the gang might have let those electric worms out on us. It didn't help any to know that somebody, maybe the guy next to you at dinner, was busy thinking ways to kill you. By the time we hit Venus, I was ready to do a Brodie out the refuse chute. Shannon set the crate down on the edge of Nahru, the first stop on our itinerary. I stood beside him, looking out the ports at the scenery. It was Venus, all right. Blue mud and thick green jungle and rain, and a bunch of ratty-looking plastic shacks huddling together in the middle of it. Men in slickers were coming out for a look. I saw Beamish's sleek yacht parked on a cradle over to the left, and our router's runabout beside it. Bucky Shannon groaned. "A blue one, Jig. A morgue if I ever saw one!" I snarled, "What do you want, with this lousy dog-and-pony show!" and went out. He followed. The gang was converging on the lock, but they weren't happy. You get so you can feel those things. The steamy Venus heat was already sneaking into the ship. While we passed the hatchway to the brute tank, I could hear Gertrude, screaming. The canvasmen were busy setting up the annex, slopping and cursing in the mud. The paste brigade was heading for the shacks. Shannon and I stood with the hot rain running off our slickers, looking. I heard a noise behind me and looked around. Ahra the Nahali woman was standing in the mud with her arms up and her head thrown back, and her triangular mouth open like a thirsty dog. She didn't have anything on but her blue-green, hard scaled hide, and she was chuckling. It didn't sound nice. You find a lot of Nahali people in side-shows, doing tricks with the electric power they carry in their own bodies. They're Venusian middle-swampers, they're not human, and they never forget it. Ahra opened her slitted red eyes and looked at me and laughed with white reptilian teeth. "Death," she whispered. "Death and trouble. The jungle tells me. I can smell it in the swamp wind." The hot rain sluiced over her. She shivered, and the pale skin under her jaw pulsed like a toad's, and her eyes were red. "The deep swamps are angry," she whispered. "Something has been taken. They are angry, and I smell death in the wind!" She turned away, laughing, and I cursed her, and my stomach was tight and cold. Bucky said, "Let's eat if they have a bar in this dump." We weren't half way across the mud puddle that passed as a landing field when a man came out of a shack on the edge of the settlement. We could see him plainly, because he was off to one side of the crowd. He fell on his knees in the mud, making noises. It took him three or four tries to get our names out clear enough to understand. Bucky said, "Jig—it's Sam Kapper." We started to run. The crowd, mostly big unshaken miners, wheeled around to see what was happening. People began to close in on the man who crawled and whimpered in the mud. Sam Kapper was a hunter, supplying animals to zoos and circuses and carnivals. He'd given us good deals a couple of times, when we weren't too broke, and we were pretty friendly. I hadn't seen him for three seasons. I remembered him as a bronzed, hard-bitten guy, lean and tough as a twist of tung wire. I felt sick, looking down at him. Bucky started to help him up. Kapper was crying, and he jerked all over like animals I've seen that were scared to death. Some guy leaned over and put a cigarette in his mouth and lighted it for him. I was thinking about Kapper, then, and I didn't pay much attention. I only caught a glimpse of the man's face as he straightened up. I didn't realize until later that he looked familiar. We got Kapper inside the shack. It turned out to be a cheap bar, with a couple of curtained booths at the back. We got him into one and pulled the curtain in a lot of curious faces. Kapper dragged hard on the cigarette. The man that gave it to him was gone. Bucky said gently, "Okay, Sam. Relax. What's the trouble?" Kapper tried to straighten up. He hadn't shaved. The lean hard lines of his face had gone slack and his eyes were bloodshot. He was covered with mud, and his mouth twitched like a sick old man's. He said thickly, "I found it. I said I'd do it, and I did. I found it and brought it out." The cigarette stub fell out of his mouth. He didn't notice it. "Help me," he said simply. "I'm scared." His mouth drooled. "I got it hidden. They want to find out, but I won't tell 'em. It's got to go back. Back where I found it. I tried to take it, but they wouldn't let me, and I was afraid they'd find it...." He reached suddenly and grabbed the edge of the table. "I don't know how they found out about it, but they did. I've got to get it back. I've got to...." Bucky looked at me. Kapper was blue around the mouth. I was scared, suddenly. I said, "Get what back where?" Bucky got up. "I'll get a doctor," he said. "Stick with him." Kapper grabbed his wrist. Kapper's nails were blue and the cords in his hands stood out like guy wires. "Don't leave me. Got to tell you—where it is. Got to take it back. Promise you'll take it back." He gasped and struggled over his breathing. "Sure," said Bucky. "Sure, well take it back. What is it?" Kapper's face was horrible. I felt sick, listening to him fight for air. I wanted to go for a doctor anyway, but somehow I knew it was no use. Kapper whispered, " Cansin . Male. Only one. You don't know...! Take him back." "Where is it, Sam?" I reached across Bucky suddenly and jerked the curtain back. Beamish was standing there. Beamish, bent over, with his ear cocked. Kapper made a harsh strangling noise and fell across the table. Beamish never changed expression. He didn't move while Bucky felt Kapper's pulse. Bucky didn't need to say anything. We knew. "Heart?" said Beamish finally. "Yeah," said Bucky. He looked as bad as I felt. "Poor Sam." I looked at the cigarette stub smoldering on the table. I looked at Beamish with his round dead baby face. I climbed over Shannon and pushed Beamish suddenly down into his lap. "Keep this guy here till I get back," I said. Shannon stared at me. Beamish started to get indignant. "Shut up," I told him. "We got a contract." I yanked the curtains shut and walked over to the bar. I began to notice something, then. There were quite a lot of men in the place. At first glance they looked okay—a hard-faced, muscular bunch of miners in dirty shirts and high boots. Then I looked at their hands. They were dirty enough. But they never did any work in a mine, on Venus or anywhere else. The place was awfully quiet, for that kind of a place. The bartender was a big pot-bellied swamp-edger with pale eyes and thick white hair coiled up on top of his bullet head. He was not happy. I leaned on the bar. " Lhak ," I said. He poured it, sullenly, out of a green bottle. I reached for it, casually. "That guy we brought in," I said. "He sure has a skinful. Passed out cold. What's he been spiking his drinks with?" " Selak ," said a voice in my ear. "As if you didn't know." I turned. The man who had given Kapper the cigarette was standing behind me. And I remembered him, then.
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B. Performed tricks with the electric power the held in their bodies
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What controversial topics are experimented with?
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### Introduction
Controversy is a phenomenom with a high impact at various levels. It has been broadly studied from the perspective of different disciplines, ranging from the seminal analysis of the conflicts within the members of a karate club BIBREF0 to political issues in modern times BIBREF1, BIBREF2. The irruption of digital social networks BIBREF3 gave raise to new ways of intentionally intervening on them for taking some advantage BIBREF4, BIBREF5. Moreover highly contrasting points of view in some groups tend to provoke conflicts that lead to attacks from one community to the other by harassing, “brigading”, or “trolling” it BIBREF6. The existing literature shows different issues that controversy brings up such as splitting of communities, biased information, hateful discussions and attacks between groups, generally proposing ways to solve them. For example, Kumar, Srijan, et al. BIBREF6 analyze many techniques to defend us from attacks in Reddit while Stewart, et al. BIBREF4 insinuate that there was external interference in Twitter during the 2016 US presidential elections to benefit one candidate. Also, as shown in BIBREF7, detecting controversy could provide the basis to improve the “news diet" of readers, offering the possibility to connect users with different points of views by recommending them new content to read BIBREF8. Moreover, other studies on “bridging echo chambers” BIBREF9 and the positive effects of intergroup dialogue BIBREF10, BIBREF11 suggest that direct engagement could be effective for mitigating such conflicts. Therefore, easily and automatically identifying controversial topics could allow us to quickly implement different strategies for preventing miss-information, fights and bias. Quantifying the controversy is even more powerful, as it allows us to establish controversy levels, and in particular to classify controversial and non-controversial topics by establishing a threshold score that separates the two types of topics. With this aim, we propose in this work a systematic, language-agnostic method to quantify controversy on social networks taking tweet's content as root input. Our main contribution is a new vocabulary-based method that works in any language and equates the performance of state-of-the-art structure-based methods. Finally, controversy quantification through vocabulary analysis opens several research avenues to analyze whether polarization is being created, maintained or augmented by the ways of talking of each community. Having this in mind and if we draw from the premise that when a discussion has a high controversy it is in general due to the presence of two principal communities fighting each other (or, conversely, that when there is no controversy there is just one principal community the members of which share a common point of view), we can measure the controversy by detecting if the discussion has one or two principal jargons in use. Our method is tested on Twitter datasets. This microblogging platform has been widely used to analyze discussions and polarization BIBREF12, BIBREF13, BIBREF14, BIBREF15, BIBREF2. It is a natural choice for these kind of problems, as it represents one of the main fora for public debate in online social media BIBREF15, it is a common destination for affiliative expressions BIBREF16 and is often used to report and read news about current events BIBREF17. An extra advantage of Twitter for this kind of studies is the availability of real-time data generated by millions of users. Other social media platforms offer similar data-sharing services, but few can match the amount of data and the accompanied documentation provided by Twitter. One last asset of Twitter for our work is given by retweets, whom typically indicate endorsement BIBREF18 and hence become a useful concept to model discussions as we can set “who is with who". However, our method has a general approach and it could be used a priori in any social network. In this work we report excellent result tested on Twitter but in future work we are going to test it in other social networks. Our paper is organized as follows: in Section SECREF2, we review related work. Section SECREF3 contains the detailed explanation of the pipeline we use for quantifying controversy of a topic, and each of its stages. In Section SECREF4 we report the results of an extensive empirical evaluation of the proposed measure of controversy. Finally, Section SECREF5 is devoted to discuss possible improvements and directions for future work, as well as lessons learned. ### Related work
Many previous works are dedicated to quantifying the polarization observed in online social networks and social media BIBREF1, BIBREF19, BIBREF20, BIBREF21, BIBREF22, BIBREF23. The main characteristic of those works is that the measures proposed are based on the structural characteristics of the underlying graph. Among them, we highlight the work of Garimella et al.BIBREF23 that presents an extensive comparison of controversy measures, different graph-building approaches, and data sources, achieving the best performance of all. In their research they propose different metrics to measure polarization on Twitter. Their techniques based on the structure of the endorsement graph can successfully detect whether a discussion (represented by a set of tweets), is controversial or not regardless of the context and most importantly, without the need of any domain expertise. They also consider two different methods to measure controversy based on the analysis of the posts contents, but both fail when used to create a measure of controversy. Matakos et al. BIBREF24 develop a polarization index. Their measure captures the tendency of opinions to concentrate in network communities, creating echo-chambers. They obtain a good performance at identifying controversy by taking into account both the network structure and the existing opinions of users. However, they model opinions as positive or negative with a real number between -1 and 1. Their performance is good, but although it is an opinion-based method it is not a text-related one.Other recent works BIBREF25, BIBREF26, BIBREF27 have shown that communities may express themselves with different terms or ways of speaking, use different jargon, which in turn can be detected with the use of text-related techniques. In his thesis BIBREF28, Jang explains controversy via generating a summary of two conflicting stances that make up the controversy. This work shows that a specific sub-set of tweets could represent the two opposite positions in a polarized debate. A good tool to see how communities interact is ForceAtlas2 BIBREF29, a force-directed layout widely used for visualization. This layout has been recently found to be very useful at visualizing community interactions BIBREF30, as this algorithm will draw groups with little communication between them in different areas, whereas, if they have many interactions they will be drawn closer to each other. Therefore, whenever there is controversy the layout will show two well separated groups and will tend to show only one big community otherwise. The method we propose to measure the controversy equates in accuracy the one developed by Garimella et al.BIBREF23 and improves considerably computing time and robustness wrt the amount of data needed to effectively apply it. Our method is also based on a graph approach but it has its main focus on the vocabulary. We first train an NLP classifier that estimates opinion polarity of main users, then we run label-propagation BIBREF31 on the endorsement graph to get polarity of the whole network. Finally we compute the controversy score through a computation inspired in Dipole Moment, a measure used in physics to estimate electric polarity on a system. In our experiments we use the same data-sets from other works BIBREF32, BIBREF23, BIBREF33 as well as other datasets that we collected by us using a similar criterion (described in Section SECREF4). ### Method
Our approach to measuring controversy is based on a systematic way of characterizing social media activity through its content. We employ a pipeline with five stages, namely graph building, community identification, model training, predicting and controversy measure. The final output of the pipeline is a value that measures how controversial a topic is, with higher values corresponding to higher degrees of controversy. The method is based on analysing posts content through Fasttext BIBREF34, a library for efficient learning of word representations and sentence classification developed by Facebook Research team. In short, our method works as follows: through Fasttext we train a language-agnostic model which can predict the community of many users by their jargon. Then we take there predictions and compute a score based on the physic notion Dipole Moment using a language approach to identify core or characteristic users and set the polarity trough them. We provide a detailed description of each stage in the following. Graph Building This paragraph provides details about the approach used to build graphs from raw data. As we said in Section SECREF1, we extract our discussions from Twitter. Our purpose is to build a conversation graph that represents activity related to a single topic of discussion -a debate about a specific event. For each topic, we build a graph $G$ where we assign a vertex to each user who contributes to it and we add a directed edge from node $u$ to node $v$ whenever user $u$ retweets a tweet posted by $v$. Retweets typically indicate endorsement BIBREF18: users who retweet signal endorsement of the opinion expressed in the original tweet by propagating it further. Retweets are not constrained to occur only between users who are connected in Twitter's social network, but users are allowed to retweet posts generated by any other user. As many other works in literature BIBREF5, BIBREF35, BIBREF36, BIBREF37, BIBREF4, BIBREF2 we establish that one retweet among a pair of users are needed to define an edge between them. Community Identification To identify a community's jargon we need to be very accurate at defining its members. If we, in our will of finding two principal communities, force the partition of the graph in that precise number of communities, we may be adding noise in the jargon of the principal communities that are fighting each other. Because of that, we decide to cluster the graph trying two popular algorithms: Walktrap BIBREF38 and Louvain BIBREF39. Both are structure-based algorithms that have very good performance with respect to the Modularity Q measure. These techniques does not detect a fixed number of clusters; their output will depend on the Modularity Q optimization, resulting in less “noisy" communities. The main differences between the two methods, in what regards our work, are that Louvain is a much faster heuristic algorithm but produces clusters with worse Modularity Q. Therefore, in order to analyze the trade-off between computing time and quality we decide to test both methods. At this step we want to capture the tweets of the principal communities to create the model that could differentiate them. Therefore, we take the two communities identified by the cluster algorithm that have the maximum number of users, and use them for the following step of our method. Model Training After detecting the principal communities we create our training dataset to feed the model. To do that, we extract the tweets of each cluster, we sanitize and we subject them to some transformations. First, we remove duplicate tweets -e.g. retweets without additional text. Second, we remove from the text of the tweets user names, links, punctuation, tabs, leading and lagging blanks, general spaces and “RT" - the text that points that a tweet is in fact a retweet. As shown in previous works, emojis are correlated with sentiment BIBREF40. Moreover, as we think that communities will express different sentiment during discussion, it is forseeable that emojis will play an important role as separators of tweets that differentiate between the two sides. Accordingly, we decide to add them to the train-set by translating each emoji into a different word. For example, the emoji :) will be translated into happy and :( into sad. Relations between emojis and words are defined in the R library textclean. Finally, we group tweets by user concatenating them in one string and labeling them with the user's community, namely with tags C1 and C2, corresponding respectively to the biggest and second biggest groups. It is important to note that we take the same number of users of each community to prevent bias in the model. Thus, we use the number of users of the smallest principal community. The train-set built that way is used to feed the model. As we said, we use Fasttext BIBREF34 to do this training. To define the values of the hyper-parameters we use the findings of BIBREF41. In their work they investigate the best hyper-parameters to train word embedding models using Fasttext BIBREF34 and Twitter data. We also change the default value of the hyper-parameter epoch to 20 instead of 5 because we want more convergence preventing as much as possible the variance between different training. These values could change in other context or social networks where we have more text per user or different discussion dynamics. Predicting The next stage consists of identifying the characteristic users of each side the discussion. These are the users that better represent the jargon of each side. To do that, tweets of the users belonging to the largest connected component of the graph are sanitized and transformed exactly as in the Training step. We decide to restrict to the largest connected component because in all cases it contains more than 90% of the nodes. The remaining 10% of the users don't participate in the discussion from a collective point of view but rather in an isolated way and this kind of intervention does not add interesting information to our approach. Then, we remove from this component users with degree smaller or equal to 2 (i.e. users that were retweeted by another user or retweeted other person less than three times in total). Their participation in the discussion is marginal, consequently they are not relevant wrt controversy as they add more noise than information at measuring time. This step could be adjusted differently in a different social network. We name this result component root-graph. Finally, let's see how we do classification. Considering that Fasttext returns for each classification both the predicted tag and the probability of the prediction, we classify each user of the resulting component by his sanitized tweets with our trained model, and take users that were tagged with a probability greater or equal than 0.9. These are the characteristic users that will be used in next step to compute the controversy measure. Controversy Measure This section describes the controversy measures used in this work. This computation is inspired in the measure presented by Morales et al. BIBREF2, and is based on the notion of dipole moment that has its origin in physics. First, we assign to the characteristic users the probability returned by the model, negativizing them if the predicted tag was C2. Therefore, these users are assigned values in the set [-1,-0.9] $\cup $ [0.9,1]. Then, we set values for the rest of the users of the root-graph by label-propagation BIBREF31 - an iterative algorithm to propagate values through a graph by node's neighborhood. Let $n^{+}$ and $n^{-}$ be the number of vertices $V$ with positive and negative values, respectively, and $\Delta A = \dfrac{\mid n^{+} - n^{-}\mid }{\mid V \mid }$ the absolute difference of their normalized size. Moreover, let $gc^{+}$ ($gc^{-}$) be the average value among vertices $n^{+}$ ($n^{-}$) and set $\tau $ as half their absolute difference, $\tau = \dfrac{\mid gc^{+} - gc^{- }\mid }{2}$. The dipole moment content controversy measure is defined as: $\textit {DMC} = (1 -\Delta A)\tau $. The rationale for this measure is that if the two sides are well separated, then label propagation will assign different extreme values to the two partitions, where users from one community will have values near to 1 and users from the other to -1, leading to higher values of the DMC measure. Note also that larger differences in the size of the two partitions (reflected in the value of $\Delta A$) lead to smaller values for the measure, which takes values between zero and one. ### Experiments
In this section we report the results obtained by running the above proposed method over different discussions. ### Experiments ::: Topic definition
In the literature, a topic is often defined by a single hashtag. However, this might be too restrictive in many cases. In our approach, a topic is operationalized as an specific hashtags or key words. Sometimes a discussion in a particular moment could not have a defined hashtag but it could be around a certain keyword, i.e. a word or expression that is not specifically a hashtag but it is widely used in the topic. For example during the Brazilian presidential elections in 2018 we captured the discussion by the mentions to the word Bolsonaro, that is the principal candidate's surname. Thus, for each topic we retrieve all the tweets that contain one of its hashtags or the keyword and that are generated during the observation window. We also ensure that the selected topic is associated with a large enough volume of activity. ### Experiments ::: Datasets
In this section we detail the discussions we use to test our metric and how we determine the ground truth (i.e. if the discussion is controversial or not). We use thirty different discussions that took place between March 2015 and June 2019, half of them with controversy and half without it. We considered discussions in four different languages: English, Portuguese, Spanish and French, occurring in five regions over the world: South and North America, Western Europe, Central and Southern Asia. We also studied these discussions taking first 140 characters and then 280 from each tweet to analyze the difference in performance and computing time wrt the length of the posts. To define the amount of data needed to run our method we established that the Fasttext model has to predict at least one user of each community with a probability greater or equal than 0.9 during ten different trainings. If that is not the case, we are not able to use DPC method. This decision made us consider only a subset of the datasets used in BIBREF23, because due to the time elapsed since their work, many tweets had been deleted and consequently the volume of the data was not enough for our framework. To enlarge our experiment base we added new debates, more detailed information about each one is shown in Table TABREF24 in UNKREF6. To select new discussions and to determine if they are controversial or not we looked for topics widely covered by mainstream media, and that have generated ample discussion, both online and offline. For non-controversy discussions we focused on “soft news" and entertainment, but also to events that, while being impactful and/or dramatic, did not generate large controversies. To validate that intuition, we manually checked a sample of tweets, being unable to identify any clear instance of controversy On the other side, for controversial debates we focused on political events such as elections, corruption cases or justice decisions. To furtherly establish the presence of absence of controversy of our datasets, we visualized the corresponding networks through ForceAtlas2 BIBREF29. Figures FIGREF9 and FIGREF9 show an example of how non-controversial and controversial discussions look like respectively with ForceAtlas2 layout. As we can see in these figures, in a controversial discussion this layout tends to show two well separated groups while in a non-controversial one it tends to be only one big group. More information on the discussions is given in Table TABREF24. To avoid potential overfitting, we use only twelve graphs as testbed during the development of the measures, half of them controversial (netanyahu, ukraine, @mauriciomacri 1-11 Jan, Kavanaugh 3 Oct, @mauriciomacri 11-18 Mar, Bolsonaro 27 Oct) and half non-controversial (sxsw, germanwings, onedirection, ultralive, nepal, mothersday). This procedure resembles a 40/60% train/test split in traditional machine learning applications. Some of the discussions we consider refer to the same topics but in different periods of time. We needed to split them because our computing infrastructure does not allow us to compute such an enormous amount of data. However, being able to estimate controversy with only a subset of the discussion is an advantage, because discussions could take many days or months and we want to identify controversy as soon as possible, without the need of downloading the whole discussion. Moreover, for very long lasting discussions in social networks gathering the whole data would be impractical for any method. ### Experiments ::: Results
Training a Fasttext model is not a deterministic process, as different runs could yield different results even using the same training set in each one. To analyze if these differences are significant, we decide to compute 20 scores for each discussion. The standard deviations among these 20 scores were low in all cases, with mean 0.01 and maximum 0.05. Consequently, we decided to report in this paper the average between the 20 scores, in practice taking the average between 5 runs would be enough. Figure FIGREF18 reports the scores computed by our measure in each topic for the two cluster methods. The beanplot shows the estimated probability density function for a measure computed on the topics, the individual observations are shown as small white lines in a one-dimensional scatter plot, and the median as a longer black line. The beanplot is divided into two groups, one for controversial topics (left/dark) and one for non-controversial ones (right/light). Hence, the black group shows the score distribution over controversial discussions and the white group over non-controversial ones. A larger separation of the two distributions indicates that the measure is better at capturing the characteristics of controversial topics, because a good separation allows to establish a threshold in the score that separates controversial and non-controversial discussions. As we may see in the figure, the medians are well separated in both cases, with little overlapping. To better quantify this overlap we measure the sensitivity BIBREF42 of these predictions by measuring the area under the ROC curve (AUC ROC), obtaining a value of 0.98 for Walktrap clustering and 0.967 for Louvain (where 1 represents a perfect separation and 0.5 means that they are indistinguishable). As Garimella et al. BIBREF23 have made their code public , we reproduced their best method Randomwalk on our datasets and measured the AUC ROC, obtaining a score of 0.935. An interesting finding was that their method had a poor performance over their own datasets. This was due to the fact (already explained in Section SECREF4) that it was not possible to retrieve the complete discussions, moreover, in no case could we restore more than 50% of the tweets. So we decided to remove these discussions and measure again the AUC ROC of this method, obtaining a 0.99 value. Our hypothesis is that the performance of that method was seriously hurt by the incompleteness of the data. We also tested our method on these datasets, obtaining a 0.99 AUC ROC with Walktrap and 0.989 with Louvain clustering. We conclude that our method works better, as in practice both approaches show same performances -specially with Walktrap, but in presence of incomplete information our measure is more robust. The performance of Louvain is slightly worse but, as we mentioned in Section SECREF3, this method is much faster. Therefore, we decided to compare the running time of our method with both clustering techniques and also with the Randomwalk algorithm. In figure FIGREF18 we can see the distribution of running times of all techniques through box plots. Both versions of our method are faster than Randomwalk, while Louvain is faster than Walktrap. We now analyze the impact of the length of the considered text in our method. Figure FIGREF18 depicts the results of similar experiment as Figure FIGREF18, but considering only 140 characters per tweet. As we may see, here the overlapping is bigger, having an AUC of 0.88. As for the impact on computing time, we observe that despite of the results of BIBREF34 that reported a complexity of O(h $log_{2}$(k)) at training and test tasks, in practice we observed a linear growth. We measured the running times of the training and predicting phases (the two text-related phases of our method), the resulting times are reported in figure FIGREF18, which shows running time as a function of the text-size. We include also the best estimated function that approximate computing time as a function of text-set size. As it may be seen, time grows almost linearly, ranging from 30 seconds for a set of 111 KB to 84 seconds for a set of 11941 KB. Finally, we measured running times for the whole method over each dataset with 280 characters. Times were between 170 and 2467 seconds with a mean of 842, making it in practice a reasonable amount of time. ### Discussions
The task we address in this work is certainly not an easy one, and our study has some limitations, which we discuss in this section. Our work lead us to some conclusions regarding the overall possibility of measuring controversy through text, and what aspects need to be considered to deepen our work. ### Discussions ::: Limitations
As our approach to controversy is similar to that of Garimella et al. BIBREF23, we share some of their limitations with respect to several aspects: Evaluation -difficulties to establish ground-truth, Multisided controversies -controversy with more than two sides, Choice of data - manually pick topics, and Overfitting - small set of experiments. Although we have more discussions, it is still small set from statistical point of view. Apart from that, our language-based approach has other limitations which we mention in the following, together with their solutions or mitigation. Data-size. Training an NLP model that can predict tags with a probability greater or equal than 0.9 requires significant amount of text, therefore our method works only for “big" discussions. Most interesting controversies are those that have consequence at a society level, in general big enough for our method. Multi-language discussions. When multiple languages are participating in a discussion it is common that users tend to retweet more tweets in their own language, creating sub-communities. In this cases our model will tend to predict higher controversy scores. This is the case for example of #germanwings, where users tweet in English, German and Spanish and it has the highest score in no-controversial topics. However, the polarization that we tackle in this work is normally part of a society cell (a nation, a city, etc.), and thus developed in just one language. We think that limiting the effectiveness of our analysis to single-language discussions is not a serious limitation. Twitter only. Our findings are based on datasets coming from Twitter. While this is certainly a limitation, Twitter is one of the main venues for online public discussion, and one of the few for which data is available. Hence, Twitter is a natural choice. However, Twitter's characteristic limit of 280 characters per message (140 till short time ago) is an intrinsic limitation of that network. We think that in other social networks as Facebook or Reddit our method will work even better, as having more text per user could redound on a better NLP model as we verified comparing the results with 140 and 280 characters per post. ### Discussions ::: Conclusions
In this article, we introduced the first large-scale systematic method for quantifying controversy in social media through content. We have shown that this method works on Spanish, English, French and Portuguese, it is context-agnostic and does not require the intervention of a domain expert. We have compared its performance with state-of-the-art structure-based controversy measures showing that they have same performance and it is more robust. We also have shown that more text implies better performance and without significantly increasing computing time, therefore, it could be used in other contexts such as other social networks like Reddit or Facebook and we are going to test it in future works. Training the model is not an expensive task since Fasttext has a good performance at this. However, the best performance for detecting principal communities is obtained by Walktrap. The complexity of that algorithm is O(m$n^2$)BIBREF38, where $m$ and $n$ are the number of edges and vertices respectively. This makes this method rather expensive to compute on big networks. Nevertheless, we have shown that with Louvain the method still obtains a very similar AUC ROC (0.99 with Walktrap and 0.989 with Louvain). With incomplete information its performance gets worse but it is still good (0.96) and better than previous state of the art. This work opens several avenues for future research. One is identifying what words, semantics/concepts or language expressions make differ one community from the other. There are various ways to do this, for instance through the word-embbedings that Fasttext returns after training BIBREF34. Also we could use interpretability techniques on machine learning models BIBREF43. Finally, we could try other techniques for measuring controversy through text, using another NLP model as pre-trained neural network BERT BIBREF44 or, in a completely different approach measuring the dispersion index of the discussions word-embbedings BIBREF25. We are currently starting to follow this direction. ### Details on the discussions
F Fig. 1 Fig. 2 Table 1: Datasets statistics, the top group represent controversial topics, while the bottom one represent non-controversial ones
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political events such as elections, corruption cases or justice decisions
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How do they represent input features of their model to train embeddings?
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### Introduction
Many speech processing tasks – such as automatic speech recognition or spoken term detection – hinge on associating segments of speech signals with word labels. In most systems developed for such tasks, words are broken down into sub-word units such as phones, and models are built for the individual units. An alternative, which has been considered by some researchers, is to consider each entire word segment as a single unit, without assigning parts of it to sub-word units. One motivation for the use of whole-word approaches is that they avoid the need for sub-word models. This is helpful since, despite decades of work on sub-word modeling BIBREF0 , BIBREF1 , it still poses significant challenges. For example, speech processing systems are still hampered by differences in conversational pronunciations BIBREF2 . A second motivation is that considering whole words at once allows us to consider a more flexible set of features and reason over longer time spans. Whole-word approaches typically involve, at some level, template matching. For example, in template-based speech recognition BIBREF3 , BIBREF4 , word scores are computed from dynamic time warping (DTW) distances between an observed segment and training segments of the hypothesized word. In query-by-example search, putative matches are typically found by measuring the DTW distance between the query and segments of the search database BIBREF5 , BIBREF6 , BIBREF7 , BIBREF8 . In other words, whole-word approaches often boil down to making decisions about whether two segments are examples of the same word or not. An alternative to DTW that has begun to be explored is the use of acoustic word embeddings (AWEs), or vector representations of spoken word segments. AWEs are representations that can be learned from data, ideally such that the embeddings of two segments corresponding to the same word are close, while embeddings of segments corresponding to different words are far apart. Once word segments are represented via fixed-dimensional embeddings, computing distances is as simple as measuring a cosine or Euclidean distance between two vectors. There has been some, thus far limited, work on acoustic word embeddings, focused on a number of embedding models, training approaches, and tasks BIBREF9 , BIBREF10 , BIBREF11 , BIBREF12 , BIBREF13 , BIBREF14 , BIBREF15 , BIBREF16 . In this paper we explore new embedding models based on recurrent neural networks (RNNs), applied to a word discrimination task related to query-by-example search. RNNs are a natural model class for acoustic word embeddings, since they can handle arbitrary-length sequences. We compare several types of RNN-based embeddings and analyze their properties. Compared to prior embeddings tested on the same task, our best models achieve sizable improvements in average precision. ### Related work
We next briefly describe the most closely related prior work. Maas et al. BIBREF9 and Bengio and Heigold BIBREF10 used acoustic word embeddings, based on convolutional neural networks (CNNs), to generate scores for word segments in automatic speech recognition. Maas et al. trained CNNs to predict (continuous-valued) embeddings of the word labels, and used the resulting embeddings to define feature functions in a segmental conditional random field BIBREF17 rescoring system. Bengio and Heigold also developed CNN-based embeddings for lattice rescoring, but with a contrastive loss to separate embeddings of a given word from embeddings of other words. Levin et al. BIBREF11 developed unsupervised embeddings based on representing each word as a vector of DTW distances to a collection of reference word segments. This representation was subsequently used in several applications: a segmental approach for query-by-example search BIBREF12 , lexical clustering BIBREF18 , and unsupervised speech recognition BIBREF19 . Voinea et al. BIBREF15 developed a representation also based on templates, in their case phone templates, designed to be invariant to specific transformations, and showed their robustness on digit classification. Kamper et al. BIBREF13 compared several types of acoustic word embeddings for a word discrimination task related to query-by-example search, finding that embeddings based on convolutional neural networks (CNNs) trained with a contrastive loss outperformed the reference vector approach of Levin et al. BIBREF11 as well as several other CNN and DNN embeddings and DTW using several feature types. There have now been a number of approaches compared on this same task and data BIBREF11 , BIBREF20 , BIBREF21 , BIBREF22 . For a direct comparison with this prior work, in this paper we use the same task and some of the same training losses as Kamper et al., but develop new embedding models based on RNNs. The only prior work of which we are aware using RNNs for acoustic word embeddings is that of Chen et al. BIBREF16 and Chung et al. BIBREF14 . Chen et al. learned a long short-term memory (LSTM) RNN for word classification and used the resulting hidden state vectors as a word embedding in a query-by-example task. The setting was quite specific, however, with a small number of queries and speaker-dependent training. Chung et al. BIBREF14 worked in an unsupervised setting and trained single-layer RNN autoencoders to produce embeddings for a word discrimination task. In this paper we focus on the supervised setting, and compare a variety of RNN-based structures trained with different losses. ### Approach
An acoustic word embedding is a function that takes as input a speech segment corresponding to a word, INLINEFORM0 , where each INLINEFORM1 is a vector of frame-level acoustic features, and outputs a fixed-dimensional vector representing the segment, INLINEFORM2 . The basic embedding model structure we use is shown in Fig. FIGREF1 . The model consists of a deep RNN with some number INLINEFORM3 of stacked layers, whose final hidden state vector is passed as input to a set of INLINEFORM4 of fully connected layers; the output of the final fully connected layer is the embedding INLINEFORM5 . The RNN hidden state at each time frame can be viewed as a representation of the input seen thus far, and its value in the last time frame INLINEFORM0 could itself serve as the final word embedding. The fully connected layers are added to account for the fact that some additional transformation may improve the representation. For example, the hidden state may need to be larger than the desired word embedding dimension, in order to be able to "remember" all of the needed intermediate information. Some of that information may not be needed in the final embedding. In addition, the information maintained in the hidden state may not necessarily be discriminative; some additional linear or non-linear transformation may help to learn a discriminative embedding. Within this class of embedding models, we focus on Long Short-Term Memory (LSTM) networks BIBREF23 and Gated Recurrent Unit (GRU) networks BIBREF24 . These are both types of RNNs that include a mechanism for selectively retaining or discarding information at each time frame when updating the hidden state, in order to better utilize long-term context. Both of these RNN variants have been used successfully in speech recognition BIBREF25 , BIBREF26 , BIBREF27 , BIBREF28 . In an LSTM RNN, at each time frame both the hidden state INLINEFORM0 and an associated “cell memory" vector INLINEFORM1 , are updated and passed on to the next time frame. In other words, each forward edge in Figure FIGREF1 can be viewed as carrying both the cell memory and hidden state vectors. The updates are modulated by the values of several gating vectors, which control the degree to which the cell memory and hidden state are updated in light of new information in the current frame. For a single-layer LSTM network, the updates are as follows: INLINEFORM0 where INLINEFORM0 , and INLINEFORM1 are all vectors of the same dimensionality, INLINEFORM2 , and INLINEFORM3 are learned weight matrices of the appropriate sizes, INLINEFORM4 and INLINEFORM5 are learned bias vectors, INLINEFORM6 is a componentwise logistic activation, and INLINEFORM7 refers to the Hadamard (componentwise) product. Similarly, in a GRU network, at each time step a GRU cell determines what components of old information are retained, overwritten, or modified in light of the next step in the input sequence. The output from a GRU cell is only the hidden state vector. A GRU cell uses a reset gate INLINEFORM0 and an update gate INLINEFORM1 as described below for a single-layer network: INLINEFORM2 where INLINEFORM0 , and INLINEFORM1 are all the same dimensionality, INLINEFORM2 , and INLINEFORM3 are learned weight matrices of the appropriate size, and INLINEFORM4 , INLINEFORM5 and INLINEFORM6 are learned bias vectors. All of the above equations refer to single-layer networks. In a deep network, with multiple stacked layers, the same update equations are used in each layer, with the state, cell, and gate vectors replaced by layer-specific vectors INLINEFORM0 and so on for layer INLINEFORM1 . For all but the first layer, the input INLINEFORM2 is replaced by the hidden state vector from the previous layer INLINEFORM3 . For the fully connected layers, we use rectified linear unit (ReLU) BIBREF29 activation, except for the final layer which depends on the form of supervision and loss used in training. ### Training
We train the RNN-based embedding models using a set of pre-segmented spoken words. We use two main training approaches, inspired by prior work but with some differences in the details. As in BIBREF13 , BIBREF10 , our first approach is to use the word labels of the training segments and train the networks to classify the word. In this case, the final layer of INLINEFORM0 is a log-softmax layer. Here we are limited to the subset of the training set that has a sufficient number of segments per word to train a good classifier, and the output dimensionality is equal to the number of words (but see BIBREF13 for a study of varying the dimensionality in such a classifier-based embedding model by introducing a bottleneck layer). This model is trained end-to-end and is optimized with a cross entropy loss. Although labeled data is necessarily limited, the hope is that the learned models will be useful even when applied to spoken examples of words not previously seen in the training data. For words not seen in training, the embeddings should correspond to some measure of similarity of the word to the training words, measured via the posterior probabilities of the previously seen words. In the experiments below, we examine this assumption by analyzing performance on words that appear in the training data compared to those that do not. The second training approach, based on earlier work of Kamper et al. BIBREF13 , is to train "Siamese" networks BIBREF30 . In this approach, full supervision is not needed; rather, we use weak supervision in the form of pairs of segments labeled as same or different. The base model remains the same as before—an RNN followed by a set of fully connected layers—but the final layer is no longer a softmax but rather a linear activation layer of arbitrary size. In order to learn the parameters, we simultaneously feed three word segments through three copies of our model (i.e. three networks with shared weights). One input segment is an “anchor", INLINEFORM0 , the second is another segment with the same word label, INLINEFORM1 , and the third is a segment corresponding to a different word label, INLINEFORM2 . Then, the network is trained using a “cos-hinge" loss: DISPLAYFORM0 where INLINEFORM0 is the cosine distance between INLINEFORM1 . Unlike cross entropy training, here we directly aim to optimize relative (cosine) distance between same and different word pairs. For tasks such as query-by-example search, this training loss better respects our end objective, and can use more data since neither fully labeled data nor any minimum number of examples of each word should be needed. ### EXPERIMENTS
Our end goal is to improve performance on downstream tasks requiring accurate word discrimination. In this paper we use an intermediate task that more directly tests whether same- and different-word pairs have the expected relationship. and that allows us to compare to a variety of prior work. Specifically, we use the word discrimination task of Carlin et al. BIBREF20 , which is similar to a query-by-example task where the word segmentations are known. The evaluation consists of determining, for each pair of evaluation segments, whether they are examples of the same or different words, and measuring performance via the average precision (AP). We do this by measuring the cosine similarity between their acoustic word embeddings and declaring them to be the same if the distance is below a threshold. By sweeping the threshold, we obtain a precision-recall curve from which we compute the AP. The data used for this task is drawn from the Switchboard conversational English corpus BIBREF31 . The word segments range from 50 to 200 frames in length. The acoustic features in each frame (the input to the word embedding models INLINEFORM0 ) are 39-dimensional MFCCs+ INLINEFORM1 + INLINEFORM2 . We use the same train, development, and test partitions as in prior work BIBREF13 , BIBREF11 , and the same acoustic features as in BIBREF13 , for as direct a comparison as possible. The train set contains approximately 10k example segments, while dev and test each contain approximately 11k segments (corresponding to about 60M pairs for computing the dev/test AP). As in BIBREF13 , when training the classification-based embeddings, we use a subset of the training set containing all word types with a minimum of 3 occurrences, reducing the training set size to approximately 9k segments. When training the Siamese networks, the training data consists of all of the same-word pairs in the full training set (approximately 100k pairs). For each such training pair, we randomly sample a third example belonging to a different word type, as required for the INLINEFORM0 loss. ### Classification network details
Our classifier-based embeddings use LSTM or GRU networks with 2–4 stacked layers and 1–3 fully connected layers. The final embedding dimensionality is equal to the number of unique word labels in the training set, which is 1061. The recurrent hidden state dimensionality is fixed at 512 and dropout BIBREF32 between stacked recurrent layers is used with probability INLINEFORM0 . The fully connected hidden layer dimensionality is fixed at 1024. Rectified linear unit (ReLU) non-linearities and dropout with INLINEFORM1 are used between fully-connected layers. However, between the final recurrent hidden state output and the first fully-connected layer no non-linearity or dropout is applied. These settings were determined through experiments on the development set. The classifier network is trained with a cross entropy loss and optimized using stochastic gradient descent (SGD) with Nesterov momentum BIBREF33 . The learning rate is initialized at 0.1 and is reduced by a factor of 10 according to the following heuristic: If 99% of the current epoch's average batch loss is greater than the running average of batch losses over the last 3 epochs, this is considered a plateau; if there are 3 consecutive plateau epochs, then the learning rate is reduced. Training stops when reducing the learning rate no longer improves dev set AP. Then, the model from the epoch corresponding to the the best dev set AP is chosen. Several other optimizers—Adagrad BIBREF34 , Adadelta BIBREF35 , and Adam BIBREF36 —were explored in initial experiments on the dev set, but all reported results were obtained using SGD with Nesterov momentum. ### Siamese network details
For experiments with Siamese networks, we initialize (warm-start) the networks with the tuned classification network, removing the final log-softmax layer and replacing it with a linear layer of size equal to the desired embedding dimensionality. We explored embeddings with dimensionalities between 8 and 2048. We use a margin of 0.4 in the cos-hinge loss. In training the Siamese networks, each training mini-batch consists of INLINEFORM0 triplets. INLINEFORM1 triplets are of the form INLINEFORM2 where INLINEFORM3 and INLINEFORM4 are examples of the same class (a pair from the 100k same-word pair set) and INLINEFORM5 is a randomly sampled example from a different class. Then, for each of these INLINEFORM6 triplets INLINEFORM7 , an additional triplet INLINEFORM8 is added to the mini-batch to allow all segments to serve as anchors. This is a slight departure from earlier work BIBREF13 , which we found to improve stability in training and performance on the development set. In preliminary experiments, we compared two methods for choosing the negative examples INLINEFORM0 during training, a uniform sampling approach and a non-uniform one. In the case of uniform sampling, we sample INLINEFORM1 uniformly at random from the full set of training examples with labels different from INLINEFORM2 . This sampling method requires only word-pair supervision. In the case of non-uniform sampling, INLINEFORM3 is sampled in two steps. First, we construct a distribution INLINEFORM4 over word labels INLINEFORM5 and sample a different label from it. Second, we sample an example uniformly from within the subset with the chosen label. The goal of this method is to speed up training by targeting pairs that violate the margin constraint. To construct the multinomial PMF INLINEFORM6 , we maintain an INLINEFORM7 matrix INLINEFORM8 , where INLINEFORM9 is the number of unique word labels in training. Each word label corresponds to an integer INLINEFORM10 INLINEFORM11 [1, INLINEFORM12 ] and therefore a row in INLINEFORM13 . The values in a row of INLINEFORM14 are considered similarity scores, and we can retrieve the desired PMF for each row by normalizing by its sum. At the start of each epoch, we initialize INLINEFORM0 with 0's along the diagonal and 1's elsewhere (which reduces to uniform sampling). For each training pair INLINEFORM1 , we update INLINEFORM2 for both INLINEFORM3 and INLINEFORM4 : INLINEFORM0 The PMFs INLINEFORM0 are updated after the forward pass of an entire mini-batch. The constant INLINEFORM1 enforces a potentially stronger constraint than is used in the INLINEFORM2 loss, in order to promote diverse sampling. In all experiments, we set INLINEFORM3 . This is a heuristic approach, and it would be interesting to consider various alternatives. Preliminary experiments showed that the non-uniform sampling method outperformed uniform sampling, and in the following we report results with non-uniform sampling. We optimize the Siamese network model using SGD with Nesterov momentum for 15 epochs. The learning rate is initialized to 0.001 and dropped every 3 epochs until no improvement is seen on the dev set. The final model is taken from the epoch with the highest dev set AP. All models were implemented in Torch BIBREF37 and used the rnn library of BIBREF38 . ### Results
Based on development set results, our final embedding models are LSTM networks with 3 stacked layers and 3 fully connected layers, with output dimensionality of 1024 in the case of Siamese networks. Final test set results are given in Table TABREF7 . We include a comparison with the best prior results on this task from BIBREF13 , as well as the result of using standard DTW on the input MFCCs (reproduced from BIBREF13 ) and the best prior result using DTW, obtained with frame features learned with correlated autoencoders BIBREF21 . Both classifier and Siamese LSTM embedding models outperform all prior results on this task of which we are aware. We next analyze the effects of model design choices, as well as the learned embeddings themselves. ### Effect of model structure
Table TABREF10 shows the effect on development set performance of the number of stacked layers INLINEFORM0 , the number of fully connected layers INLINEFORM1 , and LSTM vs. GRU cells, for classifier-based embeddings. The best performance in this experiment is achieved by the LSTM network with INLINEFORM2 . However, performance still seems to be improving with additional layers, suggesting that we may be able to further improve performance by adding even more layers of either type. However, we fixed the model to INLINEFORM3 in order to allow for more experimentation and analysis within a reasonable time. Table TABREF10 reveals an interesting trend. When only one fully connected layer is used, the GRU networks outperform the LSTMs given a sufficient number of stacked layers. On the other hand, once we add more fully connected layers, the LSTMs outperform the GRUs. In the first few lines of Table TABREF10 , we use 2, 3, and 4 layer stacks of LSTMs and GRUs while holding fixed the number of fully-connected layers at INLINEFORM0 . There is clear utility in stacking additional layers; however, even with 4 stacked layers the RNNs still underperform the CNN-based embeddings of BIBREF13 until we begin adding fully connected layers. After exploring a variety of stacked RNNs, we fixed the stack to 3 layers and varied the number of fully connected layers. The value of each additional fully connected layer is clearly greater than that of adding stacked layers. All networks trained with 2 or 3 fully connected layers obtain more than 0.4 AP on the development set, while stacked RNNs with 1 fully connected layer are at around 0.3 AP or less. This may raise the question of whether some simple fully connected model may be all that is needed; however, previous work has shown that this approach is not competitive BIBREF13 , and convolutional or recurrent layers are needed to summarize arbitrary-length segments into a fixed-dimensional representation. ### Effect of embedding dimensionality
For the Siamese networks, we varied the output embedding dimensionality, as shown in Fig. FIGREF11 . This analysis shows that the embeddings learned by the Siamese RNN network are quite robust to reduced dimensionality, outperforming the classifier model for all dimensionalities 32 or higher and outperforming previously reported dev set performance with CNN-based embeddings BIBREF13 for all dimensionalities INLINEFORM0 . ### Effect of training vocabulary
We might expect the learned embeddings to be more accurate for words that are seen in training than for ones that are not. Fig. FIGREF11 measures this effect by showing performance as a function of the number of occurrences of the dev words in the training set. Indeed, both model types are much more successful for in-vocabulary words, and their performance improves the higher the training frequency of the words. However, performance increases more quickly for the Siamese network than for the classifier as training frequency increases. This may be due to the fact that, if a word type occurs at least INLINEFORM0 times in the classifier training set, then it occurs at least INLINEFORM1 times in the Siamese paired training data. ### Visualization of embeddings
In order to gain a better qualitative understanding of the differences between clasiffier and Siamese-based embeddings, and of the learned embedding space more generally, we plot a two-dimensional visualization of some of our learned embeddings via t-SNE BIBREF40 in Fig. FIGREF12 . For both classifier and Siamese embeddings, there is a marked difference in the quality of clusters formed by embeddings of words that were previously seen vs. previously unseen in training. However, the Siamese network embeddings appear to have better relative distances between word clusters with similar and dissimilar pronunciations. For example, the word programs appears equidistant from problems and problem in the classifier-based embedding space, but in the Siamese embedding space problems falls between problem and programs. Similarly, the cluster for democracy shifts with respect to actually and especially to better respect differences in pronunciation. More study of learned embeddings, using more data and word types, is needed to confirm such patterns in general. Improvements in unseen word embeddings from the classifier embedding space to the Siamese embedding space (such as for democracy, morning, and basketball) are a likely result of optimizing the model for relative distances between words. ### Conclusion
Our main finding is that RNN-based acoustic word embeddings outperform prior approaches, as measured via a word discrimination task related to query-by-example search. Our best results are obtained with deep LSTM RNNs with a combination of several stacked layers and several fully connected layers, optimized with a contrastive Siamese loss. Siamese networks have the benefit that, for any given training data set, they are effectively trained on a much larger set, in the sense that they measure a loss and gradient for every possible pair of data points. Our experiments suggest that the models could still be improved with additional layers. In addition, we have found that, for the purposes of acoustic word embeddings, fully connected layers are very important and have a more significant effect per layer than stacked layers, particularly when trained with the cross entropy loss function. These experiments represent an initial exploration of sequential neural models for acoustic word embeddings. There are a number of directions for further work. For example, while our analyses suggest that Siamese networks are better than classifier-based models at embedding previously unseen words, our best embeddings are still much poorer for unseen words. Improvements in this direction may come from larger training sets, or may require new models that better model the shared structure between words. Other directions for future work include additional forms of supervision and training, as well as application to downstream tasks. Fig. 1: LSTM-based acoustic word embedding model. For GRUbased models, the structure is the same, but the LSTM cells are replaced with GRU cells, and there is no cell activation vector; the recurrent connections only carry the hidden state vector hlt. Fig. 2: Effect of embedding dimensionality (left) and occurrences in training set (right). Table 1: Final test set results in terms of average precision (AP). Dimensionalities marked with * refer to dimensionality per frame for DTW-based approaches. For CNN and LSTM models, results are given as means over several training runs (5 and 10, respectively) along with their standard deviations. Table 2: Average precision on the dev set, using classifier-based embeddings. S = # stacked layers, F = # fully connected layers. Fig. 3: t-SNE visualization of word embeddings from the dev set produced by the classifier (top) vs. Siamese (bottom) models. Word labels seen at training time are denoted by triangles and word labels unseen at training time are denoted by circles.
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a vector of frame-level acoustic features
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Why does Shannon reach for his gun when Beamish introduces himself?
A. The sound of the chair being pulled back sets him on high alert.
B. He sees that Beamish has something in his hands.
C. Shannon is prone to suspicion after being hunted down by people they owe money to, and thinks Beamish is one of them.
D. Beamish tells them he's there to collect money from them.
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The Blue Behemoth By LEIGH BRACKETT Shannon's Imperial Circus was a jinxed space-carny leased for a mysterious tour of the inner worlds. It made a one-night pitch on a Venusian swamp-town—to find that death stalked it from the jungle in a tiny ball of flame. [Transcriber's Note: This etext was produced from Planet Stories May 1943. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Bucky Shannon leaned forward across the little hexagonal table. He knocked over the pitcher of thil , but it didn't matter. The pitcher was empty. He jabbed me in the breastbone with his forefinger, not very hard. Not hard enough to jar the ribs clean loose, just enough to spring them. "We," he said, "are broke. We are finished, through. Washed up and down the drain." He added, as an afterthought, "Destitute." I looked at him. I said sourly, "You're kidding!" "Kidding." Shannon put his elbows on the table and peered at me through a curtain of very blond hair that was trying hard to be red. "He says I'm kidding! With Shannon's Imperial Circus, the Greatest Show in Space, plastered so thick with attachments...." "It's no more plastered than you are." I was sore because he'd been a lot quicker grabbing the pitcher. "The Greatest Show in Space. Phooey! I've wet-nursed Shannon's Imperial Circus around the Triangle for eleven years, and I know. It's lousy, it's mangy, it's broken-down! Nothing works, from the ship to the roustabouts. In short, it stinks!" I must have had the pitcher oftener than I thought. Nobody insults Buckhalter Shannon's Imperial Circus to Buckhalter Shannon's face unless he's tired and wants a long rest in a comfy fracture-frame. Shannon got up. He got up slowly. I had plenty of time to see his grey-green eyes get sleepy, and hear the quarter-Earth-blood Martian girl wailing about love over by the battered piano, and watch the slanting cat-eyes of the little dark people at the tables swing round toward us, pleased and kind of hungry. I had plenty of time to think how I only weigh one-thirty-seven to Shannon's one-seventy-five, and how I'm not as young as I used to be. I said, "Bucky. Hold on, fella. I...." Somebody said, "Excuse me, gentlemen. Is one of you Mister Buckhalter Shannon?" Shannon put his hands down on his belt. He closed his eyes and smiled pleasantly and said, very gently: "Would you be collecting for the feed bill, or the fuel?" I shot a glance at the newcomer. He'd saved me from a beating, even if he was a lousy bill-collecter; and I felt sorry for him. Bucky Shannon settled his shoulders and hips like a dancer. The stranger was a little guy. He even made me look big. He was dressed in dark-green synthesilk, very conservative. There was a powdering of grey in his hair and his skin was pink, soft, and shaved painfully clean. He had the kind of a face that nice maiden-ladies will trust with their last dime. I looked for his strong-arm squad. There didn't seem to be any. The little guy looked at Shannon with pale blue eyes like a baby, and his voice was softer than Bucky's. He said, "I don't think you understand." I felt cold, suddenly, between the shoulders. Somebody scraped a chair back. It sounded like he'd ripped the floor open, it was so quiet. I got my brassies on, and my hands were sweating. Bucky Shannon sighed, and let his fist start traveling, a long, deceptive arc. Then I saw what the little guy was holding in his hand. I yelled and knocked the table over into Bucky. It made a lot of noise. It knocked him sideways and down, and the little dark men jumped up, quivering and showing their teeth. The Martian girl screamed. Bucky heaved the table off his lap and cursed me. "What's eating you, Jig? I'm not going to hurt him." "Shut up," I said. "Look what he's got there. Money!" The little guy looked at me. He hadn't turned a hair. "Yes," he said. "Money. Quite a lot of it. Would you gentlemen permit me to join you?" Bucky Shannon got up. He grinned his pleasantest grin. "Delighted. I'm Shannon. This is Jig Bentley, my business manager." He looked down at the table. "I'm sorry about that. Mistaken identity." The little guy smiled. He did it with his lips. The rest of his face stayed placid and babyish, almost transparent. I realized with a start that it wasn't transparent at all. It was the most complete dead-pan I ever met, and you couldn't see into those innocent blue eyes any more than you could see through sheet metal. I didn't like him. I didn't like him at all. But he had money. I said, "Howdy. Let's go find a booth. These Marshies make me nervous, looking like hungry cats at a mouse-hole." The little guy nodded. "Excellent idea. My name is Beamish. Simon Beamish. I wish to—ah—charter your circus." I looked at Bucky. He looked hungrier than the Marshies did. We didn't say anything until we got Beamish into a curtained booth with a fresh pitcher of thil on the table. Then I cleared my throat. "What exactly did you have in mind, Mr. Beamish?" Beamish sipped his drink, made a polite face, and put it down. "I have independent means, gentlemen. It has always been my desire to lighten the burden of life for those less fortunate...." Bucky got red around the ears. "Just a minute," he murmured, and started to get up. I kicked him under the table. "Shut up, you lug. Let Mister Beamish finish." He sat down, looking like a mean dog waiting for the postman. Beamish ignored him. He went on, quietly, "I have always held that entertainment, of the right sort, is the most valuable aid humanity can have in its search for the alleviation of toil and boredom...." I said, "Sure, sure. But what was your idea?" "There are many towns along the Venusian frontiers where no entertainment of the— proper sort has been available. I propose to remedy that. I propose to charter your circus, Mister Shannon, to make a tour of several settlements along the Tehara Belt." Bucky had relaxed. His grey-green eyes began to gleam. He started to speak, and I kicked him again. "That would be expensive, Mister Beamish," I said. "We'd have to cancel several engagements...." He looked at me. I was lying, and he knew it. But he said, "I quite understand that. I would be prepared...." The curtains were yanked back suddenly. Beamish shut up. Bucky and I glared at the head and shoulders poking in between the drapes. It was Gow, our zoo-man—a big, ugly son-of-a-gun from a Terran colony on Mercury. I was there once. Gow looks a lot like the scenery—scowling, unapproachable, and tough. His hands, holding the curtains apart, had thick black hair on them and were not much larger than the hams of a Venusian swamp-rhino. He said, "Boss, Gertrude's actin' up again." "Gertrude be blowed," growled Bucky. "Can't you see I'm busy?" Gow's black eyes were unpleasant. "I'm tellin' you, Boss, Gertrude ain't happy. She ain't had the right food. If something...." I said, "That'll all be taken care of, Gow. Run along now." He looked at me like he was thinking it wouldn't take much timber to fit me for a coffin. "Okay! But Gertrude's unhappy. She's lonesome, see? And if she don't get happier pretty soon I ain't sure your tin-pot ship'll hold her." He pulled the curtains to and departed. Bucky Shannon groaned. Beamish cleared his throat and said, rather stiffly, "Gertrude?" "Yeah. She's kind of temperamental." Bucky took a quick drink. I finished for him. "She's the star attraction of our show, Mr. Beamish. A real blue-swamp Venusian cansin . The only other one on the Triangle belongs to Savitt Brothers, and she's much smaller than Gertrude." She was also much younger, but I didn't go into that. Gertrude may be a little creaky, but she's still pretty impressive. I only hoped she wouldn't die on us, because without her we'd have a sicker-looking circus than even I could stand. Beamish looked impressed. "A cansin . Well, well! The mystery surrounding the origin and species of the cansin is a fascinating subject. The extreme rarity of the animal...." We were getting off the subject. I said tactfully, "We'd have to have at least a hundred U.C.'s." It was twice what we had any right to ask. I was prepared to dicker. Beamish looked at me with that innocent dead pan. For a fraction of a second I thought I saw something back of his round blue eyes, and my stomach jumped like it was shot. Beamish smiled sweetly. "I'm not much of a bargainer. One hundred Universal Credits will be agreeable to me." He dragged out a roll as big as my two fists, peeled off half a dozen credit slips, and laid them on the table. "By way of a retainer, gentleman. My attorney and I will call on you in the morning with a contract and itinerary. Good night." We said good night, trying not to drool. Beamish went away. Bucky made grab for the money, but I beat him to it. "Scram," I said. "There are guys waiting for this. Big guys with clubs. Here." I gave him a small-denomination slip I'd been holding out. "We can get lushed enough on this." Shannon has a good vocabulary. He used it. When he got his breath back he said suddenly, "Beamish is pulling some kind of a game." "Yeah." "It may be crooked." "Sure. And he may be screwball and on the level. For Pete's sake!" I yelled. "You want to sit here till we all dry up and blow away?" Shannon looked at me, kind of funny. He looked at the bulge in my tunic where the roll was. He raked back his thick light hair. "Yeah," he said. "I hope there'll be enough left to bribe the jury." He poked his head outside. "Hey, boy! More thildatum !" It was pretty late when we got back to the broken-down spaceport where Shannon's Imperial Circus was crouching beneath its attachments. Late as it was, they were waiting for us. About twenty of them, sitting around and smoking and looking very ugly. It was awfully lonesome out there, with the desert cold and restless under the two moons. There's a smell to Mars, like something dead and dried long past decay, but still waiting. An unhappy smell. The blown red dust gritted in my teeth. Bucky Shannon walked out into the glare of the light at the entrance to the roped-off space around the main lock. He was pretty steady on his feet. He waved and said, "Hiya, boys." They got up off the steps, and the packing cases, and came toward us. I grinned and got into my brassies. We felt we owed those boys a lot more than money. It grates on a man's pride to have to sneak in and out of his own property through the sewage lock. This was the first time in weeks we'd come in at the front door. I waved the money in their faces. That stopped them. Very solemnly, Bucky and I checked the bills, paid them, and pocketed the receipts. Bucky yawned and stretched sleepily. "Now?" he said. "Now," I said. We had a lot of fun. Some of the boys inside the ship came out to join in. We raised a lot of dust and nobody got killed, quite. We all went home happy. They had their money, and we had their blood. The news was all over the ship before we got inside. The freaks and the green girl from Tethys who could roll herself like a hoop, and Zurt the muscle man from Jupiter, and all the other assorted geeks and kinkers and joeys that make up the usual corny carnie were doing nip-ups in the passageways and drooling over the thought of steer and toppings. Bucky Shannon regarded them possessively, wiping blood from his nose. "They're good guys, Jig. Swell people. They stuck by me, and I've rewarded them." I said, "Sure," rather sourly. Bucky hiccoughed. "Let's go see Gertrude." I didn't want to see Gertrude. I never got over feeling funny going into the brute tank, especially at night or out in space. I'm a city guy, myself. The smell and sound of wildness gives me goose bumps. But Bucky was looking stubborn, so I shrugged. "Okay. But just for a minute. Then we go beddy-bye." "You're a pal, Jif. Bes' li'l' guy inna worl'...." The fight had just put the topper on him. I was afraid he'd fall down the ladder and break his neck. That's why I went along. If I hadn't.... Oh, well, what's a few nightmares among friends? It was dark down there in the tank. Way off at the other end, there was a dim glow. Gow was evidently holding Gertrude's hand. We started down the long passageway between the rows of cages and glassed-in tanks and compression units. Our footsteps sounded loud and empty on the iron floor. I wasn't near as happy as Shannon, and my skin began to crawl a little. It's the smell, I think; rank and sour and wild. And the sound of them, breathing and rustling in the dark, with the patient hatred walled around them as strong as the cage bars. Bucky Shannon lurched against me suddenly. I choked back a yell, and then wiped the sweat off my forehead and cursed. The scream came again. A high, ragged, whistling screech like nothing this side of hell, ripping through the musty darkness. Gertrude, on the wailing wall. It had been quiet. Now every brute in the place let go at the same time. My stomach turned clear over. I called Gertrude every name I could think of, and I couldn't hear myself doing it. Presently a great metallic clash nearly burst my eardrums, and the beasts shut up. Gow had them nicely conditioned to that gong. But they didn't quiet down. Not really. They were uneasy. You can feel them inside you when they're uneasy. I think that's why I'm scared of them. They make me feel like I'm not human as I thought—like I wanted to put my back-hair up and snarl. Yeah. They were uneasy that night, all of a sudden.... Gow glared at us as we came up into the lantern light. "She's gettin' worse," he said. "She's lonesome." "That's tough," said Bucky Shannon. His grey-green eyes looked like an owl's. He swayed slightly. "That's sure tough." He sniffled. I looked at Gertrude. Her cage is the biggest and strongest in the tank and even so she looked as though she could break it open just taking a deep breath. I don't know if you've ever seen a cansin . There's only two of them on the Triangle. If you haven't, nothing I can say will make much difference. They're what the brain gang calls an "end of evolution." Seems old Dame Nature had an idea that didn't jell. The cansins were pretty successful for a while, it seems, but something gummed up the works and now there's only a few left, way in the deep-swamp country, where even the Venusians hardly ever go. Living fossils. I wouldn't know, of course, but Gertrude looks to me like she got stuck some place between a dinosaur and a grizzly bear, with maybe a little bird blood thrown in. Anyway, she's big. I couldn't help feeling sorry for her. She was crouched in the cage with her hands—yeah, hands—hanging over her knees and her snaky head sunk into her shoulders, looking out. Just looking. Not at anything. Her eyes were way back in deep horny pits, like cold green fire. The lantern light was yellow on her blue-black skin, but it made the mane, or crest, of coarse wide scales that ran from between her eyes clear down to her flat, short tail, burn all colors. She looked like old Mother Misery herself, from way back before time began. Gow said softly, "She wants a mate. And somebody better get her one." Bucky Shannon sniffled again. I said irritably, "Be reasonable, Gow! Nobody's ever seen a male cansin . There may not even be any." Gertrude screamed again. She didn't move, not even to raise her head. The sadness just built up inside her until it had to come out. That close, the screech was deafening, and it turned me all limp and cold inside. The loneliness, the sheer stark, simple pain.... Bucky Shannon began to cry. I snarled, "You'll have to snap her out of this, Gow. She's driving the rest of 'em nuts." He hammered on his gong, and things quieted down again. Gow stood looking out over the tank, sniffing a little, like a hound. Then he turned to Gertrude. "I saved her life," he said. "When we bought her out of Hanak's wreck and everybody thought she was too hurt to live, I saved her. I know her. I can do things with her. But this time...." He shrugged. He was huge and tough and ugly, and his voice was like a woman's talking about a sick child. "This time," he said, "I ain't sure." "Well for Pete's sake, do what you can. We got a charter, and we need her." I took Shannon's arm. "Come to bed, Bucky darlin'." He draped himself over my shoulder and we went off. Gow didn't look at us. Bucky sobbed. "You were right, Jig," he mumbled. "Circus is no good. I know it. But it's all I got. I love it, Jig. Unnerstan' me? Like Gow there with Gertrude. She's ugly and no good, but he loves her. I love...." "Sure, sure," I told him. "Stop crying down my neck." We were a long way from the light, then. The cages and tanks loomed high and black over us. It was still. The secret, uneasy motion all around us and the scruffing of our feet only made it stiller. Bucky was almost asleep on me. I started to slap him. And then the mist rose up out of the darkness in little lazy coils, sparkling faintly with blue, cold fire. I yelled, "Gow! Gow, the Vapor snakes! Gow—for God's sake!" I started to run, back along the passageway. Bucky weighed on me, limp and heavy. The noise burst suddenly in a deafening hell of moans and roars and shrieks, packed in tight by the metal walls, and above it all I could hear Gertrude's lonely, whistling scream. I thought, " Somebody's down here. Somebody let 'em out. Somebody wants to kill us! " I tried to yell again. It strangled in my throat. I sobbed, and the sweat was thick and cold on me. One of Bucky's dragging, stumbling feet got between mine. We fell. I rolled on top of him, covering his face, and buried my own face in the hollow of his shoulder. The first snake touched me. It was like a live wire, sliding along the back of my neck. I screamed. It came down along my cheek, hunting my mouth. There were more of them, burning me through my clothes. Bucky moaned and kicked under me. I remember hanging on and thinking, "This is it. This is it, and oh God, I'm scared!" Then I went out. II Kanza the Martian croaker, was bending over me when I woke up. His little brown face was crinkled with laughter. He'd lost most of his teeth, and he gummed thak -weed. It smelt. "You pretty, Mis' Jig," he giggled. "You funny like hell." He slapped some cold greasy stuff on my face. It hurt. I cursed him and said, "Where's Shannon? How is he?" "Mis' Bucky okay. You save life. You big hero, Mis' Jig. Mis' Gow come nickuhtime get snakes. You hero. Haw! You funny like hell!" I said, "Yeah," and pushed him away and got up. I almost fell down a couple of times, but presently I made it to the mirror over the washstand—I was in my own cell—and I saw what Kanza meant. The damned snakes had done a good job. I looked like I was upholstered in Scotch plaid. I felt sick. Bucky Shannon opened the door. He looked white and grim, and there was a big burn across his neck. He said: "Beamish is here with his lawyer." I picked up my shirt. "Right with you." Kanza went out, still giggling. Bucky closed the door. "Jig," he said, "those vapor worms were all right when we went in. Somebody followed us down and let them out. On purpose." I hurt all over. I growled, "With that brain, son, you should go far. Nobody saw anything, of course?" Bucky shook his head. "Question is, Jig, who wants to kill us, and why?" "Beamish. He realizes he's been gypped." "One hundred U.C.'s," said Bucky softly, "for a few lousy swampedge mining camps. It stinks, Jig. You think we should back out?" I shrugged. "You're the boss man. I'm only the guy that beats off the creditors." "Yeah," Bucky said reflectively. "And I hear starvation isn't a comfortable death. Okay, Jig. Let's go sign." He put his hand on the latch and looked at my feet. "And—uh—Jig, I...." I said, "Skip it. The next time, just don't trip me up, that's all!" We had a nasty trip to Venus. Gertrude kept the brute tank on edge, and Gow, on the rare occasions he came up for air, went around looking like a disaster hoping to happen. To make it worse, Zurt the Jovian strong-man got hurt during the take-off, and the Mercurian cave-cat had kittens. Nobody would have minded that, only one of 'em had only four legs. It lived just long enough to scare that bunch of superstitious dopes out of their pants. Circus people are funny that way. Shannon and I did a little quiet sleuthing, but it was a waste of time. Anybody in the gang might have let those electric worms out on us. It didn't help any to know that somebody, maybe the guy next to you at dinner, was busy thinking ways to kill you. By the time we hit Venus, I was ready to do a Brodie out the refuse chute. Shannon set the crate down on the edge of Nahru, the first stop on our itinerary. I stood beside him, looking out the ports at the scenery. It was Venus, all right. Blue mud and thick green jungle and rain, and a bunch of ratty-looking plastic shacks huddling together in the middle of it. Men in slickers were coming out for a look. I saw Beamish's sleek yacht parked on a cradle over to the left, and our router's runabout beside it. Bucky Shannon groaned. "A blue one, Jig. A morgue if I ever saw one!" I snarled, "What do you want, with this lousy dog-and-pony show!" and went out. He followed. The gang was converging on the lock, but they weren't happy. You get so you can feel those things. The steamy Venus heat was already sneaking into the ship. While we passed the hatchway to the brute tank, I could hear Gertrude, screaming. The canvasmen were busy setting up the annex, slopping and cursing in the mud. The paste brigade was heading for the shacks. Shannon and I stood with the hot rain running off our slickers, looking. I heard a noise behind me and looked around. Ahra the Nahali woman was standing in the mud with her arms up and her head thrown back, and her triangular mouth open like a thirsty dog. She didn't have anything on but her blue-green, hard scaled hide, and she was chuckling. It didn't sound nice. You find a lot of Nahali people in side-shows, doing tricks with the electric power they carry in their own bodies. They're Venusian middle-swampers, they're not human, and they never forget it. Ahra opened her slitted red eyes and looked at me and laughed with white reptilian teeth. "Death," she whispered. "Death and trouble. The jungle tells me. I can smell it in the swamp wind." The hot rain sluiced over her. She shivered, and the pale skin under her jaw pulsed like a toad's, and her eyes were red. "The deep swamps are angry," she whispered. "Something has been taken. They are angry, and I smell death in the wind!" She turned away, laughing, and I cursed her, and my stomach was tight and cold. Bucky said, "Let's eat if they have a bar in this dump." We weren't half way across the mud puddle that passed as a landing field when a man came out of a shack on the edge of the settlement. We could see him plainly, because he was off to one side of the crowd. He fell on his knees in the mud, making noises. It took him three or four tries to get our names out clear enough to understand. Bucky said, "Jig—it's Sam Kapper." We started to run. The crowd, mostly big unshaken miners, wheeled around to see what was happening. People began to close in on the man who crawled and whimpered in the mud. Sam Kapper was a hunter, supplying animals to zoos and circuses and carnivals. He'd given us good deals a couple of times, when we weren't too broke, and we were pretty friendly. I hadn't seen him for three seasons. I remembered him as a bronzed, hard-bitten guy, lean and tough as a twist of tung wire. I felt sick, looking down at him. Bucky started to help him up. Kapper was crying, and he jerked all over like animals I've seen that were scared to death. Some guy leaned over and put a cigarette in his mouth and lighted it for him. I was thinking about Kapper, then, and I didn't pay much attention. I only caught a glimpse of the man's face as he straightened up. I didn't realize until later that he looked familiar. We got Kapper inside the shack. It turned out to be a cheap bar, with a couple of curtained booths at the back. We got him into one and pulled the curtain in a lot of curious faces. Kapper dragged hard on the cigarette. The man that gave it to him was gone. Bucky said gently, "Okay, Sam. Relax. What's the trouble?" Kapper tried to straighten up. He hadn't shaved. The lean hard lines of his face had gone slack and his eyes were bloodshot. He was covered with mud, and his mouth twitched like a sick old man's. He said thickly, "I found it. I said I'd do it, and I did. I found it and brought it out." The cigarette stub fell out of his mouth. He didn't notice it. "Help me," he said simply. "I'm scared." His mouth drooled. "I got it hidden. They want to find out, but I won't tell 'em. It's got to go back. Back where I found it. I tried to take it, but they wouldn't let me, and I was afraid they'd find it...." He reached suddenly and grabbed the edge of the table. "I don't know how they found out about it, but they did. I've got to get it back. I've got to...." Bucky looked at me. Kapper was blue around the mouth. I was scared, suddenly. I said, "Get what back where?" Bucky got up. "I'll get a doctor," he said. "Stick with him." Kapper grabbed his wrist. Kapper's nails were blue and the cords in his hands stood out like guy wires. "Don't leave me. Got to tell you—where it is. Got to take it back. Promise you'll take it back." He gasped and struggled over his breathing. "Sure," said Bucky. "Sure, well take it back. What is it?" Kapper's face was horrible. I felt sick, listening to him fight for air. I wanted to go for a doctor anyway, but somehow I knew it was no use. Kapper whispered, " Cansin . Male. Only one. You don't know...! Take him back." "Where is it, Sam?" I reached across Bucky suddenly and jerked the curtain back. Beamish was standing there. Beamish, bent over, with his ear cocked. Kapper made a harsh strangling noise and fell across the table. Beamish never changed expression. He didn't move while Bucky felt Kapper's pulse. Bucky didn't need to say anything. We knew. "Heart?" said Beamish finally. "Yeah," said Bucky. He looked as bad as I felt. "Poor Sam." I looked at the cigarette stub smoldering on the table. I looked at Beamish with his round dead baby face. I climbed over Shannon and pushed Beamish suddenly down into his lap. "Keep this guy here till I get back," I said. Shannon stared at me. Beamish started to get indignant. "Shut up," I told him. "We got a contract." I yanked the curtains shut and walked over to the bar. I began to notice something, then. There were quite a lot of men in the place. At first glance they looked okay—a hard-faced, muscular bunch of miners in dirty shirts and high boots. Then I looked at their hands. They were dirty enough. But they never did any work in a mine, on Venus or anywhere else. The place was awfully quiet, for that kind of a place. The bartender was a big pot-bellied swamp-edger with pale eyes and thick white hair coiled up on top of his bullet head. He was not happy. I leaned on the bar. " Lhak ," I said. He poured it, sullenly, out of a green bottle. I reached for it, casually. "That guy we brought in," I said. "He sure has a skinful. Passed out cold. What's he been spiking his drinks with?" " Selak ," said a voice in my ear. "As if you didn't know." I turned. The man who had given Kapper the cigarette was standing behind me. And I remembered him, then.
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C. Shannon is prone to suspicion after being hunted down by people they owe money to, and thinks Beamish is one of them.
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How do they compress the model?
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### Multilingual Models for Sequence Labeling
We discuss two core models for addressing sequence labeling problems and describe, for each, training them in a single-model multilingual setting: (1) the Meta-LSTM BIBREF0 , an extremely strong baseline for our tasks, and (2) a multilingual BERT-based model BIBREF1 . ### Meta-LSTM
The Meta-LSTM is the best-performing model of the CoNLL 2018 Shared Task BIBREF2 for universal part-of-speech tagging and morphological features. The model is composed of 3 LSTMs: a character-BiLSTM, a word-BiLSTM and a single joint BiLSTM which takes the output of the character and word-BiLSTMs as input. The entire model structure is referred to as Meta-LSTM. To set up multilingual Meta-LSTM training, we take the union of all the word embeddings from the bojanowski2017enriching embeddings model on Wikipedia in all languages. For out-of-vocabulary words, a special unknown token is used in place of the word. The model is then trained as usual with cross-entropy loss. The char-BiLSTM and word-biLSTM are first trained independently. And finally we train the entire Meta-LSTM. ### Multilingual BERT
BERT is a transformer-based model BIBREF3 pretrained with a masked-LM task on millions of words of text. In this paper our BERT-based experiments make use of the cased multilingual BERT model available on GitHub and pretrained on 104 languages. Models fine-tuned on top of BERT models achieve state-of-the-art results on a variety of benchmark and real-world tasks. To train a multilingual BERT model for our sequence prediction tasks, we add a softmax layer on top of the the first wordpiece BIBREF4 of each token and finetune on data from all languages combined. During training, we concatenate examples from all treebanks and randomly shuffle the examples. ### Small and Practical Models
The results in Table TABREF1 make it clear that the BERT-based model for each task is a solid win over a Meta-LSTM model in both the per-language and multilingual settings. However, the number of parameters of the BERT model is very large (179M parameters), making deploying memory intensive and inference slow: 230ms on an Intel Xeon CPU. Our goal is to produce a model fast enough to run on a single CPU while maintaining the modeling capability of the large model on our tasks. ### Size and speed
We choose a three-layer BERT, we call MiniBERT, that has the same number of layers as the Meta-LSTM and has fewer embedding parameters and hidden units than both models. Table TABREF7 shows the parameters of each model. The Meta-LSTM has the largest number of parameters dominated by the large embeddings. BERT's parameters are mostly in the hidden units. The MiniBERT has the fewest total parameters. The inference-speed bottleneck for Meta-LSTM is the sequential character-LSTM-unrolling and for BERT is the large feedforward layers and attention computation that has time complexity quadratic to the sequence length. Table TABREF8 compares the model speeds. BERT is much slower than both MetaLSTM and MiniBERT on CPU. However, it is faster than Meta-LSTM on GPU due to the parallel computation of the transformer. The MiniBERT is significantly faster than the other models on both GPU and CPU. ### Distillation
For model distillation BIBREF6 , we extract sentences from Wikipedia in languages for which public multilingual is pretrained. For each sentence, we use the open-source BERT wordpiece tokenizer BIBREF4 , BIBREF1 and compute cross-entropy loss for each wordpiece: INLINEFORM0 where INLINEFORM0 is the cross-entropy function, INLINEFORM1 is the softmax function, INLINEFORM2 is the BERT model's logit of the current wordpiece, INLINEFORM3 is the small BERT model's logits and INLINEFORM4 is a temperature hyperparameter, explained in Section SECREF11 . To train the distilled multilingual model mMiniBERT, we first use the distillation loss above to train the student from scratch using the teacher's logits on unlabeled data. Afterwards, we finetune the student model on the labeled data the teacher is trained on. ### Data
We use universal part-of-speech tagging and morphology data from the The CoNLL 2018 Shared Task BIBREF7 , BIBREF8 . For comparison simplicity, we remove the languages that the multilingual BERT public checkpoint is not pretrained on. For segmentation, we use a baseline segmenter (UDPipe v2.2) provided by the shared task organizer to segment raw text. We train and tune the models on gold-segmented data and apply the segmenter on the raw test of test data before applying our models. The part-of-speech tagging task has 17 labels for all languages. For morphology, we treat each morphological group as a class and union all classes as a output of 18334 labels. ### Tuning
For Meta-LSTM, we use the public repository's hyperparameters. Following devlin2019, we use a smaller learning rate of 3e-5 for fine-tuning and a larger learning rate of 1e-4 when training from scratch and during distillation. Training batch size is set to 16 for finetuning and 256 for distillation. For distillation, we try temperatures INLINEFORM0 and use the teacher-student accuracy for evaluation. We observe BERT is very confident on its predictions, and using a large temperature INLINEFORM1 to soften the distribution consistently yields the best result. ### Multilingual Models
We compare per-language models trained on single language treebanks with multilingual models in Table TABREF1 and Table TABREF14 . In the experimental results we use a prefix INLINEFORM0 to denote the model is a single multilingual model. We compare Meta-LSTM, BERT, and MiniBERT. mBERT performs the best among all multilingual models. The smallest and fastest model, mMiniBERT, performs comparably to mBERT, and outperforms mMeta-LSTM, a state-of-the-art model for this task. When comparing with per-language models, the multilingual models have lower F1. DBLP:journals/corr/abs-1904-02099 shows similar results. Meta-LSTM, when trained in a multilingual fashion, has bigger drops than BERT in general. Most of the Meta-LSTM drop is due to the character-LSTM, which drops by more than 4 points F1. ### Low Resource Languages
We pick languages with fewer than 500 training examples to investigate the performance of low-resource languages: Tamil (ta), Marathi (mr), Belarusian (be), Lithuanian (lt), Armenian (hy), Kazakh (kk). Table TABREF15 shows the performance of the models. While DBLP:journals/corr/abs-1904-09077 shows effective zero-shot crosslingual transfer from English to other high-resource languages, we show that cross-lingual transfer is even effective on low-resource languages when we train on all languages as mBERT is significantly better than BERT when we have fewer than 50 examples. In these cases, the mMiniBERT distilled from the multilingual mBERT yields results better than training individual BERT models. The gains becomes less significant when we have more training data. The multilingual baseline mMeta-LSTM does not do well on low-resource languages. On the contrary, mMiniBERT performs well and outperforms the state-of-the-art Meta-LSTM on the POS tagging task and on four out of size languages of the Morphology task. ### Codemixed Input
We use the Universal Dependencies' Hindi-English codemixed data set BIBREF9 to test the model's ability to label code-mixed data. This dataset is based on code-switching tweets of Hindi and English multilingual speakers. We use the Devanagari script provided by the data set as input tokens. In the Universal Dependency labeling guidelines, code-switched or foreign-word tokens are labeled as X along with other tokens that cannot be labeled. The trained model learns to partition the languages in a codemixed input by labeling tokens in one language with X, and tokens in the other language with any of the other POS tags. It turns out that the 2nd-most likely label is usually the correct label in this case; we evaluate on this label when the 1-best is X. Table TABREF25 shows that all multilingual models handle codemixed data reasonably well without supervised codemixed traininig data. ### Conclusion
We have described the benefits of multilingual models over models trained on a single language for a single task, and have shown that it is possible to resolve a major concern of deploying large BERT-based models by distilling our multilingual model into one that maintains the quality wins with performance fast enough to run on a single CPU. Our distilled model outperforms a multilingual version of a very strong baseline model, and for most languages yields comparable or better performance to a large BERT model. ### Training Hyperparameters
We use exactly the same hyperparameters as the public multilingual BERT for finetuning our models. We train the part-of-speech tagging task for 10 epochs and the morphology task for 50 epochs. For distillation, we use the following hyperparameters for all tasks. learning rate: 1e-4 temperature: 3 batch size: 256 num epochs: 24 We take the Wikipedia pretraining data as is and drop sentences with fewer than 10 characters. ### Small BERT structure
We use the vocab and wordpiece model included with the cased public multilingual model on GitHub. We use the BERT configuration of the public multilingual BERT with the following modifications for mMiniBERT. Hidden size = 256 Intermediate layer size = 1024 Num attention heads = 4 Layers = 3 ### The Importance of Distillation
To understand the importance of distillation in training mMiniBERT, we compare it to a model with the MiniBERT structure trained from scratch using only labeled multilingual data the teacher is trained on. Table TABREF37 shows that distillation plays an important role in closing the accuracy gap between teacher and student. ### Per-Language Results
We show per-language F1 results of each model in Table SECREF38 and Table SECREF38 . For per-language models, no models are trained for treebanks without tuning data, and metrics of those languages are not reported. All macro-averaged results reported exclude those languages. lccccc treebankBERTMeta-LSTMmBERT mMeta-LSTM mMiniBERT af_afribooms97.6297.6397.4993.1696.08 am_att3.285.63.16 ar_padt90.4690.5590.328990.06 ar_pud71.5968.9671.06 be_hse94.8191.0595.0287.5994.95 bg_btb99.0198.7798.7296.4398.19 ca_ancora98.8498.6298.7797.5798.45 cs_cac99.1799.4399.398.4698.48 cs_cltt87.4887.2587.6787.6287.53 cs_fictree98.6298.6398.2597.297.18 cs_pdt99.0699.0798.9998.2298.61 cs_pud97.1396.5397 da_ddt97.5997.4797.1892.3695.93 de_gsd94.8194.1794.5391.9493.82 de_pud88.7687.4288.7 el_gdt97.9797.497.9194.8797.16 en_ewt95.8295.4595.292.2494.19 en_gum96.2295.0294.7992.3394.24 en_lines97.2296.8195.7993.9695.25 en_partut96.1195.995.0293.2994.61 es_ancora98.8798.7898.1796.2797.8 es_gsd93.793.989.6590.6189.58 es_pud85.8786.185.71 et_edt97.2797.1797.0294.3295.64 eu_bdt96.296.195.5191.5394.15 fa_seraji97.5797.1797.1795.2996.92 fi_ftb96.2696.1293.1587.2389.79 fi_pud95.5593.2395.01 fi_tdt96.8197.0293.991.5892.6 fr_gsd96.6296.4596.2395.3796.05 fr_partut96.189695.4394.3594.93 fr_pud90.7790.190.64 fr_sequoia96.7797.5997.0795.9196.75 fr_spoken97.5595.7896.190.0793.25 ga_idt91.9291.5590.8384.1685.72 gl_ctg96.9997.2196.592.8795.84 gl_treegal93.491.2891.9 he_htb82.7682.4982.6980.9381.93 hi_hdtb97.3197.3997.196.296.43 hi_pud86.4885.3385.68 hr_set97.7997.9497.4796.2497.2 hu_szeged96.5194.7195.9985.595.47 hy_armtdp84.4286.6263.8286.98 id_gsd93.0693.3793.390.8193.35 id_pud63.5263.563.33 it_isdt98.3398.0698.2796.797.8 it_partut98.1298.1798.0996.9998.06 it_postwita95.6695.8695.694.1793.2 it_pud93.8492.7293.67 ja_gsd88.6388.7388.5487.0388.43 ja_modern41.5551.2621.61 ja_pud89.1587.9689.3 kk_ktb75.9361.781.3652.9180.06 ko_gsd95.9295.6490.386.3988.62 ko_kaist95.5695.4293.8687.4693.43 ko_pud41.9346.1131.96 la_ittb98.3498.4298.397.1897.65 la_perseus89.9183.8585.23 la_proiel96.3496.3795.9792.0293.78 lt_hse88.8881.4390.0165.686.9 lv_lvtb94.7994.4793.7188.2591.3 mr_ufal77.4572.175.9265.4875.41 nl_alpino97.196.1697.3393.7896.19 nl_lassysmall95.5495.9295.7294.495.47 no_bokmaal989897.9595.2797.04 no_nynorsklia94.0888.2792.55 no_nynorsk97.9497.9297.6994.9196.59 pl_lfg98.798.598.3995.2197.48 pl_sz98.5697.9198.0594.7397.29 pt_bosque96.7496.7396.1695.5395.85 pt_gsd95.8395.4493.8493.0794.44 pt_pud89.4889.6689.29 ro_nonstandard94.6794.489492.0591.9 ro_rrt97.6397.5297.4795.7896.71 ru_gsd92.2391.3990.8488.1390.14 ru_pud89.788.9289.52 ru_syntagrus98.398.6598.3297.1398.03 ru_taiga93.6292.7593.18 sa_ufal32.4729.5827.11 sk_snk97.0896.3296.9893.6196.35 sl_ssj97.0796.6896.8994.2495.58 sl_sst94.5190.3491.79 sr_set98.6398.3398.3194.7997.36 sv_lines97.2196.5996.9993.6495.57 sv_pud94.5292.0694.32 sv_talbanken98.0397.3497.7794.9196.76 ta_ttb75.7172.774.2861.5174.6 te_mtg94.2592.7293.4287.3293.42 th_pud2.372.731.54 tl_trg70.6928.6268.28 tr_imst93.9694.0393.184.6491.8 tr_pud73.168.3672.47 uk_iu97.2996.697.289396.88 ur_udtb93.8393.8793.699393.05 vi_vtb77.6776.4277.4472.0177.06 yo_ytb43.4830.8534.59 zh_cfl49.8339.7749.42 zh_gsd87.685.785.9682.7686.08 zh_hk66.2957.8865.86 zh_pud83.373.382.95 POS tagging F1 of all models. lccccc treebankBERT F1Meta-LSTM F1mBERT F1mMeta-LSTM F1mMiniBERT F1 af_afribooms97.1197.3696.5388.9893.75 am_att32.3632.36 ar_padt88.2688.2487.7683.1485.34 ar_pud36.3334.2836.08 be_hse82.8374.0387.5259.1681.82 bg_btb97.5497.5897.4791.4195.4 ca_ancora98.3798.2198.2896.0497.67 cs_cac96.3396.4996.5488.1193.47 cs_cltt81.6179.8983.8678.8280.61 cs_fictree96.3996.494.0983.3787.59 cs_pdt97.1896.9197.1589.7794.63 cs_pud93.8887.4491.81 da_ddt97.2297.0895.6289.8294.08 de_gsd90.8490.5890.480.6988.99 de_pud30.4130.5530.4 el_gdt94.5793.9594.8387.692.07 en_gum96.879693.7990.1193.71 en_lines97.3296.6893.1187.4992.07 en_partut94.8895.3890.7679.9990.18 en_pud93.2591.2393.1 es_ancora98.4598.4297.695.1797 es_gsd93.5293.7288.7289.2688.78 es_pud52.752.852.73 et_edt96.1496.1195.7890.5192.14 eu_bdt93.2792.5692.6776.7284.53 fa_seraji97.3597.2596.9193.8296.28 fi_ftb96.3496.4892.3277.8986.47 fi_pud93.5891.1291.65 fi_tdt95.0395.5890.9688.4487.48 fr_gsd96.0596.1194.6786.9794.51 fr_partut93.3292.9388.987.4887.05 fr_pud59.1557.558.94 fr_sequoia97.0997.1391.5485.2390.74 fr_spoken10010098.6280.6796.67 ga_idt82.281.7881.263.4466.82 gl_ctg98.9898.9595.2789.9895.1 gl_treegal80.0568.7375.97 he_htb81.2780.8580.7976.8978.74 hi_hdtb93.3293.8592.9189.0990.65 hi_pud22.122.3722.03 hr_set91.9991.8591.2481.6287.81 hu_szeged93.6591.2892.9371.2587.36 hy_armtdp41.1354.4551.0836.5946.43 id_gsd94.849694.8591.6294.39 id_pud39.8342.7939.79 it_isdt97.797.8297.8795.4797.37 it_partut97.3597.7398.0196.3397.9 it_postwita95.6296.0595.0391.5293.17 it_pud57.8257.4157.6 ja_gsd90.2990.4590.2990.3990.41 ja_modern63.961.1763.99 ja_pud57.457.2657.27 kk_ktb64.625.5559.49 ko_gsd99.6299.5599.498.9999.37 ko_kaist10010099.9499.2499.93 ko_pud38.3338.6638.27 la_ittb96.796.9497.1590.7893.91 la_perseus82.0964.7372.24 la_proiel90.8291.0191.5179.0883.99 lt_hse75.2169.6573.6142.5165.22 lv_lvtb88.6191.3488.179.1181.91 mr_ufal63.9559.1164.233.6354.01 nl_alpino96.2296.1396.5391.995.67 nl_lassysmall96.4696.0295.5592.1695.28 no_bokmaal96.8597.1396.4891.1795.31 no_nynorsklia94.2289.5691.08 no_nynorsk96.797.0496.4992.1294.79 pl_lfg95.8594.6884.9647.9984.56 pl_sz93.991.9371.473.0265.36 pt_bosque96.2796.1687.0483.1385.72 pt_gsd97.295.3367.7276.0171.88 pt_pud52.0649.7950.95 ro_nonstandard88.5288.9186.8982.182.14 ro_rrt97.0297.2396.5893.294.85 ru_gsd88.8386.7381.4464.278.93 ru_pud37.9735.2637.49 ru_syntagrus97.0296.995.9991.9694.33 ru_taiga88.5684.0286.01 sa_ufal15.916.1416.33 sk_snk92.0689.6391.5868.2585.29 sl_ssj94.3993.7894.4182.6989.23 sl_sst88.4691.8978.2285.59 sr_set94.8394.7192.7973.5190.48 sv_lines89.5489.5588.6683.2786.4 sv_pud77.3973.9476.79 sv_talbanken96.9296.5696.1390.2394.49 ta_ttb72.9171.0173.7546.970.22 te_mtg98.9698.9698.5498.6898.54 th_pud8.2708.43 tl_trg29.3128.6225.17 tr_imst89.59188.6373.2381.99 tr_pud23.7223.8423.46 uk_iu92.490.9892.6479.4988.79 ur_udtb82.2483.7282.6481.8982.48 vi_vtb83.748483.9383.5883.94 yo_ytb58.7886.8261.88 zh_cfl46.5543.5545.73 zh_gsd87.6488.3888.3187.0588.5 zh_hk66.3364.9766.23 zh_pud86.3583.686.14 Morphology F1 of all models. Table 1: Macro-averaged F1 comparison of per-language models and multilingual models over 48 languages. For non-multilingual models, F1 is the average over each per-language model trained. Table 2: The number of parameters of each model. Tokens refers to the number of tokens of the embedding rows. For the Meta-LSTM, a word-based model, this is the number of words in training. For BERT, this means the size of the Wordpiece vocabulary. And Hidden Units refers to all units that are not among the embedding layer or and output layer. Table 3: Relative inference speedup over BERT. We see MiniBERT is the fastest on both CPU and GPU. CPU is an Intel Xeon CPU E5-1650 v3 @3.50GHz. GPU is an Nvidia Titan V. Table 4: Macro-averaged F1 comparison of multilingual models. Multilingual models are prefixed with ‘m’. Table 5: POS tagging and Morphology F1 for all models on low-resource languages. Multilingual models are prefixed with ‘m’. Table 6: F1 score on Hindi-English codemixed POS tagging task. Each multilingual model is within 10 points of the supervised BERT model without having explicitly seen code-mixed data. Table 7: Ablation study to show the effect of distillation. The model without distillation has 3.5 points lower macro-averaged F1 on the part-of-speech task and 3.1 lower F1 on the morphology task. Table 8: POS tagging F1 of all models.
|
we extract sentences from Wikipedia in languages for which public multilingual is pretrained. For each sentence, we use the open-source BERT wordpiece tokenizer BIBREF4 , BIBREF1 and compute cross-entropy loss for each wordpiece: INLINEFORM0
|
Which imaging study, done on 01/04/20, indicated progression of Mr. Hurley's tuberculosis?
Choose the correct answer from the following options:
A. Neck Ultrasound
B. Chest CT
C. Neck/Thorax/Abdomen/Pelvis CT
D. Abdominal CT
E. Chest X-ray
|
### Patient Report 0
**Dear colleague, **
We are reporting on Mr. Bruno Hurley, born on 12/24/1965, who has been
under our outpatient treatment since 02/11/2020.
**Diagnoses:**
- Refractory tuberculosis
- Manifestations: Open pulmonary tuberculosis, lymph node tuberculosis
(cervical, hilar, mediastinal), liver tuberculosis
**Imaging:**
- 11/01/19 Chest CT: Mediastinal lymph node conglomerate centrally
with poststenotic infiltrates on both sides. Splenomegaly.
- 11/04/19 Bronchoscopy: Large mediastinal and right hilar lymphomas.
Subcritical constriction of right segmental bronchi. EBUS-TBNA LK4R
and 10/11R.
**Microbiology:**
- 11/04/19 Tracheobronchial Secretions: Microscopic detection of
acid-fast rods, cultural detection of Mycobacterium tuberculosis,
phenotypically no evidence of resistance.
**Therapy:**
- Initial omission of pyrazinamide due to pancytopenia.
- Moxifloxacin: 11/10/19-11/20/19
- Pyrazinamide: 11/20/19-02/11/20
- Ethambutol: 11/08/19-02/11/20
- Rifampicin since: 11/08/19
- Isoniazid since: 11/08/19
- Levofloxacin since: 02/11/20
- Immunomodulatory therapy for low basal interferon / interferon
levels (ACTIMMUNE®)
**Microbiology:**
- 01/20/20 Sputum: Cultural detection of Mycobacterium tuberculosis:
Phenotypically no evidence of resistance.
- 01/02/20 Sputum: Last cultural detection of Mycobacterium
tuberculosis.
- 06/15/20 BAL: Occasional acid-fast rods, 16S-rRNA-PCR: M.
tuberculosis complex, no cultural evidence of Mycobacteria.
- 06/15/20 Lung biopsy: Occasional acid-fast rods, no cultural
evidence of Mycobacteria.
- 03/12/21 Sputum: first sputum without acid-fast rods, consistently
microscopically negative sputum samples since then.
**Histology:**
- 07/16/21: Mediastinal lymph node biopsy: Histologically no evidence
of malignancy/lymphoma.
**Other Diagnoses: **
- Secondary Acute Myeloid Leukemia with Myelodysplastic Syndrome
- Blood count at initial diagnosis: 15% blasts, erythrocyte
substitution required.
**Therapy:**
- 12/20-03/21 TB therapy
- 02/20-01/21 TB therapy: RMP + INH + FQ
- 01/21-04/21 RMP + INH + FQ + Actimmune® 04/22 CT: Regressive
findings of pulmonary TB changes, regressive cervical lymph nodes,
mediastinal LAP, and liver lesions size-stable; Sputum: No acid-fast
rods detected for the first time since 03/21.
- BM aspiration: Secondary AML.
**Current Presentation:** Admission for allogeneic stem cell
transplantation
Pathogen Location / Material of Detection or Infection Month/Year or
Last Detection
- HIV Serology: Negative - 11/19
- Mycobacterium tuberculosis Complex: Bronchoalveolar Lavage,
Tracheobronchial Secretion, Sputum - 11/19
**Medical History:** We took over Mr. Hurley for the continuation of TB
therapy on 11/02/20. His hospital admission took place at the end of
October 2019 due to neutropenic fever. The patient reported temperatures
up to 39°C for the past 3 days. Since 08/19, the patient has been
receiving hematological-oncological treatment for MDS. The colleagues
from hematology performed a repeat bone marrow aspiration before
transferring to Station 12. The blast percentage was significantly
reduced. HLA typing of the brother for allogeneic stem cell
transplantation planning had already been done in the summer of 2019.
After a chest CT revealed extensive mediastinal lymphomas with
compression of the bronchial tree bilaterally and post-stenotic
infiltrates, a bronchoscopy was performed. M. tuberculosis was cultured
from sputum and TBS. An EBUS-guided lymph node biopsy was histologically
processed, revealing granulomatous inflammation and molecular evidence
of the M. tuberculosis complex. On 11/08/19, a four-drug
anti-tuberculosis therapy was initiated, initially with Moxifloxacin
instead of Pyrazinamide due to pancytopenia. Moxifloxacin was replaced
by Pyrazinamide on 11/20/19. The four-drug therapy was continued for a
total of 3 months due to prolonged microscopic evidence of acid-fast
rods in follow-up sputum samples. Isoniazid dosage was adjusted after
peak level control (450 mg q24h), as was Rifampicin dose (900 mg q24h).
On 01/02/20, Mycobacterium tuberculosis was last cultured in a sputum
sample. Nevertheless, acid-fast rods continued to be detected in the
sputum. Due to the lack of culturability of mycobacteria, Mr. Hurley was
discharged to home care after consultation with the Tuberculosis Welfare
Office.
**Allergies**: None known. Toxic Substances: Smoking: Non-smoker;
Alcohol: No; Drugs: No
**Social History:** Originally from Brazil, has been living in the US
for 8 years. Lives with his partner.
**Current lab results:**
**Parameter** **Results** **Reference Range**
---------------------------------------- -------------- ---------------------
ConA-Induced Cytokines (Th1/Th2)
Interleukin 10 10 pg/mL \< 364 pg/mL
Interferon Gamma 265-6781 pg/mL
Interleukin 2 74 pg/mL 43-374 pg/mL
Interleukin 4 13 pg/mL \< 34 pg/mL
Interleukin 5 3 pg/mL \< 55 pg/mL
Naive CD45RA+CCR7+ (% of CD8+) 6.35 % 8.22-59.58 %
TEMRA CD45RA+CCR7- (% of CD8+) 50.44 % 7.32-55.99 %
Central Memory CD45RA-CCR7+ (% of CD) 2.60 % 1.67-5.84 %
Effector Memory CD45RA-CCR7- (% of CD) 40.60 % 22.52-62.25 %
Naive CD45RA+ (% of CD4+) 26.26 % 17.46-60.24 %
TEMRA CD45RA+ CCR7- (% of CD4+) 1.26 % 2.74-15.54 %
Central Memory CD45RA-CCR7+ (% of CD) 34.21 % 16.40-33.41 %
Effector Memory CD45RA-CCR7- (% of CD) 38.28 % 17.38-40.38 %
Granulocytes 0.60 abs./nL 3.00-6.50 abs./nL
Granulocytes (relative) 45 % 50-80 %
Lymphocytes 0.57 abs./nL 1.50-3.00 abs./nL
Lymphocytes (relative) 43 % 20-40 %
Monocytes 0.13 abs./nL \<0.50 abs./nL
Monocytes (relative) 10 % 2-10 %
NK Cells 0.16 abs./nL 0.10-0.40 abs./nL
NK Cells (% of Lymphocytes) 29 5-25
γ/δ TCR+ T-Cells (relative) 2 % \< 10 %
α/β TCR+ T-Cells (relative) 98 % \>90 %
CD19+ B-Cells (% of Lymphocytes) 3 % 5-25 %
CD4/CD8 Ratio 0.9 % 1.1-3.0 %
CD8-CD4-T-Cells (% of T-Cells) 5.86 % \< 15.00 %
CD8+CD4+-T-Cells (% of T-Cells) 0.74 % \< 10.00 %
CD3+ T-Cells 0.38 abs./nL 0.90-2.20 abs./nL
**Parameter** **Results** **Reference Range**
-------------------------------------------------- ---------------- ---------------------
Complete Blood Count (EDTA)
Hemoglobin 6.6 g/dL 13.5-17.0 g/dL
Hematocrit 19.0 % 39.5-50.5 %
Erythrocytes 2.3 x 10\^6/uL 4.3-5.8 x 10\^6/uL
Platelets 61 x 10\^3/uL 150-370 x 10\^3/uL
MCV (Mean Corpuscular Volume) 81.5 fL 80.0-99.0 fL
MCH (Mean Corpuscular Hemoglobin) 28.3 pg 27.0-33.5 pg
MCHC (Mean Corpuscular Hemoglobin Concentration) 34.7 g/dL 31.5-36.0 g/dL
MPV (Mean Platelet Volume) 10.4 fL 7.0-12.0 fL
RDW-CV (Red Cell Distribution Width-CV) 12.7 % 11.5-15.0 %
**Parameter** **Results** **Reference Range**
-------------------------- ------------- ---------------------
Other Investigations
QFT-TB Gold plus TB1 0.11 IU/mL \<0.35 IU/mL
QFT-TB Gold plus TB2 0.07 IU/mL \<0.35 IU/mL
QFT-TB Gold plus Mitogen 3.38 IU/mL \>0.50 IU/mL
QFT-TB Gold plus Result Negative
**Lung Aspiration from 06/15/20:** Examination Request: Acid-fast rods
(Microscopy + Culture) **Microscopic Findings:**
- Auramine stain: Occasionally, acid-fast rods Result: No growth of
Mycobacterium sp. after 12 weeks of incubation.
2. Forceps Biopsy Exophytic Trachea: One piece of tissue. Microscopy:
HE, PAS, Giemsa, Diagnosis:
3. Predominantly blood clot and necrotic material alongside sparsely
altered lymphatic tissue due to sampling (EBUS-TBNA LK 7 as
indicated).
4. Components of a granulation tissue polyp (Forceps Biopsy Exophytic
Trachea as indicated). Comment: The finding in 1. continues to be
suspicious of a mycobacterial infection. We are conducting molecular
pathological examinations in this regard and will report again.
> [Comment]{.underline}: Detection of mycobacterial DNA of the M.
> tuberculosis complex type. No evidence of atypical mycobacteria. No
> evidence of malignancy.
**Current Medication:**
**Medication** **Dosage** **Frequency**
------------------------- ------------ ---------------
Rifampin (Rifadin) 600 mg 1-0-0
Isoniazid (Nydrazid) 500 mg 1-0-0
Levofloxacin (Levaquin) 450 mg 1-0-1
**\
**
### Patient Report 1
**Dear colleague, **
We report to you about our patient Mr. Bruno Hurley, born on 12/24/1965.
Who has received inpatient treatment from 07/17/2021 to 09/03/2021.
**Diagnoses**:
- Acute Myeloid Leukemia with Myelodysplasia-Related Changes (AML-MRC)
<!-- -->
- Myelodysplastic Syndrome EB-2, diagnosed in July 2010. Blood count
at initial diagnosis: 15% blasts, erythrocyte transfusion-dependent.
Cytogenetics: 46,XY \[1\]; 47,XY,+Y,i(21)(q10)\[15\];
47,XY,+Y,trp(21)(q11q22)\[4\]. Molecular genetics: Mutations in
RUNX1, SF3B1. IPSS-R: 7 (very high risk).
- In 08/2020, diagnosed with Myelodysplastic Syndrome with ring
sideroblasts.
- Received transfusions of 2 units of red blood cells every 3-4 weeks
to maintain hemoglobin between 4-6 g/dL.
- Bone marrow biopsy showed MDS-EB2 with 14.5% blasts.
- Initiated Azacitidine treatment (2x 75 mg subcutaneously, days 1-5 +
8-9 every 4 weeks) as an outpatient.
- 10/23/2019: Hospitalized for fever during neutropenia.
- 12/06/2019: Diagnosed with tuberculosis - positive Tbc-PCR in
tracheobronchial secretions, acid-fast bacilli in tracheobronchial
secretions, histological confirmation from EBUS biopsy of a
conglomerate of melted lymph nodes from 11/03/2019.
- 01/2021: Bone marrow biopsy showed secondary AML with 26% blasts.
- 03/2021: Started Venetoclax/Vidaza.
- 05/2021: Bone marrow biopsy showed 0.8% myeloid blasts coexpressing
CD117 and CD7. Cytology showed 6% blasts.
- 05/2021: Started the 4th cycle of Vidaza/Venetoclax.
- 06/17/2022: Started the 5th cycle of Vidaza/Venetoclax.
- 07/29/2021: Underwent allogeneic stem cell transplantation from a
HLA-identical unrelated donor (10/10 antigen match) for AML-MRC in
first complete remission (CR). Conditioning regimen included
Treosulfan 12g/m2, Fludarabin 5x 30 mg/m2, ATG 3x 10 mg/kg.
**Other Diagnoses:**
- Persistent tuberculosis with lymph node swelling since June 2020.
- Open lung tuberculosis diagnosed in November 2019.
- Location: CT of the chest showed central mediastinal lymph node
conglomerate with post-stenotic infiltrates bilaterally,
splenomegaly.
- Bronchoscopy on December 5, 2020, showed large mediastinal and
right hilar lymph nodes, subcritical narrowing of right
segmental bronchi. EBUS-TBNA
- CT Chest/Neck on 02/05/2020: Regression of pulmonary
infiltrates, enlargement of necrotic lymph nodes in the upper
mediastinum and infraclavicular on the right (compressing the
internal jugular vein/esophagus).
- Culture confirmation of Mycobacterium tuberculosis,
pansensitive: Tracheobronchial secretion
- Initiated antituberculous combination therapy
**Current Presentation:** Admission for allogeneic stem cell
transplantation from a HLA-identical unrelated donor (10/10 antigen
match) for AML-MRC in first complete remission.
**Medical History:** In 2019, Mr. Hurley was diagnosed with
Myelodysplastic Syndrome EB-2. Starting from September 2019, he received
Azacitidine therapy. In December 2020, he was diagnosed with open lung
tuberculosis, which was challenging to treat due to his dysfunctional
immune system. In January 2021, his MDS progressed to AML-MRC with 26%
blasts. After treatment with Venetoclax/Vidaza, he achieved remission in
May 2021. Tuberculosis remained largely under control.
Due to AML-MRC, he was recommended for allogeneic stem cell
transplantation from a HLA-identical unrelated donor. At the time of
admission for transplantation, he was largely asymptomatic. He
occasionally experienced mild dry cough but denied fever, night sweats,
or weight loss. The admission and counseling were conducted with
translation assistance from his life partner due to limited proficiency
in English.
**Allergies**: None
**Transfusion History**: Currently requires transfusions every 14 days.
Both red blood cell and platelet transfusions have been tolerated
without problems.
**Abdominal CT from 01/20/2021:**
**Findings**: Significant peripancreatic fluid accumulation in the upper
abdominal area with a somewhat indistinct border between the pancreatic
tissue, particularly in the pancreatic head region. Evidence of
inflammation affecting the stomach and duodenum. No presence of free air
or indications of hollow organ perforation. No conclusive signs of a
well-defined abscess. Moreover, the other parenchymal abdominal organs,
especially those lacking focal abnormalities suggestive of neoplastic or
inflammatory conditions, displayed normal appearances. The gallbladder
showed no notable issues, and there were no radiopaque concretions
observed. Both the intra- and extrahepatic bile ducts appeared
adequately dilated. Abdominal hollow organs exhibited unremarkable and
normal appearances without corresponding contrast and dilation. The
appendix appeared within normal parameters. Abdominal lymph nodes showed
no unusual findings. Some degree of aortic vasosclerosis was noted. The
depiction of the included lung portions revealed no abnormalities.
**Results**: Findings indicative of acute pancreatitis, most likely of
an exudative nature. No signs of hollow organ perforation were detected,
and there was no definitive evidence of an abscess (as far as could be
determined from native imaging).
**Summary**: The patient was admitted to our hospital through the
emergency department with the symptoms described above. With typical
upper abdominal pain and significantly elevated serum lipase levels, we
diagnosed acute pancreatitis. This diagnosis was corroborated by
peripancreatic fluid and ill-defined organ involvement in the abdominal
CT scan. There were no laboratory or anamnestic indications of a biliary
origin. The patient denied excessive alcohol consumption.
**Medication upon Admission:**
**Medication** **Dosage** **Frequency**
------------------------- ------------ ---------------
Rifampin (Rifadin) 600 mg 1-0-0
Isoniazid (Nydrazid) 500 mg 1-0-0
Levofloxacin (Levaquin) 450 mg 1-0-1
**Physical Examination:** General: Oriented in all qualities, in good
general condition with normal body weight (75 kg, 187 cm) Vital signs at
admission: Heart rate 63/min, Blood pressure 110/78 mmHg. Temperature at
admission 36.8 °C, Oxygen saturation 100% on room air. Skin and mucous
membranes: Dry skin, normal skin color, normal skin turgor. No scleral
icterus, non-irritated conjunctiva. Normal oral mucosa, moist tongue
without coating, no ulcers or thrush. Heart: Normal heart sounds,
rhythmic, regular rate, no pathological heart murmurs heard on
auscultation. Lungs: Resonant percussion sound, clear breath sounds
bilaterally, no wheezing, no prolonged expiration. Abdomen: Unremarkable
scar tissue, normal bowel sounds in all quadrants, soft, non-tender, no
guarding, liver and spleen not enlarged. Vascular: Central and
peripheral pulses palpable, no jugular vein distention, no peripheral
edema, extremities warm with no significant difference in size. Lymph
nodes: Palpable cervical swelling, inguinal and axillary lymph nodes
unremarkable. Neurology: Grossly neurologically unremarkable.
On 08/22/2021, a four-lumen central venous catheter was placed in the
right internal jugular vein without complications. During the
conditioning regimen, the patient received the following:
**Medication** **Dosage** **Frequency**
---------------------------------------------- ---------------------- -------------------------
Fludarabine (Fludara) 30 mg/m² (5x 57 mg) 07/23/2023 - 07/27/2023
Treosulfan (Ovastat) 12 g/m² (3x 22.9 g) 07/23/2023 - 07/25/2023
Anti-Thymocyte Globulin (ATG, Thymoglobulin) 10 mg/kg (3x 700 mg) 07/23/2023 - 07/28/2023
**Antiemetic Therapy:**
The antiemetic therapy included Ondansetron, Aprepitant, and
Dexamethasone, and the conditioning regimen was well tolerated.
**Prophylaxis of Graft-Versus-Host Disease (GvHD):**
**Substances** **Start Date** **Day -2** **Day 1**
---------------- ---------------- ------------ -----------
Cyclosporine 08/28/2022
Mycophenolate 07/30/2021
**Stem Cell Source** **Date** **CD34/kg KG** **CD45/kg KG** **CD3/kg KG** **Volume**
---------------------- ------------ ---------------- ---------------- --------------- ------------
PBSCT 07/29/2021 7.39 x10\^6 8.56 x10\^8 260.7 x10\^6 194 ml
**Summary:** Mr. Hurley was admitted for allogeneic stem cell
transplantation from a HLA-identical unrelated donor for AML-MRC. The
conditioning regimen with Treosulfan, Fludarabin, and ATG was well
tolerated, and the transplantation proceeded without complications.
**Toxicities:** There was an adverse event-related increase in bilirubin
levels, reaching a maximum of 2.68 mg/dL. Elevated ALT levels, up to a
maximum of 53 U/L, were observed.
**Acute Graft-Versus-Host Disease (GvHD):** Signs of GvHD were not
observed until the time of discharge.
**Medication upon Discharge:**Formularbeginn
**Medication ** **Dosage** **Frequency**
---------------------------------- ------------ ------------------------------------------------
Acyclovir (Zovirax) 500 mg 1-0-1-0
Entecavir (Baraclude) 0.5 mg 1-0-0-0
Rifampin (Rifadin) 600 mg 1.5-0-0-0
Isoniazid/Pyridoxine (Nydrazid) 300 mg 2-0-0-0
Levofloxacin (Levaquin) 500 mg 1-0-1-0
Mycophenolate Mofetil (CellCept) 500 mg 2-0-2-0
Folic Acid 5 mg 1-0-0-0
Magnesium \-- 3-3-3-0
Pantoprazole (Protonix) 40 mg 1-0-0-0 (before a meal)
Ursodeoxycholic Acid (Actigall) 250 mg 1-1-1-0
Cyclosporine (Sandimmune) 100 mg 100 mg 4-0-4-0
Cyclosporine (Sandimmune) 50 mg 50 mg 4-0-4-0 (based on TDM, last dose 400 mg 1-0-1)
Cyclosporine (Sandimmune) 10 mg 10 mg 4-0-4-0 (based on TDM, last dose 400 mg 1-0-1)
**Current Recommendations: **
1. Bone marrow puncture on Day +60, +120, and +360 post-transplantation
(including MRD and chimerism) and Day +180 depending on MRD and
chimerism progression.
2. Continuation of immunosuppressive therapy with ciclosporin adjusted
to achieve target levels of around 150 ng/ml, for a minimum of 3
months post-transplantation. Immunosuppression with mycophenolate
mofetil will be continued until Day +40.
3. Prophylaxis with Aciclovir must continue for 6 weeks after
discontinuation of immunosuppression at a dosage of 15-20 mg/kg/day
(divided into 2 doses). Dose adjustment based on renal function may
be necessary.
4. Pneumocystis pneumonia prophylaxis through monthly Pentamidine
inhalation or administration of Cotrim forte 960mg must continue at
least until immunosuppression is discontinued or until an absolute
CD4+ T-cell count exceeds \>200/µL in peripheral blood. Cotrim forte
960mg has not been started when leukocytes are \<2/nL.
5. Weekly monitoring of CMV and EBV viral loads through quantitative
PCR from EDTA blood.
6. Timing of antituberculous medication intake:
- Take Rifampicin and Isoniazid in the morning on an empty stomach, 30
minutes before breakfast.
- Take levofloxacin with a 2-hour gap from divalent cations (Mg2+,
strongly calcium-rich foods).
**Lab results upon Discharge:**
**Parameter** **Result** **Reference Range**
------------------------------ -------------------- ---------------------
Cyclosporine 127.00 ng/mL \--
Sodium 141 mEq/L 136-145 mEq/L
Potassium 4.1 mEq/L 3.5-4.5 mEq/L
Glucose 108 mg/dL 60-110 mg/dL
Creatinine 0.65 mg/dL 0.70-1.20 mg/dL
Estimated GFR (eGFR CKD-EPI) 111 mL/min/1.73 m² \--
Urea 26 mg/dL 17-48 mg/dL
Total Bilirubin 0.35 mg/dL \<1.20 mg/dL
**Complete Blood Count **
**Parameter** **Results** **Reference Range**
--------------- ----------------- -----------------------
Hemoglobin 9.5 g/dL 13.5-17.0 g/dL
Hematocrit 28.2% 39.5-50.5%
Erythrocytes 3.2 x 10\^6/µL 4.3-5.8 x 10\^6/µL
Leukocytes 1.47 x 10\^3/µL 3.90-10.50 x 10\^3/µL
Platelets 193 x 10\^3/µL 150-370 x 10\^3/µL
MCV 88.7 fL 80.0-99.0 fL
MCH 29.9 pg 27.0-33.5 pg
MCHC 33.7 g/dL 31.5-36.0 g/dL
MPV 9.8 fL 7.0-12.0 fL
RDW-CV 18.9% 11.5-15.0%
### Patient Report 2
**Dear colleague, **
We report on Mr. Bruno Hurley, born on 12/24/1965, who was under our
inpatient care from 2/20/2022, to 02/24/2022.
**Diagnoses:**
- Acute Pancreatitis, possibly medication-related under antitubercular
therapy.
- Current medications include Entecavir, Rifampicin, and
Isoniazid/Pyridoxin, which have been paused after consultation with
the infectious disease team.
**Other Diagnoses:**
- Acute Myeloid Leukemia with Myelodysplasia-Related Changes (AML-MRC)
- Myelodysplastic Syndrome EB-2
- Allogeneic stem cell transplantation
- EBV Reactivation (Treated with immunoglobulins for 3 days)
- Persistent Tuberculosis with lymph node swelling
- Open Lung Tuberculosis - Initial Diagnosis
- Antitubercular combination therapy since (Moxifloxacin, Pyrazinamid,
Ethambutol, Rifampicin, Isoniazid).
- Rectal colonization with 4-MRGN.
**Medical History:** The patient presented via ambulance from his
workplace. The patient reported sudden onset upper abdominal pain,
mainly in the epigastric region, accompanied by nausea and vomiting. He
also experienced watery diarrhea once today. He had lunch around noon,
consisting noodles. There was no fever, cough, sputum production,
dyspnea, or urinary abnormalities. He has been taking daily
antitubercular combination therapy, including Rifampicin, for open
tuberculosis. The patient denied alcohol consumption and weight loss.
**Medication** **Dosage** **Frequency**
----------------------------------------- ------------ ----------------------------
Acyclovir (Zovirax) 400 mg 1-0-1
Entecavir (Baraclude) 0.5 mg 1-0-0
Rifampin (Rifadin) 600 mg 1.5-0-0
Isoniazid/Pyridoxine (Nydrazid) 300 mg 1-0-1
Pantoprazole (Protonix) 40 mg 1-0-0
Trimethoprim/Sulfamethoxazole (Bactrim) 960 mg 1 tablet, on Mon, Wed, Fri
Methylprednisolone (Medrol) 0.79 mg As needed
Prednisolone 4 mg As needed
**Allergies:** None
**Physical Exam:**
Vital Signs: Blood Pressure 178/90 mmHg, Pulse 85/min, SpO2 89%,
Temperature 36.7°C, Respiratory Rate 20/min.
Clinical Status: Upon initial examination, a reduced general condition.
Cardiovascular: Heart sounds were normal, rhythm was regular, and no
murmurs were heard.
Respiratory: Vesicular breath sounds, sonorous percussion.
Abdominal: Sluggish peristalsis, soft abdominal walls, guarding and
tenderness in the epigastrium, liver and spleen not palpable, no free
fluid.
Extremities: Minimal edema.
**ECG Findings:** ECG on admission showed normal sinus rhythm (69/min),
normal ST intervals, R/S transition in V3/V4, and no significant
abnormalities.
´
**Medication upon Discharge:**
**Medication ** **Dosage** **Frequency**
----------------------------------------- ------------ ----------------------------
Acyclovir (Zovirax) 400 mg 1-0-1
Entecavir (Baraclude) 0.5 mg PAUSED
Rifampin (Rifadin) 600 mg PAUSED
Isoniazid/Pyridoxine (Nydrazid) 300 mg PAUSED
Pantoprazole (Protonix) 40 mg 1-0-0
Trimethoprim/Sulfamethoxazole (Bactrim) 960 mg 1 tablet, on Mon, Wed, Fri
Methylprednisolone (Medrol) 0.79 mg As needed (as needed)
Prednisolone 4 mg As needed (as needed)
Tramadol (Ultram) 50 mg 1 tablet, every 6 hours
**Parameter** **Results** **Reference Range**
------------------------- ----------------- -----------------------
White Blood Cells (WBC) 5.0 x 10\^9/L 3.7 - 9.9 x 10\^9/L
Hemoglobin 14.0 g/dL 13.6 - 17.5 g/dL
Hematocrit 40% 40 - 53%
Red Blood Cells (RBC) 4.00 x 10\^12/L 4.4 - 5.9 x 10\^12/L
MCV 99 fL 80 - 96 fL
MCH 32.8 pg 28.3 - 33.5 pg
MCHC 33.1 g/dL 31.5 - 34.5 g/dL
Platelets 161 x 10\^9/L 146 - 328 x 10\^9/L
Absolute Neutrophils 3.7 x 10\^9/L 1.8 - 6.2 x 10\^9/L
Absolute Monocytes 0.31 x 10\^9/L 0.25 - 0.85 x 10\^9/L
Absolute Eosinophils 0.03 x 10\^9/L 0.03 - 0.44 x 10\^9/L
Absolute Basophils 0.01 x 10\^9/L 0.01 - 0.08 x 10\^9/L
Absolute Lymphocytes 0.9 x 10\^9/L 1.1 - 3.2 x 10\^9/L
Immature Granulocytes 0.0 x 10\^9/L 0.0 x 10\^9/L
### Patient Report 3
**Dear colleague, **
We are writing to inform you on our patient, Mr. Hurley, who presented
to our outpatient clinic on 07/12/2022.
**Diagnoses:**
- Acute Pancreatitis, possibly medication-related under antitubercular
therapy.
- Current medications include Entecavir, Rifampicin, and
Isoniazid/Pyridoxin, which have been paused after consultation with
the infectious disease team.
**Other Diagnoses:**
- Acute Myeloid Leukemia with Myelodysplasia-Related Changes (AML-MRC)
- Myelodysplastic Syndrome EB-2
- Allogeneic stem cell transplantation
- EBV Reactivation (Treated with immunoglobulins for 3 days)
- Persistent Tuberculosis with lymph node swelling
- Open Lung Tuberculosis - Initial Diagnosis
- Antitubercular combination therapy since (Moxifloxacin, Pyrazinamid,
Ethambutol, Rifampicin, Isoniazid).
- Rectal colonization with 4-MRGN.
**Current Presentation:** Presented with a referral from outpatient
oncologist for suspected recurrent AML, with DD GvHD ITP in the setting
of progressive pancytopenia, primarily thrombocytopenia. The patient is
in good general condition, denying acute symptoms, particularly no rash,
diarrhea, dyspnea, or fever.
**Physical Examination:** Alert, oriented, no signs of respiratory
distress, heart sounds regular, abdomen soft, no tenderness, no skin
rashes, especially no signs of GvHD, no edema.
- Heart Rate (HR): 130/85
- Temperature (Temp): 36.7°C
- Oxygen Saturation (SpO2): 97
- Respiratory Rate (AF): 12
- Pupillary Response: 15
**Imaging (CT):**
- [11/04/19 CT Chest/Abdomen/Pelvis ]{.underline}
- [01/04/20 Chest CT:]{.underline} Marked necrotic lymph nodes hilar
right with bronchus and vascular stenosis. Significant increasing
pneumonic infiltrates predominantly on the right.
- [02/05/20 Neck/Chest CT]{.underline}: Regression of pulmonary
infiltrates, but increased size of necrotic lymph nodes, especially
in the upper mediastinum and right infraclavicular with slit-like
compression of the right internal jugular vein and the esophagus.
- [06/07/20 Neck/Chest CT]{.underline}: Size-stable necrotic lymph
node conglomerate infraclavicular right, dimensioned axially up to
about 6 x 2 cm, with ongoing slit-shaped compression of the right
internal jugular vein. Hypoplastic mastoid cells left, idem.
Progressive, partly new and large-volume consolidations with
adjacent ground glass infiltrates on the right in the anterior, less
posterior upper lobe and perihilar. Inhomogeneous, partially reduced
contrast of consolidated lung parenchyma, broncho pneumogram
preserved dorsally only.
- [10/02/20 Neck/Chest/Abdomen/Pelvis CT:]{.underline} Size-regressive
consolidating infiltrate in the right upper lobe and adjacent
central lower lobe with increasing signs of liquefaction.
Progressive right pleural effusion and progressive signs of
pulmonary volume load. Regressive cervical, mediastinal, and right
hilar lymphadenopathy. Ongoing central hilar conglomerates that
compress the central hilar structures. Partly constant, partly
regressive presentation of known tuberculosis-suspected liver
lesions.
- [12/02/20 CT Chest/Abdomen/Pelvis]{.underline}.
- [01/20/2021 Abdominal CT.]{.underline}
- [02/23/21 Neck/Chest CT:]{.underline} Slightly regressive/nodular
fibrosing infiltrate in the right upper lobe and adjacent central
lower lobe with continuing significant residual findings. Within the
infiltrate, larger poorly perfused areas with cavitations and
scarred bronchiectasis. Increasing, partly patchy densities on the
left basal region, differential diagnoses include infiltrates and
ventilation disorders. Essentially constant cervical, mediastinal,
and hilar lymphadenopathy. Constant liver lesions in the upper
abdomen, differential diagnoses include TB manifestations and cystic
changes.
- [06/12/21 Neck/Chest/Abdomen/Pelvis CT:]{.underline} Improved
ventilation with regressive necrotic TB manifestations perihilar,
now only subtotal lobar atelectasis. Essentially constant necrotic
lymph node manifestations cervical, mediastinal, and right hilar,
exemplarily suprasternal right or right paratracheal. Narrow right
pleural effusion. Medium-term constant hypodense liver lesions
(regressive).
**Patient History:** Known to have AML with myelodysplastic changes,
first diagnosed 01/2021, myelodysplastic syndrome EB-2, fist diagnoses
07/2019, and history of allogeneic stem cell transplantation.
**Treatment and Progression:** Patient is hemodynamically stable, vital
signs within normal limits, afebrile. In good general condition,
clinical examination unremarkable, especially no skin GvHD signs. Venous
blood gas: Acid-base status balanced, electrolytes within normal range.
Laboratory findings show pancytopenia, Hb 11.3 g/dL, thrombocytopenia
29/nL, leukopenia 1.8/nL, atypical lymphocytes described as \"resembling
CLL,\" no blasts noted. Consultation with Hemato/Oncology confirmed no
acute need for hospitalization. Follow-up in the Hemato-Oncological
Clinic in September.
**Imaging:**
**CT Chest/Abdomen/Pelvis on 11/04/19:**
**Assessment:** In comparison with 10/23/19: In today\'s
contrast-enhanced examination, a newly unmasked large tumor is noted in
the right pulmonary hilum with encasement of the conduits of the right
lung lobe. Differential diagnosis includes a lymph node conglomerate,
central bronchial carcinoma, or, less likely, an inflammatory lesion.
Multiple suspicious malignant enlarged mediastinal lymph nodes,
particularly on the right paratracheal and infracarinal regions.
Short-term progression of peribronchovascular consolidation in the right
upper lobe and multiple new subsolid micronodules bilaterally.
Differential diagnosis includes inflammatory lesions, especially in the
presence of known neutropenia, which could raise suspicion of fungal
infection.
Intraabdominally, there is an image suggestive of small bowel subileus
without a clearly defined mechanical obstruction.
Density-elevated and ill-defined cystic lesion in the left upper pole of
the kidney. Primary consideration is a hemorrhaged or thickened cyst,
but ultimately, the nature of the lesion remains uncertain.
**CT Chest on 01/04/20:** Significant necrotic hilar lymph nodes on the
right with bronchial and vascular stenosis. Marked progression of
pulmonary infiltrates, particularly on the right, still compatible with
superinfection in the context of known active tuberculosis
**CT Chest from 02/05/20**: Marked necrotic lymph nodes hilar right with
bronchial and vascular stenosis. Significantly increasing pneumonia-like
infiltrates, particularly on the right, still compatible with
superinfection in the context of known open tuberculosis.
**Neck/Chest CT from 06/07/20:** Size-stable necrotic lymph node
conglomerate infraclavicular right, dimensioned axially up to about 6 x
2 cm, with ongoing slit-shaped compression of the right internal jugular
vein. Hypoplastic mastoid cells left, idem. Progressive, partly new and
large-volume consolidations with adjacent ground glass infiltrates on
the right in the anterior, less posterior upper lobe and perihilar.
Inhomogeneous, partially reduced contrast of consolidated lung
parenchyma, broncho pneumogram preserved dorsally only.
**Neck Ultrasound from 08/14/2020:** Clinical History, Question,
Justifying Indication: Follow-up of cervical lymph nodes in
tuberculosis.
**Findings/Assessment:** Neck Lymph Node Ultrasound from 05/20/2020 for
comparison. As in the previous examination, evidence of two
significantly enlarged supraclavicular lymph nodes on the right, both
showing a decrease in size compared to the previous examination: The
more medial node measures 2.9 x 1.6 cm compared to the previous 3.7 x
1.7 cm, while the more laterally located lymph node measures 3.3 x 1.4
cm compared to the previous 4.2 x 1.5 cm. The more medial lymph node
appears centrally hypoechoic, indicative of partial liquefaction, while
the more lateral lymph node has a rather solid appearance. No other
pathologically enlarged lymph nodes detected in the cervical region.
**CT Neck/Chest/Abdomen/Pelvis from 10/02/2020:** Assessment: Compared
to the previous examination from 06/07/2020, there is evidence of
regression in findings: Size regression of consolidating infiltrate in
the right upper lobe and the adjacent central lower lobe, albeit with
increasing signs of cavitation. Progressive right pleural effusion and
progressive signs of pulmonary volume overload. Regression of cervical,
mediastinal, and right hilar lymphadenopathy. Persistent centrally
liquefying lymph node conglomerates in the right hilar region,
compressing central hilar structures. Some findings remain stable, while
others have regressed. No evidence of new manifestations.
**CT Chest/Abdomen/Pelvis from 12/02/20:** Assessment: Compared to
10/02/20: In today\'s contrast examination, a newly unmasked large tumor
is located right pulmonary hilar, encasing the conduits of the right
lung lobe; Differential diagnosis includes lymph node conglomerate,
central bronchial carcinoma, and a distant possibility of inflammatory
lesions. Multiple suspiciously enlarged mediastinal lymph nodes,
especially right paratracheal and infracarinal. In a short time,
progressive peribronchovascular consolidations in the right upper lobe
and multiple new subsolid micronodules bilaterally; Differential
diagnosis includes inflammatory lesions, potentially fungal in the
context of known neutropenia. Intra-abdominally, there is a picture of
small bowel subileus without discernible mechanical obstruction.
Corresponding symptoms? Densely elevated and ill-defined cystic lesion
in the upper pole of the left kidney; Differential diagnosis primarily
includes a hemorrhaged/thickened cyst, ultimately with uncertain
malignancy.
**Chest in two planes on 04/23/2021:** **Findings/Assessment:** In
comparison with the corresponding prior images, most recently on
08/14/2020. Also refer to CT Neck and Chest on 01/23/2021. The heart is
enlarged with a leftward emphasis, but there are no signs of acute
congestion. Extensive consolidation projecting onto the right mid-field,
with a long-term trend toward regression but still clearly demarcated.
No pneumothorax. No pleural effusion. Known lymph nodes in the
mediastinum/hilum. Degenerative spinal changes.
**Neck/Chest CT on 02/23/21:** Slightly regressive/nodular fibrosing
infiltrate in the right upper lobe and adjacent central lower lobe with
continuing significant residual findings. Within the infiltrate, larger
poorly perfused areas with cavitations and scarred bronchiectasis.
Increasing, partly patchy densities on the left basal region,
differential diagnoses include infiltrates and ventilation disorders.
Essentially constant cervical, mediastinal, and hilar lymphadenopathy.
Constant liver lesions in the upper abdomen, differential diagnoses
include TB manifestations and cystic changes.
**CT Neck/Chest/Abdomen/Pelvis from 06/12/2021**: CT from 02/23/2021
available for comparison. Neck/Chest: Improved right upper lobe (ROL)
ventilation with regressive necrotic TB manifestations peri-hilar, now
only with subtotal lobar atelectasis. Essentially stable necrotic lymph
node manifestations in the cervical, mediastinal, and right hilar
regions, for example, supraclavicular on the right (18 mm, previously
30.1 Im 21.2) or right paratracheal (18 mm, previously 30.1 Im 33.8).
Narrow right pleural effusion, same as before. No pneumothorax. Heart
size normal. No pericardial effusion. Abdomen: Mid-term stable hypodense
liver lesions (regressing since 07/2021).
**Treatment and Progression:** Due to the extensive findings and the
untreatable immunocompromising underlying condition, we decided to
switch from a four-drug TB therapy to a three-drug therapy after nearly
3 months. In addition to rifampicin and isoniazid, levofloxacin was
initiated. Despite very good therapy adherence, acid-fast bacilli
continued to be detected microscopically in sputum samples without
culture confirmation of mycobacteria, even after discharge. Furthermore,
the radiological findings worsened. In April 2020, liver lesions were
identified in the CT that had not been described up to that point, and
pulmonary and mediastinal changes increased. Clinically, right cervical
lymphadenopathy also progressed in size. Due to a possible immune
reaction, a therapy with prednisolone was attempted for several weeks,
which did not lead to improvement. In June 2020, Mr. Hurley was
readmitted for bronchoscopy with BAL and EBUS-guided biopsy to rule out
differential diagnoses. An NTM-NGS-PCR was performed on the BAL, which
did not detect DNA from nontuberculous mycobacteria. Histologically,
predominantly necrotic material was found in the lymph node tissue, and
molecular pathological analysis detected DNA from the M. tuberculosis
complex. There were no indications of malignancy. In addition,
whole-genome sequencing of the most recently cultured mycobacteria was
performed, and latent resistance genes were also ruled out. Other
pathogens, including fungi, were likewise not detected. Aspergillus
antigen in BAL and serum was also negative. We continued the three-drug
therapy with Rifampicin, Isoniazid, and Levofloxacin. Mr. Hurley
developed an increasing need for red blood cell transfusions due to
myelodysplastic syndrome and began receiving regular transfusions from
his outpatient hematologist-oncologist in the summer of 2020. In a
repeat CT control in October 2020, increasing necrotic breakdown of the
right upper and middle lobes was observed, as well as progressive
ipsilateral pleural effusion and persistent mediastinal lymphadenopathy
and liver lesions. Mr. Hurley was referred to the immunology colleagues
to discuss additional immunological treatment options. After extensive
immune deficiency assessment, a low basal interferon-gamma level was
noted in the setting of lymphopenia due to MDS. In an immunological
conference, the patient was thoroughly discussed, and a trial of
interferon-gamma therapy in addition to antituberculous therapy was
discussed due to a low basal interferon-gamma level and a negative
Quantiferon test. After approval of an off-label application, we began
Actimmune® injections in January 2021 after extensive patient education.
Mr. Hurley learned to self-administer the subcutaneous injections and
initially tolerated the treatment well. Due to continuous worsening of
the blood count, a bone marrow puncture was performed again on an
outpatient basis by the attending hematologist-oncologist, and secondary
AML was diagnosed. Since February 2021, Mr. Hurley has received
Azacitidine and regular red blood cell and platelet concentrates. After
3 months of Actimmune® therapy, sputum no longer showed acid-fast
bacilli in March 2021, and radiologically, the left pleural effusion had
completely regressed, and the infiltrates had decreased. Actimmune® was
discontinued after 3 months. Towards the end of Actimmune® therapy, Mr.
Hurley developed pronounced shoulder arthralgia and pain in the upper
thoracic spine. Fractures were ruled out. With pain therapy, the pain
became tolerable and gradually improved. Arthralgia and myalgia are
common side effects of interferon-gamma. Due to the demonstrable
therapeutic response, we presented Mr. Hurley, along with an
interpreter, at the Department of Hematology and Oncology to discuss
further therapeutic options for AML in the context of the hematological
and infectious disease situation. After extensive explanation of the
disease situation, the risks of aggressive AML therapy in the presence
of unresolved tuberculosis, and the consequences of palliative AML
therapy. Mr. Hurley agreed to allogeneic stem cell transplantation after
some consideration. On an outpatient basis, the cytostatic therapy with
Azacitidine was expanded to include Venetoclax. Antituberculous therapy
with rifampicin, isoniazid, and levofloxacin was continued. Regular
sputum checks remained consistently microscopically negative until
complete AML remission was achieved. Mr. will be admitted for allogeneic
stem cell transplantation in July 2021. A repeat CT in June 2021
confirmed continued regression of the tuberculosis findings.
Antituberculous therapy will be continued indefinitely.
**CT Neck/Chest/Abdomen/Pelvis on 06/12/2022:** CT for comparison.
Neck/Chest: Improved right lung upper lobe ventilation with regressing
necrotic tuberculosis manifestations, now with only subtotal lobar
atelectasis. Essentially constant necrotic lymph node manifestations in
the cervical, mediastinal, and right hilar regions, as exemplified by
the right supraclavicular (18 mm, SE 301 HU 212) or right paratracheal
(18 mm, SE 301 HU 338) nodes. Narrow pleural effusion on the right,
likewise. No pneumothorax. The heart is not enlarged. No pericardial
effusion. Abdomen: Medium-term constant hypodense liver lesions
(regressing)
**Current Recommendations:** Continue antituberculous therapy without a
defined endpoint. Sputum checks during allogeneic stem cell
transplantation every 1-2 weeks. In case of clinical signs of persistent
infection, perform early CT scans of the neck, chest, and abdomen.
Follow-up appointment in our infectious diseases outpatient clinic after
allogeneic stem cell transplantation.
|
Chest CT
|
What was the initial procedure performed for Mrs. Jane Done in February 2018?
Choose the correct answer from the following options:
A. Excision of benign nevus on the right shoulder
B. Excision of malignant melanoma on the left upper back
C. Biopsy of a mole on the left arm
D. Microsurgical resection of right frontal tumor
E. Excision of empyema
|
### Patient Report 0
**Dear colleague, **
We wish to provide an update regarding Mrs. Jane Done, born on
01.01.1966. She was admitted to our clinic from 02/18/2018 to
03/01/2018.
**Diagnoses: **
- Malignant melanoma of the left scapula, TD 16 mm, exophytic
ulcerating, invasion stage - III, R0
- **Mutation analysis:** BRAF status: mutated. PD-L1 status: PD-L1
tumor proportion score (TPS): \<1%. Immune cell infiltrate (IC): 2%
of tumor area. PD-L1 combined-positive score (CPS): 2.
- **History:** Ms. Done was admitted to the hospital with high grade
suspicion of malignant melanoma of the back. The patient reported a
skin lesion that had been present for approximately 4 weeks. The
lesion had grown rapidly during this time and appeared to be oozing
and bleeding. She presented to our outpatient clinic, where she was
advised to undergo surgical excision in case of suspected
malignancy.
- Questions about B-symptoms, AP complaints, stool or urine
abnormalities were negated.
- System Therapy (Adjuvant Treatment for Stage III Melanoma): 1
02/22/18: 1st dose pembrolizumab 200mg
03/15/18: 2nd dose Pembrolizumab 200mg
04/05/18: 3rd dose Pembrolizumab 200mg
04/26/18: 4th dose Pembrolizumab 200mg
05/17/18: 5th dose Pembrolizumab 200mg
06/07/18: 6th dose Pembrolizumab 200mg
06/28/18: 7th dose Pembrolizumab 200mg
07/19/18: 8th dose Pembrolizumab 200mg
08/09/18: 9th dose Pembrolizumab 200mg i.v.
**Physical examination findings:** 52-year-old female patient in normal
general condition, nutritional status, consciousness unremarkable.
Cranial mobility free, eye movement normal. Pupils are equal and
reactive to light and accommodation. Regular, normocardial heart rate
during recording. Cor and pulmo auscultatory and percutaneously
unremarkable. No typical heart murmurs. Abdomen: Abdominal wall, liver
and spleen not enlarged, no pain to palpation, no resistance to
palpation, vivid bowel sounds. Renal bed and spine not palpable. No
enlarged cervical, submandibular, supra- and infraclavicular, axillary
and inguinal lymph nodes palpable. inguinal lymph nodes palpable.
Further internal and orienting neurological examination neurological
examination remained without pathological findings.
**Skin findings:** In the area of the left scapula, a table tennis-ball
sized area with a slightly fissured, oozing, pink-black pigmented
surface. On the cranial side an irregularly black-brown pigmented macula
of about 3.2x1.2 cm is visible.
**PET/CT with 203 MBq (F-18)-Fluorodeoxyglucose from 02/18/2018: **
Weight: 66 kg, blood glucose: 118 mg/dL. 20 mg furosemide; acquisition
start 91 min after tracer injection; 821 mm scan length á () mm/s in
flow technique (neck to proximal thigh); oral and i.v. contrast (1.5
mL/kg, i.v., max. 120 mL). Quantitative analysis of
attenuation-corrected image data using SUV calculation.
**Findings:**
CT: In case of known contrast agent allergy, premedication was performed
with one ampoule each of H1 and H2 antihistamine. The contrast-enhanced
examination proceeded without complications during the course.
Neck: Symmetrical visualization of the soft tissues of the neck. No
evidence of pathologically enlarged cervical lymph nodes. Struma nodosa
with several hypodense nodes on the right side up to max. approx. 1 cm.
Thorax: Cutaneous/subcutaneous irregular-shaped lesion caudal to the
right scapula. Limited assessability in the lung window with motion
artifacts and shallow inspiration depth. As far as assessable, no
evidence of larger suspicious intrapulmonary pulmonary round foci. No
infiltrate. No pleural effusion. No evidence of pathologically enlarged
lymph nodes mediastinal, hilar and axillary bilaterally.
Abdomen/pelvis: Normal contrast of liver parenchyma without evidence of
suspicious focal liver lesions. Portal vein and hepatic veins perfused
regularly. Gallbladder without irritation. Spleen with accessory spleen,
pancreas and adrenal glands bds. regular. Kidneys perfused at the same
side. No urinary retention. Nephrolithiasis on the right side.
Visualization of the parenchymatous upper abdominal organs. No evidence
of pathologically enlarged coeliacal, mesenteric, retroperitoneal,
iliac, and inguinal lymph nodes. Inhomogeneously contrasted enlarged
prostate. Urinary bladder wall, as far as assessable with low filling
circumferentially wall thickened.
Skeleton: no evidence of suspicious osteodestructive lesions. Osteopenia
with degenerative skeletal changes.
PET:
Increased tracer enhancement of the suspicious lesion caudal to left
scapula, indicative of a melanoma (SUVmax 67). Focal intense tracer
enhancement in the right thyroid lobe (SUVmax approximately 7.9).
Elongated intense tracer enhancement in the lower abdomen ventrally
median without clear correlate, most consistent with contamination.
Otherwise, unremarkable activity distribution in the study area.
Assessment:
No evidence of metabolically active metastases in the study area.
**Operation report from** **02/22/2018**:
Procedure: Excision of malignant melanoma on the left upper back.
Preoperative Diagnosis: Malignant melanoma, left upper back.
Postoperative Diagnosis: Malignant melanoma, left upper back.
Anesthesia: Local anesthesia using 70 mL tumescent solution comprising
0.21% Lidocaine/Ropivacaine with epinephrine.
Procedure Details: The surgical area was prepped using Betadine. The
area was draped in a sterile fashion. Excision of the exophytic tumor
was performed, measuring 51 x 20 x 15 mm. A safety margin of 10 mm was
maintained in depth, with the excision extending slightly into the
subcutaneous tissue but not beyond the fascia. This resulted in a total
defect size of 75 x 45 mm. The defect could not be closed with a simple
primary suture. Perforator vessels were coagulated, and the defect was
bridged using skin flaps. Additional resection of Burow triangles was
done according to aesthetic units. The wound was closed using an
intracutaneous suture technique. A continuous overhand blocked suture
was used with 3-0 Vicryl. The patient was advised that the visible
suture material could be removed between postoperative days 14 and 16. A
dressing was applied, followed by a pressure dressing to minimize
swelling and promote healing. Comments: The patient tolerated the
procedure well and was provided postoperative care instructions.
Plan: Follow up in clinic for suture removal and wound assessment
between postoperative days 14 and 16.
**Histology Dermatohistology:** **02/23/2018.**
**Gross Examination:** A roughly oval excision specimen measuring 48 x
36 x 14 mm. The specimen is serially sectioned into lamellar stages A
through H (8 cassettes).
**Microscopic Examination:**
Stage A: Displays a benign epidermis and dermis without evidence of
melanocytic tumor cells.
Stage B: Features an irregularly thickened epidermis. At the center of
the section, melanocytic tumor cells are observed at the dermoepidermal
junction (positive for MelanA stain). Additionally, abundant
melanophages and pigment deposits are noted. The lateral safety margin
measures at least 8 mm.
Stage C: Resembles stage B. Atypical melanocytic tumor cells are present
at the dermoepidermal junction. Upper dermis displays fibrosis,
inflammation, and numerous melanophages (confirmed by positive MelanA
staining). The lateral safety margin is at least 6 mm.
Stage D: Central region shows melanocytic tumor cells in both the
epidermis and upper dermis. There is significant inflammation,
melanophages, and pigment deposition (confirmed by MelanA staining).
The maximum lateral safety margin here is approximately 8 mm. A small
lymph node in the subcutaneous fat tissue is also seen, infiltrated by
melanocytic tumor cells.
The tumor shows stages E, F, G and H: Exophytic, bovist-like growing
ulcerated hemorrhagic tumor consisting of completely pleomorphic tumor
cells. These cells vary in morphology, appearing both nested and
spindle-shaped, with clear cytoplasm and conspicuous nucleoli. Notable
pigment production is observed, as are numerous atypical mitoses.
Control staining in stage F with MelanA is completely positive. The
sections are entirely excised.
**Diagnosis:** Exophytic, ulcerated malignant melanoma with a tumor
thickness of at least 15 mm. The tumor invasion is categorized as stage
III.
**Medication upon discharge: **
**Medication** **Dosage** **Route** **Frequency**
----------------------------------------- --------------- -------------- ------------------------------------------------------------------------
Clopidogrel (Plavix) 75 mg Oral Once daily in the morning
Enoxaparin (Lovenox) 0.2 mL Subcutaneous In the evening, only on days when not receiving dialysis
Dronabinol (Marinol) Drops 3 drops Oral Morning and evening
Leuprorelin (Lupron Depot) 3.75 mg Depot Subcutaneous Every 4 weeks
Fentanyl Transdermal System (Duragesic) 12 μg/hr Transdermal Changed every 3 days
Pantoprazole (Protonix) 40 mg Oral Once daily in the morning
Sevelamer (Renagel) 800 mg Oral Once daily in the morning
Multivitamin One tablet Oral Once daily in the morning
Torsemide (Demadex) 200 mg Oral Once daily in the morning
Cholecalciferol (Dekristol) 20,000 IU Oral Once weekly
Sodium Bicarbonate (Bicanorm) One tablet Oral Once daily in the morning
Calcitriol (Rocaltrol) 0.25 μg Oral Once daily in the morning
Valacyclovir (Valtrex) 500 mg Oral Half-tablet daily in the morning
Trimethoprim/Sulfamethoxazole (Bactrim) 480 mg Oral Mornings on Mondays, Wednesdays, and Fridays
Dexamethasone (Decadron) 4 mg Oral In the morning on day 1 and day 2 following daratumumab administration
### Patient Report 1
**Dear colleague, **
We wish to provide an update regarding Mrs. Jane Done, born on
01.01.1966. She was admitted to our clinic from 10/23/2020 to
11/01/2020.
- Metastatic malignant melanoma (presumed ID 2018); M1, stage IV
according to UICC.
- Therapies to date:
- Resection of primary tumor (malignant melanoma) on the left upper
back (02/2018)
- 01/20 Microsurgical resection right frontal tumor
- 02/20 Excision of empyema
- 02-03/20: Radiation therapy
- 05/02/20: Start of immunotherapy with Nivolumab & 05/26/20: Start of
combination immunotherapy 60 mg nivolumab, 200 mg ipilimumab (-\>
drug exanthema)
**Physical examination findings: **
On admission, the patient was awake and adequately oriented. Height:
166cm, weight: 56kg. Nutritional status, consciousness unremarkable.
Cranial mobility free, eye movement regular. Pupils equal, pupillary
reflex responsive to accommodation and light. Regular, normocardial
heart rate on admission. Heart and lung: auscultatory and percutaneous
unremarkable. No typical heart murmurs. Abdomen: Abdominal wall Liver
and spleen are not enlarged, no tenderness, no rebound palpable.
Resistences palpable, loud bowel sounds. No enlarged No enlarged
cervical, submandibular, supra- and infraclavicular lymph nodes
palpable. **Skin findings:** Pronounced xerosis cutis, raised skin
folds, some with erythema and fine lamellar scale and fine lamellar
scale, especially on the arms and face. **Microbiology:** Nasal swab:
normal flora, no MRSA. Throat swab: Normal flora, no MRSA Virology:
10/23/2020: No detection of SARS-CoV-2 by PCR in the submitted material.
**Therapy and Progression:**
**Summary:** The patient presented with exsiccation eczema on the arms,
legs, and face.
**Treatment Details:** Topical Treatment for Eczema: Applied Desonide
Cream once daily to the affected areas. For maintenance, applied Eucerin
Cream daily to the body and a moisturizing ointment like Cetaphil to the
face.
**Antipruritic Treatment:** Prescribed Benadryl tablets, to be taken as
needed.
**Oncology Consultation:** The patient was educated by our oncologist,
Dr. Ex, regarding adjuvant therapy options. The potential benefits and
risks of a combination immunotherapy with Nivolumab and Ipilimumab were
discussed. The patient had already started Nivolumab 200 mg therapy on
05/26/2020.
**Incident on 10/28/2020**: The patient had an unattended fall,
resulting in a hematoma on the left forehead. An emergency CT scan
showed no new fractures or acute hemorrhage but confirmed the presence
of previously known cystic metastasis.
**Operation report (01/02/2020): **
**Diagnosis:** Hemorrhaged right frontal metastasis from previously
diagnosed malignant melanoma (ID 2018)
**Procedure:** Microsurgical resection of right frontal mass with
intraoperative neuromonitoring (MEPs stable) and neuronavigation via a
left frontolateral craniotomy.
Time: 10:34 am Closure Time: 1:04 pm. Total Duration: 2 hours 30 minutes
**Preoperative Evaluation:** Imaging identified a hemorrhage in the
right frontal lobe. Given the patient\'s history of malignant melanoma,
a hemorrhagic melanoma metastasis was suspected. No other intracranial
metastases were detected. The patient and their family were informed of
the surgical benefits and risks. After ample time for consideration and
questions, written informed consent was obtained.
**Procedure Details:** The patient was positioned supine and intubated.
The head was secured in a Mayfield clamp and rotated 60° to the right.
The navigation dataset was reviewed. Using the navigation system, a left
frontotemporal craniotomy was planned. An arcuate incision line was
drawn. The surgical area was shaved, cleaned, and sterilized.
Prophylactic antibiotics and mannitol were administered. A time-out was
conducted preoperatively. The skin was incised, and Raney clips were
inserted. The left temporal muscle was split. Using the navigation
system for guidance, a left frontolateral craniotomy was performed. The
bone flap was carefully removed and preserved in an antibiotic solution
for later reimplantation. The dura mater was opened, and the operating
microscope was introduced. Upon inspection, the tumor was evident.
**MRI brain report (01/04/2020): **
**Clinical Information:** Postoperative assessment following
microsurgical resection of a left frontal hemorrhaged metastasis from
previously diagnosed malignant melanoma.
**Technique:** Multiplanar, multisequence MRI of the brain, including
T1-weighted, T2-weighted, FLAIR, diffusion-weighted imaging (DWI), and
post-contrast T1-weighted sequences.
**Findings:** There is evidence of a right frontotemporal craniotomy
with associated post-surgical changes in the right frontal region.
Titanium plates and screws are noted securing the bone flap, causing
minimal artifact. The previous tumor site in the right frontal lobe
shows post-surgical changes with a well-circumscribed cavity. There is
no evidence of residual enhancing tumor within this cavity on
post-contrast sequences, suggesting complete resection. Surrounding this
cavity, there\'s mild edema, consistent with expected post-operative
changes. No other intracranial metastases. The ventricles are of normal
size and symmetric. There is no evidence of hydrocephalus. No midline
shift or mass effect is observed. There are scattered foci of
susceptibility artifact in the surgical bed on gradient echo sequences,
consistent with expected postoperative blood products. Major
intracranial vessels appear patent with no evidence of vascular
occlusion or significant stenosis. The remaining brain parenchyma
appears normal in signal intensity and morphology on all sequences. No
other significant abnormalities are identified.
**Impression:** Post-surgical changes in the left frontal lobe
consistent with recent tumor resection. There is no evidence of residual
tumor in the surgical bed. Expected postoperative edema and blood
products adjacent to the resection site. No new metastatic foci
identified. No evidence of complications such as hydrocephalus, midline
shift, or vascular abnormalities.
**Operation report (02/04/2020): **
**Diagnosis:** Subfascial, epidural, and subdural empyema following
resection of right frontal metastasis for malignant melanoma.
**Procedure:** Empyema removal (subfascial, epidural, subdural) S
Incision Time: 15:23 Closure Time: 04:01 PM Total Duration: 2 hours 31
minutes
**Preoperative Evaluation:** The patient had a prior surgical resection
of a right frontal metastasis due to known malignant melanoma. On a
recent outpatient visit, a cerebrospinal fluid (CSF) cushion was
identified and punctured, revealing the presence of pathogens. Imaging
indicated deep and subcutaneous abscesses, necessitating revision
surgery. The patient was adequately informed about the procedure,
understood the associated risks, and provided written consent.
**Procedure Details:** The patient was positioned supine with the head
rotated approximately 60° in a Mayfield clamp. The surgical area was
washed and sterilized, focusing on the pre-existing access point. A team
time-out was conducted. Perioperative antibiotics were withheld until
all samples for microbiology were obtained. The skin was incised,
revealing multiple layers of muscle. These were carefully dissected,
leading to the identification and evacuation of the subcutaneous
epifascial abscess. Infected muscle tissue and abscess walls were
resected. The skull flap appeared loosened. A miniplate was removed, and
upon further inspection, the dura mater appeared strained. It was
incised and revealed turbid fluid, indicating a deep abscess. The dura
mater was mobilized, though adherence to the cortex was observed around
the resection cavity, suggesting possible tumor regrowth. Affected areas
were carefully resected. After thorough irrigation, a drainage system
was inserted into the resection cavity. A duraplasty was performed,
followed by the reimplantation of the bone flap using a miniplate. The
patient was also included in a bone flap study and was randomized for
flap reimplantation. After further irrigation, the wound was
meticulously closed, and a subfascial drain was inserted. The final
closure was completed with single button sutures. Under the guidance of
the operating microscope, the tumor was meticulously dissected from the
surrounding healthy tissue. Special care was taken to minimize damage to
the surrounding brain structures. The intraoperative neuromonitoring
indicated stable MEPs throughout, suggesting that motor pathways
remained undisturbed during the procedure. Throughout the resection,
periodic hemostasis was achieved using bipolar electrocautery to control
bleeding. Following the complete resection of the tumor, the surgical
cavity was irrigated with sterile saline to remove any residual debris.
The integrity of the surrounding brain tissue was assessed, and no
immediate complications were observed. The dura mater was sutured,
ensuring a watertight closure. A synthetic dural graft was used to
reinforce the suture line. The preserved bone flap was reimplanted and
secured in place using titanium plates and screws. The temporal muscle
and soft tissues were reapproximated and sutured in layers. The skin was
closed using a combination of absorbable sutures for the subcutaneous
layer and non-absorbable sutures for the skin. Sterile dressings were
applied to the incision site. Postoperative Assessment: The procedure
was completed without complications. Immediate postoperative
neurological examination revealed no new deficits. The patient was
transferred to the recovery room in stable condition, awaiting
extubation by the anesthesiology team.
**Recommendations:** Close monitoring in the neurological intensive care
unit (NICU) is advised for the first 24 hours. Postoperative imaging,
typically an MRI, should be scheduled within the next 48 hours to assess
the extent of tumor resection and to rule out any postoperative
complications.
**Summary:** Mrs. Done\'s recent hospital course was complicated by the
detection and subsequent excision of a hemorrhagic metastasis from a
known history of malignant melanoma. She continues to be on targeted
therapy with close monitoring. No new metastasis or recurrence has been
detected as of the last evaluation. The interdisciplinary approach
involving the neurosurgery and oncology teams has been pivotal in her
management. Given the aggressive nature of melanoma, regular
surveillance and immediate action upon detection of new
lesions/metastasis are paramount for her prognosis.
**02-03/20: Radiation therapy **
Diagnosis: Metastatic malignant melanoma with a focus on the right
frontal metastasis. Technique: Stereotactic radiosurgery (SRS) using a
linear accelerator (LINAC). Fractionation: Given the aggressive nature
of malignant melanoma, a hypofractionated regimen was adopted. The
patient underwent five sessions, each delivering a dose of 6 Gy for a
cumulative total dose of 30 Gy.
Treatment Planning: A simulation CT scan with a 1mm slice thickness was
performed in the treatment position, with a thermoplastic mask for
immobilization. The treatment planning system utilized the simulation
CT, along with MRI for better tumor delineation. The target volume and
critical structures like the eyes, optic nerves, chiasm, and brainstem
were contoured. The radiation plan was optimized to ensure maximal dose
to the target while sparing the critical structures.
Procedure: At each session, patient positioning was verified using
cone-beam CT (CBCT) to ensure precise targeting. Real-time monitoring
was employed to account for any intrafraction motion.
Side Effects: The patient tolerated the treatment well. She reported
transient fatigue and mild scalp irritation, which resolved with
conservative measures. No acute radiation-induced neurotoxicity was
observed.
**Patient History Update: Mrs. Jane Done (DOB: 01/01/1966)**
**General Status (10/03/2020):**
Mrs. Done presented in stable condition with stable vital signs.
Neurologically, she\'s intact with no new focal deficits. The surgical
scars in the frontal region from previous operations are not fully
healed and there is some dehiscence and swelling, indicative of
infection. This wound complication can be traced back to her previous
history of an empyema which required surgical intervention.
**Dermatological Assessment:**
The previous exsiccation eczema, prominent on her arms, legs, and face,
has improved markedly. The treatment regimen involving consistent
moisturization and targeted topical therapies seems effective.
Importantly, there were no new suspicious skin lesions or nodules noted
during her most recent full-body skin check.
**Oncology Status:**
Mrs. Done remains on her immunotherapy regimen, specifically the
combination of Nivolumab and Ipilimumab. Her response has been positive,
with no new metastatic sites identified in the latest assessments. She
has displayed commendable compliance with this regimen and regular
follow-up evaluations.
**Recent MRI Brain (09/30/2020):**
Her latest multiplanar, multisequence MRI revealed post-surgical
alterations in the right frontal lobe, consistent with previous
observations. Encouragingly, there was no sign of any residual or
recurrent tumor activity. Moreover, the MRI did not show any new
intracranial metastatic sites or other significant abnormalities.
**Thoracic CT Scan (10/01/2020): **
Technique: Post complication-free bolus i.v. administration of Imeron
400, a multiline spiral CT was performed through the thorax during the
venous contrast phase, supplemented with thin-section, coronary, and
sagittal secondary reconstructions.
Findings: Multiple roundish subsolid nodules found bipulmonary, notably
a 4mm nodule in the right upper lobe. Blurred subpleural condensations
in the left upper lobe. Another blurred bronchus-associated
consolidation was observed in the left upper lobe and pleurally in the
left dorsal lower lobe. No evidence of pathologically enlarged lymph
nodes in the hilar, mediastinal, or axillary regions. Unchanged
presentation of the left adrenal gland from the preliminary examination.
Thickened imprinting of the gastric wall noted. Ventrally emphasized
spondylophytic attachments observed in the thoracic spine. No
osteodestructive processes detected.
**Impression:** Presence of multiple subsolid pulmonary nodules;
recommended follow-up in 4-6 weeks for potential (post-) inflammatory or
malignant genesis. No evidence of pathologically enlarged lymph nodes.
**Abdomen/Pelvis CT Scan (10/01/2023): **
Technique: A low dose CT scan was taken of the abdomen and pelvis.
**Findings:** Regular visualization of the acquired basal lung sections.
Orthotopic kidneys without urinary stasis. No evidence of urinary
calculi. Suspected uterine fibroids attached to the uterus wall.
Enlarged right ovary with minor calcifications. Assessment: Absence of
urinary calculi. Possible uterine fibroids and an enlarged right ovary,
suggesting a specialized gynecological examination.
**PICC Line Installation (10/02/2020)**
**Diagnosis:**
Home antibiotics required for wound healing disorder following discharge
due to an empyema.
**Type of Surgery:**
Installation of a PICC line in the left basilic vein.
**Anesthesia:**
Local anesthesia
**Procedure Details:**
The patient was presented for long-term antibiotic treatment due to a
wound healing disturbance post the discharge of an epidural abscess. The
primary aim was to apply a PICC-line catheter for the antibiotic
regimen. A written informed consent was duly obtained prior to the
procedure.
The standard procedure began with the washing off and draping of the
patient. A preoperative sonography of the arm veins was conducted. Based
on the sonographic results, it was decided to insert the catheter via
the left basilica vein.
Under venous congestion and following local anesthesia with 2mL Mecain,
a 2mm skin incision was made. The sonographically guided puncture was
performed successfully. Post this, the peel-away sheath was inserted.
With the wire in place, the catheter was advanced with its tip
positioned approximately 2cm below the carina. The wire was subsequently
removed. Following this, the catheter was aspirated and flushed with
NaCl to ensure its patency. A sterile fixation was then applied, and the
wound was dressed.
**Notes:**
No complications were observed during the procedure. The patient was
advised on the care and maintenance of the PICC line. Regular follow-ups
are recommended to monitor the wound healing and the effectiveness of
the antibiotic treatment.
The patient was discharged with instructions and is scheduled for a
follow-up in two weeks.
**Additional Therapeutic Engagements:**
For her overall well-being and to counter the side effects of her
treatment journey, Mrs. Done has been actively involved in physical
therapy sessions. These sessions focus on enhancing her strength and
balance, especially given the previous incident of an unattended fall.
To address the inevitable psychological strains of her diagnosis, she
has also been attending counseling sessions.
**Current Recommendations:**
-Continue the ongoing immunotherapy without changes.
-Dermatological check-ups every month are advised for early detection of
any potential skin abnormalities.
-Regular neurological evaluations are crucial to ensure no emergence of
new deficits.
-Imaging should be scheduled every six months for proactive monitoring.
-Her physical therapy regimen should be ongoing to maintain and improve
mobility.
-Continue counseling to support her emotional and psychological
well-being.
**Summary and Notes:**
Mrs. Done\'s resilience and adherence to her treatments are commendable.
Her progress is a testament to the integrated care approach she has been
receiving. Maintaining a proactive surveillance stance will be essential
for her long-term prognosis and quality of life.
### Patient Report 2
**Dear colleague, **
We wish to provide an update regarding our mutual patient, Mrs. Jane
Done, born on 01.01.1966. She was admitted to our clinic from 11/23/2020
to 12/01/2020.
**Previous Diagnoses and Therapies:**
-Metastatic malignant melanoma (presumed ID 2018); M1, stage IV
according to UICC.
-Resection of primary tumor (malignant melanoma) on the left upper back
(02/2018)
-01/20 Microsurgical resection right frontal tumor
-02/20 Excision of empyema
-02-03/20: Radiation therapy
-05/02/20: Start of immunotherapy with Nivolumab
-05/26/20: Start of combination immunotherapy 60 mg nivolumab, 200 mg
ipilimumab (resulting in drug exanthema)
**Current Presentation:**
Mrs. Done presented for a follow-up visit on 11/23/2020. Over the past
few months, she reported fatigue and intermittent bouts of nausea. Of
significant concern were newly identified skin changes located on her
right arm.
**Clinical Findings:**
Skin: Multiple macules and patches on the right arm, the largest
measuring about 1.5cm in diameter, hyperpigmented with irregular
borders.
**US: **
Ultrasound imaging of the right arm revealed no deep extension or
invasion of underlying structures. This preliminary assessment was
crucial, suggesting that if malignancy is present, it might be in early
stages.
**Histology: **
Histological examination: Gross Description: The sample consists of
multiple tan-pink soft tissue fragments, aggregating to 1.8 cm in the
greatest dimension.
Microscopic description: Sections show a proliferation of atypical
melanocytes arranged in nests and as single units at the dermoepidermal
junction. Some of these cells infiltrate the papillary dermis.
Immunohistochemistry: The atypical cells are positive for HMB-45 and
S-100. Melan A is focally positive. Ki-67 proliferation index is about
10%.
Final Diagnosis: Dysplastic nevus with severe atypia; margins appear
clear. Further excision is recommended to ensure complete removal and to
rule out invasive melanoma.
**Lab results: **
Complete Blood Count (CBC):
Hemoglobin: 12.3 g/dL (Normal range: 12-16 g/dL)
White Blood Cell Count: 6,200 cells/µL (Normal range: 4,000-11,000
cells/µL)
Platelet Count: 290,000 cells/µL (Normal range: 150,000-450,000
cells/µL)
Differential:
Neutrophils 65%, Lymphocytes 25%, Monocytes 8%, Eosinophils 2%. B.
Liver Function Tests (LFTs):
ALT (Alanine Aminotransferase): 40 U/L (Normal range: 7-56 U/L)
AST (Aspartate Aminotransferase): 38 U/L (Normal range: 10-40 U/L)
ALP (Alkaline Phosphatase): 90 U/L (Normal range: 44-147 U/L)
Total Bilirubin: 1.0 mg/dL (Normal range: 0.1-1.2 mg/dL)
Albumin: 4.2 g/dL (Normal range: 3.4-5.4 g/dL)
Assessment/Recommendations:
Given her history and the suspicious nature of the new skin changes, we
have decided to send the biopsy for urgent histological assessment.
Furthermore, considering her reported symptoms, we have conducted a
thorough internal check-up, including blood tests and liver function
tests, to rule out any systemic side effects of the immunotherapy.
We recommend continuous monitoring of Mrs. Done's condition and kindly
request your valuable input in managing her case optimally. A
multidisciplinary approach, given her complicated medical history, will
be most beneficial for the patient.
Please find attached the detailed examination and investigative reports
for your reference.
With kind regards,
### Patient Report 3
**Dear colleague, **
We wish to provide a comprehensive update regarding our mutual patient,
Mrs. Jane Done, born on 01.01.1966. She has had a history of various
medical conditions and treatments, which we believe is essential to
discuss for her optimal management and was admitted to our clinical from
01/01/2021 to 01/28/2021.
**Previous Diagnoses and Therapies:**
Metastatic malignant melanoma (presumed ID 2018); M1, stage IV according
to UICC. Resection of primary tumor (malignant melanoma) on the left
upper back (02/2018)
01/20 Microsurgical resection right frontal tumor
02/20 Excision of empyema
02-03/20: Radiation therapy
05/02/20: Start of immunotherapy with Nivolumab
05/26/20: Start of combination immunotherapy 60 mg nivolumab, 200 mg
ipilimumab (resulting in drug exanthema)
Imaging 01/02/2021: PET/CT: Cervical lymph node metastasis;
cMRI: no evidence of metastases. Contrast-enhancing meninges.
**Virology: **
Upon Admission: SARS-CoV2 PCR (Nose/Throat): POSITIVE with a viral load
of 7,000 Geq/mL and a Ct value of 32.
At Discharge: SARS-CoV2 PCR (Nose/Throat): POSITIVE with a viral load of
2,350 Geq/mL and a Ct value of 32.
**Microbiology: **
MRSA Screening Upon Admission: Nasal Swab: Normal flora detected; MRSA
not present. Throat Swab: Normal flora detected; MRSA not present.
Procedures:
\- Presentation to neurology for CSF puncture (e.g., exclude
meningeosis)
\- Panel sequencing complement
\- Surgery/therapy: Neck dissection followed by adjuvant therapy with
pembrolizumab.
Clinical examination:
Examination findings: Patient in normal general and nutritional
condition, consciousness unremarkable. Cranial mobility free, ocular
mobility normal. Pupils are isocor, pupillary reflex prompt to
accommodation and light. Regular, normocardial heart rate on admission.
No typical heart murmurs. Abdomen: abdominal wall soft, liver and spleen
not enlarged, vivid bowel sounds. Renal bed and spine not palpable. No
enlarged in the axillary or inguinal region palpable.
PET-CT from 01/02/2021:
Intense metabolically active lymph node metastases, otherwise no
evidence of vital tumor tissue in the study area.
**PET CT report from 01/02/2021: **
Procedure: PET/CT with 246 MBq (F-18)-fluorodeoxyglucose and a 60-minute
uptake period.
Findings: CT Findings: Neck: Right Level II: Three lymph nodes, largest
measuring 2.1 x 1.8 cm with central necrosis. Right Level III: Two lymph
nodes, largest measuring 1.5 x 1.2 cm. Left Level II: One lymph node
measuring 1.3 x 1.1 cm. Left Level IV: Two lymph nodes, largest
measuring 1.7 x 1.4 cm. Retropharyngeal space: One lymph node measuring
1.0 x 0.9 cm.
PET Findings: Neck: Right Level II: Increased FDG uptake with SUVmax of
7.8, consistent with metastatic disease. Right Level III: Increased FDG
uptake with SUVmax of 6.5. Left Level II: Increased FDG uptake with
SUVmax of 6.0. Left Level IV: Increased FDG uptake with SUVmax of 7.2.
Retropharyngeal space: Increased FDG uptake with SUVmax of 6.1.
Impression: Cervical Lymph Nodes: Multiple pathologically enlarged
cervical lymph nodes in bilateral level II, right level III, left level
IV, and retropharyngeal space with increased FDG uptake, highly
suggestive of metastatic involvement from the known primary melanoma.
**Surgery report 01/05/2021: **
The surgery commenced with a collaborative discussion with the
anesthesia team and a standard team time-out was executed. The patient
was properly positioned, and the surgical site was aseptically draped.
The facial neuromonitoring system was set up and verified. Local
anesthesia was then administered at the site of the skin incision, which
was located near the previous scar. This incision followed the anterior
border of the sternocleidomastoid muscle in a curved pattern. Upon
incising the subcutaneous tissue, the external jugular vein became
visible and was selectively ligated. The encountered tissue appeared
notably fibrotic and scarred. A skin incision extended from the mastoid
region down nearly to the clavicle. The platysma muscle was subsequently
cut. Due to the presence of a lymph node mass, the auricularis magnus
nerve had to be severed. The sternocleidomastoid muscle and the
posterior belly of the digastric muscle were then exposed. Multiple
darkened lymph node metastases were identified, both beneath the skin
and within the sternocleidomastoid muscle. In subsequent steps, efforts
were made to distinguish the internal jugular vein from the surrounding
scarred tissue. A lymph node mass, which exhibited characteristics
highly suggestive of metastasis (given its darkened color), was removed.
The accessory nerve was identified and preserved. Further dissection was
done posteriorly to the sternocleidomastoid muscle, in the direction of
level V. An expansive mass of lymph nodes was excised in this region.
The trapezoid branch of the accessory nerve was visualized, and its
function was monitored and preserved with the aid of neuromonitoring.
The removed lymph node mass, some excised tissue, and portions of the
sternocleidomastoid muscle with embedded lymph nodes were sent for
histological analysis. During the procedure, care was taken to avoid
damaging major neck vessels and nerves. Concluding the procedure, 8 and
10 French Redon drains were placed, the wound was closed in layers, and
then covered with a spray-on bandage, steristrips, and a pressure
dressing. The surgical site appeared bloodless at the conclusion of the
surgery.
**Macroscopy:**
**Macroscopic Description:**
Dimensions: 6.8 x 0.7 x 0.4 cm spindle-shaped, non-oriented skin and
subcutaneous tissue resection. Central area shows an irritation-free,
fine scar measuring up to 6.3 x 4.8 cm. The cut surface appears
consistently off-white.
Ink markings: soft tissue margin of specimen = green. A: central
lamellae B: spindle tips perpendicular
Anterior Margin of Upper Third of Sternocleidomastoid Muscle:
Dimensions: Four combined tissue samples totaling 4.7 x 3.8 x 1.1 cm.
Appearance: Tan, fibrous soft tissues with multiple uniformly dark
nodules on the cut surface, each measuring up to 1.1 cm.
A, B: one nodule each halved C, D: other nodular sections E: remaining
tan fibrous sections Anterior Margin of Lower Third of
Sternocleidomastoid Muscle: Largest measurement: 3.4 cm.
Appearance: Grayish-brown with some fibrous regions and homogeneously
dark-brown nodes up to 1.5 cm in size on the cut surface. A, B: one node
each halved C: other nodes D: brown-fibrous sections Region V Occipital:
Largest measurement: Two samples, each up to 3.8 cm.
Appearance: Mixture of grayish-tan and light brown fibrous soft tissue
with nodes up to 2.2 cm, uniformly dark brown.
A, B: one node halved C, D: another node halved each Processing: 16
paraffin blocks, HE stained.
Microscopic Description: Dermis and subcutaneous resection shows
scarring with fibrosis. Epidermis is regular, without any atypical
cells. No evidence of melanoma or carcinoma. 2./3.
Multiple nodular tumor clusters present in the soft tissue and skeletal
muscles, lacking lymph node structure. Tumor cells are polygonal, with
some spindle-shaped cells having moderately large, irregular nuclei and
noticeable nucleoli. Cytoplasm appears slightly granular with a light
brownish pigment.
Seven lymph nodes (measuring up to 3.6 cm) indicate metastasis from the
previously mentioned tumor, with extracapsular spread. Four other lymph
nodes are free from the tumor.
**Critical Findings:** Multiple nodular soft tissue metastases, with the
largest measuring 1.3 cm, indicative of melanoma present in both soft
tissue and muscle. Resection margins are mostly free of tumor, with the
closest approach being less than 0.15 cm (points 2 and 3). Seven lymph
nodes (up to 3.6 cm in size) show metastasis from the melanoma, with
extracapsular spread. Four lymph nodes are tumor-free (7 out of 11
nodes, ECE positive) (point 4). Dermis and subcutaneous excision shows
scarring fibrosis (point 1).
For the optimal management of Mrs. Done, close monitoring and a
multidisciplinary approach will be essential. Thank you for your
continued collaboration in ensuring the best care for our mutual
patient.
**Lab values upon discharge: **
**Parameter** **Result** **Reference Range** **Interpretation**
-------------------------------- -------------- ---------------------------------------- ---------------------
**Complete Blood Count (CBC)**
Hemoglobin (Hb) 12.4 g/dL 12.0 - 16.0 g/dL Within normal range
White Blood Cell (WBC) 9.2 x10\^9/L 4.0 - 10.0 x10\^9/L Within normal range
Platelets 250 x10\^9/L 150 - 400 x10\^9/L Within normal range
**Liver Function Tests (LFT)**
AST 28 U/L 10 - 35 U/L Within normal range
ALT 32 U/L 10 - 40 U/L Within normal range
Total Bilirubin 0.8 mg/dL 0.2 - 1.2 mg/dL Within normal range
**Kidney Function Test**
Serum Creatinine 0.9 mg/dL 0.5 - 1.2 mg/dL Within normal range
Blood Urea Nitrogen (BUN) 15 mg/dL 7 - 20 mg/dL Within normal range
**Electrolytes**
Sodium 138 mEq/L 135 - 145 mEq/L Within normal range
Potassium 4.2 mEq/L 3.5 - 5.0 mEq/L Within normal range
Chloride 101 mEq/L 95 - 105 mEq/L Within normal range
**Thyroid Function Tests**
TSH 3.1 mU/L 0.5 - 5.0 mU/L Within normal range
Free T4 1.4 ng/dL 0.9 - 2.4 ng/dL Within normal range
**Lipid Profile**
Total Cholesterol 190 mg/dL \< 200 mg/dL Desirable
LDL Cholesterol 100 mg/dL \< 100 mg/dL Optimal
HDL Cholesterol 55 mg/dL \> 40 mg/dL (Men), \> 50 mg/dL (Women) Normal
Triglycerides 110 mg/dL \< 150 mg/dL Normal
**Medication: **
**Medication** **Dosage** **Route** **Frequency**
---------------- ------------ ----------- -----------------------------
Pembrolizumab 200mg IV Every 3 weeks
Nivolumab 60mg IV As per oncologist\'s advice
Ipilimumab 200mg IV As per oncologist\'s advice
Paracetamol 500mg Oral Every 4-6 hours as needed
Omeprazole 20mg Oral Once daily
### Patient Report 4
**Dear colleague, **
We wish to provide an update regarding Mrs. Jane Done, born on
01.01.1966. She was admitted to our clinic from 02/14/2022 to
03/01/2022.
**Previous Diagnoses and Therapies:**
-Metastatic malignant melanoma (presumed ID 2018); M1, stage IV
according to UICC.
-Resection of primary tumor (malignant melanoma) on the left upper back
(02/2018)
-01/20 Microsurgical resection right frontal tumor
-02/20 Excision of empyema
-02-03/20: Radiation therapy
-05/02/20: Start of immunotherapy with Nivolumab
-05/26/20: Start of combination immunotherapy 60 mg nivolumab, 200 mg
ipilimumab (resulting in drug exanthema)
**Current Presentation:**
Mrs. Done showed multiple metastases in her CT examination. On physical
examination, Mrs. Done appears well-nourished and in no acute distress.
Her vital signs are stable. Cardiovascular examination reveals regular
heart sounds with no murmurs. Respiratory examination shows clear breath
sounds bilaterally. Abdominal examination reveals no palpable masses or
organomegaly. Neurological examination is within normal limits.
**Radiology/Nuclear Medicine**
**CT thorax/abdomen/pelvis + Contrast from 02/10/2022**
**Technique:** Multi-phase, multi-slice computed tomography of the
thorax, abdomen, and pelvis was performed following the intravenous
administration of contrast material. Coronal and sagittal
reconstructions were obtained.
**Thorax:** In the thoracic region, the lungs are notable for multiple
nodular opacities across both lung fields, consistent with metastatic
deposits. The most sizable lesion is seen in the right upper lobe,
approximately 1.5 cm in diameter. No associated cavitation or pleural
effusion is detected. A concerning 2 cm mass abutting the lateral wall
of the left ventricle is noted, raising the suspicion for cardiac
metastasis. The mediastinum also exhibits lymphadenopathy with a
dominant node in the prevascular space, measuring 2.2 cm. Further, there
are lytic lesions involving the sternum and right 4th rib, consistent
with osseous metastatic disease.
**Abdomen/pelvis**: Liver shows multiple hypodense lesions throughout
both lobes, indicative of metastatic spread. The dominant lesion in the
right lobe measures 3 cm. The kidneys, however, are unremarkable without
discernible metastatic deposits. Retroperitoneal lymphadenopathy is also
present, highlighted by a node anterior to the aorta of 1.8 cm. In
addition, there is a 2.5 cm mass identified within the left psoas
muscle, consistent with muscular metastasis. Both the left acetabulum
and the right iliac wing manifest with lytic lesions, suggestive of
metastatic involvement. There is also enlargement of the bilateral
internal iliac lymph nodes, with the left side\'s node measuring up to
1.6 cm. Bladder, prostate, and rectum with no discernible pathology.
**Impression**: Multiple pulmonary nodules consistent with pulmonary
metastases. Cardiac lesion suggestive of metastatic involvement.
Evidence of skeletal metastases in the thorax and pelvis. Hepatic and
muscular metastases, indicative of disseminated disease. Lymphadenopathy
in the mediastinal, retroperitoneal, and pelvic regions.
**PET-CT scan from 02/11/2022**
**Clinical Indication:** Follow-up evaluation of a known case of
Metastatic Melanoma, Stage IV, M1c with notable findings from a CT scan
dated 12/01/2014.
**Technique:** Whole-body PET-CT scan was conducted after intravenous
administration of 18F-FDG. The patient fasted for 6 hours prior to the
scan, and blood glucose levels were confirmed to be within the
acceptable range. Both CT and PET images were acquired, and images were
co-registered for optimal evaluation. Standard uptake values (SUVs) were
calculated for areas of interest.
**Findings: **
**Thorax:** Both lungs depict several hypermetabolic foci, corroborating
the CT findings of multiple nodules. The largest lesion in the right
upper lobe demonstrates an SUVmax of 8.2, indicative of active metabolic
disease. The cardiac mass adjacent to the left ventricle, measuring
approximately 2 cm, also reveals increased 18F-FDG uptake with an SUVmax
of 9.5, strengthening the suspicion of cardiac metastasis. Enlarged
mediastinal lymph nodes, particularly the node in the prevascular space,
shows marked hypermetabolism with an SUVmax of 7.4. Notably, the lytic
skeletal lesions identified on the CT in the sternum and right 4th rib
also display increased metabolic activity, consistent with metastatic
bone disease.
**Abdomen/Pelvis:** Hepatic lesions are congruent with the findings of
the preceding CT, showing heightened metabolic activity. The most
prominent lesion in the right lobe exhibits an SUVmax of 8.8.
Retroperitoneal lymph nodes are metabolically active, with the anterior
aortic node demonstrating an SUVmax of 6.9. The 2.5 cm left psoas muscle
mass also reveals increased uptake with an SUVmax of 7.3, suggesting
active muscular metastasis. In the pelvic region, the lytic lesions
identified in the left acetabulum and right iliac wing on the CT confirm
their malignant nature with notable metabolic activity. Bilateral
internal iliac lymph nodes show hypermetabolism with the left node\'s
SUVmax reaching 7.1. Other pelvic organs, including the bladder,
prostate, and rectum, did not show any significant 18F-FDG uptake, in
line with the unremarkable CT findings.
**Impression:** The PET-CT findings are consistent with active
metastatic disease. There is evidence of hypermetabolic pulmonary
nodules, a likely cardiac metastasis, hepatic and muscular metastases,
and metabolically active skeletal lesions in both the thorax and pelvis.
Additionally, there is hypermetabolism in the lymph nodes across
multiple regions. These findings align closely with the previously
diagnosed metastatic melanoma, Stage IV, M1c**. **
**Discussion**
Mrs. Done has been diagnosed with recurrent metastatic melanoma with
lymph node involvement. This poses significant implications for her
prognosis, emphasizing the need for urgent and comprehensive
intervention.
Her molecular profile has revealed the presence of the BRAF V600E
mutation.
Our recommended therapeutic combination includes Vemurafenib and
Cobimetinib, both of which are aimed at disrupting the aberrant BRAF-MEK
signaling cascade. Complementing this, we suggest the administration of
Pembrolizumab.
Mrs. Done is scheduled for six cycles of this treatment regimen. We will
monitor her laboratory parameters, such as blood counts, electrolytes,
and hepatic and renal profiles, bi-weekly. It is imperative to note that
any fevers surpassing 38.3°C warrant immediate medical attention.
Comprehensive patient education module has been designed to enable Mrs.
Done to identify and manage any potential side effects efficiently.
We will ensure rigorous monitoring of her blood pressure and lipid
metrics, with the possibility of introducing alternative medications if
clinical scenarios demand.
We deeply value your collaboration in Mrs. Done\'s healthcare journey.
Our team remains at your disposal for any queries or clarifications.
|
Excision of malignant melanoma on the left upper back
|
What was the issue with having Pinov on the communication system?
A. He rarely paid attention well enough to handle the communications.
B. He didn't speak English
C. He didn't know how to work the system properly.
D. He always selected the wrong communcations channel
|
The Winning of the Moon BY KRIS NEVILLE The enemy was friendly enough. Trouble was—their friendship was as dangerous as their hate! [Transcriber's Note: This etext was produced from Worlds of If Science Fiction, September 1962. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] General Finogenov notified Major Winship that the underground blast was scheduled for the following morning. Major Winship, after receiving the message, discussed precautions with the three other Americans. Next morning, before the sunlight exploded, the four of them donned their space suits and went and sat outside the dome, waiting. The sun rose with its bright, silent clap of radiance. Black pools of shadows lay in harsh contrast, their edges drawn with geometric precision. Major Winship attempted unsuccessfully to communicate with Base Gagarin. "Will you please request the general to keep us informed on the progress of the countdown?" "Is Pinov," came the reply. "Help?" " Nyet ," said Major Winship, exhausting his Russian. "Count down. Progress. When—boom?" "Is Pinov," came the reply. "Boom! Boom!" said Major Winship in exasperation. "Boom!" said Pinov happily. "When?" "Boom—boom!" said Pinov. "Oh, nuts." Major Winship cut out the circuit. "They've got Pinov on emergency watch this morning," he explained to the other Americans. "The one that doesn't speak English." "He's done it deliberately," said Capt. Wilkins, the eldest of the four Americans. "How are we going to know when it's over?" No one bothered to respond. They sat for a while in silence while the shadows evaporated. One by one they clicked on their cooling systems. Ultimately, Lt. Chandler said, "This is a little ridiculous. I'm going to switch over to their channel. Rap if you want me." He sat transfixed for several minutes. "Ah, it's all Russian. Jabbering away. I can't tell a thing that's going on." In the airless void of the moon, the blast itself would be silent. A moth's wing of dust would, perhaps, rise and settle beyond the horizon: no more. "Static?" "Nope." "We'll get static on these things." A small infinity seemed to pass very slowly. Major Winship shifted restlessly. "My reefer's gone on the fritz." Perspiration was trickling down his face. "Let's all go in," said the fourth American, Capt. Lawler. "It's probably over by now." "I'll try again," Major Winship said and switched to the emergency channel. "Base Gagarin? Base Gagarin?" "Is Pinov. Help?" " Nyet. " "Pinov's still there," Major Winship said. "Tell him, 'Help'," said Capt. Wilkins, "so he'll get somebody we can talk to." "I'll see them all in hell, first," Major Winship said. Five minutes later, the perspiration was rivers across his face. "This is it," he said. "I'm going in." "Let's all—" "No. I've got to cool off." "Hell, Charlie, I feel stupid sitting out here," Capt. Lawler said. "The shot probably went off an hour ago." "The static level hasn't gone up much, if at all." "Maybe," Lt. Chandler said, "it's buried too deep." "Maybe so," Major Winship said. "But we can't have the dome fall down around all our ears." He stood. "Whew! You guys stay put." He crossed with the floating moon-motion to the airlock and entered, closing the door behind him. The darkness slowly filled with air, and the temperature inside the suit declined steadily. At the proper moment of pressure, the inner lock slid open and Major Winship stepped into the illuminated central area. His foot was lifted for the second step when the floor beneath him rose and fell gently, pitching him forward, off balance. He stumbled against the table and ended up seated beside the radio equipment. The ground moved again. "Charlie! Charlie!" "I'm okay," Major Winship answered. "Okay! Okay!" "It's—" There was additional surface movement. The movement ceased. "Hey, Les, how's it look?" Capt. Wilkins asked. "Okay from this side. Charlie, you still okay?" "Okay," Major Winship said. "We told them this might happen," he added bitterly. There was a wait during which everyone seemed to be holding their breath. "I guess it's over," said Major Winship, getting to his feet. "Wait a bit more, there may be an after-shock." He switched once again to the emergency channel. "Is Pinov," came the supremely relaxed voice. "Help?" Major Winship whinnied in disgust. " Nyet! " he snarled. To the other Americans: "Our comrades seem unconcerned." "Tough." They began to get the static for the first time. It crackled and snapped in their speakers. They made sounds of disapproval at each other. For a minute or two, static blanked out the communications completely. It then abated to something in excess of normal. "Well," Lt. Chandler commented, "even though we didn't build this thing to withstand a moonquake, it seems to have stood up all right." "I guess I was just—" Major Winship began. "Oh, hell! We're losing pressure. Where's the markers?" "By the lug cabinet." "Got 'em," Major Winship said a moment later. He peeled back a marker and let it fall. Air currents whisked it away and plastered it against a riveted seam of the dome. It pulsed as though it were breathing and then it ruptured. Major Winship moved quickly to cut out the emergency air supply which had cut in automatically with the pressure drop. "You guys wait. It's on your right side, midway up. I'll try to sheet it." He moved for the plastic sheeting. "We've lost about three feet of calk out here," Capt. Lawler said. "I can see more ripping loose. You're losing pressure fast at this rate." Major Winship pressed the sheeting over the leak. "How's that?" "Not yet." "I don't think I've got enough pressure left to hold it, now. It's sprung a little, and I can't get it to conform over the rivet heads." There was a splatter of static. "Damn!" Major Winship said, "they should have made these things more flexible." "Still coming out." "Best I can do." Major Winship stepped back. The sheet began slowly to slide downward, then it fell away completely and lay limply on the floor. "Come on in," he said dryly. With the four of them inside, it was somewhat cramped. Most of the five hundred square feet was filled with equipment. Electrical cables trailed loosely along the walls and were festooned from the ceiling, radiating from the connections to the outside solar cells. The living space was more restricted than in a submarine, with the bunks jutting out from the walls about six feet from the floor. Lt. Chandler mounted one of the bunks to give them more room. "Well," he said wryly, "it doesn't smell as bad now." "Oops," said Major Winship. "Just a second. They're coming in." He switched over to the emergency channel. It was General Finogenov. "Major Winship! Hello! Hello, hello, hello. You A Okay?" "This is Major Winship." "Oh! Excellent, very good. Any damage, Major?" "Little leak. You?" "Came through without damage." General Finogenov paused a moment. When no comment was forthcoming, he continued: "Perhaps we built a bit more strongly, Major." "You did this deliberately," Major Winship said testily. "No, no. Oh, no, no, no, no. Major Winship, please believe me. I very much regret this. Very much so. I am very distressed. Depressed. After repeatedly assuring you there was no danger of a quake—and then to have something like this happen. Oh, this is very embarrassing to me. Is there anything at all we can do?" "Just leave us alone, thank you," Major Winship said and cut off the communication. "What'd they say?" Capt. Wilkins asked. "Larry, General Finogenov said he was very embarrassed by this." "That's nice," Lt. Chandler said. "I'll be damned surprised," Major Winship said, "if they got any seismic data out of that shot.... Well, to hell with them, let's get this leak fixed. Skip, can you get the calking compound?" "Larry, where's the inventory?" "Les has got it." Lt. Chandler got down from the bunk and Capt. Wilkins mounted. "Larry," Major Winship said, "why don't you get Earth?" "Okay." Capt. Wilkins got down from the bunk and Capt. Lawler ascended. "Got the inventory sheet, Les?" "Right here." Squeezed in front of the massive transmitter, Capt. Wilkins had energized the circuits. There was a puzzled look on his face. He leaned his helmet against the speaker and then shook his head sadly. "We can't hear anything without any air." Major Winship looked at the microphone. "Well, I'll just report and—" He started to pick up the microphone and reconsidered. "Yes," he said. "That's right, isn't it." Capt. Wilkins flicked off the transmitter. "Some days you don't mine at all," he said. "Les, have you found it?" "It's around here somewhere. Supposed to be back here." "Well, find it." Lt. Chandler began moving boxes. "I saw it—" "Skip, help look." Capt. Lawler got down from the bunk and Major Winship mounted. "We haven't got all day." A few minutes later, Lt. Chandler issued the triumphant cry. "Here it is! Dozen tubes. Squeeze tubes. It's the new stuff." Major Winship got down and Capt. Wilkins got up. "Marker showed it over here," Major Winship said, inching over to the wall. He traced the leak with a metallic finger. "How does this stuff work?" Capt. Lawler asked. They huddled over the instruction sheet. "Let's see. Squeeze the tube until the diaphragm at the nozzle ruptures. Extrude paste into seam. Allow to harden one hour before service." Major Winship said dryly, "Never mind. I notice it hardens on contact with air." Capt. Wilkins lay back on the bunk and stared upward. He said, "Now that makes a weird kind of sense, doesn't it?" "How do they possibly think—?" "Gentlemen! It doesn't make any difference," Lt. Chandler said. "Some air must already have leaked into this one. It's hard as a rock. A gorilla couldn't extrude it." "How're the other ones?" asked Major Winship. Lt. Chandler turned and made a quick examination. "Oh, they're all hard, too." "Who was supposed to check?" demanded Capt. Wilkins in exasperation. "The only way you can check is to extrude it," Lt. Chandler said, "and if it does extrude, you've ruined it." "That's that," Major Winship said. "There's nothing for it but to yell help." II Capt. Lawler and Lt. Chandler took the land car to Base Gagarin. The Soviet base was situated some ten miles toward sunset at the bottom of a natural fold in the surface. The route was moderately direct to the tip of the gently rolling ridge. At that point, the best pathway angled left and made an S-shaped descent to the basin. It was a one-way trip of approximately thirty exhausting minutes. Major Winship, with his deficient reefer, remained behind. Capt. Wilkins stayed for company. "I want a cigarette in the worst way," Capt. Wilkins said. "So do I, Larry. Shouldn't be more than a couple of hours. Unless something else goes wrong." "As long as they'll loan us the calking compound," Capt. Wilkins said. "Yeah, yeah," Major Winship said. "Let's eat." "You got any concentrate? I'm empty." "I'll load you," Capt. Wilkins volunteered wearily. It was an awkward operation that took several minutes. Capt. Wilkins cursed twice during the operation. "I'd hate to live in this thing for any period." "I think these suits are one thing we've got over the Russians," Major Winship said. "I don't see how they can manipulate those bulky pieces of junk around." They ate. "Really horrible stuff." "Nutritious." After the meal, Major Winship said reflectively, "Now I'd like a cup of hot tea. I'm cooled off." Capt. Wilkins raised eyebrows. "What brought this on?" "I was just thinking.... They really got it made, Larry. They've got better than three thousand square feet in the main dome and better than twelve hundred square feet in each of the two little ones. And there's only seven of them right now. That's living." "They've been here six years longer, after all." "Finogenov had a clay samovar sent up. Lemon and nutmeg, too. Real, by God, fresh lemons for the tea, the last time I was there. His own office is about ten by ten. Think of that. One hundred square feet. And a wooden desk. A wooden desk. And a chair. A wooden chair. Everything big and heavy. Everything. Weight, hell. Fifty pounds more or less—" "They've got the power-plants for it." "Do you think he did that deliberately?" Major Winship asked. "I think he's trying to force us off. I think he hoped for the quake. Gagarin's built to take it, I'll say that. Looks like it, anyhow. You don't suppose they planned this all along? Even if they didn't, they sure got the jump on us again, didn't they? I told you what he told me?" "You told me," Capt. Wilkins said. After a moment, Major Winship said bitterly, "To hell with the Russian engineer." "If you've got all that power...." "That's the thing. That's the thing that gripes me, know what I mean? It's just insane to send up a heavy wooden desk. That's showing off. Like a little kid." "Maybe they don't make aluminum desks." "They've—got—aluminum. Half of everything on the whole planet is aluminum. You know they're just showing off." "Let me wire you up," Capt. Wilkins said. "We ought to report." "That's going to take awhile." "It's something to do while we wait." "I guess we ought to." Major Winship came down from the bunk and sat with his back toward the transmitter. Capt. Wilkins slewed the equipment around until the emergency jacks were accessible. He unearthed the appropriate cable and began unscrewing the exterior plate to the small transmitter-receiver set on Major Winship's back. Eventually, trailing wires, Major Winship was coupled into the network. "Okay?" "Okay," Major Winship gestured. They roused Earth. "This is Major Charles Winship, Commanding Officer, Freedom 19, the American moonbase." At this point, Major Winship observed for the first time that he was now on emergency air. He started to ask Capt. Wilkins to change his air bottle, but then he realized his communications were cut off. He reached over and rapped Capt. Wilkins' helmet. "This is the Cape. Come in, Major Winship." "Just a moment." "Is everything all right?" Major Winship was squirming nervously, obviously perturbed. "A-Okay," he said. "Just a moment." "What's wrong?" came the worried question. In the background, he heard someone say, "I think there's something wrong." Capt. Wilkins peered intently. Major Winship contorted his face in a savage grimace. Capt. Wilkins raised his eyebrows in alarm. They were face to face through their helmets, close together. Each face appeared monstrously large to the other. Major Winship made a strangling motion and reached for his throat. One arm tangled a cable and jerked the speaker jack loose. Major Winship could no longer hear the alarmed expressions from the Cape. The effort was not entirely subvocal, since he emitted a little gasping cry in involuntary realism. This, in the course of some 90 seconds, was transmitted to Earth. Capt. Wilkins's lips were desperately forming the word "Leak?" Air, Major Winship said silently. Leak? Bottle! Bottle! Bottle! It was a frog-like, unvocal expletive. Comprehension dawned. Capt. Wilkins nodded and started to turn away. Major Winship caught his arm and nodded his head toward the loose jack. Oh. Capt. Wilkins nodded and smiled. He reached across and plugged the speaker in again. "... Freedom 19! Hello, Freedom 19! Come in!" "We're here," Major Winship said. "All right? Are you all right?" "We're all right. A-Okay." Major Winship, mindful of the extent of his potential audience, took a deep breath. "Earlier this morning, the Soviet Union fired an underground atomic device for the ostensible purpose of investigating the composition of the lunar mass by means of seismic analysis of the resultant shock waves. This was done in spite of American warnings that such a disturbance might release accumulated stresses in the long undisturbed satellite, and was done in the face of vigorous American protests." Capt. Wilkins tapped his helmet and gestured for him to swivel around. The turn was uncomfortably tight and complicated by the restraining cables. Capt. Wilkins began replacement of the air bottle. "These protests have proved well founded," Major Winship continued. "Immediately following the detonation, Freedom 19 was called on to withstand a moderately severe shifting of the Lunar surface. No personnel were injured and there was no equipment damage." Capt. Wilkins tapped his shoulder to indicate the new air bottle was being inserted. Another tap indicated it was seated. Major Winship flicked the appropriate chest button and nodded in appreciation. "However," he continued, "we did experience a minor leak in the dome, which is presently being repaired." "The Soviet Union," came the reply, "has reported the disturbance and has tendered their official apology. You want it?" "It can wait until later. Send it by mail for all I care. Vacuum has destroyed our organic air reconditioner. We have approximately three weeks of emergency air. However, Base Gagarin reports no damage, so that, in the event we exhaust our air, we will be able to obtain the necessary replacement." The wait of a little better than three seconds for the response gave the conversation a tone of deliberation. A new voice came on. "We tried to contact you earlier, Major. We will be able to deliver replacements in about ten days." "I will forward a coded report on the occurrence," Major Winship said. "Let us hear from you again in ... about three hours. Is the leak repaired?" "The leak has not yet been repaired. Over and out." He nodded to Capt. Wilkins and leaned back. Methodically, Capt. Wilkins set about disconnecting the major from the transmitter. "Wow!" said Major Winship when he was once more in communication. "For a moment there, I thought...." "What?" Capt. Wilkins asked with interest. "I could see myself asking them to ask the Russians to ask Finogenov to get on the emergency channel to ask you to charge the air bottle. I never felt so ... idiotic is not quite strong enough ... there for a minute in my whole life. I didn't know how much emergency air was left, and I thought, my God, I'll never live this down. All the hams in the world listening, while I try to explain the situation. I could see the nickname being entered in my files: aka. The Airless Idiot. I tell you, that was rough." III Capt. Lawler and Lt. Chandler returned with the calking compound. It occupied the rear section of the land car. Lt. Chandler sat atop it. It was a fifty-five gallon drum. The airlock to Freedom 19 was open. "What is that ?" asked Major Winship, squinting out into the glaring sunlight. "That," said Capt. Lawler, "is the calking compound." "You're kidding," said Capt. Wilkins. "I am not kidding." Capt. Lawler and Lt. Chandler came inside. Capt. Wilkins mounted a bunk. "Why didn't you just borrow a cupful?" Major Winship said sarcastically. "It's this way," Lt. Chandler said. "They didn't have anything but 55-gallon drums of it." "Oh, my," said Capt. Wilkins. "I suppose it's a steel drum. Those things must weigh...." "Actually, I think you guys have got the general wrong," Capt. Lawler said. "He was out, himself, to greet us. I think he was really quite upset by the quake. Probably because his people had misfigured so bad." "He's too damned suspicious," Major Winship said. "You know and I know why they set that blast off. I tried to tell him. Hell. He looks at me like an emasculated owl and wants to know our ulterior motive in trying to prevent a purely scientific experiment, the results of which will be published in the technical press for the good of everybody. I'll bet!" "About this drum," Capt. Wilkins said. "Well, like I said, it's this way," Lt. Chandler resumed. "I told him we needed about a pint. Maybe a quart. But this stuff you have to mix up. He only had these drums. There's two parts to it, and you have to combine them in just the right proportion. He told me to take a little scale—" "A little scale?" asked Capt. Wilkins, rolling his eyes at the dome. "That's what I told him. We don't have any little scale." "Yeah," said Captain Lawler, "and he looked at us with that mute, surprised look, like everybody, everywhere has dozens of little scales." "Well, anyway," Lt. Chandler continued, "he told us just to mix up the whole fifty-five gallon drum. There's a little bucket of stuff that goes in, and it's measured just right. We can throw away what we don't need." "Somehow, that sounds like him," Major Winship said. "He had five or six of them." "Jesus!" said Capt. Wilkins. "That must be three thousand pounds of calking compound. Those people are insane." "The question is," Capt. Lawler said, "'How are we going to mix it?' It's supposed to be mixed thoroughly." They thought over the problem for a while. "That will be a man-sized job," Major Winship said. "Let's see, Charlie. Maybe not too bad," said Capt. Wilkins. "If I took the compressor motor, we could make up a shaft and ... let's see ... if we could...." It took the better part of an hour to rig up the electric mixer. Capt. Wilkins was profusely congratulated. "Now," Major Winship said, "we can either bring the drum inside or take the mixer out there." "We're going to have to bring the drum in," Capt. Wilkins said. "Well," said Capt. Lawler, "that will make it nice and cozy." It took the four of them to roll the drum inside, rocking it back and forth through the airlock. At that time, it was apparent the table was interposing itself. Lt. Chandler tried to dismantle the table. "Damn these suits," he said. "You've got it stuck between the bunk post." "I know that." "I don't think this is the way to do it," Major Winship said. "Let's back the drum out." Reluctantly, they backed the drum out and deposited it. With the aid of Capt. Lawler, Lt. Chandler got the table unstuck. They passed it over to Major Winship, who handed it out to Capt. Wilkins. Captain Wilkins carried it around the drum of calking compound and set it down. It rested uneasily on the uneven surface. "Now, let's go," said Major Winship. Eventually, they accomplished the moving. They wedged the drum between the main air-supply tank and the transmitter. They were all perspiring. "It's not the weight, it's the mass," said Capt. Wilkins brightly. "The hell it isn't the weight," said Lt. Chandler. "That's heavy." "With my reefer out," said Major Winship, "I'm the one it's rough on." He shook perspiration out of his eyes. "They should figure a way to get a mop in here, or a towel, or a sponge, or something. I'll bet you've forgotten how much sweat stings in the eyes." "It's the salt." "Speaking of salt. I wish I had some salt tablets," Major Winship said. "I've never sweat so much since basic." "Want to bet Finogenov hasn't got a bushel of them?" "No!" Major Winship snapped. With the drum of calking compound inside, both Capt. Lawler and Lt. Chandler retreated to the bunks. Capt. Wilkins maneuvered the mixing attachment. "I feel crowded," he said. "Cozy's the word." "Watch it! Watch it! You almost hit me in the face plate with that!" "Sorry." At length the mixer was in operation in the drum. "Works perfectly," said Capt. Wilkins proudly. "Now what, Skip? The instructions aren't in English." "You're supposed to dump the bucket of stuff in. Then clean the area thoroughly around the leak." "With what?" asked Major Winship. "Sandpaper, I guess." "With sandpaper?" Major Winship said, emptying the bucket of fluid into the drum. "We don't have any sandpaper." "It's been a long day," Capt. Wilkins said. "Mix it thoroughly," Lt. Chandler mused. "I guess that means let it mix for about ten minutes or so. Then you apply it. It sets for service in just a little bit, Finogenov said. An hour or so, maybe." "I hope this doesn't set on exposure to air." "No," Capt. Lawler said. "It sets by some kind of chemical action. General Finogenov wasn't sure of the English name for it. Some kind of plastic." "Let's come back to how we're going to clean around the leak," Major Winship said. "Say, I—" interrupted Capt. Wilkins. There was a trace of concern in his voice. "This is a hell of a time for this to occur to me. I just wasn't thinking, before. You don't suppose it's a room-temperature-curing epoxy resin, do you? " "Larry," said Major Winship, "I wouldn't know a room-temperature-curing epoxy resin from—" "Hey!" exclaimed Capt. Wilkins. "The mixer's stopped." He bent forward and touched the drum. He jerked back. "Ye Gods! that's hot! And it's harder than a rock! It is an epoxy! Let's get out of here." "Huh?" "Out! Out!" Major Winship, Lt. Chandler, and Capt. Lawler, recognizing the sense of urgency, simultaneously glanced at the drum. It was glowing cherry red. "Let's go!" Capt. Wilkins said. He and the Major reached the airlock at the same time and became temporarily engaged with each other. Movement was somewhat ungainly in the space suits under the best of conditions, and now, with the necessity for speed, was doubly so. The other two crashed into them from behind, and they spewed forth from the dome in a tangle of arms and legs. At the table, they separated, two going to the left, two to the right. The table remained untouched. When they halted, Capt. Wilkins said, "Get to one side, it may go off like shrapnel." They obeyed. "What—what—what?" Capt. Lawler stuttered. They were still separated, two on one side of the airlock, two on the other. "I'm going to try to look," Capt. Wilkins said. "Let me go." He lumbered directly away from the dome for a distance of about fifteen feet, then turned and positioned himself, some five feet behind the table, on a line of sight with the airlock. "I can see it," he said. "It's getting redder. It's ... it's ... melting, yes. Melting down at the bottom a little. Now it's falling over to one side and laying on the air tank. The air tank is getting red, too. I'm afraid ... it's weakening it.... Redder. Oh, oh." "What?" said Capt. Lawler. "Watch out! There. There! " Capt. Wilkins leaped from his position. He was still floating toward the ground when there was an incredibly bright flare from inside the dome, and a great, silent tongue of flame lashed through the airlock and rolled across the lunar surface. The table was sent tumbling. The flame was gone almost instantly. "There went the air," Capt. Lawler commented. "We got T-Trouble," said Lt. Chandler.
|
B. He didn't speak English
|
On Paul Doe's lab results upon discharge in January 2022, which of the following values was elevated?
Choose the correct answer from the following options:
A. Sodium
B. Potassium
C. Creatinine
D. eGFR (CKD-EPI)
E. C-Reactive Protein
|
### Patient Report 0
**Dear colleague, ****Dear colleague, **
We are writing to provide an update regarding Mr. Paul Doe, born on
08/08/1965, who was treated in our clinic from 05/28/14 to 06/20/14.
**Diagnoses: **
- pT1, pN0 (0/21, ECE negative), cM0, Pn0, G2, RX, L0, V0, left
midline tongue carcinoma
- Arterial hypertension
- Status post liver surgery 2013
- Status post endoprosthetic hip treatment
- Idiopathic thrombocytopenia
- Non-insulin-dependent diabetes mellitus type II
- Hypothyroidism
- Nicotine abuse
<!-- -->
- Panendoscopy with sampling on 04/14/2014 and 04/26/2014
**Current Presentation**: With histologically confirmed carcinoma in the
region of the base of the tongue on the left side, Mr. Doe presents for
surgical treatment of the findings. In accordance with the tumor board
decision, resection is performed via a lateral pharyngotomy and neck
dissection on both sides.
**Physical Examination:** Patient in stable general condition (85 kg,
188 cm). MUST score: 0, pain NRS 8/10 intermittent (adjusted with
Acetaminophen) \| fatigue I°, dysphagia I° \| aspiration 0°, ulcer 0°,
trismus 0°, taste disturbance I°, xerostomia I°, osteonecrosis 0°,
hypothyroidism I° (L-thyroxine increased to 150 μg 1-0-0), hoarseness
0°, hearing loss 0° (subjectively reduced), dyspnea: 0°, pneumonitis 0°,
nausea/vomiting 0°.
No suspicious lymph nodes palpable \| movement restrictions 0°,
subcutaneous fibrosis: I°, hyperpigmentation: I° cervical, mucositis 0°,
lymphedema I° (lymphatic drainage prescribed), telangiectasia 0°.
A tumorous mass can be inspected at the base of the left tongue. Tongue
mobility is unremarkable.
**CT chest, abdomen, pelvis on 05/28/14:**
Emphasized mediastinal as well as abdominal lymph
nodes.** **Vasosclerosis. Otherwise, there is no evidence for the
presence of distant metastases with a suspected base of tongue
carcinoma. Liver cirrhosis.
**CT neck on 06/11/14:**
Suspected left tongue base carcinoma crossing midline with extension
into the left vallecula and compression of the left piriform sinus with
suspected lymph node metastases in levels I-III ipsilateral.
Contralateral prominent but not certainly suspicious lymph nodes. The
prominent structure on the left supraclavicular side can also be
interpreted as circumscribed cystiform ectasia of the thoracic duct.
**Ultrasound abdomen on 06/15/14:**
Image of liver cirrhosis status post cholecystectomy.
Hepatosplenomegaly. Moderate aortic sclerosis.
**X-ray pap swallow on 06/17/14:**
Clear tracheal aspiration in the absence of epiglottis envelope. The
cough reflex is preserved. Otherwise, essentially unremarkable
swallowing act.
**Histology**: Invasive, moderately differentiated, squamous cell
carcinoma with keratinization of the medial left base of the tongue,
maximum extent 1.0 cm. Carcinoma- and dysplasia-free biopsies of the
left tonsil, the oropharyngeal tumor/tongue base on the left, deep
resection of the tumor, lower tonsillar pole transition on the left
tongue base, tongue base on the left and medial left tongue base, as
well as median tongue base.
Metastasis-free lymph nodes in Neck-dissection Level IIa to IV on the
left (0/16), Neck-dissection Level IIb on the left (0/1), and
Neck-dissection Level II to IV on the right (0/3), occasionally with
lymphofollicular hyperplasia. Carcinoma-free bone of the left lateral
thigh of the hyoid.
**Final UICC classification:** pT1. pN0 (0/21). L0. V0. Pn0. G2. RX.
**Therapy and Progression**: After the usual clinical and laboratory
preparations, we performed the above-mentioned therapy on 05/29/14 in
intubation anesthesia without complications. For perioperative infection
prophylaxis, the patient received intravenous antibiotic therapy with
Ampicillin and Sulbactam 3g three times daily for the duration of his
hospital stay.
During this procedure, the left lingual artery was interrupted
prophylactically. No postoperative bleeding and no wound healing
disturbances occurred.
A porridge swallow examination showed no evidence of a fistula. On the
following day, the patient was decannulated in consultation with the
colleagues of the speech therapy. After this, a food build-up was
carried out in cooperation with speech therapists. At the time of
discharge, the patient was receiving regular oral nutrition. The stoma
continued to shrink. The patient was monitored, and if necessary, the
tracheostoma was closed with local anesthesia. Histological findings
were pT1. Due to an RX status, adjuvant radiotherapy will be performed
as decided by the tumor board. A prophylactic presentation at the
colleagues of the MKG as a preparatory measure for the upcoming
radiotherapy. We asked for a control re-presentation in our outpatient
clinic on 06/26/14 at 3:00 PM. Further controls take place at the half
and at the end of the radiotherapy and further in 4-6 weeks rhythm. In
case of acute complaints, an immediate re-presentation is possible at
any time.
**Type of surgery**: Lateral pharyngotomy with resection of the base of
the tongue on the left as well as selective neck dissection on both
sides level II-IV with ligature of the lingual artery on the left side,
creation of a stable tracheostoma and tonsillectomy on the left side.
**Surgery report: **First, tracheotomy in a typical manner. A horizontal
incision was made on the skin, positioned approximately two transverse
finger widths above the jugulum. Subsequently, the subcutaneous tissue
and the platysma colli were incised. To facilitate access to the
trachea, the laryngeal muscles were carefully displaced to the side. The
thyroid isthmus was undermined and clamped bilaterally. A precise
transection of the thyroid isthmus followed, with both halves of the
thyroid gland being meticulously sutured using 0- Vicryl. The thyroid
halves were repositioned to expose the trachea. A visceral tracheotomy
was performed, and re-intubation was achieved utilizing a U-tube. The
surgical procedure then transitioned to a neck dissection on the left
side. This phase began with an incision along the anterior edge of the
sternocleidomastoid muscle. The subcutaneous tissue and platysma colli
were carefully cut, with due respect to the auricularis magnus nerve.
Dissection continued dorsally along the sternocleidomastoid muscle to
reach the anterior border of the trapezius muscle. Further exposure
involved the accessorius nerve in a cranialward direction, with
preservation of this neural structure. Dissection proceeded along the
cervical vascular sheath, revealing the common carotid artery, internal
jugular vein, and vagus nerve up to the digastric muscle. Below this
level, exposure of the hypoglossal nerve was achieved.
Successive dissection involved the lymph node fat package, progressing
from level II to level IV in a cranial to caudal and ventral to dorsal
direction. Throughout this process, careful attention was paid to
sparing the aforementioned neural and vascular structures. Subsequently,
access to the lateral pharyngectomy area was gained, allowing
visualization of the external carotid artery along with its branches,
including the superior thyroid artery, superior laryngeal artery, and
lingual artery. Notably, the lingual artery was interrupted during this
stage.
Further exploration revealed the superior laryngeal nerve and
hypoglossal nerve intersecting in a loop above the internal carotid
artery and externally below the external jugular vein. Additional
dissection in a ventral direction followed. The hypoglossal nerve was
prepared meticulously. Exposure of the hyoid bone was achieved, with a
posterior resection of half of the hyoid bone. Importantly, the
hypoglossal nerve was spared during this procedure. Subsequent to these
steps, the lateral pharynx wall was opened, exposing the base of the
hyoid. The next phase of the procedure involved enoral tumor
tonsillectomy on the left side. Starting from the left side, the
surgical team identified the tonsil capsule at the anterior palatal arch
using a Henke spatula. The upper tonsillar pole was then dislodged and
dissected with the Rosenblatt instrument, proceeding from cranial to
caudal. Hemostasis was meticulously achieved through swab pressure and
electrocautery. The excised tonsil tissue was sent for frozen section
examination for further analysis.
**Frozen Section Report: **No evidence of malignancy was found. The
resection was carried out at the junction of the caudal tonsillar pole
and the base of the tongue. At this location, tissue from the base of
the tongue was resected and sent for a frozen section examination, which
revealed no indication of malignancy. Subsequently, a medial resection
of the base of the tongue was performed, confirming the presence of
squamous cell carcinoma in the frozen section analysis. Mucosal suturing
with inverting sutures was then conducted. On the left side, a neck
dissection procedure was performed. The dissection extended along the
sternocleidomastoid muscle, reaching dorsally to the anterior border of
the trapezius muscle. This approach allowed for cranial exposure of the
accessorius nerve while sparing the same. Dissection continued along the
cervical vascular sheath, exposing the common carotid artery, internal
jugular vein, and the vagus nerve up to the digastric muscle. Below
this, the hypoglossal nerve was exposed. Subsequently, the lymph node
fat package was dissected systematically from level II to level IV,
progressing from cranial to caudal and ventral to dorsal, while
carefully preserving the mentioned structures. The surgical procedure
concluded with the placement of a drain, subcutaneous suturing, and skin
suturing.
**Frozen section report:** Invasive squamous cell carcinoma.
**Microscopy:**
Even after paraffin embedding, mucosal cross-sections show a covering of
stratified, non-keratinizing squamous epithelium with occasional
significant stratification disturbances extending into superficial cell
layers. This transitions into invasive growth with solid clusters of
polygonal tumor cells, some of which exhibit identifiable intercellular
bridges. The cell nuclei are enlarged, round to oval, with occasional
small nucleoli and mild to moderate nuclear pleomorphism. Dyskeratosis
is observed in some areas.
**Lab results upon Discharge: **
**Parameter** **Result** **Reference Range**
-------------------- ----------------------- -----------------------
Sodium 141 mEq/L 135 - 145 mEq/L
Potassium 4.7 mEq/L 3.5 - 5.0 mEq/L
Creatinine 1.0 mg/dL 0.7 - 1.3 mg/dL
Calcium 9.04 mg/dL 8.8 - 10.6 mg/dL
GFR (MDRD) \> 60 mL/min/1.73m\^2 \> 60 mL/min/1.73m\^2
GFR (CKD-EPI,CREA) 80 mL/min/1.73m\^2 \> 90 mL/min/1.73m\^2
C-reactive protein 1.0 mg/dL \< 0.5 mg/dL
### Patient Report 1
**Dear colleague, **
We are writing to provide an update regarding Mr. Paul Doe, born on
08/08/1965, who presented to our outpatient clinic on 09/14/2014.
**Diagnosis: **Tongue base Carcinoma ICD-10: C01, stage: pT1 pN0 (0/21)
L0 V0 Pn0 G2 RX
**Other Diagnoses:**
- Arterial hypertension
- Diabetes mellitus type II
- Status post liver surgery 2013
- Status post endoprosthetic hip treatment
- Hypothyroidism
- Oral thrush
- Hypacusis
- Since 03/2014: Odynophagia
<!-- -->
- 05/14/2014: Panendoscopy, biopsy, and initial diagnosis of left
tongue base carcinoma.
- 05/29/2014: Tumor resection and selective neck dissection LI-III
**Histology:**
Invasive, moderately differentiated, squamous cell carcinoma with
keratinization of the medial left base of the tongue, maximum extent 1.0
cm. Carcinoma- and dysplasia-free biopsies of the left tonsil, the
oropharyngeal tumor/tongue base on the left, deep resection of the
tumor, lower tonsillar pole transition on the left tongue base, tongue
base on the left and medial left tongue base, as well as median tongue
base.
Metastasis-free lymph nodes in Neck-dissection Level IIa to IV on the
left (0/16), Neck-dissection Level IIb on the left (0/1), and
Neck-dissection Level II to IV on the right (0/3), occasionally with
lymphofollicular hyperplasia. Carcinoma-free bone of the left lateral
thigh of the hyoid.
**Final UICC classification:** min pT1, pN0 (0/21). L0. V0. Pn0. G2. RX.
**Current Radiotherapy:**
**Indication**: According to the decision made by the interdisciplinary
tumor board for head and neck tumors, it was determined by our medical
team that, in the postoperative condition following the resection of a
tongue base carcinoma with an unclear resection status, there is an
indication for radiation therapy of the former tumor site.
**Technique:** Percutaneous radiotherapy of the former primary tumor
region with 6-MeVPhotons, in Rapid-Arc technique, with a single dose of
2 Gy up to a total dose of 60 Gy.
**Radiotherapy 07/27/2014 - 09/06/2014:**
During the course of radiotherapy, the patient experienced enoral
mucositis (grade II according to CTCAE) leading to subsequent
odynophagia and dysphagia. We managed these symptoms with oral rinses
and initiated pain management using Acetaminophen, resulting in an
acceptable reduction of pain over time. At the end of the therapy, the
patient\'s general condition remained stable (ECOG performance status:
70%). Second-degree mucositis enoral persisted, causing ongoing
dysphagia and odynophagia. Additionally, the patient exhibited localized
radiodermatitis (grade II according to CTCAE) within the radiation
field. The patient did not report xerostomia or dysgeusia.
**Current Recommendations:**
The patient received comprehensive instructions on continued skincare
and side-effect management. An initial follow-up appointment with the
radio-oncology team has been scheduled in our outpatient clinic. We
kindly request the patient to provide a renewed referral for
radiotherapy on the day of the appointment.
The ongoing oncological treatment plan will be determined by the
patient\'s Ear, Nose, and Throat specialists. Regular follow-up
examinations are strongly recommended. Additionally, for patients who
have completed radiation therapy in the ENT region, we advise lifelong
adherence to fluoride prophylaxis and antibiotic therapy during any
dental procedures.
### Patient Report 2
**Dear colleague, **
We report about our patient, Mr. Doe, born on 08/08/1965, who presented
to our outpatient clinic for phoniatrics and pedaudiology on 10/10/2014.
**Diagnoses: **
- Tongue base carcinoma ICD-10: C01, stage: pT1 pN0 (0/21) L0 V0 Pn0
G2 RX
- Since 03/2014: Odynophagia
- 05/14/2014: Panendoscopy, biopsy, and initial diagnosis of left
tongue base carcinoma.
- 05/29/2014: Tumor resection and selective neck dissection LI-III
**Other Diagnoses:**
- Arterial hypertension
- Diabetes mellitus type II
- Status post liver surgery 2013
- Status post endoprosthetic hip treatment
- Hypothyroidism
- Oral thrush
- Hypacusis
**Medical History: **We may kindly assume the detailed history as known.
**Phoniatrics: Fiberoptic endoscopic swallow examination:**
Tongue motor function is well preserved, sensitivity of lip and tongue
laterally equal,
Mucous membranes non-irritant on all sides. Tracheal mucosa
non-irritant, no evidence of saliva intratracheal. Neopharynx
inconspicuous, air bubbles visible above Provox outlet on pressing
attempt. Tongue retraction slightly limited. Velopharyngeal closure
good.
**Therapy and Course:** After completion of the adjuvant radiotherapy
approximately 6 weeks ago, phonation via the Provox voice prosthesis was
no longer possible after this had initially worked after the operation.
Additionally, there were issues with regurgitation of ingested
substances, regardless of their consistency. In some cases, nasal
penetration with fluids occurred. There were no indications of
aspiration. A self-assessment, involving the use of blue-colored liquid,
revealed no signs of leakage from the Provox device.
**Current Recommendations:** Oncological follow-up in 12 months.
### Patient Report 3
**Dear colleague, **
We report about our patient, Mr. Doe, born on 08/08/1965 who presented
at our outpatient clinic for radio-oncological follow-up on 10/09/2020.
**Diagnoses: **
- Tongue base Carcinoma ICD-10: C01, stage: pT1 pN0 (0/21) L0 V0 Pn0
G2 RX
- Since 03/2014: Odynophagia
- 05/14/2014: Panendoscopy, biopsy, and initial diagnosis of left
tongue base carcinoma.
- 05/29/2014: Tumor resection and selective neck dissection LI-III
**Other Diagnoses:**
- Arterial hypertension
- Diabetes mellitus type II
- Status post liver surgery 2013
- Status post endoprosthetic hip treatment
- Hypothyroidism
- Oral thrush
- Hypacusis
**Current Presentation: **The patient presented to our general
outpatient clinic for a radio-oncological follow-up on 10/09/2020 in the
presence of his wife.
**Physical Examination**: Patient in stable general condition (85 kg,188
cm). MUST score: 0, pain NRS 8/10 intermittent (adjusted with
Acetaminophen) \| fatigue I°, dysphagia I° \| aspiration 0°, ulcer 0°,
trismus 0°, taste disturbance I°, xerostomia I°, osteonecrosis 0°,
hypothyroidism I°, hoarseness 0°, hearing loss 0° (subjectively
reduced), dyspnea: 0°, pneumonitis 0°, nausea/vomiting 0°.
No suspicious lymph nodes palpable \| movement restrictions 0°,
subcutaneous fibrosis: I°, hyperpigmentation: I° cervical, mucositis 0°,
lymphedema I° (lymphatic drainage prescribed), telangiectasia 0°.
**MRI scan of the neck from 10/09/2020:**
Clear post-therapeutic changes in the resection and radiation area after
adjuvant RTx following tumor resection with laryngectomy for extensive
recurrence of oropharyngeal cancer.
Size constant, but still clearly accentuated lymph nodes in level Ib/IIa
on the left. Regredience of seroma formation under the left
sternocleidomastoid muscle.
**Current Recommendations: **Primary oncological care and follow-up,
including imaging, will be provided by the ENT clinic according to the
guidelines. A re-appointment for a further radio-oncological follow-up
at the follow-up appointment at the Radiation Therapy Tumor Therapy
Center has been scheduled. After head and neck radiation therapy,
regular fluoridation of the teeth and guideline-based antibiotic
prophylaxis is required prior to major dental procedures. We also
recommend temporomandibular joint opening exercises to prevent
temporomandibular joint fibrosis and consecutive temporomandibular joint
opening obstruction. We also refer to regular control of thyroid
function parameters and, if necessary, initiation of substitution
therapy after radiotherapy to the neck.
### Patient Report 4
**Dear colleague, **
We hereby report on our patient Mr. Paul Doe, born 08/08/1965 for
radio-oncological follow-up on 09/24/2021.
**Diagnoses: **
- Tongue base carcinoma ICD-10: C01, stage: pT1 pN0 (0/21) L0 V0 Pn0
G2 RX
- Since 03/2014: Odynophagia
- 05/14/2014: Panendoscopy, biopsy, and initial diagnosis of left
tongue base carcinoma.
- 05/29/2014: Tumor resection and selective neck dissection LI-III
**Other Diagnoses:**
- Arterial hypertension
- Diabetes mellitus type II
- Status post liver surgery 2013
- Status post endoprosthetic hip treatment
- Hypothyroidism
- Oral thrush
- Hypacusis
**Current Presentation: **The patient presented to our general
outpatient clinic for radio-oncological follow-up on 09/24/2021.
**Physical Examination: **Patient in reduced general condition (KPS 60%,
86 kg,188 cm). Weight loss 0°, MUST score: 0, pain VAS 1-2/10, fatigue
I°, dysphagia I° with solid food (liquids occasionally flow out of the
nose again when swallowing), aspiration 0°, ulcer 0°, trismus 0°, taste
disorder I° (present in approx. 80%), xerostomia I°, osteonecrosis 0°,
hypothyroidism II°, hoarseness II°, hearing loss, I°, dyspnea: 0°,
pneumonitis 0°, nausea/vomiting 0°.
No suspicious lymph nodes palpable, movement restrictions I° head
reclination restricted with tension and pain, subcutaneous fibrosis: I°,
hyperpigmentation: I°, mucositis 0°, lymphedema I° (lymphatic drainage),
telangiectasia 0°.
**MR neck plain + contrast agent on 09/24/2021**:
[Technique]{.underline}: STIR triplanar, T1 ax -/+ contrast agent, T1
mDixon cor after
contrast agent.
[Findings]{.underline}: Known status post tumor resection with
laryngectomy for extensive recurrence of oropharyngeal Carcinoma;
Follow-up after RTx. Somewhat increasing swelling of nasopharynx to
oropharynx. From the uvula the swelling is stable. As far as can be
assessed, no clear recurrence-specific tissue proliferation or contrast
uptake. Unchanged accentuated lymph nodes in level Ib/IIa on the left
(one exemplary measured lymph node borderline large, idem to preliminary
examination). Mastoid cells minimally displaced on the left. Moderate
degenerative changes of the cervical spine. Assessment. Increasing
swelling of the naso- to oropharynx. Neopharynx unchanged swollen. No
evidence of malignancy-suspicious lymph nodes.
**CT scan of the thorax on 09/24/2021**:
Size-constant visualization of interlobar oval compaction in the left
upper lobe corresponding to an interlobar lymph node. New to the
previous examination, two small nodular condensations appear, basal in
the right and in the left lower lobe, differentially inflammatory;
follow-up is recommended. Unchanged the prominent mediastinal lymph
nodes, constant in size and number.
**Current Recommendations:**
Primary oncologic care and follow-up including imaging will take place
via the ENT clinic on 01/14/22 at 11:00 AM. A re-appointment for the
next radio-oncological follow-up has been arranged for 01/14/2022 at
1:00 PM in our radiotherapy outpatient clinic in the Tumor Therapy
Center.
**Lab results upon Discharge:**
**Hematology**
**Parameter ** **Result** **Reference**
---------------- ------------- -----------------------
WBC 6,900 /μL 4,500 - 11,000 /μL
RBC 2.7M /μL 4.5M - 5.9M /μL
Hemoglobin 8.2 g/dL 14 - 18 g/dL
Hematocrit 25.1 % 40 - 48 %
MCH 31.27 pg 27 - 33 pg
MCV 94 fL 82 - 92 fL
MCHC 32.7 g/dL 32 - 36 g/dL
Platelets 638,000 /μL 150,000 - 450,000 /μL
**Serum chemistry**
**Parameter ** **Result** **Reference**
---------------- ------------ -----------------
Sodium 144 mEq/L 135 - 145 mEq/L
Potassium 4.8 mEq/L 3.5 - 5.0 mEq/L
Creatinine 1.3 mg/dL 0.7 - 1.3 mg/dL
ALT 21 U/L 10 - 50 U/L
eGFR 55 mL/min \> 90 mL/min
CRP 2.9 mg/dL \< 0.5 mg/dL
**Coagulation**
**Parameter ** **Result** **Reference**
---------------- ------------ ---------------
PT 93 % 70 - 120 %
INR 1.1 0.8 - 1.2
aPTT 31 sec 26 - 37 sec
**Thyroid hormones**
**Parameter ** **Result** **Reference**
---------------- ------------- ------------------
TSH 1.16 μIU/mL 0.4 - 4.2 μIU/mL
fT3 2.38 pg/mL 2.3 - 4.2 pg/mL
fT4 1.70 ng/dL 0.9 - 1.7 ng/dL
### Patient Report 5
**Dear colleague, **
We are reporting on Mr. Paul Doe, born on 08/08/1965, who was admitted
to our hospital from 01/10/2022 to 01/27/2022.
**Diagnosis**: Metachronous pulmonary metastatic squamous cell carcinoma
**Diagnoses: **
- Tongue base Carcinoma ICD-10: C01, stage: pT1 pN0 (0/21) L0 V0 Pn0
G2 RX
- Since 03/2014 Odynophagia
- 05/14/2014 Panendoscopy, biopsy, and initial diagnosis of left
tongue base carcinoma.
- 05/29/2014 Tumor resection and selective neck dissection LI-III
**Other Diagnoses:**
- Arterial hypertension
- Diabetes mellitus type II
- Status post liver surgery 2013
- Status post endoprosthetic hip treatment
- Hypothyroidism
- Oral thrush
- Hypacusis
**Planned Surgical Procedure:**
- Perioperative bronchoscopy
- Left-sided video-assisted thoracoscopic surgery
- Pleurolysis
- Anatomical upper lobe resection
- Systematic mediastinal, hilar, and interlobar lymph node dissection
- Placement of double chest drains
**Medical History**: Mr. Paul Doe initially presented with a diagnosis
of pT1, pN0 (0/21, ECE negative), cM0, Pn0, G2, RX, L0, V0, left midline
tongue carcinoma. Panendoscopy with specimen collection on 04/14/2014
and 04/26/2014 confirmed carcinoma.
Surgical resection was performed via lateral pharyngotomy and neck
dissection. Histology confirmed squamous cell carcinoma. He subsequently
received radiotherapy.
During a follow-up CT examination, a suspicious lesion was identified in
the lung, which raised concerns regarding the possibility of metastasis
originating from the previously diagnosed left midline tongue carcinoma
(pT1, pN0, G2, RX).
**Current Presentation:** Mr. Doe was admitted for further examination
and treatment to assess the behavior and extent of the lesion.
Clinically, Mr. Doe was in stable general condition and had no symptoms
suggestive of B symptoms.
**Therapy and Progression**: The above-mentioned procedure was performed
without complications on 01/10/2022. Histologically, the final resection
specimen confirmed the presence of a 2.9 cm squamous cell carcinoma,
consistent with a metastatic recurrence of the previously known
hypopharyngeal carcinoma. The dissected lymph nodes were free of tumor.
The postoperative course was uneventful. In the absence of any
complications, surgical sutures were removed on day 10 after surgery. A
current chest X-ray showed a regular postoperative outcome with
sufficient expansion of the left lobe. Further monitoring is recommended
by the treating colleagues in this regard. Mr. Doe is also connected to
the radiation therapy team for ongoing follow-up.
If there are any complications or questions, please contact the relevant
ward or reach out to our Central Patient Management. Outside regular
working hours, you can contact the on-call colleague in the Abdominal
Surgery department for assistance.
For further information on the patient\'s discharge management, treating
providers are available for inquiries from Monday to Friday, 9 AM to 7
PM, as well as on weekends and holidays from 10 AM to 2 PM.
Mr. Doe was discharged from the hospital on 01/27/2022.
**Addition:**
**Histology Report:** Resected left upper lobe specimen with a 2.9 cm
solid carcinoma. The histological picture is consistent with a
metastasis from the previously diagnosed non-keratinizing squamous cell
carcinoma. There were focal vascular invasions. No pleural invasion was
observed. The resection was complete, with all dissected lymph nodes
showing no tumor involvement.
**Chest X-ray, anterior-posterior view from 01/21/2022**:
[Clinical Information:]{.underline} History of VATS with wedge
resection, yesterday\'s drain removal
[Question:]{.underline} Follow-up, pneumothorax after drain removal?
Infiltrates? Atelectasis?
[Findings:]{.underline} Left chest drainage tube has been removed. Left
apical pneumothorax line, measuring approximately 2.3 cm. Continued
extensive shadowing of the left upper field, most likely postoperative,
infiltrate cannot be definitively ruled out. Slightly hypotransparent
left lung in comparison, most likely due to residual postoperative
reduced ventilation. No effusion. Widened cardiac silhouette. Regression
of dystelectasis in the right lower field. No acute signs of pulmonary
venous congestion. Trachea is mid-positioned and not stenosed.
Left-sided port catheter still in place.
[Summary]{.underline}: Left apical corax with a width of 2.3 cm.
Continued extensive shadowing of the left upper field, most likely
postoperative, with infiltrate not definitively excluded. Residual
postoperative reduced ventilation on the left side. Regression of
dystelectasis in the right lower field. No effusion. No acute signs of
pulmonary venous congestion. Follow-up recommended.
**Examinations Chest X-ray, anterior-posterior view from 01/23/2022:**
[Question]{.underline}**:** Follow-up.
[Findings]{.underline}: Left apical pneumothorax, measuring
approximately 1.4 cm. Extensive shadowing in projection onto the left
upper lobe, differentials include postoperative changes, incipient
infiltrate not excluded. Dystelectasis of the right lower field. No
evidence of pleural effusion or acute pulmonary venous congestion.
Cardiomegaly. Indwelling chest drainage with the catheter tip projecting
onto the left upper lobe. Well-positioned port catheter tip projecting
onto the right atrial entrance plane. No evidence of pleural effusion.
Assessment Left apical pneumothorax, measuring approximately 1.4 cm,
with indwelling left chest drainage. Extensive shadowing in projection
onto the left upper lobe, differentials include postoperative changes,
incipient infiltrate not excluded. Dystelectasis of the right lower
field. No significant pleural effusion. No acute pulmonary venous
congestion. Cardiomegaly.
**Chest X-ray, anterior-posterior view from 01/25/2022**
[Previous Examinations]{.underline}: Appearance of a diffuse
postoperative shadow in the left upper field. No evidence of pleural
effusion, inflammatory infiltrate, or pulmonary venous congestion.
[Findings]{.underline}: Left-sided chest port with the tip projecting
onto the superior vena cava. The upper mediastinum is narrow, the
trachea is mid-positioned and patent.
[Assessment]{.underline}: The pneumothorax appears to be largely
resolved.
**Urinanalysis**:
Material: Urine, midstream sample collected on 01/11/2022
- Antimicrobial inhibitors negative
- No evidence of growth-inhibiting substances in the sample material.
- Colony Count (CFU) / mL \<1,000, Assessment: A low colony count
typically does not support a urinary tract infection.
- Epithelial cells (microscopic) \<20 epithelial cells/μL
- Leukocytes (microscopic) \<20 leukocytes/μL
- Microorganisms (microscopic) 20-100 microorganisms/μL Pathogen
Enterococci
**Lab values upon Discharge: **
**Parameter** **Result** **Reference Range**
-------------------- --------------------- ---------------------
Sodium 141 mEq/L 135 - 145 mEq/L
Potassium 4.7 mEq/L 3.5 - 5.0 mEq/L
Creatinine 1.1 mg/dL 0.7 - 1.3 mg/dL
Calcium 10.4 mg/dL 8.8 - 10.6 mg/dL
eGFR (MDRD) \> 60 mL/min/1.73m² \> 60 mL/min/1.73m²
eGFR (CKD-EPI) 85 mL/min/1.73m² \> 90 mL/min/1.73m²
C-Reactive Protein 5.0 mg/dL \< 0.5 mg/dL
### Patient Report 6
**Dear colleague, **
We are reporting on Mr. Paul Doe, born on 08/08/1965, who presented to
our surgical outpatient clinic on 01/24/2022.
**Diagnoses**: Metachronous pulmonary metastatic squamous cell carcinoma
at the base of the tongue.
**Surgical Procedure from 01/11/2022:**
- Perioperative bronchoscopy
- Left-sided video-assisted thoracoscopic surgery
- Pleurolysis
- Anatomical upper lobe resection
- Systematic mediastinal, hilar, and interlobar lymph node dissection
- Placement of double chest drains
**Previous Diagnoses and Therapies:**
- Recurrent oropharyngeal carcinoma ICD-10: C01
- Stage: rpT2 rpN2(2/24, ECE -) L1 V0 Pn0 G2 R0
- Tumor localization: base of tongue, crossing midline
- Since 04/2014: Odynophagia
- 04/14/2014: Panendoscopy, biopsy and initial diagnosis of left
tongue base carcinoma.
- 05/29/2014: Tumor resection and selective neck dissection LI-III
- 08-10/2015: radiotherapy of former PTR with 60 Gy à 2 Gy.
- OSAS with CPAP incompliance
<!-- -->
- Liver cirrhosis with alcohol abuse
- Non-insulin-dependent diabetes mellitus type II
- Arterial hypertension
- History of endoprosthetic hip treatment
- Hypothyroidism
- Oral thrush
- Hypacusis
**Current Presentation:** Mr. Doe presented for postoperative follow-up
after his left-sided videothoracoscopic upper lobe resection due to
previously diagnosed pulmonary metastatic hypopharyngeal carcinoma.
**Medical History:** The patient\'s general condition is good. He is
currently on intermittent as-needed analgesia with Acetaminophen. The
final resection specimen histologically confirmed the presence of a 2.9
cm squamous cell carcinoma, consistent with a metastatic recurrence of
the previously known hypopharyngeal carcinoma. The dissected lymph nodes
were free of tumor.
**Therapy and Progression**: During the follow-up appointment, Mr. Doe
underwent a clinical examination and a chest X-ray to assess his
postoperative condition. The examination revealed no new concerning
findings, and Mr. Doe continued to remain in stable general condition.
His surgical incision site was inspected, showing signs of satisfactory
healing without any signs of infection or complications.
Furthermore, Mr. Doe\'s lung function was evaluated through spirometry,
which indicated adequate pulmonary function post-surgery. He was also
provided with personalized recommendations for respiratory exercises to
optimize his lung function during the recovery period.
**Current Recommendations:**
- Mr. Doe is connected to the radiation therapy team for ongoing
follow-up.
### Patient Report 7
**Dear colleague, **
We are reporting on Mr. Paul Doe, born on 08/08/1965, who presented to
our surgical outpatient clinic on 01/24/2022.
**Diagnoses**: Metachronous pulmonary metastatic squamous cell carcinoma
at the base of the tongue.
**Surgery on 01/11/2022:**
- Left-sided video-assisted thoracoscopic surgery
- Anatomical upper lobe resection
- Systematic mediastinal, hilar, and interlobar lymph node dissection
**Previous Diagnoses and Therapies:**
- Recurrent oropharyngeal carcinoma ICD-10: C01
- Stage: rpT2 rpN2(2/24, ECE -) L1 V0 Pn0 G2 R0
- Tumor localization: base of tongue, crossing midline
- Since 04/2014: Odynophagia
- 04/14/2014: Panendoscopy, biopsy and initial diagnosis of left
tongue base carcinoma.
- 05/29/2014: Tumor resection and selective neck dissection LI-III
- 08-10/2015 Radiotherapy of former PTR with 60 Gy à 2 Gy.
**Other Diagnoses:**
- OSAS with CPAP incompliance
- Liver cirrhosis with alcohol abuse
- Non-insulin-dependent diabetes mellitus type II
- Arterial hypertension
- History of endoprosthetic hip treatment
- Hypothyroidism
- Oral thrush
- Hypacusis
**Current Presentation:** Mr. Doe presented for routine follow-up.
Clinically, he remains in stable general condition, with no signs of
B-symptoms.
**Medical History**: The surgical procedure performed on 01/11/2022
involved perioperative bronchoscopy, left VATS, pleurolysis, anatomical
upper lobe resection, systematic mediastinal, hilar, and interlobar
lymph node dissection, as well as the placement of double chest drains.
Histologically, the final resection specimen confirmed a 2.9 cm solid
carcinoma, consistent with metastasis from the previously diagnosed
squamous cell carcinoma. Lymph nodes dissected during the procedure were
tumor-free. Mr. Doe\'s postoperative course was uneventful, and surgical
sutures were removed on day 10 after surgery.
**Physical Examination:** Patient in good general condition. Weight loss
0°, MUST score: 0, pain VAS 1-2/10, fatigue I°, dysphagia I° with solid
food (liquids occasionally flow out of the nose again when swallowing),
aspiration 0°, ulcer 0°, trismus 0°, taste disorder I° (present in
approx. 80%), xerostomia I°, osteonecrosis 0°, hypothyroidism II°,
hoarseness II°, hearing loss, I°, dyspnea: 0°, pneumonitis 0°,
nausea/vomiting 0°.
No suspicious lymph nodes palpable, movement restrictions I° head
reclination restricted with tension and pain, subcutaneous fibrosis: I°,
hyperpigmentation: I°, mucositis 0°, lymphedema I° (lymphatic drainage),
telangiectasia 0°.
**Current Recommendations:** Mr. Doe is advised to continue his
follow-up appointments.
**Lab results upon Discharge:**
**Parameter** **Results** **Reference Range**
-------------------------------- -------------- ---------------------
Neutrophils 72.2 % 42.0-77.0 %
Lymphocytes 8.6 % 20.0-44.0 %
Monocytes 11.6 % 2.0-9.5 %
Basophils 1.4 % 0.0-1.8 %
Eosinophils 6.0 % 0.5-5.5 %
Immature Granulocytes 0.2 % 0.0-1.0 %
Sodium 137 mEq/L 136-145 mEq/L
Potassium 4.2 mEq/L 3.5-4.5 mEq/L
Calcium 9.24 mg/dL 8.8-10.2 mg/dL
Chloride 100 mEq/L 98-107 mEq/L
Creatinine 1.27 mg/dL 0.70-1.20 mg/dL
BUN 48 mg/dL 17-48 mg/dL
Uric Acid 5.2 mg/dL 3.6-8.2 mg/dL
CRP 0.8 mg/L \< 5.0 mg/L
PSA 2.31 ng/mL \< 4.40 ng/mL
ALT 12 U/L \< 41 U/L
AST 38 U/L \< 50 U/L
Alkaline Phosphatase 115 U/L 40-130 U/L
GGT 20 U/L 8-61 U/L
LDH 335 U/L 135-250 U/L
Testosterone \<0.03 ng/mL 1.32-8.92 ng/mL
TSH 1.42 mIU/L 0.27-4.20 mIU/L
Hemoglobin 10.1 g/dL 12.5-17.2 g/dL
Hematocrit 28.5 % 37.0-49.0 %
RBC 3.3 M/µL 4.0-5.6 M/µL
WBC 4.98 K/µL 3.90-10.50 K/µL
Platelets 281 K/µL 150-370 K/µL
MCV 85.6 fL 80.0-101.0 fL
MCH 30.3 pg 27.0-34.0 pg
MCHC 35.4 g/dL 31.5-36.0 g/dL
MPV 9.2 fL 7.0-12.0 fL
RDW 13.4 % 11.5-15.0 %
Absolute Neutrophils 3.59 K/µL 1.50-7.70 K/µL
Absolute Immature Granulocytes 0.010 K/µL \< 0.050 K/µL
Absolute Lymphocytes 0.43 K/µL 1.10-4.50 K/µL
Absolute Monocytes 0.58 K/µL 0.10-0.90 K/µL
Absolute Eosinophils 0.30 K/µL 0.02-0.50 K/µL
Absolute Basophils 0.07 K/µL 0.00-0.20 K/µL
Reticulocytes 31.3 K/µL 25.0-105.0 K/µL
Reticulocyte % 0.94 % 0.50-2.00 %
Ret-Hb 33.9 pg 28.5-34.5 pg
PT 112 % \> 78 %
INR 0.95 \< 1.25
aPTT 30.2 sec. 25.0-38.0 sec.
|
C-Reactive Protein
|
Which best describes Stephen's vision for the future of innovation?
A. He thinks innovation should be led by the AI developers but checked by people in other industrues
B. The regulation of technological development will provide the necessary structure for successful innovation
C. He says that international connections are the only way true innovation will happen over time
D. He wants people to be responsible and held accountable by different kinds of people
|
AI: what's the worst that could happen? The Centre for the Future of Intelligence is seeking to investigate the implications of artificial intelligence for humanity, and make sure humans take advantage of the opportunities while dodging the risks. It launched at the University of Cambridge last October, and is a collaboration between four universities and colleges – Cambridge, Oxford, Imperial and Berkeley – backed with a 10-year, £10m grant from the Leverhulme Trust. Because no single discipline is ideally suited to this task, the centre emphasises the importance of interdisciplinary knowledge-sharing and collaboration. It is bringing together a diverse community of some of the world's best researchers, philosophers, psychologists, lawyers and computer scientists. Executive director of the centre is Stephen Cave, a writer, philosopher and former diplomat. Harry Armstrong, head of futures at Nesta, which publishes The Long + Short, spoke with Cave about the impact of AI. Their conversation has been edited. Harry Armstrong: Do you see the interdisciplinary nature of the centre as one of its key values and one of the key impacts you hope it will have on the field? Stephen Cave: Thinking about the impact of AI is not something that any one discipline owns or does in any very systematic way. So if academia is going to rise to the challenge and provide thought leadership on this hugely important issue, then we’re going to need to do it by breaking down current disciplinary boundaries and bringing people with very different expertise together. That means bringing together the technologists and the experts at developing these algorithms together with social scientists, philosophers, legal scholars and so forth. I think there are many areas of science where more interdisciplinary engagement would be valuable. Biotech’s another example. In that sense AI isn’t unique, but I think because thinking about AI is still in very early stages, we have an opportunity to shape the way in which we think about it, and build that community. We want to create a space where many different disciplines can come together and develop a shared language, learn from each other’s approaches, and hopefully very quickly move to be able to actually develop new ideas, new conclusions, together. But the first step is learning how to talk to each other. At a recent talk, Naomi Klein said that addressing the challenge of climate change could not have come at a worse time. The current dominant political and economic ideologies, along with growing isolationist sentiment, runs contrary to the bipartisan, collaborative approaches needed to solve global issues like climate change. Do you see the same issues hampering a global effort to respond to the challenges AI raises? Climate change suffers from the problem that the costs are not incurred in any direct way by the industrialists who own the technology and are profiting from it. With AI, that has been the case so far; although not on the same scale. There has been disruption but so far, compared to industrialisation, the impact has been fairly small. That will probably change. AI companies, and in particular the big tech companies, are very concerned that this won't go like climate change, but rather it will go like GMOs: that people will have a gut reaction to this technology as soon as the first great swathe of job losses take hold. People speculate that 50m jobs could be lost in the US if trucking is automated, which is conceivable within 10 years. You could imagine a populist US government therefore simply banning driverless cars. So I think there is anxiety in the tech industry that there could be a serious reaction against this technology at any point. And so my impression is that there is a feeling within these companies that these ethical and social implications need to be taken very seriously, now. And that a broad buy-in by society into some kind of vision of the future in which this technology plays a role is required, if a dangerous – or to them dangerous – counteraction is to be avoided. My personal experience working with these tech companies is that they are concerned for their businesses and genuinely want to do the right thing. Of course there are intellectual challenges and there is money to be made, but equally they are people who don't think when they get up in the morning that they're going to put people out of jobs or bring about the downfall of humanity. As the industry matures it's developing a sense of responsibility. So I think we've got a real opportunity, despite the general climate, and in some ways because of it. There's a great opportunity to bring industry on board to make sure the technology is developed in the right way. One of the dominant narratives around not only AI but technology and automation more generally is that we, as humans, are at the mercy of technological progress. If you try and push against this idea you can be labelled as being anti-progress and stuck in the past. But we do have a lot more control than we give ourselves credit for. For example, routineness and susceptibility to automation are not inevitable features of occupations, job design is hugely important. How do we design jobs? How do we create jobs that allow people to do the kind of work they want to do? There can be a bit of a conflict between being impacted by what's happening and having some sort of control over what we want to happen. Certainly, we encounter technological determinism a lot. And it's understandable. For us as individuals, of course it does feel like it always is happening and we just have to cope. No one individual can do much about it, other than adapt. But that's different when we consider ourselves at a level of a society, as a polis [city state], or as an international community. I think we can shape the way in which technology develops. We have various tools. In any given country, we have regulations. There's a possibility of international regulation. Technology is emerging from a certain legal, political, normative, cultural, and social framework. It's coming from a certain place. And it is shaped by all of those things. And I think the more we understand a technology's relationship with those things, and the more we then consciously try to shape those things, the more we are going to influence the technology. So, for example, developing a culture of responsible innovation. For example, a kind of Hippocratic oath for AI developers. These things are within the realms of what is feasible, and I think will help to shape the future. One of the problems with intervention, generally, is that we cannot control the course of events. We can attempt to, but we don't know how things are going to evolve. The reality is, societies are much too complex for us to be able to shape them in any very specific way, as plenty of ideologies and political movements have found to their cost. There are often unforeseen consequences that can derail a project. I think, nonetheless, there are things we can do. We can try to imagine how things might go very badly wrong, and then work hard to develop systems that will stop that from happening. We can also try collectively to imagine how things could go very right. The kind of society that we actually want to live in that uses this technology. And I'm sure that will be skewed in all sorts of ways, and we might imagine things that seem wonderful and actually have terrible by-products. This conversation cannot be in the hands of any one group. It oughtn't be in the hands of Silicon Valley billionaires alone. They've got their role to play, but this is a conversation we need to be having as widely as possible. The centre is developing some really interesting projects but perhaps one of the most interesting is the discussion of what intelligence might be. Could you go into a bit more detail about the kinds of questions you are trying to explore in this area? You mean kinds of intelligence? Yeah. I think this is very important because historically, we've had an overwhelming tendency to anthropomorphise. We define what intelligence is, historically, as being human-like. And then within that, being like certain humans. And it's taken a very long time for the academic community to accept that there could be such a thing as non-human intelligence at all. We know that crows, for example, who have had a completely different evolutionary history, or octopuses, who have an even more different evolutionary history, might have a kind of intelligence that's very different to ours. That in some ways rivals our own, and so forth. But luckily, we have got to that point in recent years of accepting that we are not the only form of intelligence. But now, AI is challenging that from a different direction. Just as we are accepting that the natural world offers this enormous range of different intelligences, we are at the same time inventing new intelligences that are radically different to humans. And I think, still, this anthropomorphic picture of the kind of humanoid android, the robot, dominates our idea of what AI is too much. And too many people, and the industry as well, talk about human-level artificial intelligence as a goal, or general AI, which basically means like a human. But actually what we're building is nothing like a human. When the first pocket calculator was made, it didn't do maths like a human. It was vastly better. It didn't make the occasional mistake. When we set about creating these artificial agents to solve these problems, because they have a completely different evolutionary history to humans, they solve problems in very different ways. And until now, people have been fairly shy about describing them as intelligent. Or rather, in the history of AIs, we think solving a particular problem would require intelligence. Then we solve it. And then that's no longer intelligence, because we've solved it. Chess is a good example. But the reality is, we are creating a whole new world of different artificial agents. And we need to understand that world. We need to understand all the different ways of being clever, if you like. How you can be extremely sophisticated at some particular rational process, and yet extremely bad at another one in a way that bears no relation to the way humans are on these axes. And this is important, partly because we need to expand our sense of what is intelligent, like we have done with the natural world. Because lots of things follow from saying something is intelligent. Historically, we have a long tradition in Western philosophy of saying those who are intelligent should rule. So if intelligence equates to power, then obviously we need to think about what we mean by intelligence. Who has it and who doesn't. Or how it equates to rights and responsibilities. It certainly is a very ambitious project to create the atlas of intelligence. There was a point I read in something you wrote on our ideas of intelligence that I thought was very interesting. We actually tend to think of intelligence at the societal level when we think about human ability, rather than at the individual level but in the end conflate the two. I think that's a very good point, when we think about our capabilities, we think about what we can achieve as a whole, not individually. But when we talk about AI, we tend to think about that individual piece of technology, or that individual system. So for example if we think about the internet of things and AI, we should discuss intelligence as something encompassed by the whole. Yeah, absolutely. Yes, right now, perhaps it is a product of our anthropomorphising bias. But there is a tendency to see a narrative of AI versus humanity, as if it's one or the other. And yet, obviously, there are risks in this technology long before it acquires any kind of manipulative agency. Robotic technology is dangerous. Or potentially dangerous. But at the same time, most of what we're using technology for is to enhance ourselves, to increase our capacities. And a lot of what AI is going to be doing is augmenting us – we're going to be working as teams, AI-human teams. Where do you think this AI-human conflict, or concept of a conflict, comes from? Do you think that's just a reflection of historical conversations we've had about automation, or do you think it is a deeper fear? I do think it comes both from some biases that might well be innate, such as anthropomorphism, or our human tendency to ascribe agency to other objects, particularly moving ones, is well-established and probably has sound evolutionary roots. If it moves, it's probably wise to start asking yourself questions like, "What is it? What might it want? Where might it be going? Might it be hungry? Do I look like food to it?" I think it makes sense, it's natural for us to think in terms of agency. And when we do, it's natural for us to project our own ways of being and acting. And we, as primates, are profoundly co-operative. But at the same time, we're competitive and murderous. We have a strong sense of in-group versus out-group, which is responsible for both a great deal of cooperation, within the in-group, but also terrible crimes. Murder, rape, pillage, genocide; and they're pointed at the out-group. And so I think it's very natural for us to see AIs in terms of agents. We anthropomorphise them as these kind of android robots. And then we think about, well, you know, are they part of our in-group, or are they some other group? If they're some other group, it's us against them. Who's going to win? Well, let's see. So I think that's very natural, I think that's very human. There is this long tradition, in Western culture in particular, with associating intelligence and dominance and power. It's interesting to speculate about how, and I wish I knew more about it, and I'd like to see more research on this, about how different cultures perceive AI. It's well known that Japan is very accepting of technology and robots, for example. You can think, well, we in the West have long been justifying power relations of a certain kind on the basis that we're 'cleverer'. That's why men get to vote and women don't, or whatever. In a culture where power is not based on intelligence but, say, on a caste system, which is purely hereditary, we’d build an AI, and it would just tune in, drop out, attain enlightenment, just sit in the corner. Or we beg it to come back and help us find enlightenment. It might be that we find a completely different narrative to the one that's dominant in the West. One of the projects the centre is running is looking into what kind of AI breakthroughs may come, when and what the social consequences could be. What do you think the future holds? What are your fears – what do you think could go right and wrong in the short, medium and long term? That's a big question. Certainly I don't lie awake at night worried that robots are going to knock the door down and come in with a machine gun. If the robots take over the world, it won't be by knocking the door down. At the moment, I think it's certainly as big a risk that we have a GMO moment, and there's a powerful reaction against the technology which prevents us from reaping the benefits, which are enormous. I think that's as big a risk as the risks from the technologies themselves. I think one worry that we haven't talked about is that we've become extremely dependent upon this technology. And that we essentially become deskilled. There's an extent to which the history of civilisation is the history of the domestication of the human species sort of by ourselves, and also by our technology, to some extent. And AI certainly allows for that to reach a whole new level. Just think about GPs with diagnostic tools. Even now, my GP consults the computer fairly regularly. But as diagnostic tools get better, what are they going to be doing other than just typing something into the computer and reading out what comes back? At which point, you might as well do away with the GP. But then, who does know about medicine? And so we do need to worry about deskilling and about becoming dependent. And it is entirely possible that you can imagine a society in which we're all sort of prosperous, in a sense. Our basic bodily needs are provided for, perhaps, in a way, to an extent that we've never before even dreamed of. Unprecedented in human history. And yet, we're stripped of any kind of meaningful work. We have no purpose. We're escaping to virtual reality. And then you could imagine all sorts of worrying countercultures or Luddite movements or what have you. I guess that's the kind of scenario that – I haven't sketched it terribly well – but that's the kind of thing that worries me more than missile-toting giant robots. As to utopian, yes, that's interesting. I certainly mentioned a couple of things. One thing that I hope is that this new technological revolution enables us to undo some of the damage of the last one. That's a very utopian thought and not terribly realistic, but we use fossil fuels so incredibly efficiently. The idea that driverless cars that are shared, basically a kind of shared service located off a Brownfield site does away with 95 per cent of all cars, freeing up a huge amount of space in the city to be greener, many fewer cars need to be produced, they would be on the road much less, there'd be fewer traffic jams. It's just one example, but the idea that we can live much more resource-efficiently, because we are living more intelligently through using these tools. And therefore can undo some of the damage of the last Industrial Revolution. That's my main utopian hope, I guess. Vintage toy robot image by josefkubes/Shutterstock This article was originally published on TheLong+Short. Read the original article.
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B. The regulation of technological development will provide the necessary structure for successful innovation
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What was the point in Grannie Annie and Billy-boy venturing into the desert?
A. They were there to find Baker
B. They were trying to locate the strange birds
C. They were looking for proof of the Red Spot Fever
D. They were trying to locate the kites
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DOUBLE TROUBLE by CARL JACOBI Grannie Annie, that waspish science-fiction writer, was in a jam again. What with red-spot fever, talking cockatoos and flagpole trees, I was running in circles—especially since Grannie became twins every now and then. [Transcriber's Note: This etext was produced from Planet Stories Spring 1945. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] We had left the offices of Interstellar Voice three days ago, Earth time, and now as the immense disc of Jupiter flamed across the sky, entered the outer limits of the Baldric. Grannie Annie strode in the lead, her absurd long-skirted black dress looking as out of place in this desert as the trees. Flagpole trees. They rose straight up like enormous cat-tails, with only a melon-shaped protuberance at the top to show they were a form of vegetation. Everything else was blanketed by the sand and the powerful wind that blew from all quarters. As we reached the first of those trees, Grannie came to a halt. "This is the Baldric all right. If my calculations are right, we've hit it at its narrowest spot." Ezra Karn took a greasy pipe from his lips and spat. "It looks like the rest of this God-forsaken moon," he said, "'ceptin for them sticks." Xartal, the Martian illustrator, said nothing. He was like that, taciturn, speaking only when spoken to. He could be excused this time, however, for this was only our third day on Jupiter's Eighth Moon, and the country was still strange to us. When Annabella C. Flowers, that renowned writer of science fiction, visiphoned me at Crater City, Mars, to meet her here, I had thought she was crazy. But Miss Flowers, known to her friends as Grannie Annie, had always been mildly crazy. If you haven't read her books, you've missed something. She's the author of Lady of the Green Flames , Lady of the Runaway Planet , Lady of the Crimson Space-Beast , and other works of science fiction. Blood-and-thunder as these books are, however, they have one redeeming feature—authenticity of background. Grannie Annie was the original research digger-upper, and when she laid the setting of a yarn on a star of the sixth magnitude, only a transportation-velocity of less than light could prevent her from visiting her "stage" in person. Therefore when she asked me to meet her at the landing field of Interstellar Voice on Jupiter's Eighth Moon, I knew she had another novel in the state of embryo. What I didn't expect was Ezra Karn. He was an old prospector Grannie had met, and he had become so attached to the authoress he now followed her wherever she went. As for Xartal, he was a Martian and was slated to do the illustrations for Grannie's new book. Five minutes after my ship had blasted down, the four of us met in the offices of Interstellar Voice . And then I was shaking hands with Antlers Park, the manager of I. V. himself. "Glad to meet you," he said cordially. "I've just been trying to persuade Miss Flowers not to attempt a trip into the Baldric." "What's the Baldric?" I had asked. Antlers Park flicked the ash from his cheroot and shrugged. "Will you believe me, sir," he said, "when I tell you I've been out here on this forsaken moon five years and don't rightly know myself?" I scowled at that; it didn't make sense. "However, as you perhaps know, the only reason for colonial activities here at all is because of the presence of an ore known as Acoustix. It's no use to the people of Earth but of untold value on Mars. I'm not up on the scientific reasons, but it seems that life on the red planet has developed with a supersonic method of vocal communication. The Martian speaks as the Earthman does, but he amplifies his thoughts' transmission by way of wave lengths as high as three million vibrations per second. The trouble is that by the time the average Martian reaches middle age, his ability to produce those vibrations steadily decreases. Then it was found that this ore, Acoustix, revitalized their sounding apparatus, and the rush was on." "What do you mean?" Park leaned back. "The rush to find more of the ore," he explained. "But up until now this moon is the only place where it can be found. "There are two companies here," he continued, " Interstellar Voice and Larynx Incorporated . Chap by the name of Jimmy Baker runs that. However, the point is, between the properties of these two companies stretches a band or belt which has become known as the Baldric. "There are two principal forms of life in the Baldric; flagpole trees and a species of ornithoid resembling cockatoos. So far no one has crossed the Baldric without trouble." "What sort of trouble?" Grannie Annie had demanded. And when Antlers Park stuttered evasively, the old lady snorted, "Fiddlesticks, I never saw trouble yet that couldn't be explained. We leave in an hour." So now here we were at the outer reaches of the Baldric, four travelers on foot with only the barest necessities in the way of equipment and supplies. I walked forward to get a closer view of one of the flagpole trees. And then abruptly I saw something else. A queer-looking bird squatted there in the sand, looking up at me. Silver in plumage, it resembled a parrot with a crest; and yet it didn't. In some strange way the thing was a hideous caricature. "Look what I found," I yelled. "What I found," said the cockatoo in a very human voice. "Thunder, it talks," I said amazed. "Talks," repeated the bird, blinking its eyes. The cockatoo repeated my last statement again, then rose on its short legs, flapped its wings once and soared off into the sky. Xartal, the Martian illustrator, already had a notebook in his hands and was sketching a likeness of the creature. Ten minutes later we were on the move again. We saw more silver cockatoos and more flagpole trees. Above us, the great disc of Jupiter began to descend toward the horizon. And then all at once Grannie stopped again, this time at the top of a high ridge. She shielded her eyes and stared off into the plain we had just crossed. "Billy-boy," she said to me in a strange voice, "look down there and tell me what you see." I followed the direction of her hand and a shock went through me from head to foot. Down there, slowly toiling across the sand, advanced a party of four persons. In the lead was a little old lady in a black dress. Behind her strode a grizzled Earth man in a flop-brimmed hat, another Earth man, and a Martian. Detail for detail they were a duplicate of ourselves! "A mirage!" said Ezra Karn. But it wasn't a mirage. As the party came closer, we could see that their lips were moving, and their voices became audible. I listened in awe. The duplicate of myself was talking to the duplicate of Grannie Annie, and she was replying in the most natural way. Steadily the four travelers approached. Then, when a dozen yards away, they suddenly faded like a negative exposed to light and disappeared. "What do you make of it?" I said in a hushed voice. Grannie shook her head. "Might be a form of mass hypnosis superinduced by some chemical radiations," she replied. "Whatever it is, we'd better watch our step. There's no telling what might lie ahead." We walked after that with taut nerves and watchful eyes, but we saw no repetition of the "mirage." The wind continued to blow ceaselessly, and the sand seemed to grow more and more powdery. For some time I had fixed my gaze on a dot in the sky which I supposed to be a high-flying cockatoo. As that dot continued to move across the heavens in a single direction, I called Grannie's attention to it. "It's a kite," she nodded. "There should be a car attached to it somewhere." She offered no further explanation, but a quarter of an hour later as we topped another rise a curious elliptical car with a long slanting windscreen came into view. Attached to its hood was a taut wire which slanted up into the sky to connect with the kite. A man was driving and when he saw us, he waved. Five minutes later Grannie was shaking his hand vigorously and mumbling introductions. "This is Jimmy Baker," she said. "He manages Larynx Incorporated , and he's the real reason we're here." I decided I liked Baker the moment I saw him. In his middle thirties, he was tall and lean, with pleasant blue eyes which even his sand goggles could not conceal. "I can't tell you how glad I am you're here, Grannie," he said. "If anybody can help me, you can." Grannie's eyes glittered. "Trouble with the mine laborers?" she questioned. Jimmy Baker nodded. He told his story over the roar of the wind as we headed back across the desert. Occasionally he touched a stud on an electric windlass to which the kite wire was attached. Apparently these adjustments moved planes or fins on the kite and accounted for the car's ability to move in any direction. "If I weren't a realist, I'd say that Larynx Incorporated has been bewitched," he began slowly. "We pay our men high wages and give them excellent living conditions with a vacation on Callisto every year. Up until a short time ago most of them were in excellent health and spirits. Then the Red Spot Fever got them." "Red Spot Fever?" Grannie looked at him curiously. Jimmy Baker nodded. "The first symptoms are a tendency to garrulousness on the part of the patient. Then they disappear." He paused to make an adjustment of the windlass. "They walk out into the Baldric," he continued, "and nothing can stop them. We tried following them, of course, but it was no go. As soon as they realize they're being followed, they stop. But the moment our eyes are turned, they give us the slip." "But surely you must have some idea of where they go," Grannie said. Baker lit a cigarette. "There's all kinds of rumors," he replied, "but none of them will hold water. By the way, there's a cockatoo eyrie ahead of us." I followed his gaze and saw a curious structure suspended between a rude circle of flagpole trees. A strange web-like formation of translucent gauzy material, it was. Fully two hundred cockatoos were perched upon it. They watched us with their mild eyes as we passed, but they didn't move. After that we were rolling up the driveway that led to the offices of Larynx Incorporated . As Jimmy Baker led the way up the inclined ramp, a door in the central building opened, and a man emerged. His face was drawn. "Mr. Baker," he said breathlessly, "seventy-five workers at Shaft Four have headed out into the Baldric." Baker dropped his cigarette and ground his heel on it savagely. "Shaft Four, eh?" he repeated. "That's our principal mine. If the fever spreads there, I'm licked." He motioned us into his office and strode across to a desk. Silent Xartal, the Martian illustrator, took a chair in a corner and got his notebook out, sketching the room's interior. Grannie Annie remained standing. Presently the old lady walked across to the desk and helped herself to the bottle of Martian whiskey there. "There must be ways of stopping this," she said. "Have you called in any physicians? Why don't you call an enforced vacation and send the men away until the plague has died down?" Baker shook his head. "Three doctors from Callisto were here last month. They were as much at loss as I am. As for sending the men away, I may have to do that, but when I do, it means quits. Our company is chartered with Spacolonial, and you know what that means. Failure to produce during a period of thirty days or more, and you lose all rights." A visiphone bell sounded, and Baker walked across to the instrument. A man's face formed in the vision plate. Baker listened, said "Okay" and threw off the switch. "The entire crew of Shaft Four have gone out into the Baldric," he said slowly. There was a large map hanging on the wall back of Baker's desk. Grannie Annie walked across to it and began to study its markings. "Shaft Four is at the outer edge of the Baldric at a point where that corridor is at its widest," she said. Baker looked up. "That's right. We only began operations there a comparatively short time ago. Struck a rich vein of Acoustix that runs deep in. If that vein holds out, we'll double the output of Interstellar Voice , our rival, in a year." Grannie nodded. "I think you and I and Xartal had better take a run up there," she said. "But first I want to see your laboratory." There was no refusing her. Jimmy Baker led the way down to a lower level where a huge laboratory and experimental shop ran the length of the building. Grannie seized a light weight carry-case and began dropping articles into it. A pontocated glass lens, three or four Wellington radite bulbs, each with a spectroscopic filament, a small dynamo that would operate on a kite windlass, and a quantity of wire and other items. The kite car was brought out again, and the old woman, Baker and the Martian took their places in it. Then Jimmy waved, and the car began to roll down the ramp. Not until they had vanished in the desert haze did I sense the loneliness of this outpost. With that loneliness came a sudden sense of foreboding. Had I been a fool to let Grannie go? I thought of her, an old woman who should be in a rocking chair, knitting socks. If anything happened to Annabella C. Flowers, I would never forgive myself and neither would her millions of readers. Ezra Karn and I went back into the office. The old prospector chuckled. "Dang human dynamo. Got more energy than a runaway comet." A connecting door on the far side of the office opened onto a long corridor which ended at a staircase. "Let's look around," I said. We passed down the corridor and climbed the staircase to the second floor. Here were the general offices of Larynx Incorporated , and through glass doors I could see clerks busy with counting machines and report tapes. In another chamber the extremely light Acoustix ore was being packed into big cases and marked for shipment. At the far end a door to a small room stood open. Inside a young man was tilted back in a swivel chair before a complicated instrument panel. "C'mon in," he said, seeing us. "If you want a look at your friends, here they are." He flicked a stud, and the entire wall above the panel underwent a slow change of colors. Those colors whirled kaleidescopically, then coalesced into a three-dimensional scene. It was a scene of a rapidly unfolding desert country as seen from the rear of a kite car. Directly behind the windscreen, backs turned to me, were Jimmy Baker, Grannie, and Xartal. It was as if I were standing directly behind them. "It's Mr. Baker's own invention," the operator said. "An improvement on the visiphone." "Do you mean to say you can follow the movements of that car and its passengers wherever it goes? Can you hear them talk too?" "Sure." The operator turned another dial, and Grannie's falsetto voice entered the room. It stopped abruptly. "The machine uses a lot of power," the operator said, "and as yet we haven't got much." The cloud of anxiety which had wrapped itself about me disappeared somewhat as I viewed this device. At least I could now keep myself posted of Grannie's movements. Karn and I went down to the commissary where we ate our supper. When we returned to Jimmy Baker's office, the visiphone bell was ringing. I went over to it and turned it on, and to my surprise the face of Antlers Park flashed on the screen. "Hello," he said in his friendly way. "I see you arrived all right. Is Miss Flowers there?" "Miss Flowers left with Mr. Baker for Shaft Four," I said. "There's trouble up there. Red spot fever." "Fever, eh?" repeated Park. "That's a shame. Is there anything I can do?" "Tell me," I said, "has your company had any trouble with this plague?" "A little. But up until yesterday the fever's been confined to the other side of the Baldric. We had one partial case, but my chemists gave the chap an antitoxin that seems to have worked. Come to think of it, I might drive over to Shaft Four and give Jimmy Baker the formula. I haven't been out in the Baldric for years, but if you didn't have any trouble, I shouldn't either." We exchanged a few more pleasantries, and then he rang off. In exactly an hour I went upstairs to the visiscreen room. Then once more I was directly behind my friends, listening in on their conversation. The view through the windscreen showed an irregular array of flagpole trees, with the sky dotted by high-flying cockatoos. "There's an eyrie over there," Jimmy Baker was saying. "We might as well camp beside it." Moments later a rude circle of flagpole trees loomed ahead. Across the top of them was stretched a translucent web. Jimmy and Grannie got out of the car and began making camp. Xartal remained in his seat. He was drawing pictures on large pieces of pasteboard, and as I stood there in the visiscreen room, I watched him. There was no doubt about it, the Martian was clever. He would make a few rapid lines on one of the pasteboards, rub it a little to get the proper shading and then go on to the next. In swift rotation likenesses of Ezra Karn, of myself, of Jimmy Baker, and of Antlers Park took form. Ezra spoke over my shoulder. "He's doing scenes for Grannie's new book," he said. "The old lady figures on using the events here for a plot. Look at that damned nosy bird! " A silver cockatoo had alighted on the kite car and was surveying curiously Xartal's work. As each drawing was completed, the bird scanned it with rapt attention. Abruptly it flew to the top of the eyrie, where it seemed to be having a consultation with its bird companions. And then abruptly it happened. The cockatoos took off in mass flight. A group of Earth people suddenly materialized on the eyrie, talking and moving about as if it were the most natural thing in the world. With a shock I saw the likeness of myself; I saw Ezra Karn; and I saw the image of Jimmy Baker. The real Jimmy Baker stood next to Grannie, staring up at this incredible mirage. Grannie let out a whoop. "I've got it!" she said. "Those things we see up there are nothing more than mental images. They're Xartal's drawings!" "Don't you see," the lady continued. "Everything that Xartal put on paper has been seen by one or more of these cockatoos. The cockatoos are like Earth parrots all right, but not only have they the power of copying speech, they also have the ability to recreate a mental image of what they have seen. In other words their brains form a powerful photographic impression of the object. That impression is then transmitted simultaneously in telepathic wavelengths to common foci. That eyrie might be likened to a cinema screen, receiving brain vibrations from a hundred different sources that blend into the light field to form what are apparently three-dimensional images." The Larynx manager nodded slowly. "I see," he said. "But why don't the birds reconstruct images from the actual person. Why use drawings?" "Probably because the drawings are exaggerated in certain details and made a greater impression on their brains," Grannie replied. Up on the eyrie a strange performance was taking place. The duplicate of Grannie Annie was bowing to the duplicate of Jimmy Baker, and the image of Ezra Karn was playing leap frog with the image of Antlers Park. Then abruptly the screen before me blurred and went blank. "Sorry," the operator said. "I've used too much power already. Have to give the generators a chance to build it up again." Nodding, I turned and motioned to Karn. We went back downstairs. "That explains something at any rate," the old prospector said. "But how about that Red spot fever?" On Jimmy Baker's desk was a large file marked: FEVER VICTIMS. I opened it and found it contained the case histories of those men who had been attacked by the strange malady. Reading them over, I was struck by one detail. Each patient had received the first symptoms, not while working in the mines, but while sleeping or lounging in the barracks. Five minutes later Karn and I were striding down a white ramp that led to the nearest barracks. The building came into sight, a low rectangular structure, dome-roofed to withstand the violent winds. Inside double tiers of bunks stretched along either wall. In those bunks some thirty men lay sleeping. The far wall was taken up by a huge window of denvo-quartz. As I stood there, something suddenly caught Ezra Karn's eye. He began to walk toward that window. "Look here," he said. Six feet up on that window a small almost imperceptible button of dull metal had been wedged into an aperture cut in the quartz. The central part of the button appeared to be a powerful lens of some kind, and as I seized it and pulled it loose, I felt the hum of tiny clock work. All at once I had it! Red spot fever. Heat fever from the infra-red rays of Jupiter's great spot. Someone had constructed this lens to concentrate and amplify the power of those rays. The internal clockwork served a double purpose. It opened a shutter, and it rotated the lens slowly so that it played for a time on each of the sleeping men. I slid the metal button in my pocket and left the barracks at a run. Back in the visiscreen room, I snapped to the operator: "Turn it on!" The kite car swam into view in the screen above the instrument panel. I stared with open eyes. Jimmy Baker no longer was in the car, nor was Xartal, the Martian. Grannie Annie was there, but seated at the controls was Antlers Park, the manager of Interstellar Voice. Ezra Karn jabbed my elbow. "Grannie's coming back. I thought she'd be getting sick of this blamed moon." It didn't make sense. In all the years I'd known Annabella C. Flowers, never yet had I seen her desert a case until she had woven the clues and facts to a logical conclusion. "Ezra," I said, "we're going to drive out and meet them. There's something screwy here." Ten minutes later in another kite car we were driving at a fast clip through the powdery sands of the Baldric. And before long we saw another car approaching. It was Grannie. As the car drew up alongside I saw her sitting in her prim way next to Antlers Park. Park said: "We left the others at the mine. Miss Flowers is going back with me to my offices to help me improve the formula for that new antitoxin." He waved his hand, and the car moved off. I watched it as it sped across the desert, and a growing suspicion began to form in my mind. Then, like a knife thrust, the truth struck me. "Ezra!" I yelled, swinging the car. "That wasn't Grannie! That was one of those damned cockatoo images. We've got to catch him." The other car was some distance ahead now. Park looked back and saw us following. He did something to the kite wire, and his car leaped ahead. I threw the speed indicator hard over. Our kite was a huge box affair with a steady powerful pull to the connecting wire. Park's vehicle was drawn by a flat triangular kite that dove and fluttered with each variance of the wind. Steadily we began to close in. The manager of Interstellar Voice turned again, and something glinted in his hand. There was a flash of purple flame, and a round hole appeared in our windscreen inches above Karn's head. "Heat gun!" Ezra yelled. Now we were rocketing over the sand dunes, winding in and out between the flagpole trees. I had to catch that car I told myself. Grannie Annie's very life might be at stake, not to mention the lives of hundreds of mine workers. Again Park took aim and again a hole shattered our windscreen. The wind shifted and blew from another quarter. The box kite soared, but the triangular kite faltered. Taking advantage of Park's loss of speed, I raced alongside. The I. V. manager lifted his weapon frantically. But before he could use it a third time, Ezra Karn had whipped a lariat from his belt and sent it coiling across the intervening space. The thong yanked tight about the manager's throat. Park did the only thing he could do. He shut off power, and the two cars coasted to a halt. Then I was across in the other seat, wrenching the weapon free from his grasp. "What have you done with Miss Flowers?" I demanded. The manager's eyes glittered with fear as he saw my finger tense on the trigger. Weakly he lifted an arm and pointed to the northwest. "Val-ley. Thir-ty miles. Entrance hidden by wall of ... flagpole trees." I leaped into the driver's seat and gave the kite its head. And now the country began to undergo a subtle change. The trees seemed to group themselves in a long flanking corridor in a northwesterly direction, as if to hide some secret that lay beyond. Twice I attempted to penetrate that wall, only to find my way blocked by those curious growths. Then a corridor opened before me; a mile forward and the desert began again. But it was a new desert this time: the sand packed hard as granite, the way ahead utterly devoid of vegetation. In the distance black bulging hills extended to right and left, with a narrow chasm or doorway between. I headed for that entrance, and when I reached it, I shut off power with an exclamation of astonishment. There was a huge chair-shaped rock there, and seated upon it was Grannie Annie. She had a tablet in her hands, and she was writing. "Grannie!" I yelled. "What're you doing here? Where's Mr. Baker?" She rose to her feet and clambered down the rock. "Getting back Jimmy's mine laborers," she said, a twinkle in her eyes. "I see you've got Antlers Park. I'm glad of that. It saves me a lot of trouble." She took off her spectacles and wiped them on her sleeve. "Don't look so fuddled, Billy-boy. Come along, and I'll show you." She led the way through the narrow passage into the valley. A deep gorge, it was, with the black sheer cliffs on either side pressing close. Ten feet forward, I stopped short, staring in amazement. Advancing toward me like a column of infantry came a long line of Larynx miners. They walked slowly, looking straight ahead, moving down the center of the gorge toward the entrance. But there was more! A kite car was drawn up to the side. The windscreen had been removed, and mounted on the hood was a large bullet-like contrivance that looked not unlike a search lamp. A blinding shaft of bluish radiance spewed from its open end. Playing it back and forth upon the marching men were Jimmy Baker and Xartal, the Martian. "Ultra violet," Grannie Annie explained. "The opposite end of the vibratory scale and the only thing that will combat the infra-red rays that cause red spot fever. Those men won't stop walking until they've reached Shaft Four." Grannie Annie told her story during the long ride back to Shaft Four. We drove slowly, keeping the line of marching Larynx miners always ahead of us. Jimmy Baker had struck a new big lode of Acoustix, a lode which if worked successfully would see Larynx Incorporated become a far more powerful exporting concern than Interstellar Voice . Antlers Park didn't want that. It was he or his agents who placed those lens buttons in the Larynx barracks. For he knew that just as Jupiter's great spot was responsible for a climate and atmosphere suitable for an Earthman on this Eighth Moon, so also was that spot a deadly power in itself, capable when its rays were concentrated of causing a fatal sickness. Then suddenly becoming fearful of Grannie's prying, Antlers Park strove to head her off before she reached Shaft Four. He did head her off and managed to lure her and Baker and Xartal into the Shaft barracks where they would be exposed to the rays from the lens button. But Grannie only pretended to contract the plague. Park then attempted to outwit Ezra Karn and me by returning in Jimmy Baker's kite car with a cockatoo image of Grannie.
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A. They were there to find Baker
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Which of the model yields the best performance?
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### Introduction
Current neural networks for language understanding rely heavily on unsupervised pretraining tasks like language modeling. However, it is still an open question what degree of knowledge state-of-the-art language models (LMs) acquire about different linguistic phenomena. Many recent studies BIBREF0, BIBREF1, BIBREF2 have advanced our understanding in this area by evaluating LMs' preferences between minimal pairs of sentences, as in Example SECREF1. However, these studies have used different analysis metrics and focused on a small set of linguistic paradigms, making a big-picture comparison between these studies limited. . Ṫhe cat annoys Tim. (grammatical) The cat annoy Tim. (ungrammatical) We introduce the Benchmark of Linguistic Minimal Pairs (shortened to BLiMP or just *X ) a linguistically-motivated benchmark for assessing LMs' knowledge across a wide variety of English phenomena, encapsulating both previously studied and novel contrasts. *X consists of 67 datasets automatically generated from expert-crafted grammars, each containing 1000 minimal pairs and organized by phenomenon into 12 categories. Validation with crowd workers shows that humans overwhelmingly agree with the contrasts in *X . We use *X to study several pretrained LMs: Transformer-based LMs GPT-2 BIBREF3 and Transformer-XL BIBREF4, an LSTM LM trained by BIBREF5, and a $n$-gram LM. We evaluate whether the LM assigns a higher probability to the acceptable sentence in each minimal pair in *X . This experiment gives a sense of which grammatical distinctions LMs are sensitive to in general, and the extent to which unrelated models have similar strengths and weaknesses. We conclude that current neural LMs robustly learn agreement phenomena and even some subtle syntactic phenomena such as ellipsis and control/raising. They perform comparatively worse (and well below human level) on minimal pairs related to argument structure and the licensing of negative polarity items and quantifiers. All models perform at or near chance on extraction islands, which we conclude is the most challenging phenomenon covered by *X . Overall, we note that all models we evaluate fall short of human performance by a wide margin. GPT-2, which performs the best, does match (even just barely exceeds) human performance on some grammatical phenomena, but remains 8 percentage points below human performance overall. We conduct additional experiments to investigate the effect of training size on LSTM model performance on *X . We show that learning trajectories differ, sometimes drastically, across different paradigms in the dataset, with phenomena such as anaphor agreement showing consistent improvement as training size increases, and other phenomena such as NPIs and extraction islands remaining near chance despite increases in training size. We also compare overall sentence probability to two other built-in metrics coded on *X and find that the chosen metric changes how we evaluate relative model performance. ### Background & Related Work ::: Language Models
The objective of a language model is to give a probability distribution over the possible strings of a language. Language models can be built on neural network models or non-neural network models. Due to their unsupervised nature, they can be trained without external annotations. More recently, neural network based language modeling has been shown to be a strong pretraining task for natural language understanding tasks BIBREF6, BIBREF7, BIBREF8, BIBREF9. Some recent models, such as BERT BIBREF9 use closely related tasks such as masked language modeling. In the last decade, we have seen two major paradigm shifts in the state of the art for language modeling. The first major shift for language modeling was the movement from statistical methods based on $n$-grams BIBREF10 to neural methods such as LSTMs BIBREF11, which directly optimize on the task of predicting the next word. More recently, Transformer-based architectures employing self-attention BIBREF12 have outperformed LSTMs at language modeling BIBREF4. Although it is reasonably clear that these shifts have resulted in stronger language models, the primary metric of performance is perplexity, which cannot give detailed insight into these models' linguistic knowledge. Evaluation on downstream task benchmarks BIBREF13, BIBREF14 is more informative, but might not present a broad enough challenge or represent grammatical distinctions at a sufficiently fine-grained level. ### Background & Related Work ::: Evaluating Linguistic Knowledge
A large number of recent studies has used acceptability judgments to reveal what neural networks know about grammar. One branch of this literature has focused on using minimal pairs to infer whether LMs learn about specific linguistic phenomena. Table TABREF4 gives a summary of work that has studied linguistic phenomena in this way. For instance, linzen2016assessing look closely at minimal pairs contrasting subject-verb agreement. marvin2018targeted look at a larger set of phenomena, including negative polarity item licensing and reflexive licensing. However, a relatively small set of phenomena is covered by these studies, to the exclusion of well-studied phenomena in linguistics such as control and raising, ellipsis, distributional restrictions on quantifiers, and countless others. This is likely due to the labor-intensive nature of collecting examples that exhibit informative grammatical phenomena and their acceptability judgments. A related line of work evaluates neural networks on acceptability judgments in a more general domain of grammatical phenomena. Corpora of sentences and their grammaticality are collected for this purpose in a number of computational studies on grammaticality judgment BIBREF26, BIBREF27, BIBREF16. The most recent and comprehensive corpus is CoLA BIBREF16, which contains around 10k sentences covering a wide variety of linguistic phenomena from 23 linguistic papers and textbooks. CoLA, which is included in the GLUE benchmark BIBREF13, has been used to track advances in the general grammatical knowledge of reusable sentence understanding models. Current models like BERT BIBREF9 and T5 BIBREF28 can be trained to give acceptability judgments that approach or even exceed individual human agreement with CoLA. While CoLA can also be used to evaluate phenomenon-specific knowledge of models, this method is limited by the need to train a supervised classifier on CoLA data prior to evaluation. BIBREF29 compare the CoLA performance of pretrained sentence understanding models: an LSTM, GPT BIBREF8, and BERT. They find that these models have good performance on sentences involving marked argument structure, and struggle on sentences with long-distance dependencies like those found in questions, though the Transformers have a noticeable advantage. However, evaluating supervised classifiers prevents making strong conclusions about the models themselves, since biases in the training data may affect the results. For instance, relatively strong performance on a phenomenon might be due to a model's implicit knowledge or to frequent occurrence of similar examples in the training data. Evaluating LMs on minimal pairs evades this problem by eschewing supervised training on acceptability judgments. It is possible to use the LM probability of a sentence as a proxy for acceptability because other factors impacting a sentence's probability such as length and lexical content are controlled for. ### Data
The *X dataset consists of 67 paradigms of 1000 sentence pairs. Each paradigm is annotated for the unique contrast it isolates and the broader category of phenomena it is part of. The data is automatically generated according to expert-crafted grammars, and our automatic labels are validated with crowd-sourced human judgments. ### Data ::: Data generation procedure
To create minimal pairs exemplifying a wide array of linguistic contrasts, it is necessary to artificially generate all datasets. This ensures both that we have sufficient unacceptable examples, and that the data is fully controlled, allowing for repeated isolation of a single linguistic phenomenon in each paradigm BIBREF30. The data generation scripts use a basic template to create each paradigm, pulling from a vocabulary of over 3000 words annotated for morphological, syntactic, and semantic features needed to create grammatical and semantically felicitous sentences. Examples SECREF6 and SECREF6 show one such template for the `acceptable' and `unacceptable' sentences within a pair: the sole difference between them is the underlined word, which differs only in whether the anaphor agrees in number with its antecedent. Our generation codebase and scripts are freely available. . DP1 V1 refl_match . The cats licked themselves . . DP1 V1 refl_mismatch . The cats licked itself . This generation procedure is not without limitations, and despite the very detailed vocabulary we use, implausible sentences are occasionally generated (e.g., `Sam ran around some glaciers'). In these cases, though, both the acceptable and unacceptable sentences will be equally implausible given world knowledge, so any difference in the probability assigned to them is still due to the intended grammatical contrast. ### Data ::: Coverage
The paradigms that are covered by *X represent well-established contrasts in English morphology, syntax, and semantics. Each paradigm is grouped into one of 12 phenomena, shown in Table TABREF1. The paradigms are selected with the constraint that they can be illustrated with minimal pairs of equal sentence length and that it is of a form that could be written as a template, like in SECREF6 and SECREF6. While this dataset has broad coverage, it is not exhaustive – it is not possible to include every grammatical phenomenon of English, and there is no agreed-upon set of core phenomena. However, we consider frequent inclusion of a phenomenon in a syntax/semantics textbook as an informal proxy for what linguists consider to be core phenomena. We survey several syntax textbooks BIBREF31, BIBREF32, BIBREF33, and find that nearly all of the phenomena in *X are discussed in some source, and most of the topics that repeatedly appear in textbooks and can be represented with minimal pairs (e.g. agreement, argument selection, control/raising, wh-extraction/islands, binding) are present in *X . Because the generation code is reusable, it is possible to generate paradigms not included in *X in the future. ### Data ::: Comparison to Related Resources
With over 3000 words, *X has by far the widest lexical variability of any related generated dataset. The vocabulary includes verbs with 11 different subcategorization frames, including verbs that select for PPs, infinitival VPs, and embedded clauses. By comparison, datasets by BIBREF30 and BIBREF1 each use a vocabulary of well under 200 items. Other datasets of minimal pairs that achieve greater lexical and syntactic variety use data-creation methods that are limited in terms of empirical scope or control. BIBREF0 construct a dataset of minimal pairs for subject-verb agreement by changing the number marking on present-tense verbs in a subset of English Wikipedia. However this approach does not generalize beyond simple agreement phenomena. BIBREF27 build a dataset of minimal pairs by taking sentences from the BNC through round-trip machine translation. The resulting sentences contain a wider variety of grammatical violations, but it is not possible to control the nature of the violation and a single sentence may contain several violations. ### Data ::: Data validation
To verify that the generated sentences represent a real contrast in acceptability, we conduct human validation via Amazon Mechanical Turk. Twenty separate validators rated five pairs from each of the 67 paradigms, for a total of 6700 judgments. We restricted validators to individuals currently located in the US who self-reported as native speakers of English. To assure that our validators made a genuine effort on the task, each HIT included an attention check item and a hidden field question to catch bot-assisted humans. For each minimal pair, 20 different individuals completed a forced-choice task that mirrors the task done by the LMs; the human-determined “acceptable” sentence was calculated via majority vote of annotators. By this metric, we estimate aggregate human agreement with our annotations to be 96.4% overall. As a threshold of inclusion in *X , the majority of validators needed to agree with *X on at least 4/5 examples from each paradigm. Thus, all 67 paradigms in the public version of *X passed this validation, and only two additional paradigms had to be rejected on this criterion. We also estimate individual human agreement to be 88.6% overall using the approximately 100 annotations from each paradigm. Figure TABREF14 reports these individual human results (alongside model results) as a conservative measure of human agreement. white ### Models & Methods ::: Models ::: GPT-2
GPT-2 BIBREF3 is a large-scale language model using the Transformer architecture BIBREF12. We use the large version of GPT-2, which contains 24 layers and 345M parameters. The model is pretrained on BIBREF3's custom-built WebText dataset, which contains 40GB of text extracted from web pages and filtered by humans. To our best knowledge, the WebText corpus is not publicly available. Assuming approximately 5-6 bytes/chars per word on average, we estimate WebText contains approximately 8B tokens. The testing code for GPT-2 has been integrated into jiant, a codebase for training and evaluating sentence understanding models BIBREF34. ### Models & Methods ::: Models ::: Transformer-XL
Transformer-XL BIBREF4 is another multi-layer Transformer-based neural language model. We test a pretrained Transformer-XL model with 18 layers of Transformer decoders and 16 attention heads for each layer. The model is trained on WikiText-103 BIBREF35, a corpus of 103M tokens from high-quality Wikipedia articles. Code for testing Transformer-XL on *X is also implemented in jiant. ### Models & Methods ::: Models ::: LSTM
We include a long-short term memory (LSTM, BIBREF36) language model in our experiments. Specifically, we test a pretrained LSTM language model from BIBREF5 on *X . The model is trained on a 90M token corpus extracted from English Wikipedia. For investigating the effect of training size on models' *X performance, We retrain a series of LSTM models with the same hyperparameters and the following training sizes: 64M, 32M, 16M, 8M, 4M, 2M, 1M, 1/2M, 1/4M, and 1/8M tokens. For each size, we train the model on five different random samples drawing from the original training data, which has a size of 83M tokens. We release our LSTM evaluation code. ### Models & Methods ::: Models ::: 5-gram
We build a 5-gram LM on the English Gigaword corpus BIBREF37, which consists of 3.07B tokens. To efficiently query $n$-grams we use an implementation based on BIBREF38, which is shown to speed up estimation BIBREF39. We release our $n$-gram evaluation code. ### Models & Methods ::: Evaluation
We mainly evaluate the models by measuring whether the LM assigns a higher probability to the grammatical sentence within the minimal pair. This method, used by BIBREF1, is only meaningful for comparing sentences of similar length and lexical content, as overall sentence probability tends to decrease as sentence length increases or word frequencies decrease BIBREF27. However, as discussed in Section SECREF3 we design every paradigm in *X to be compatible with this method. ### Results
We report the 12-category accuracy results for all models and human evaluation in Table TABREF14. ### Results ::: Overall Results
An LM's overall performance on *X can be measured simply by taking the proportion of correct predictions across the 67,000 minimal pairs from all paradigms. GPT-2 achieves the highest score and the $n$-gram the lowest. Transformer-XL and the LSTM LM perform in the middle, and at roughly the same level as each other. All models perform well below estimated human agreement (as described in Section SECREF11). The $n$-gram model's poor overall performance confirms *X is not solvable from co-occurrence information alone. Rather, success at *X is driven by the more abstract features learned by neural networks. There are no categories in which the $n$-gram approaches human performance. Because we evaluate pretrained models that differ in architecture and training data quantity/domain, we can only speculate about what drives these differences (though see Section SECREF37 for a controlled ablation study on the LSTM LM). Nonetheless, the results seem to indicate that access to training data is the main driver of performance on *X for the neural models we evaluate. On purely architectural grounds, the similar performance of Transformer-XL and the LSTM is surprising since Transformer-XL is the state of the art on several LM training sets. However, they are both trained 100$\pm 10$M tokens of Wikipedia text. Relatedly, GPT-2's advantage may come from the fact that it is trained on roughly two orders of magnitude more data. While it is unclear whether LSTMs trained on larger datasets could rival GPT-2, such experiments are impractical due to the difficulty of scaling LSTMs to this size. ### Results ::: Phenomenon-Specific Results
The results also reveal considerable variation in performance across grammatical phenomena. Models generally perform best and closest to human level on morphological phenomena. This includes anaphor agreement, determiner-noun agreement, and subject-verb agreement. In each of these domains, GPT-2's performance is within 2.1 percentage points of humans. The set of challenging phenomena is more diverse. Islands are the hardest phenomenon by a wide margin. Only GPT-2 performs noticeably above chance, but it remains 20 points below humans. Some semantic phenomena, specifically those involving NPIs and quantifiers, are also challenging overall. All models show relatively weak performance on argument structure. From results we conclude that current SotA LMs have robust knowledge of basic facts of English agreement. This does not mean that LMs will come close to human performance for all agreement phenomena. Section SECREF32 discusses evidence that increased dependency length and the presence of agreement attractors of the kind investigated by BIBREF0 and BIBREF5 reduce performance on agreement phenomena. The exceptionally poor performance on islands is hard to reconcile with BIBREF2's (BIBREF2) conclusion that LSTMs have knowledge of some island constraints. In part, this difference may come down to differences in metrics. BIBREF2 compare a set of four related sentences with gaps in the same position or no gaps to obtain the wh-licensing interaction as a metric of how strongly the LM identifies a filler-gap dependency in a single syntactic position. They consider an island constraint to have been learned if this value is close to zero. We instead compare LM probabilities of sentences with similar lexical content but with gaps in different syntactic positions. These metrics target different forms of grammatical knowledge, though both are desirable properties to find in an LM. We also note that the LMs we test do not have poor knowledge of filler-gap dependencies in general, with all neural models perform above well above chance. This suggests that, while these models are able to establish long-distance dependencies in general, they are comparatively worse at identifying the syntactic domains in which these dependencies are blocked. The semantic phenomena that models struggle with are usually attributed in current theories to a presupposition failure or contradiction arising from semantic composition or pragmatic reasoning BIBREF40, BIBREF41, BIBREF42. These abstract semantic and pragmatic factors may be difficult for LMs to learn. BIBREF1 also find that LSTMs largely fail to recognize NPI licensing conditions. BIBREF20 find that BERT (which is similar in scale to GPT-2) recognizes these conditions inconsistently in an unuspervised setting. The weak performance on argument structure is somewhat surprising, since arguments are usually (though by no means always) local to their heads. Argument structure is closely related to semantic event structure BIBREF43, which may be comparatively difficult for LMs to learn. This finding contradicts BIBREF29's (BIBREF29) conclusion that argument structure is one of the strongest domains for neural models. However, BIBREF29 study supervised models trained on CoLA, which includes a large proportion of sentences related to argument structure. ### Results ::: Correlation of Model & Human Performance
We also examine to what extent the models' performances are similar to each other, and how they are similar to human evaluation in terms of which phenomena are comparatively difficult. Figure TABREF29 shows the Pearson correlation between the four LMs and human evaluation on their accuracies in 67 paradigms. Compared to humans, GPT-2 has the highest correlation, closely followed by Transformer-XL and LSTM, though the correlation is only moderate. The $n$-gram's performance correlates with humans relatively weakly. Transformer-XL and LSTM are very highly correlated at 0.9, possibly reflecting their similar training data. Also, neural models correlate with each other more strongly than with humans or the $n$-gram model, suggesting neural networks share some biases that are not entirely human-like. white ### Results ::: Shallow Predictors of Performance
We also ask what factors aside from linguistic phenomena make a minimal pair harder or easier for an LM to distinguish. We test whether shallow features like sentence length or overall sentence likelihood are predictors of whether the LM will have the right preference. The results are shown in Figure FIGREF31. While sentence length, perplexity and the probability of the good sentence all seem to predict model performance to a certain extent, the predictive power is not strong, especially for GPT-2, which is much less influenced by greater perplexity of the good sentence than the other models. ### Additional Experiments ::: Long-Distance Dependencies
The presence of intervening material that lengthens an agreement dependency lowers accuracy on that sentence in both humans and LMs. We study how the presence or absence of this intervening material affects the ability of LMs to detect mismatches in agreement in *X . First, we test for knowledge of determiner-noun agreement with and without an intervening adjective, as in Example SECREF32. The results are plotted in Figure FIGREF33. The $n$-gram model is the most heavily impacted, performing on average 35 points worse. This is unsurprising, since the bigram consisting of a determiner and noun is far more likely to be observed than the trigram of determiner, adjective, and noun. For the neural models, we find a weak but consistent effect, with all models performing on average between 5 and 3 points worse when there is an intervening adjective. . Ṙon saw that man/*men. Ron saw that nice man/*men. Second, we test for sensitivity to mismatches in subject-verb agreement when an “attractor” noun of the opposite number intervenes. We compare attractors in relative clauses and as part of a relational noun as in Example SECREF32, following experiments by BIBREF0 and others. Again, we find an extremely large effect for the $n$-gram model, which performs over 50 points worse and well below chance when there is an attractor present, showing that the $n$-gram model is consistently misled by the presence of the attractor. All of the neural models perform above chance with an attractor present, but GPT-2 and the LSTM perform 22 and 20 points worse when an attractor is present. Transformer-XL's performance is harmed by only 5 points. Note that GPT-2 still has the highest performance in both cases, and even outperforms humans in the relational noun case. Thus, we reproduce BIBREF0's finding that attractors significantly reduce LSTM LMs' sensitivity to mismatches in agreement and find evidence that this holds true of Transformer LMs as well. . Ṫhe sisters bake/*bakes. The sisters who met Cheryl bake/*bakes. The sisters of Cheryl bake/*bakes. ### Additional Experiments ::: Regular vs. Irregular Agreement
In the determiner-noun agreement and subject-verb agreement categories, we generate separate datasets for nouns with regular and irregular number marking, as in Example SECREF34. All else being equal, only models with access to sub-word-level information should make any distinction between regular and irregular morphology. . Ṙon saw that nice kid/*kids. (regular) Ron saw that nice man/*men. (irregular) Contrary to this prediction, the results in Figure FIGREF36 show that the sub-word-level models GPT-2 and Transformer-XL show little effect of irregular morphology: they perform less than $0.013$ worse on irregulars than regulars. Given their high performance overall, this suggests they robustly encode number features without relying on segmental cues. ### Additional Experiments ::: Training size and *X performance
We also use *X to track how a model's knowledge of particular phenomena varies with the quantity of training data. We test this with the LSTM model and find that different phenomena in *X have notably different learning curves across different training sizes, as shown in Figure FIGREF39. Crucially, phenomena with similar results from the LSTM model trained on the full 83M tokens of training data may have very different learning curves. For example, the LSTM model performs well on both irregular forms and anaphor agreement, but the different learning curves suggest that more training data is required in the anaphor agreement case to achieve this same performance level. This is supported by a regression analysis showing that the best-fit line for anaphor agreement has the steepest slope (0.0623), followed by Determiner-Noun agreement (0.0426), Subject-Verb agreement (0.041), Irregular (0.039) and Ellipsis (0.0389). By contrast, Binding (0.016), Argument Structure (0.015), and Filler-Gap Dependency (0.0095) have shallower learning curves, showing a less strong effect of increases in training data size. The phenomena that showed the lowest performance overall, NPIs and Islands, also show the lowest effects of increases to training size, with slopes of 0.0078 and 0.0036, respectively. This indicates that, even given a substantially larger amount training data, the LSTM is unlikely to achieve human-like performance on these phenomena – it simply fails to learn the necessary dependencies. It should be noted that these differences in learning curves show how *X performance dissociates from perplexity, the standard measure of LM performance: while perplexity keeps decreasing as training size increases, the performance in different *X phenomena show very different learning curves. ### Additional Experiments ::: Alternate Evaluation Methods
There are several other techniques one can use to measure an LM's “preference” between two minimally different sentences. So far, we have considered only the full-sentence method, advocated for by BIBREF1, which compares the LM likelihood of the full sentences. In a followup experiment, we use two “prefix methods”, each of which has appeared in prior work in this area, that evaluate the model's preferences by comparing its prediction at a key point of divergence between the two sentences. Subsets of *X data—from the binding, determiner-noun agreement, and subject-verb agreement categories—are designed to be compatible with multiple methods, allowing us to conduct the first direct comparison. We find that all methods give broadly similar results when aggregating over a large set of paradigms, but some results diverge sharply for specific paradigms. ### Additional Experiments ::: Alternate Evaluation Methods ::: One-prefix method
In the one-prefix method, used by BIBREF0, a pair of sentences share the same initial portion of a sentence, but differ in a critical word that make them differ in grammaticality (e.g., The cat eats mice vs. The cat eat mice). The model's prediction is correct if it assigns a higher probability to the grammatical token given the shared prefix. ### Additional Experiments ::: Alternate Evaluation Methods ::: Two-prefix method
In the two-prefix method, used by BIBREF19, a pair of sentences have a different initial portion that diverge in some critical way, but the grammaticality difference is only revealed when a shared critical word is included (e.g., The cat eats mice vs. The cats eats mice). For these paradigms, we evaluate whether the model assigns a higher probability to the critical word conditioned on the grammatical prefix compared the ungrammatical prefix. Note that the same pair of sentences cannot be compatible with both prefix methods, and that a pair may be compatible with the full-sentence method but neither prefix method. For both prefix methods, it is crucial that the grammaticality of the sentence is unambiguously predictable from the critical word, but not sooner. With simple LM probabilities, the probabilities of the rest of the word tokens in the sentence also affect the performance. For example, a model may predict that `The cat ate the mouse' is more likely than `The cat eaten the mouse' without correctly predicting that $P(\emph {ate}|\emph {the cat}) > P(\emph {eaten}|\emph {the cat})$ if it predicts that $P(\emph {the mouse}|\emph {the cat ate})$ is much greater than $P(\emph {the mouse}|\emph {the cat eaten})$. Furthermore, it is unclear how a model assigns probabilities conditioned on an ungrammatical prefix, since ungrammatical sentences are largely absent from the training data. Using prefix probabilities allow us to exclude models' use of this additional information and evaluate how the models perform when they have just enough information to judge grammaticality. ### Additional Experiments ::: Alternate Evaluation Methods ::: Results
The results in Figure FIGREF42 show that models have generally comparable accuracies overall in prefix methods and the simple whole-sentence LM method. However, A deeper examination of the differences between these methods in each paradigm reveals some cases where a models' performance fluctuates more between these methods. For example, Transformer-XL performs much worse at binding, determiner-noun agreement, and subject-verb agreement in the simple LM method, suggesting that the probabilities Transformer-XL assigns to the irrelevant part at the end of the sentence very often overturn the `judgment' based on probability up to the critical word. On the other hand, GPT-2 benefits from reading the whole sentence for binding phenomena, as its performance is better in the simple LM method than in the prefix method. Overall, we observe that Transformer-XL and GPT-2 are more affected by evaluation methods than LSTM and $n$-gram when we compare the simple LM method and the two-prefix method. ### Discussion & Future Work
We have shown ways in which *X can be used as tool to gain both high-level and fine-grained insight into the grammatical knowledge of language models. Like the GLUE benchmark BIBREF13, *X assigns a single overall score to an LM which summarizes its general sensitivity to minimal pair contrasts. Thus, it can function as a linguistically motivated benchmark for the general evaluation of new language models. *X also provides a breakdown of LM performance by linguistic phenomenon, which can be used to draw concrete conclusions about the kinds of grammatical knowledge acquired by a given model. This kind of information is useful for detailed comparisons across models, as well as in ablation studies. One question we leave unexplored is how well supervised acceptability classifiers built on top of pretrained models like BERT BIBREF9 perform on *X . It would be possible to evaluate how well such classifiers generalize to unseen phenomena by training on a subset of paradigms in *X and evaluating on the held-out sets, giving an idea of to what extent models are able to transfer knowledge in one domain to a similar one. BIBREF20 find that this method is potentially more revealing of implicit grammatical knowledge than purely unsupervised methods. An important goal of linguistically-informed analysis of LMs is to better understand those empirical domains where current LMs appear to acquire some relevant knowledge, but still fall short of human performance. The results from *X suggest that—in addition to relatively well-studied phenomena like filler-gap dependencies, NPIs, and binding—argument structure remains one area where there is much to uncover about what LMs learn. More generally, as language modeling techniques continue to improve, it will be useful to have large-scale tools like *X to efficiently track changes in what these models do and do not know about grammar. ### Acknowledgments
This material is based upon work supported by the National Science Foundation under Grant No. 1850208. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation. This project has also benefited from support to SB by Eric and Wendy Schmidt (made by recommendation of the Schmidt Futures program), by Samsung Research (under the project Improving Deep Learning using Latent Structure), by Intuit, Inc., and by NVIDIA Corporation (with the donation of a Titan V GPU).
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GPT-2
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Why does Moran think it could be beneficial if one of the crew members was killed on the alien planet?
A. He would be more likely to survive an attack from the Nadine crew if they ambushed him.
B. He could convert their body to nutrients, which he could use to survive longer on the alien planet.
C. He and the remaining crew members could pass security clearance with only five members on board.
D. He could steal the deceased crew member's identity and use it to start a new life on a new planet.
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PLANET of DREAD By MURRAY LEINSTER Illustrator ADKINS [Transcriber's Note: This etext was produced from Fantastic Stories of Imagination May 1962. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] I. Moran cut apart the yard-long monstrosity with a slash of flame. The thing presumably died, but it continued to writhe senselessly. He turned to see other horrors crawling toward him. Then he knew he was being marooned on a planet of endless terrors. Moran, naturally, did not mean to help in the carrying out of the plans which would mean his destruction one way or another. The plans were thrashed out very painstakingly, in formal conference on the space-yacht Nadine , with Moran present and allowed to take part in the discussion. From the viewpoint of the Nadine's ship's company, it was simply necessary to get rid of Moran. In their predicament he might have come to the same conclusion; but he was not at all enthusiastic about their decision. He would die of it. The Nadine was out of overdrive and all the uncountable suns of the galaxy shone steadily, remotely, as infinitesimal specks of light of every color of the rainbow. Two hours since, the sun of this solar system had been a vast glaring disk off to port, with streamers and prominences erupting about its edges. Now it lay astern, and Moran could see the planet that had been chosen for his marooning. It was a cloudy world. There were some dim markings near one lighted limb, but nowhere else. There was an ice-cap in view. The rest was—clouds. The ice-cap, by its existence and circular shape, proved that the planet rotated at a not unreasonable rate. The fact that it was water-ice told much. A water-ice ice-cap said that there were no poisonous gases in the planet's atmosphere. Sulfur dioxide or chlorine, for example, would not allow the formation of water-ice. It would have to be sulphuric-acid or hydrochloric-acid ice. But the ice-cap was simple snow. Its size, too, told about temperature-distribution on the planet. A large cap would have meant a large area with arctic and sub-arctic temperatures, with small temperate and tropical climate-belts. A small one like this meant wide tropical and sub-tropical zones. The fact was verified by the thick, dense cloud-masses which covered most of the surface,—all the surface, in fact, outside the ice-cap. But since there were ice-caps there would be temperate regions. In short, the ice-cap proved that a man could endure the air and temperature conditions he would find. Moran observed these things from the control-room of the Nadine , then approaching the world on planetary drive. He was to be left here, with no reason ever to expect rescue. Two of the Nadine's four-man crew watched out the same ports as the planet seemed to approach. Burleigh said encouragingly; "It doesn't look too bad, Moran!" Moran disagreed, but he did not answer. He cocked an ear instead. He heard something. It was a thin, wabbling, keening whine. No natural radiation sounds like that. Moran nodded toward the all-band speaker. "Do you hear what I do?" he asked sardonically. Burleigh listened. A distinctly artificial signal came out of the speaker. It wasn't a voice-signal. It wasn't an identification beacon, such as are placed on certain worlds for the convenience of interstellar skippers who need to check their courses on extremely long runs. This was something else. Burleigh said: "Hm ... Call the others, Harper." Harper, prudently with him in the control-room, put his head into the passage leading away. He called. But Moran observed with grudging respect that he didn't give him a chance to do anything drastic. These people on the Nadine were capable. They'd managed to recapture the Nadine from him, but they were matter-of-fact about it. They didn't seem to resent what he'd tried to do, or that he'd brought them an indefinite distance in an indefinite direction from their last landing-point, and they had still to re-locate themselves. They'd been on Coryus Three and they'd gotten departure clearance from its space-port. With clearance-papers in order, they could land unquestioned at any other space-port and take off again—provided the other space-port was one they had clearance for. Without rigid control of space-travel, any criminal anywhere could escape the consequences of any crime simply by buying a ticket to another world. Moran couldn't have bought a ticket, but he'd tried to get off the planet Coryus on the Nadine . The trouble was that the Nadine had clearance papers covering five persons aboard—four men and a girl Carol. Moran made six. Wherever the yacht landed, such a disparity between its documents and its crew would spark an investigation. A lengthy, incredibly minute investigation. Moran, at least, would be picked out as a fugitive from Coryus Three. The others were fugitives too, from some unnamed world Moran did not know. They might be sent back where they came from. In effect, with six people on board instead of five, the Nadine could not land anywhere for supplies. With five on board, as her papers declared, she could. And Moran was the extra man whose presence would rouse space-port officials' suspicion of the rest. So he had to be dumped. He couldn't blame them. He'd made another difficulty, too. Blaster in hand, he'd made the Nadine take off from Coryus III with a trip-tape picked at random for guidance. But the trip-tape had been computed for another starting-point, and when the yacht came out of overdrive it was because the drive had been dismantled in the engine-room. So the ship's location was in doubt. It could have travelled at almost any speed in practically any direction for a length of time that was at least indefinite. A liner could re-locate itself without trouble. It had elaborate observational equipment and tri-di star-charts. But smaller craft had to depend on the Galactic Directory. The process would be to find a planet and check its climate and relationship to other planets, and its flora and fauna against descriptions in the Directory. That was the way to find out where one was, when one's position became doubtful. The Nadine needed to make a planet-fall for this. The rest of the ship's company came into the control-room. Burleigh waved his hand at the speaker. "Listen!" They heard it. All of them. It was a trilling, whining sound among the innumerable random noises to be heard in supposedly empty space. "That's a marker," Carol announced. "I saw a costume-story tape once that had that sound in it. It marked a first-landing spot on some planet or other, so the people could find that spot again. It was supposed to be a long time ago, though." "It's weak," observed Burleigh. "We'll try answering it." Moran stirred, and he knew that every one of the others was conscious of the movement. But they didn't watch him suspiciously. They were alert by long habit. Burleigh said they'd been Underground people, fighting the government of their native world, and they'd gotten away to make it seem the revolt had collapsed. They'd go back later when they weren't expected, and start it up again. Moran considered the story probable. Only people accustomed to desperate actions would have remained so calm when Moran had used desperate measures against them. Burleigh picked up the transmitter-microphone. "Calling ground," he said briskly. "Calling ground! We pick up your signal. Please reply." He repeated the call, over and over and over. There was no answer. Cracklings and hissings came out of the speaker as before, and the thin and reedy wabbling whine continued. The Nadine went on toward the enlarging cloudy mass ahead. Burleigh said; "Well?" "I think," said Carol, "that we should land. People have been here. If they left a beacon, they may have left an identification of the planet. Then we'd know where we are and how to get to Loris." Burleigh nodded. The Nadine had cleared for Loris. That was where it should make its next landing. The little yacht went on. All five of its proper company watched as the planet's surface enlarged. The ice-cap went out of sight around the bulge of the globe, but no markings appeared. There were cloud-banks everywhere, probably low down in the atmosphere. The darker vague areas previously seen might have been highlands. "I think," said Carol, to Moran, "that if it's too tropical where this signal's coming from, we'll take you somewhere near enough to the ice-cap to have an endurable climate. I've been figuring on food, too. That will depend on where we are from Loris because we have to keep enough for ourselves. But we can spare some. We'll give you the emergency-kit, anyhow." The emergency-kit contained antiseptics, seeds, and a weapon or two, with elaborate advice to castaways. If somebody were wrecked on an even possibly habitable planet, the especially developed seed-strains would provide food in a minimum of time. It was not an encouraging thought, though, and Moran grimaced. She hadn't said anything about being sorry that he had to be marooned. Maybe she was, but rebels learn to be practical or they don't live long. Moran wondered, momentarily, what sort of world they came from and why they had revolted, and what sort of set-back to the revolt had sent the five off in what they considered a strategic retreat but their government would think defeat. Moran's own situation was perfectly clear. He'd killed a man on Coryus III. His victim would not be mourned by anybody, and somebody formerly in very great danger would now be safe, which was the reason for what Moran had done. But the dead man had been very important, and the fact that Moran had forced him to fight and killed him in fair combat made no difference. Moran had needed to get off-planet, and fast. But space-travel regulations are especially designed to prevent such escapes. He'd made a pretty good try, at that. One of the controls on space-traffic required a ship on landing to deposit its fuel-block in the space-port's vaults. The fuel-block was not returned until clearance for departure had been granted. But Moran had waylaid the messenger carrying the Nadine's fuel-block back to that space-yacht. He'd knocked the messenger cold and presented himself at the yacht with the fuel. He was admitted. He put the block in the engine's gate. He duly took the plastic receipt-token the engine only then released, and he drew a blaster. He'd locked two of the Nadine's crew in the engine-room, rushed to the control-room without encountering the others, dogged the door shut, and threaded in the first trip-tape to come to hand. He punched the take-off button and only seconds later the overdrive. Then the yacht—and Moran—was away. But his present companions got the drive dismantled two days later and once the yacht was out of overdrive they efficiently gave him his choice of surrendering or else. He surrendered, stipulating that he wouldn't be landed back on Coryus; he still clung to hope of avoiding return—which was almost certain anyhow. Because nobody would want to go back to a planet from which they'd carried away a criminal, even though they'd done it unwillingly. Investigation of such a matter might last for months. Now the space-yacht moved toward a vast mass of fleecy whiteness without any visible features. Harper stayed with the direction-finder. From time to time he gave readings requiring minute changes of course. The wabbling, whining signal was louder now. It became louder than all the rest of the space-noises together. The yacht touched atmosphere and Burleigh said; "Watch our height, Carol." She stood by the echometer. Sixty miles. Fifty. Thirty. A correction of course. Fifteen miles to surface below. Ten. Five. At twenty-five thousand feet there were clouds, which would be particles of ice so small that they floated even so high. Then clear air, then lower clouds, and lower ones still. It was not until six thousand feet above the surface that the planet-wide cloud-level seemed to begin. From there on down it was pure opacity. Anything could exist in that dense, almost palpable grayness. There could be jagged peaks. The Nadine went down and down. At fifteen hundred feet above the unseen surface, the clouds ended. Below, there was only haze. One could see the ground, at least, but there was no horizon. There was only an end to visibility. The yacht descended as if in the center of a sphere in which one could see clearly nearby, less clearly at a little distance, and not at all beyond a quarter-mile or so. There was a shaded, shadowless twilight under the cloud-bank. The ground looked like no ground ever seen before by anyone. Off to the right a rivulet ran between improbable-seeming banks. There were a few very small hills of most unlikely appearance. It was the ground, the matter on which one would walk, which was strangest. It had color, but the color was not green. Much of it was a pallid, dirty-yellowish white. But there were patches of blue, and curious veinings of black, and here and there were other colors, all of them unlike the normal color of vegetation on a planet with a sol-type sun. Harper spoke from the direction-finder; "The signal's coming from that mound, yonder." There was a hillock of elongated shape directly in line with the Nadine's course in descent. Except for the patches of color, it was the only considerable landmark within the half-mile circle in which anything could be seen at all. The Nadine checked her downward motion. Interplanetary drive is rugged and sure, but it does not respond to fine adjustment. Burleigh used rockets, issuing great bellowings of flame, to make actual contact. The yacht hovered, and as the rocket-flames diminished slowly she sat down with practically no impact at all. But around her there was a monstrous tumult of smoke and steam. When the rockets went off, she lay in a burned-out hollow some three or four feet deep with a bottom of solid stone. The walls of the hollow were black and scorched. It seemed that at some places they quivered persistently. There was silence in the control-room save for the whining noise which now was almost deafening. Harper snapped off the switch. Then there was true silence. The space-yacht had come to rest possibly a hundred yards from the mound which was the source of the space-signal. That mound shared the peculiarity of the ground as far as they could see through the haze. It was not vegetation in any ordinary sense. Certainly it was no mineral surface! The landing-pockets had burned away three or four feet of it, and the edge of the burned area smoked noisesomely, and somehow it looked as if it would reek. And there were places where it stirred. Burleigh blinked and stared. Then he reached up and flicked on the outside microphones. Instantly there was bedlam. If the landscape was strange, here, the sounds that came from it were unbelievable. There were grunting noises. There were clickings, uncountable clickings that made a background for all the rest. There were discordant howls and honkings. From time to time some thing unknown made a cry that sounded very much like a small boy trailing a stick against a picket fence, only much louder. Something hooted, maintaining the noise for an impossibly long time. And persistently, sounding as if they came from far away, there were booming noises, unspeakably deep-bass, made by something alive. And something shrieked in lunatic fashion and something else still moaned from time to time with the volume of a steam-whistle.... "This sounds and looks like a nice place to live," said Moran with fine irony. Burleigh did not answer. He turned down the outside sound. "What's that stuff there, the ground?" he demanded. "We burned it away in landing. I've seen something like it somewhere, but never taking the place of grass!" "That," said Moran as if brightly, "that's what I'm to make a garden in. Of evenings I'll stroll among my thrifty plantings and listen to the delightful sounds of nature." Burleigh scowled. Harper flicked off the direction-finder. "The signal still comes from that hillock yonder," he said with finality. Moran said bitingly; "That ain't no hillock, that's my home!" Then, instantly he'd said it, he recognized that it could be true. The mound was not a fold in the ground. It was not an up-cropping of the ash-covered stone on which the Nadine rested. The enigmatic, dirty-yellow-dirty-red-dirty-blue-and-dirty-black ground-cover hid something. It blurred the shape it covered, very much as enormous cobwebs made solid and opaque would have done. But when one looked carefully at the mound, there was a landing-fin sticking up toward the leaden skies. It was attached to a large cylindrical object of which the fore part was crushed in. The other landing-fins could be traced. "It's a ship," said Moran curtly. "It crash-landed and its crew set up a signal to call for help. None came, or they'd have turned the beacon off. Maybe they got the lifeboats to work and got away. Maybe they lived as I'm expected to live until they died as I'm expected to die." Burleigh said angrily; "You'd do what we are doing if you were in our shoes!" "Sure," said Moran, "but a man can gripe, can't he?" "You won't have to live here," said Burleigh. "We'll take you somewhere up by the ice-cap. As Carol said, we'll give you everything we can spare. And meanwhile we'll take a look at that wreck yonder. There might be an indication in it of what solar system this is. There could be something in it of use to you, too. You'd better come along when we explore." "Aye, aye, sir," said Moran with irony. "Very kind of you, sir. You'll go armed, sir?" Burleigh growled; "Naturally!" "Then since I can't be trusted with a weapon," said Moran, "I suggest that I take a torch. We may have to burn through that loathesome stuff to get in the ship." "Right," growled Burleigh again. "Brawn and Carol, you'll keep ship. The rest of us wear suits. We don't know what that stuff is outside." Moran silently went to the space-suit rack and began to get into a suit. Modern space-suits weren't like the ancient crudities with bulging metal casings and enormous globular helmets. Non-stretch fabrics took the place of metal, and constant-volume joints were really practical nowadays. A man could move about in a late-model space-suit almost as easily as in ship-clothing. The others of the landing-party donned their special garments with the brisk absence of fumbling that these people displayed in every action. "If there's a lifeboat left," said Carol suddenly, "Moran might be able to do something with it." "Ah, yes!" said Moran. "It's very likely that the ship hit hard enough to kill everybody aboard, but not smash the boats!" "Somebody survived the crash," said Burleigh, "because they set up a beacon. I wouldn't count on a boat, Moran." "I don't!" snapped Moran. He flipped the fastener of his suit. He felt all the openings catch. He saw the others complete their equipment. They took arms. So far they had seen no moving thing outside, but arms were simple sanity on an unknown world. Moran, though, would not be permitted a weapon. He picked up a torch. They filed into the airlock. The inner door closed. The outer door opened. It was not necessary to check the air specifically. The suits would take care of that. Anyhow the ice-cap said there were no water-soluble gases in the atmosphere, and a gas can't be an active poison if it can't dissolve. They filed out of the airlock. They stood on ash-covered stone, only slightly eroded by the processes which made life possible on this planet. They looked dubiously at the scorched, indefinite substance which had been ground before the Nadine landed. Moran moved scornfully forward. He kicked at the burnt stuff. His foot went through the char. The hole exposed a cheesy mass of soft matter which seemed riddled with small holes. Something black came squirming frantically out of one of the openings. It was eight or ten inches long. It had a head, a thorax, and an abdomen. It had wing-cases. It had six legs. It toppled down to the stone on which the Nadine rested. Agitatedly, it spread its wing-covers and flew away, droning loudly. The four men heard the sound above even the monstrous cacophony of cries and boomings and grunts and squeaks which seemed to fill the air. "What the devil—." Moran kicked again. More holes. More openings. More small tunnels in the cheese-like, curd-like stuff. More black things squirming to view in obvious panic. They popped out everywhere. It was suddenly apparent that the top of the soil, here, was a thick and blanket-like sheet over the whitish stuff. The black creatures lived and thrived in tunnels under it. Carol's voice came over the helmet-phones. " They're—bugs! " she said incredulously. " They're beetles! They're twenty times the size of the beetles we humans have been carrying around the galaxy, but that's what they are! " Moran grunted. Distastefully, he saw his predicament made worse. He knew what had happened here. He could begin to guess at other things to be discovered. It had not been practical for men to move onto new planets and subsist upon the flora and fauna they found there. On some new planets life had never gotten started. On such worlds a highly complex operation was necessary before humanity could move in. A complete ecological complex had to be built up; microbes to break down the rock for soil, bacteria to fix nitrogen to make the soil fertile; plants to grow in the new-made dirt and insects to fertilize the plants so they would multiply, and animals and birds to carry the seeds planet-wide. On most planets, to be sure, there were local, aboriginal plants and animals. But still terrestrial creatures had to be introduced if a colony was to feed itself. Alien plants did not supply satisfactory food. So an elaborate adaptation job had to be done on every planet before native and terrestrial living things settled down together. It wasn't impossible that the scuttling things were truly beetles, grown large and monstrous under the conditions of a new planet. And the ground.... "This ground stuff," said Moran distastefully, "is yeast or some sort of toadstool growth. This is a seedling world. It didn't have any life on it, so somebody dumped germs and spores and bugs to make it ready for plants and animals eventually. But nobody's come back to finish up the job." Burleigh grunted a somehow surprised assent. But it wasn't surprising; not wholly so. Once one mentioned yeasts and toadstools and fungi generally, the weird landscape became less than incredible. But it remained actively unpleasant to think of being marooned on it. "Suppose we go look at the ship?" said Moran unpleasantly. "Maybe you can find out where you are, and I can find out what's ahead of me." He climbed up on the unscorched surface. It was elastic. The parchment-like top skin yielded. It was like walking on a mass of springs. "We'd better spread out," added Moran, "or else we'll break through that skin and be floundering in this mess." "I'm giving the orders, Moran!" said Burleigh shortly. "But what you say does make sense." He and the others joined Moran on the yielding surface. Their footing was uncertain, as on a trampoline. They staggered. They moved toward the hillock which was a covered-over wrecked ship. The ground was not as level as it appeared from the Nadine's control-room. There were undulations. But they could not see more than a quarter-mile in any direction. Beyond that was mist. But Burleigh, at one end of the uneven line of advancing men, suddenly halted and stood staring down at something he had not seen before. The others halted. Something moved. It came out from behind a very minor spire of whitish stuff that looked like a dirty sheet stretched over a tall stone. The thing that appeared was very peculiar indeed. It was a—worm. But it was a foot thick and ten feet long, and it had a group of stumpy legs at its fore end—where there were eyes hidden behind bristling hair-like growths—and another set of feet at its tail end. It progressed sedately by reaching forward with its fore-part, securing a foothold, and then arching its middle portion like a cat arching its back, to bring its hind part forward. Then it reached forward again. It was of a dark olive color from one end to the other. Its manner of walking was insane but somehow sedate. Moran heard muffled noises in his helmet-phone as the others tried to speak. Carol's voice came anxiously; " What's the matter? What do you see? " Moran said with savage precision; "We're looking at an inch-worm, grown up like the beetles only more so. It's not an inch-worm any longer. It's a yard-worm." Then he said harshly to the men with him; "It's not a hunting creature on worlds where it's smaller. It's not likely to have turned deadly here. Come on!" He went forward over the singularly bouncy ground. The others followed. It was to be noted that Hallet the engineer, avoided the huge harmless creature more widely than most. They reached the mound which was the ship. Moran unlimbered his torch. He said sardonically; "This ship won't do anybody any good. It's old-style. That thick belt around its middle was dropped a hundred years ago, and more." There was an abrupt thickening of the cylindrical hull at the middle. There was an equally abrupt thinning, again, toward the landing-fins. The sharpness of the change was blurred over by the revolting ground-stuff growing everywhere. "We're going to find that this wreck has been here a century at least!" Without orders, he turned on the torch. A four-foot flame of pure blue-white leaped out. He touched its tip to the fungoid soil. Steam leaped up. He used the flame like a gigantic scalpel, cutting a square a yard deep in the whitish stuff, and then cutting it across and across to destroy it. Thick fumes arose, and quiverings and shakings began. Black creatures in their labyrinths of tunnels began to panic. Off to the right the blanket-like surface ripped and they poured out. They scuttled crazily here and there. Some took to wing. By instinct the other men—the armed ones—moved back from the smoke. They wore space-helmets but they felt that there should be an intolerable smell. Moran slashed and slashed angrily with the big flame, cutting a way to the metal hull that had fallen here before his grandfather was born. Sometimes the flame cut across things that writhed, and he was sickened. But above all he raged because he was to be marooned here. He could not altogether blame the others. They couldn't land at any colonized world with him on board without his being detected as an extra member of the crew. His fate would then be sealed. But they also would be investigated. Official queries would go across this whole sector of the galaxy, naming five persons of such-and-such description and such-and-such fingerprints, voyaging in a space-yacht of such-and-such size and registration. The world they came from would claim them as fugitives. They would be returned to it. They'd be executed. Then Carol's voice came in his helmet-phone. She cried out; " Look out! It's coming! Kill it! Kill it—. " He heard blast-rifles firing. He heard Burleigh pant commands. He was on his way out of the hollow he'd carved when he heard Harper cry out horribly. He got clear of the newly burned-away stuff. There was still much smoke and stream. But he saw Harper. More, he saw the thing that had Harper. It occurred to him instantly that if Harper died, there would not be too many people on the Nadine . They need not maroon him. In fact, they wouldn't dare. A ship that came in to port with two few on board would be investigated as thoroughly as one that had too many. Perhaps more thoroughly. So if Harper were killed, Moran would be needed to take his place. He'd go on from here in the Nadine , necessarily accepted as a member of her crew. Then he rushed, the flame-torch making a roaring sound. II. They went back to the Nadine for weapons more adequate for encountering the local fauna when it was over. Blast-rifles were not effective against such creatures as these. Torches were contact weapons but they killed. Blast-rifles did not. And Harper needed to pull himself together again, too. Also, neither Moran nor any of the others wanted to go back to the still un-entered wreck while the skinny, somehow disgusting legs of the thing still kicked spasmodically—quite separate—on the whitish ground-stuff. Moran had disliked such creatures in miniature form on other worlds. Enlarged like this. It seemed insane that such creatures, even in miniature, should painstakingly be brought across light-years of space to the new worlds men settled on. But it had been found to be necessary. The ecological system in which human beings belonged had turned out to be infinitely complicated. It had turned out, in fact, to be the ecological system of Earth, and unless all parts of the complex were present, the total was subtly or glaringly wrong. So mankind distastefully ferried pests as well as useful creatures to its new worlds as they were made ready for settlement. Mosquitos throve on the inhabited globes of the Rim Stars. Roaches twitched nervous antennae on the settled planets of the Coal-sack. Dogs on Antares had fleas, and scratched their bites, and humanity spread through the galaxy with an attendant train of insects and annoyances. If they left their pests behind, the total system of checks and balances which make life practical would get lopsided. It would not maintain itself. The vagaries that could result were admirably illustrated in and on the landscape outside the Nadine . Something had been left out of the seeding of this planet. The element—which might be a bacterium or a virus or almost anything at all—the element that kept creatures at the size called "normal" was either missing or inoperable here. The results were not desirable.
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C. He and the remaining crew members could pass security clearance with only five members on board.
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Why is the qualification interviewer under a glass dome?
A. The interviewer is protecting themself from aliens.
B. The glass dome is to protect the interviewer from human contact.
C. The interviewer has a compromised immune system.
D. The interviewer is an alien, and it does not breathe oxygen.
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THE PERFECTIONISTS By ARNOLD CASTLE ILLUSTRATED by SUMMERS Is there something wrong with you? Do you fail to fit in with your group? Nervous, anxious, ill-at-ease? Happy about it? Lucky you! Frank Pembroke sat behind the desk of his shabby little office over Lemark's Liquors in downtown Los Angeles and waited for his first customer. He had been in business for a week and as yet had had no callers. Therefore, it was with a mingled sense of excitement and satisfaction that he greeted the tall, dark, smooth-faced figure that came up the stairs and into the office shortly before noon. "Good day, sir," said Pembroke with an amiable smile. "I see my advertisement has interested you. Please stand in that corner for just a moment." Opening the desk drawer, which was almost empty, Pembroke removed an automatic pistol fitted with a silencer. Pointing it at the amazed customer, he fired four .22 caliber longs into the narrow chest. Then he made a telephone call and sat down to wait. He wondered how long it would be before his next client would arrive. The series of events leading up to Pembroke's present occupation had commenced on a dismal, overcast evening in the South Pacific a year earlier. Bound for Sydney, two days out of Valparaiso, the Colombian tramp steamer Elena Mia had encountered a dense greenish fog which seemed vaguely redolent of citrus trees. Standing on the forward deck, Pembroke was one of the first to perceive the peculiar odor and to spot the immense gray hulk wallowing in the murky distance. Then the explosion had come, from far below the waterline, and the decks were awash with frantic crewmen, officers, and the handful of passengers. Only two lifeboats were launched before the Elena Mia went down. Pembroke was in the second. The roar of the sinking ship was the last thing he heard for some time. Pembroke came as close to being a professional adventurer as one can in these days of regimented travel, organized peril, and political restriction. He had made for himself a substantial fortune through speculation in a great variety of properties, real and otherwise. Life had given him much and demanded little, which was perhaps the reason for his restiveness. Loyalty to person or to people was a trait Pembroke had never recognized in himself, nor had it ever been expected of him. And yet he greatly envied those staunch patriots and lovers who could find it in themselves to elevate the glory and safety of others above that of themselves. Lacking such loyalties, Pembroke adapted quickly to the situation in which he found himself when he regained consciousness. He awoke in a small room in what appeared to be a typical modern American hotel. The wallet in his pocket contained exactly what it should, approximately three hundred dollars. His next thought was of food. He left the room and descended via the elevator to the restaurant. Here he observed that it was early afternoon. Ordering a full dinner, for he was unusually hungry, he began to study the others in the restaurant. Many of the faces seemed familiar; the crew of the ship, probably. He also recognized several of the passengers. However, he made no attempt to speak to them. After his meal, he bought a good corona and went for a walk. His situation could have been any small western American seacoast city. He heard the hiss of the ocean in the direction the afternoon sun was taking. In his full-gaited walk, he was soon approaching the beach. On the sand he saw a number of sun bathers. One in particular, an attractive woman of about thirty, tossed back her long, chestnut locks and gazed up intently at Pembroke as he passed. Seldom had he enjoyed so ingenuous an invitation. He halted and stared down at her for a few moments. "You are looking for someone?" she inquired. "Much of the time," said the man. "Could it be me?" "It could be." "Yet you seem unsure," she said. Pembroke smiled, uneasily. There was something not entirely normal about her conversation. Though the rest of her compensated for that. "Tell me what's wrong with me," she went on urgently. "I'm not good enough, am I? I mean, there's something wrong with the way I look or act. Isn't there? Please help me, please!" "You're not casual enough, for one thing," said Pembroke, deciding to play along with her for the moment. "You're too tense. Also you're a bit knock-kneed, not that it matters. Is that what you wanted to hear?" "Yes, yes—I mean, I suppose so. I can try to be more casual. But I don't know what to do about my knees," she said wistfully, staring across at the smooth, tan limbs. "Do you think I'm okay otherwise? I mean, as a whole I'm not so bad, am I? Oh, please tell me." "How about talking it over at supper tonight?" Pembroke proposed. "Maybe with less distraction I'll have a better picture of you—as a whole." "Oh, that's very generous of you," the woman told him. She scribbled a name and an address on a small piece of paper and handed it to him. "Any time after six," she said. Pembroke left the beach and walked through several small specialty shops. He tried to get the woman off his mind, but the oddness of her conversation continued to bother him. She was right about being different, but it was her concern about being different that made her so. How to explain that to her? Then he saw the weird little glass statuette among the usual bric-a-brac. It rather resembled a ground hog, had seven fingers on each of its six limbs, and smiled up at him as he stared. "Can I help you, sir?" a middle-aged saleswoman inquired. "Oh, good heavens, whatever is that thing doing here?" Pembroke watched with lifted eyebrows as the clerk whisked the bizarre statuette underneath the counter. "What the hell was that?" Pembroke demanded. "Oh, you know—or don't you? Oh, my," she concluded, "are you one of the—strangers?" "And if I were?" "Well, I'd certainly appreciate it if you'd tell me how I walk." She came around in front of the counter and strutted back and forth a few times. "They tell me I lean too far forward," she confided. "But I should think you'd fall down if you didn't." "Don't try to go so fast and you won't fall down," suggested Pembroke. "You're in too much of a hurry. Also those fake flowers on your blouse make you look frumpy." "Well, I'm supposed to look frumpy," the woman retorted. "That's the type of person I am. But you can look frumpy and still walk natural, can't you? Everyone says you can." "Well, they've got a point," said Pembroke. "Incidentally, just where are we, anyway? What city is this?" "Puerto Pacifico," she told him. "Isn't that a lovely name? It means peaceful port. In Spanish." That was fine. At least he now knew where he was. But as he left the shop he began checking off every west coast state, city, town, and inlet. None, to the best of his knowledge, was called Puerto Pacifico. He headed for the nearest service station and asked for a map. The attendant gave him one which showed the city, but nothing beyond. "Which way is it to San Francisco?" asked Pembroke. "That all depends on where you are," the boy returned. "Okay, then where am I?" "Pardon me, there's a customer," the boy said. "This is Puerto Pacifico." Pembroke watched him hurry off to service a car with a sense of having been given the runaround. To his surprise, the boy came back a few minutes later after servicing the automobile. "Say, I've just figured out who you are," the youngster told him. "I'd sure appreciate it if you'd give me a little help on my lingo. Also, you gas up the car first, then try to sell 'em the oil—right?" "Right," said Pembroke wearily. "What's wrong with your lingo? Other than the fact that it's not colloquial enough." "Not enough slang, huh? Well, I guess I'll have to concentrate on that. How about the smile?" "Perfect," Pembroke told him. "Yeah?" said the boy delightedly. "Say, come back again, huh? I sure appreciate the help. Keep the map." "Thanks. One more thing," Pembroke said. "What's over that way—outside the city?" "Sand." "How about that way?" he asked, pointing north. "And that way?" pointing south. "More of the same." "Any railroads?" "That we ain't got." "Buses? Airlines?" The kid shook his head. "Some city." "Yeah, it's kinda isolated. A lot of ships dock here, though." "All cargo ships, I'll bet. No passengers," said Pembroke. "Right," said the attendant, giving with his perfect smile. "No getting out of here, is there?" "That's for sure," the boy said, walking away to wait on another customer. "If you don't like the place, you've had it." Pembroke returned to the hotel. Going to the bar, he recognized one of the Elena Mia's paying passengers. He was a short, rectangular little man in his fifties named Spencer. He sat in a booth with three young women, all lovely, all effusive. The topic of the conversation turned out to be precisely what Pembroke had predicted. "Well, Louisa, I'd say your only fault is the way you keep wigglin' your shoulders up 'n' down. Why'n'sha try holdin' 'em straight?" "I thought it made me look sexy," the redhead said petulantly. "Just be yourself, gal," Spencer drawled, jabbing her intimately with a fat elbow, "and you'll qualify." "Me, me," the blonde with a feather cut was insisting. "What is wrong with me?" "You're perfect, sweetheart," he told her, taking her hand. "Ah, come on," she pleaded. "Everyone tells me I chew gum with my mouth open. Don't you hate that?" "Naw, that's part of your charm," Spencer assured her. "How 'bout me, sugar," asked the girl with the coal black hair. "Ah, you're perfect, too. You are all perfect. I've never seen such a collection of dolls as parade around this here city. C'mon, kids—how 'bout another round?" But the dolls had apparently lost interest in him. They got up one by one and walked out of the bar. Pembroke took his rum and tonic and moved over to Spencer's booth. "Okay if I join you?" "Sure," said the fat man. "Wonder what the hell got into those babes?" "You said they were perfect. They know they're not. You've got to be rough with them in this town," said Pembroke. "That's all they want from us." "Mister, you've been doing some thinkin', I can see," said Spencer, peering at him suspiciously. "Maybe you've figured out where we are." "Your bet's as good as mine," said Pembroke. "It's not Wellington, and it's not Brisbane, and it's not Long Beach, and it's not Tahiti. There are a lot of places it's not. But where the hell it is, you tell me. "And, by the way," he added, "I hope you like it in Puerto Pacifico. Because there isn't any place to go from here and there isn't any way to get there if there were." "Pardon me, gentlemen, but I'm Joe Valencia, manager of the hotel. I would be very grateful if you would give me a few minutes of honest criticism." "Ah, no, not you, too," groaned Spencer. "Look, Joe, what's the gag?" "You are newcomers, Mr. Spencer," Valencia explained. "You are therefore in an excellent position to point out our faults as you see them." "Well, so what?" demanded Spencer. "I've got more important things to do than to worry about your troubles. You look okay to me." "Mr. Valencia," said Pembroke. "I've noticed that you walk with a very slight limp. If you have a bad leg, I should think you would do better to develop a more pronounced limp. Otherwise, you may appear to be self-conscious about it." Spencer opened his mouth to protest, but saw with amazement that it was exactly this that Valencia was seeking. Pembroke was amused at his companion's reaction but observed that Spencer still failed to see the point. "Also, there is a certain effeminateness in the way in which you speak," said Pembroke. "Try to be a little more direct, a little more brusque. Speak in a monotone. It will make you more acceptable." "Thank you so much," said the manager. "There is much food for thought in what you have said, Mr. Pembroke. However, Mr. Spencer, your value has failed to prove itself. You have only yourself to blame. Cooperation is all we require of you." Valencia left. Spencer ordered another martini. Neither he nor Pembroke spoke for several minutes. "Somebody's crazy around here," the fat man muttered after a few moments. "Is it me, Frank?" "No. You just don't belong here, in this particular place," said Pembroke thoughtfully. "You're the wrong type. But they couldn't know that ahead of time. The way they operate it's a pretty hit-or-miss operation. But they don't care one bit about us, Spencer. Consider the men who went down with the ship. That was just part of the game." "What the hell are you sayin'?" asked Spencer in disbelief. "You figure they sunk the ship? Valencia and the waitress and the three babes? Ah, come on." "It's what you think that will determine what you do, Spencer. I suggest you change your attitude; play along with them for a few days till the picture becomes a little clearer to you. We'll talk about it again then." Pembroke rose and started out of the bar. A policeman entered and walked directly to Spencer's table. Loitering at the juke box, Pembroke overheard the conversation. "You Spencer?" "That's right," said the fat man sullenly. "What don't you like about me? The truth , buddy." "Ah, hell! Nothin' wrong with you at all, and nothin'll make me say there is," said Spencer. "You're the guy, all right. Too bad, Mac," said the cop. Pembroke heard the shots as he strolled casually out into the brightness of the hotel lobby. While he waited for the elevator, he saw them carrying the body into the street. How many others, he wondered, had gone out on their backs during their first day in Puerto Pacifico? Pembroke shaved, showered, and put on the new suit and shirt he had bought. Then he took Mary Ann, the woman he had met on the beach, out to dinner. She would look magnificent even when fully clothed, he decided, and the pale chartreuse gown she wore hardly placed her in that category. Her conversation seemed considerably more normal after the other denizens of Puerto Pacifico Pembroke had listened to that afternoon. After eating they danced for an hour, had a few more drinks, then went to Pembroke's room. He still knew nothing about her and had almost exhausted his critical capabilities, but not once had she become annoyed with him. She seemed to devour every factual point of imperfection about herself that Pembroke brought to her attention. And, fantastically enough, she actually appeared to have overcome every little imperfection he had been able to communicate to her. It was in the privacy of his room that Pembroke became aware of just how perfect, physically, Mary Ann was. Too perfect. No freckles or moles anywhere on the visible surface of her brown skin, which was more than a mere sampling. Furthermore, her face and body were meticulously symmetrical. And she seemed to be wholly ambidextrous. "With so many beautiful women in Puerto Pacifico," said Pembroke probingly, "I find it hard to understand why there are so few children." "Yes, children are decorative, aren't they," said Mary Ann. "I do wish there were more of them." "Why not have a couple of your own?" he asked. "Oh, they're only given to maternal types. I'd never get one. Anyway, I won't ever marry," she said. "I'm the paramour type." It was obvious that the liquor had been having some effect. Either that, or she had a basic flaw of loquacity that no one else had discovered. Pembroke decided he would have to cover his tracks carefully. "What type am I?" he asked. "Silly, you're real. You're not a type at all." "Mary Ann, I love you very much," Pembroke murmured, gambling everything on this one throw. "When you go to Earth I'll miss you terribly." "Oh, but you'll be dead by then," she pouted. "So I mustn't fall in love with you. I don't want to be miserable." "If I pretended I was one of you, if I left on the boat with you, they'd let me go to Earth with you. Wouldn't they?" "Oh, yes, I'm sure they would." "Mary Ann, you have two other flaws I feel I should mention." "Yes? Please tell me." "In the first place," said Pembroke, "you should be willing to fall in love with me even if it will eventually make you unhappy. How can you be the paramour type if you refuse to fall in love foolishly? And when you have fallen in love, you should be very loyal." "I'll try," she said unsurely. "What else?" "The other thing is that, as my mistress, you must never mention me to anyone. It would place me in great danger." "I'll never tell anyone anything about you," she promised. "Now try to love me," Pembroke said, drawing her into his arms and kissing with little pleasure the smooth, warm perfection of her tanned cheeks. "Love me my sweet, beautiful, affectionate Mary Ann. My paramour." Making love to Mary Ann was something short of ecstasy. Not for any obvious reason, but because of subtle little factors that make a woman a woman. Mary Ann had no pulse. Mary Ann did not perspire. Mary Ann did not fatigue gradually but all at once. Mary Ann breathed regularly under all circumstances. Mary Ann talked and talked and talked. But then, Mary Ann was not a human being. When she left the hotel at midnight, Pembroke was quite sure that she understood his plan and that she was irrevocably in love with him. Tomorrow might bring his death, but it might also ensure his escape. After forty-two years of searching for a passion, for a cause, for a loyalty, Frank Pembroke had at last found his. Earth and the human race that peopled it. And Mary Ann would help him to save it. The next morning Pembroke talked to Valencia about hunting. He said that he planned to go shooting out on the desert which surrounded the city. Valencia told him that there were no living creatures anywhere but in the city. Pembroke said he was going out anyway. He picked up Mary Ann at her apartment and together they went to a sporting goods store. As he guessed there was a goodly selection of firearms, despite the fact that there was nothing to hunt and only a single target range within the city. Everything, of course, had to be just like Earth. That, after all, was the purpose of Puerto Pacifico. By noon they had rented a jeep and were well away from the city. Pembroke and Mary Ann took turns firing at the paper targets they had purchased. At twilight they headed back to the city. On the outskirts, where the sand and soil were mixed and no footprints would be left, Pembroke hopped off. Mary Ann would go straight to the police and report that Pembroke had attacked her and that she had shot him. If necessary, she would conduct the authorities to the place where they had been target shooting, but would be unable to locate the spot where she had buried the body. Why had she buried it? Because at first she was not going to report the incident. She was frightened. It was not airtight, but there would probably be no further investigation. And they certainly would not prosecute Mary Ann for killing an Earthman. Now Pembroke had himself to worry about. The first step was to enter smoothly into the new life he had planned. It wouldn't be so comfortable as the previous one, but should be considerably safer. He headed slowly for the "old" part of town, aging his clothes against buildings and fences as he walked. He had already torn the collar of the shirt and discarded his belt. By morning his beard would grow to blacken his face. And he would look weary and hungry and aimless. Only the last would be a deception. Two weeks later Pembroke phoned Mary Ann. The police had accepted her story without even checking. And when, when would she be seeing him again? He had aroused her passion and no amount of long-distance love could requite it. Soon, he assured her, soon. "Because, after all, you do owe me something," she added. And that was bad because it sounded as if she had been giving some womanly thought to the situation. A little more of that and she might go to the police again, this time for vengeance. Twice during his wanderings Pembroke had seen the corpses of Earthmen being carted out of buildings. They had to be Earthmen because they bled. Mary Ann had admitted that she did not. There would be very few Earthmen left in Puerto Pacifico, and it would be simple enough to locate him if he were reported as being on the loose. There was no out but to do away with Mary Ann. Pembroke headed for the beach. He knew she invariably went there in the afternoon. He loitered around the stalls where hot dogs and soft drinks were sold, leaning against a post in the hot sun, hat pulled down over his forehead. Then he noticed that people all about him were talking excitedly. They were discussing a ship. It was leaving that afternoon. Anyone who could pass the interview would be sent to Earth. Pembroke had visited the docks every day, without being able to learn when the great exodus would take place. Yet he was certain the first lap would be by water rather than by spaceship, since no one he had talked to in the city had ever heard of spaceships. In fact, they knew very little about their masters. Now the ship had arrived and was to leave shortly. If there was any but the most superficial examination, Pembroke would no doubt be discovered and exterminated. But since no one seemed concerned about anything but his own speech and behavior, he assumed that they had all qualified in every other respect. The reason for transporting Earth People to this planet was, of course, to apply a corrective to any of the Pacificos' aberrant mannerisms or articulation. This was the polishing up phase. Pembroke began hobbling toward the docks. Almost at once he found himself face to face with Mary Ann. She smiled happily when she recognized him. That was a good thing. "It is a sign of poor breeding to smile at tramps," Pembroke admonished her in a whisper. "Walk on ahead." She obeyed. He followed. The crowd grew thicker. They neared the docks and Pembroke saw that there were now set up on the roped-off wharves small interviewing booths. When it was their turn, he and Mary Ann each went into separate ones. Pembroke found himself alone in the little room. Then he saw that there was another entity in his presence confined beneath a glass dome. It looked rather like a groundhog and had seven fingers on each of its six limbs. But it was larger and hairier than the glass one he had seen at the gift store. With four of its limbs it tapped on an intricate keyboard in front of it. "What is your name?" queried a metallic voice from a speaker on the wall. "I'm Jerry Newton. Got no middle initial," Pembroke said in a surly voice. "Occupation?" "I work a lot o' trades. Fisherman, fruit picker, fightin' range fires, vineyards, car washer. Anything. You name it. Been out of work for a long time now, though. Goin' on five months. These here are hard times, no matter what they say." "What do you think of the Chinese situation?" the voice inquired. "Which situation's 'at?" "Where's Seattle?" "Seattle? State o' Washington." And so it went for about five minutes. Then he was told he had qualified as a satisfactory surrogate for a mid-twentieth century American male, itinerant type. "You understand your mission, Newton?" the voice asked. "You are to establish yourself on Earth. In time you will receive instructions. Then you will attack. You will not see us, your masters, again until the atmosphere has been sufficiently chlorinated. In the meantime, serve us well." He stumbled out toward the docks, then looked about for Mary Ann. He saw her at last behind the ropes, her lovely face in tears. Then she saw him. Waving frantically, she called his name several times. Pembroke mingled with the crowd moving toward the ship, ignoring her. But still the woman persisted in her shouting. Sidling up to a well-dressed man-about-town type, Pembroke winked at him and snickered. "You Frank?" he asked. "Hell, no. But some poor punk's sure red in the face, I'll bet," the man-about-town said with a chuckle. "Those high-strung paramour types always raising a ruckus. They never do pass the interview. Don't know why they even make 'em." Suddenly Mary Ann was quiet. "Ambulance squad," Pembroke's companion explained. "They'll take her off to the buggy house for a few days and bring her out fresh and ignorant as the day she was assembled. Don't know why they keep making 'em, as I say. But I guess there's a call for that type up there on Earth." "Yeah, I reckon there is at that," said Pembroke, snickering again as he moved away from the other. "And why not? Hey? Why not?" Pembroke went right on hating himself, however, till the night he was deposited in a field outside of Ensenada, broke but happy, with two other itinerant types. They separated in San Diego, and it was not long before Pembroke was explaining to the police how he had drifted far from the scene of the sinking of the Elena Mia on a piece of wreckage, and had been picked up by a Chilean trawler. How he had then made his way, with much suffering, up the coast to California. Two days later, his identity established and his circumstances again solvent, he was headed for Los Angeles to begin his save-Earth campaign. Now, seated at his battered desk in the shabby rented office over Lemark's Liquors, Pembroke gazed without emotion at the two demolished Pacificos that lay sprawled one atop the other in the corner. His watch said one-fifteen. The man from the FBI should arrive soon. There were footsteps on the stairs for the third time that day. Not the brisk, efficient steps of a federal official, but the hesitant, self-conscious steps of a junior clerk type. Pembroke rose as the young man appeared at the door. His face was smooth, unpimpled, clean-shaven, without sweat on a warm summer afternoon. "Are you Dr. Von Schubert?" the newcomer asked, peering into the room. "You see, I've got a problem—" The four shots from Pembroke's pistol solved his problem effectively. Pembroke tossed his third victim onto the pile, then opened a can of lager, quaffing it appreciatively. Seating himself once more, he leaned back in the chair, both feet upon the desk. He would be out of business soon, once the FBI agent had got there. Pembroke was only in it to get the proof he would need to convince people of the truth of his tale. But in the meantime he allowed himself to admire the clipping of the newspaper ad he had run in all the Los Angeles papers for the past week. The little ad that had saved mankind from God-knew-what insidious menace. It read: ARE YOU IMPERFECT? LET DR. VON SCHUBERT POINT OUT YOUR FLAWS IT IS HIS GOAL TO MAKE YOU THE AVERAGE FOR YOUR TYPE FEE—$3.75 MONEY BACK IF NOT SATISFIED! THE END Transcriber's Note: This etext was produced from Amazing Science Fiction Stories January 1960. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note.
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D. The interviewer is an alien, and it does not breathe oxygen.
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What are the relative improvements observed over existing methods?
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### Introduction
Reasoning about entities and their relations is an important problem for achieving general artificial intelligence. Often such problems are formulated as reasoning over graph-structured representation of knowledge. Knowledge graphs, for example, consist of entities and relations between them BIBREF0 , BIBREF1 , BIBREF2 , BIBREF3 . Representation learning BIBREF4 , BIBREF5 , BIBREF6 , BIBREF7 and reasoning BIBREF8 , BIBREF9 , BIBREF10 , BIBREF11 with such structured representations is an important and active area of research. Most previous work on knowledge representation and reasoning relies on a pipeline of natural language processing systems, often consisting of named entity extraction BIBREF12 , entity resolution and coreference BIBREF13 , relationship extraction BIBREF4 , and knowledge graph inference BIBREF14 . While this cascaded approach of using NLP systems can be effective at reasoning with knowledge bases at scale, it also leads to a problem of compounding of the error from each component sub-system. The importance of each of these sub-component on a particular downstream application is also not clear. For the task of question-answering, we instead make an attempt at an end-to-end approach which directly models the entities and relations in the text as memory slots. While incorporating existing knowledge (from curated knowledge bases) for the purpose of question-answering BIBREF11 , BIBREF8 , BIBREF15 is an important area of research, we consider the simpler setting where all the information is contained within the text itself – which is the approach taken by many recent memory based neural network models BIBREF16 , BIBREF17 , BIBREF18 , BIBREF19 . Recently, BIBREF17 proposed a dynamic memory based neural network for implicitly modeling the state of entities present in the text for question answering. However, this model lacks any module for relational reasoning. In response, we propose RelNet, which extends memory-augmented neural networks with a relational memory to reason about relationships between multiple entities present within the text. Our end-to-end method reads text, and writes to both memory slots and edges between them. Intuitively, the memory slots correspond to entities and the edges correspond to relationships between entities, each represented as a vector. The only supervision signal for our method comes from answering questions on the text. We demonstrate the utility of the model through experiments on the bAbI tasks BIBREF18 and find that the model achieves smaller mean error across the tasks than the best previously published result BIBREF17 in the 10k examples regime and achieves 0% error on 11 of the 20 tasks. ### RelNet Model
We describe the RelNet model in this section. Figure 1 provides a high-level view of the model. The model is sequential in nature, consisting of the following steps: read text, process it into a dynamic relational memory and then attention conditioned on the question generates the answer. We model the dynamic memory in a fashion similar to Recurrent Entity Networks BIBREF17 and then equip it with an additional relational memory. There are three main components to the model: 1) input encoder 2) dynamic memory, and 3) output module. We will describe these three modules in details. The input encoder and output module implementations are similar to the Entity Network BIBREF17 and main novelty lies in the dynamic memory. We describe the operations executed by the network for a single example consisting of a document with $T$ sentences, where each sentence consists of a sequence of words represented with $K$ -dimensional word embeddings $\lbrace e_1, \ldots , e_N\rbrace $ , a question on the document represented as another sequence of words and an answer to the question. ### Related Work
There is a long line of work in textual question-answering systems BIBREF21 , BIBREF22 . Recent successful approaches use memory based neural networks for question answering, for example BIBREF23 , BIBREF18 , BIBREF24 , BIBREF19 , BIBREF17 . Our model is also a memory network based model and is also related to the neural turing machine BIBREF25 . As described previously, the model is closely related to the Recurrent Entity Networks model BIBREF17 which describes an end-to-end approach to model entities in text but does not directly model relations. Other approaches to question answering use external knowledge, for instance external knowledge bases BIBREF26 , BIBREF11 , BIBREF27 , BIBREF28 , BIBREF9 or external text like Wikipedia BIBREF29 , BIBREF30 . Very recently, and in parallel to this work, a method for relational reasoning called relation networks BIBREF31 was proposed. They demonstrated that simple neural network modules are not as effective at relational reasoning and their proposed module is similar to our model. However, relation network is not a memory-based model and there is no mechanism to read and write relevant information for each pair. Moreover, while their approach scales as the square of the number of sentences, our approach scales as the square of the number of memory slots used per QA pair. The output module in our model can be seen as a type of relation network. Representation learning and reasoning over graph structured data is also relevant to this work. Graph based neural network models BIBREF32 , BIBREF33 , BIBREF34 have been proposed which take graph data as an input. The relational memory however does not rely on a specified graph structure and such models can potentially be used for multi-hop reasoning over the relational memory. BIBREF35 proposed a method for learning a graphical representation of the text data for question answering, however the model requires explicit supervision for the graph at every step whereas RelNet does not require explicit supervision for the graph. ### Experiments
We evaluate the model's performance on the bAbI tasks BIBREF18 , a collection of 20 question answering tasks which have become a benchmark for evaluating memory-augmented neural networks. We compare the performance with the Recurrent Entity Networks model (EntNet) BIBREF17 . Performance is measured in terms of mean percentage error on the tasks. Training Details: We used Adam and did a grid search for the learning rate in {0.01, 0.005, 0.001} and choose a fixed learning rate of 0.005 based on performance on the validation set, and clip the gradient norm at 2. We keep all other details similar to BIBREF17 for a fair comparison. embedding dimensions were fixed to be 100, models were trained for a maximum of 250 epochs with mini-batches size of 32 for all tasks except 3 for which the batch size was 16. The document sizes were limited to most recent 70 sentences for all tasks, except for task 3 for which it was limited to 130. The RelNet models were run for 5 times with random seed on each task and the model with best validation performance was chosen as the final model. The baseline EntNet model was run for 10 times for each task BIBREF17 . The results are shown in Table 1 . The RelNet model achieves a mean error of 0.285% across tasks which is better than the results of the EntNet model BIBREF17 . The RelNet model is able to achieve 0% test error on 11 of the tasks, whereas the EntNet model achieves 0% error on 7 of the tasks. ### Conclusion
We demonstrated an end-to-end trained neural network augmented with a structured memory representation which can reason about entities and relations for question answering. Future work will investigate the performance of these models on more real world datasets, interpreting what the models learn, and scaling these models to answer questions about entities and relations from reading massive text corpora. Figure 1: RelNet Model: The model represents the state of the world as a neural turing machine with relational memory. At each time step, the model reads the sentence into an encoding vector and updates both entity memories and all edges between them representing the relations. Table 1: Mean % Error on the 20 Babi tasks.
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The RelNet model achieves a mean error of 0.285% across tasks which is better than the results of the EntNet model BIBREF17 . The RelNet model is able to achieve 0% test error on 11 of the tasks, whereas the EntNet model achieves 0% error on 7 of the tasks.
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Which would the author say of both directors?
A. they missed a key component in their films
B. there were times when the movies were unclear
C. the films portrayed the real characters poorly
D. the visual imagery was done well
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War and Pieces No movie in the last decade has succeeded in psyching out critics and audiences as fully as the powerful, rambling war epic The Thin Red Line , Terrence Malick's return to cinema after 20 years. I've sat through it twice and am still trying to sort out my responses, which run from awe to mockery and back. Like Saving Private Ryan , the picture wallops you in the gut with brilliant, splattery battle montages and Goyaesque images of hell on earth. But Malick, a certified intellectual and the Pynchonesque figure who directed Badlands and Days of Heaven in the 1970s and then disappeared, is in a different philosophical universe from Steven Spielberg. Post-carnage, his sundry characters philosophize about their experiences in drowsy, runic voice-overs that come at you like slow bean balls: "Why does nature vie with itself? ... Is there an avenging power in nature, not one power but two?" Or "This great evil: Where's it come from? What seed, what root did it grow from? Who's doin' this? Who's killin' us, robbin' us of life and light?" First you get walloped with viscera, then you get beaned by blather. Those existential speculations don't derive from the screenplay's source, an archetypal but otherwise down-to-earth 1962 novel by James Jones (who also wrote From Here to Eternity ) about the American invasion of the South Pacific island of Guadalcanal. They're central to Malick's vision of the story, however, and not specious. In the combat genre, the phrase "war is hell" usually means nothing more than that it's a bummer to lose a limb or two, or to see your buddy get his head blown off. A true work of art owes us more than literal horrors, and Malick obliges by making his theater of war the setting for nothing less than a meditation on the existence of God. He tells the story solemnly, in three parts, with a big-deal cast (Sean Penn, Nick Nolte, John Cusack) and a few other major stars (John Travolta, Woody Harrelson, George Clooney) dropping by for cameos. After an Edenic prelude, in which a boyishly idealistic absent without leave soldier, Pvt. Witt (Jim Caviezel), swims with native youths to the accompaniment of a heavenly children's choir, the first part sees the arrival of the Allied forces on the island, introduces the principal characters (none of whom amounts to a genuine protagonist), and lays out the movie's geographical and philosophical terrain. The centerpiece--the fighting--goes on for over an hour and features the most frantic and harrowing sequences, chiefly the company's initially unsuccessful frontal assault on a Japanese hilltop bunker. The coda lasts nearly 40 minutes and is mostly talk and cleanup, the rhythms growing more relaxed until a final, incongruous spasm of violence--whereupon the surviving soldiers pack their gear and motor off to another South Pacific battle. In the final shot, a twisted tree grows on the waterline of the beach, the cycle of life beginning anew. The Thin Red Line has a curious sound-scape, as the noise of battle frequently recedes to make room for interior monologues and Hans Zimmer's bump-bump, minimalist New Age music. Pvt. Bell (Ben Chaplin) talks to his curvy, redheaded wife, viewed in deliriously sensual flashbacks. ("Love: Where does it come from? Who lit this flame in us?") Lt. Col. Tall (Nolte), a borderline lunatic passed over one too many times for promotion and itching to win a battle no matter what the human cost, worries groggily about how his men perceive him. The dreamer Witt poses folksy questions about whether we're all a part of one big soul. If the movie has a spine, it's his off-and-on dialogue with Sgt. Welsh (Penn), who's increasingly irritated by the private's beatific, almost Billy Budd-like optimism. Says Welsh, "In this world, a man himself is nothin', and there ain't no world but this one." Replies Witt, high cheekbones glinting, "I seen another world." At first it seems as if Witt will indeed be Billy Budd to Welsh's vindictive Claggart. But if Witt is ultimately an ethereal martyr, Welsh turns out to be a Bogart-like romantic who can't stop feeling pain in the face of an absent God. He speaks the movie's epitaph, "Darkness and light, strife and love: Are they the workings of one mind, the feature of the same face? O my soul, let me be in you now. Look out through my eyes. Look out at the things you made, all things shining." Malick puts a lot of shining things on the screen: soldiers, natives, parrots, bats, rodents, visions of Eden by way of National Geographic and of the Fall by way of Alpo. Malick's conception of consciousness distributes it among the animate and inanimate alike; almost every object is held up for rapturous contemplation. I could cite hundreds of images: A soldier in a rocking boat hovers over a letter he's writing, which is crammed from top to bottom and side to side with script. (You don't know the man, but you can feel in an instant his need to cram everything in.) A small, white-bearded Melanesian man strolls nonchalantly past a platoon of tensely trudging grunts who can't believe they're encountering this instead of a hail of Japanese bullets. Two shots bring down the first pair of soldiers to advance on the hill; a second later, the sun plays mystically over the tall, yellow grass that has swallowed their bodies. John Toll's camera rushes in on a captured Japanese garrison: One Japanese soldier shrieks; another, skeletal, laughs and laughs; a third weeps over a dying comrade. The face of a Japanese soldier encased in earth speaks from the dead, "Are you righteous? Know that I was, too." Whether or not these pearllike epiphanies are strung is another matter. Malick throws out his overarching theme--is nature two-sided, at war with itself?--in the first few minutes but, for all his startling juxtapositions, he never dramatizes it with anything approaching the clarity of, say, Brian De Palma's Casualties of War (1989). Besides the dialogue between Welsh and Witt, The Thin Red Line 's other organizing story involves a wrenching tug of war between Nolte's ambition-crazed Tall and Capt. Staros (Elias Koteas), who refuses an order to send his men on what will surely be a suicidal--and futile--assault on a bunker. But matters of cause and effect don't really interest Malick. Individual acts of conscience can and do save lives, and heroism can win a war or a battle, he acknowledges. But Staros is ultimately sent packing, and Malick never bothers to trace the effect of his action on the Guadalcanal operation. In fact, the entire battle seems to take place in a crazed void. Tall quotes Homer's "rosy-fingered dawn" and orders a meaningless bombardment to "buck the men up--it'll look like the Japs are catching hell." Soldiers shoot at hazy figures, unsure whether they're Japanese or American. Men collide, blow themselves in half with their own mishandled grenades, stab themselves frantically with morphine needles, shove cigarettes up their noses to keep the stench of the dying and the dead at bay. A tiny bird, mortally wounded, flutters in the grass. Malick is convincing--at times overwhelming--on the subject of chaos. It's when he tries to ruminate on order that he gets gummed up, retreating to one of his gaseous multiple mouthpieces: "Where is it that we were together? Who is it that I lived with? Walked with? The brother. ... The friend. ... One mind." I think I'd have an easier time with Malick's metaphysical speculations if I had a sense of some concomitant geopolitical ones--central to any larger musings on forces of nature as viewed through the prism of war. Couldn't it be that the German and Japanese fascist orders were profoundly anti-natural, and that the Allies' cause was part of a violent but natural correction? You don't have to buy into Spielberg's Lincolnesque pieties in Saving Private Ryan to believe that there's a difference between World War II and Vietnam (or, for that matter, World War II and the invasion of Grenada or our spats with Iraq). While he was at Harvard, Malick might have peeled himself off the lap of his pointy-headed mentor, Stanley Cavell, the philosopher and film theorist, and checked out a few of Michael Waltzer's lectures on just and unjust wars. Maybe then he'd view Guadalcanal not in an absurdist vacuum (the soldiers come, they kill and are killed, they leave) but in the larger context of a war that was among the most rational (in its aims, if not its methods) fought in the last several centuries. For all his visionary filmmaking, Malick's Zen neutrality sometimes seems like a cultivated--and pretentious--brand of fatuousness. John Travolta's empty nightclub impersonation of Bill Clinton in Primary Colors (1998) had one positive result: It gave him a jump-start on Jan Schlichtmann, the reckless personal injury lawyer at the center of A Civil Action . Travolta's Schlichtmann is much more redolent of Clinton: slick and selfish and corrupt in lots of ways but basically on the side of the angels, too proud and arrogant to change tactics when all is certainly lost. Schlichtmann pursued--and more or less blew--a civil liability case against the corporate giants Beatrice and W.R. Grace over the allegedly carcinogenic water supply of Woburn, Mass. Boston writer Jonathan Harr, in the book the movie is based on, went beyond the poison in the Woburn wells to evoke (stopping just short of libel) the poison of the civil courts, where platoons of overpaid corporate lawyers can drive opponents with pockets less deep and psyches less stable into bankruptcy and hysteria. Director Steven Zaillian's version doesn't capture the mounting rage that one experiences while reading Harr's book, or even the juicy legal machinations that Francis Ford Coppola giddily manipulated in his underrated adaptation of John Grisham's The Rainmaker (1997). But A Civil Action is a sturdy piece of work, an old-fashioned conversion narrative with some high-tech zip. Schlichtmann doesn't take this "orphan" case--brought by the parents of several children who died of leukemia--because he wants to do good but because he figures that Grace and Beatrice will fork over huge sums of money to keep the parents from testifying publicly about their children's last days. He might succeed, too, if it weren't for Jerome Facher (Robert Duvall), the Beatrice lawyer who knows how to keep Schlichtmann shadowboxing while his small firm's financial resources dwindle to nothing. Zaillian is at his most assured when he cuts back and forth between Facher's Harvard Law School lectures on what not to do in court and Schlichtmann's fumbling prosecution. The sequence has the extra dimension of good journalism: It dramatizes and comments simultaneously. Plus, it gives Duvall a splendid platform for impish understatement. (Duvall has become more fun to watch than just about anyone in movies.) Elsewhere, Zaillian takes a more surface approach, sticking to legal minutiae and rarely digging for the deeper evil. As in his Searching for Bobby Fischer (1993), the outcome of every scene is predictable, but how Zaillian gets from beat to beat is surprisingly fresh. He also gets sterling bit performances from Sydney Pollack as the spookily sanguine Grace CEO, William H. Macy as Schlichtmann's rabbity accountant, and Kathleen Quinlan as the mother of one of the victims. Quinlan knows that when you're playing a woman who has lost a child you don't need to emote--you reveal the emotion by trying not to emote. To the families involved in the Woburn tragedy, the real climax of this story isn't the downbeat ending of the book or the sleight of hand, "let's call the Environmental Protection Agency," upbeat ending of the movie. The climax is the publication of a book that takes the plaintiffs' side and that remains on the best-seller list in hardcover and paperback for years. The climax is the movie starring John Travolta. Beatrice and Grace made out OK legally, but some of us will never use their products again without thinking about Travolta losing his shirt in the name of those wasted-away little kids.
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A. they missed a key component in their films
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Why was Mr. Burnside so determined to have such a large and specific asteroid delivered to his backyard?
A. He didn't actually want it, he just wanted the Saylor brothers and Parker and Queazy to be occupied.
B. He had previously had one that was similar and wanted another for reminiscing.
C. He wanted something more grand and valuable than anyone else.
D. His granddaughter had requested one for her wedding.
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COSMIC YO-YO By ROSS ROCKLYNNE "Want an asteroid in your backyard? We supply cheap. Trouble also handled without charge." Interplanetary Hauling Company. (ADVT.) [Transcriber's Note: This etext was produced from Planet Stories Summer 1945. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Bob Parker, looking through the photo-amplifiers at the wedge-shaped asteroid, was plainly flabbergasted. Not in his wildest imaginings had he thought they would actually find what they were looking for. "Cut the drive!" he yelled at Queazy. "I've got it, right on the nose. Queazy, my boy, can you imagine it? We're in the dough. Not only that, we're rich! Come here!" Queazy discharged their tremendous inertia into the motive-tubes in such a manner that the big, powerful ship was moving at the same rate as the asteroid below—47.05 miles per second. He came slogging back excitedly, put his eyes to the eyepiece. He gasped, and his big body shook with joyful ejaculations. "She checks down to the last dimension," Bob chortled, working with slide-rule and logarithm tables. "Now all we have to do is find out if she's made of tungsten, iron, quartz crystals, and cinnabar! But there couldn't be two asteroids of that shape anywhere else in the Belt, so this has to be it!" He jerked a badly crumpled ethergram from his pocket, smoothed it out, and thumbed his nose at the signature. "Whee! Mr. Andrew S. Burnside, you owe us five hundred and fifty thousand dollars!" Queazy straightened. A slow, likeable smile wreathed his tanned face. "Better take it easy," he advised, "until I land the ship and we use the atomic whirl spectroscope to determine the composition of the asteroid." "Have it your way," Bob Parker sang, happily. He threw the ethergram to the winds and it fell gently to the deck-plates. While Queazy—so called because his full name was Quentin Zuyler—dropped the ship straight down to the smooth surface of the asteroid, and clamped it tight with magnetic grapples, Bob flung open the lazarette, brought out two space-suits. Moments later, they were outside the ship, with star-powdered infinity spread to all sides. In the ship, the ethergram from Andrew S. Burnside, of Philadelphia, one of the richest men in the world, still lay on the deck-plates. It was addressed to: Mr. Robert Parker, President Interplanetary Hauling & Moving Co., 777 Main Street, Satterfield City, Fontanaland, Mars. The ethergram read: Received your advertising literature a week ago. Would like to state that yes I would like an asteroid in my back yard. Must meet following specifications: 506 feet length, long enough for wedding procession; 98 feet at base, tapering to 10 feet at apex; 9-12 feet thick; topside smooth-plane, underside rough-plane; composed of iron ore, tungsten, quartz crystals, and cinnabar. Must be in my back yard before 11:30 A.M. my time, for important wedding June 2, else order is void. Will pay $5.00 per ton. Bob Parker had received that ethergram three weeks ago. And if The Interplanetary Hauling & Moving Co., hadn't been about to go on the rocks (chiefly due to the activities of Saylor & Saylor, a rival firm) neither Bob nor Queazy would have thought of sending an answering ethergram to Burnside stating that they would fill the order. It was, plainly, a hair-brained request. And yet, if by some chance there was such a rigidly specified asteroid, their financial worries would be over. That they had actually discovered the asteroid, using their mass-detectors in a weight-elimination process, seemed like an incredible stroke of luck. For there are literally millions of asteroids in the asteroid belt, and they had been out in space only three weeks. The "asteroid in your back yard" idea had been Bob Parker's originally. Now it was a fad that was sweeping Earth, and Burnside wasn't the first rich man who had decided to hold a wedding on top of an asteroid. Unfortunately, other interplanetary moving companies had cashed in on that brainstorm, chiefly the firm of the Saylor brothers—which persons Bob Parker intended to punch in the nose some day. And would have before this if he hadn't been lanky and tall while they were giants. Now that he and Queazy had found the asteroid, they were desperate to get it to its destination, for fear that the Saylor brothers might get wind of what was going on, and try to beat them out of their profits. Which was not so far-fetched, because the firm of Saylor & Saylor made no pretense of being scrupulous. Now they scuffed along the smooth-plane topside of the asteroid, the magnets in their shoes keeping them from stepping off into space. They came to the broad base of the asteroid-wedge, walked over the edge and "down" the twelve-foot thickness. Here they squatted, and Bob Parker happily clamped the atomic-whirl spectroscope to the rough surface. By the naked eye, they could see iron ore, quartz crystals, cinnabar, but he had the spectroscope and there was no reason why he shouldn't use it. He satisfied himself as to the exterior of the asteroid, and then sent the twin beams deep into its heart. The beams crossed, tore atoms from molecules, revolved them like an infinitely fine powder. The radiations from the sundered molecules traveled back up the beams to the atomic-whirl spectroscope. Bob watched a pointer which moved slowly up and up—past tungsten, past iridium, past gold— Bob Parker said, in astonishment, "Hell! There's something screwy about this business. Look at that point—" Neither he nor Queazy had the opportunity to observe the pointer any further. A cold, completely disagreeable feminine voice said, "May I ask what you interlopers are doing on my asteroid?" Bob started so badly that the spectroscope's settings were jarred and the lights in its interior died. Bob twisted his head around as far as he could inside the "aquarium"—the glass helmet, and found himself looking at a space-suited girl who was standing on the edge of the asteroid "below." "Ma'am," said Bob, blinking, "did you say something?" Queazy made a gulping sound and slowly straightened. He automatically reached up as if he would take off his hat and twist it in his hands. "I said," remarked the girl, "that you should scram off of my asteroid. And quit poking around at it with that spectroscope. I've already taken a reading. Cinnabar, iron ore, quartz crystals, tungsten. Goodbye." Bob's nose twitched as he adjusted his glasses, which he wore even inside his suit. He couldn't think of anything pertinent to say. He knew that he was slowly working up a blush. Mildly speaking, the girl was beautiful, and though only her carefully made-up face was visible—cool blue eyes, masterfully coiffed, upswept, glinting brown hair, wilful lips and chin—Bob suspected the rest of her compared nicely. Her expression darkened as she saw the completely instinctive way he was looking at her and her radioed-voice rapped out, "Now you two boys go and play somewhere else! Else I'll let the Interplanetary Commission know you've infringed the law. G'bye!" She turned and disappeared. Bob awoke from his trance, shouted desperately, "Hey! Wait! You! " He and Queazy caught up with her on the side of the asteroid they hadn't yet examined. It was a rough plane, completing the rigid qualifications Burnside had set down. "Wait a minute," Bob Parker begged nervously. "I want to make some conversation, lady. I'm sure you don't understand the conditions—" The girl turned and drew a gun from a holster. It was a spasticizer, and it was three times as big as her gloved hand. "I understand conditions better than you do," she said. "You want to move this asteroid from its orbit and haul it back to Earth. Unfortunately, this is my home, by common law. Come back in a month. I don't expect to be here then." "A month!" Parker burst the word out. He started to sweat, then his face became grim. He took two slow steps toward the girl. She blinked and lost her composure and unconsciously backed up two steps. About twenty steps away was her small dumbbell-shaped ship, so shiny and unscarred that it reflected starlight in highlights from its curved surface. A rich girl's ship, Bob Parker thought angrily. A month would be too late! He said grimly, "Don't worry. I don't intend to pull any rough stuff. I just want you to listen to reason. You've taken a whim to stay on an asteroid that doesn't mean anything to you one way or another. But to us—to me and Queazy here—it means our business. We got an order for this asteroid. Some screwball millionaire wants it for a backyard wedding see? We get five hundred and fifty thousand dollars for it! If we don't take this asteroid to Earth before June 2, we go back to Satterfield City and work the rest of our lives in the glass factories. Don't we, Queazy?" Queazy said simply, "That's right, miss. We're in a spot. I assure you we didn't expect to find someone living here." The girl holstered her spasticizer, but her completely inhospitable expression did not change. She put her hands on the bulging hips of her space-suit. "Okay," she said. "Now I understand the conditions. Now we both understand each other. G'bye again. I'm staying here and—" she smiled sweetly "—it may interest you to know that if I let you have the asteroid you'll save your business, but I'll meet a fate worse than death! So that's that." Bob recognized finality when he saw it. "Come on, Queazy," he said fuming. "Let this brat have her way. But if I ever run across her without a space-suit on I'm going to give her the licking of her life, right where it'll do the most good!" He turned angrily, but Queazy grabbed his arm, his mouth falling open. He pointed off into space, beyond the girl. "What's that?" he whispered. "What's wha— Oh! " Bob Parker's stomach caved in. A few hundred feet away, floating gently toward the asteroid, came another ship—a ship a trifle bigger than their own. The girl turned, too. They heard her gasp. In another second, Bob was standing next to her. He turned the audio-switch to his headset off, and spoke to the girl by putting his helmet against hers. "Listen to me, miss," he snapped earnestly, when she tried to draw away. "Don't talk by radio. That ship belongs to the Saylor brothers! Oh, Lord, that this should happen! Somewhere along the line, we've been double-crossed. Those boys are after this asteroid too, and they won't hesitate to pull any rough stuff. We're in this together, understand? We got to back each other up." The girl nodded dumbly. Suddenly she seemed to be frightened. "It's—it's very important that this—this asteroid stay right where it is," she said huskily. "What—what will they do?" Bob Parker didn't answer. The big ship had landed, and little blue sparks crackled between the hull and the asteroid as the magnetic clamps took hold. A few seconds later, the airlocks swung down, and five men let themselves down to the asteroid's surface and stood surveying the three who faced them. The two men in the lead stood with their hands on their hips; their darkish, twin faces were grinning broadly. "A pleasure," drawled Wally Saylor, looking at the girl. "What do you think of this situation Billy?" "It's obvious," drawled Billy Saylor, rocking back and forth on his heels, "that Bob Parker and company have double-crossed us. We'll have to take steps." The three men behind the Saylor twins broke into rough, chuckling laughter. Bob Parker's gorge rose. "Scram," he said coldly. "We've got an ethergram direct from Andrew S. Burnside ordering this asteroid." "So have we," Wally Saylor smiled—and his smile remained fixed, dangerous. He started moving forward, and the three men in back came abreast, forming a semi-circle which slowly closed in. Bob Parker gave back a step, as he saw their intentions. "We got here first," he snapped harshly. "Try any funny stuff and we'll report you to the Interplanetary Commission!" It was Bob Parker's misfortune that he didn't carry a weapon. Each of these men carried one or more, plainly visible. But he was thinking of the girl's spasticizer—a paralyzing weapon. He took a hair-brained chance, jerked the spasticizer from the girl's holster and yelled at Queazy. Queazy got the idea, urged his immense body into motion. He hurled straight at Billy Saylor, lifted him straight off the asteroid and threw him away, into space. He yelled with triumph. At the same time, the spasticizer Bob held was shot cleanly out of his hand by Wally Saylor. Bob roared, started toward Wally Saylor, knocked the smoking gun from his hand with a sweeping arm. Then something crushing seemed to hit him in the stomach, grabbing at his solar plexus. He doubled up, gurgling with agony. He fell over on his back, and his boots were wrenched loose from their magnetic grip. Vaguely, before the flickering points of light in his brain subsided to complete darkness, he heard the girl's scream of rage—then a scream of pain. What had happened to Queazy he didn't know. He felt so horribly sick, he didn't care. Then—lights out. Bob Parker came to, the emptiness of remote starlight in his face. He opened his eyes. He was slowly revolving on an axis. Sometimes the Sun swept across his line of vision. A cold hammering began at the base of his skull, a sensation similar to that of being buried alive. There was no asteroid, no girl, no Queazy. He was alone in the vastness of space. Alone in a space-suit. "Queazy!" he whispered. "Queazy! I'm running out of air!" There was no answer from Queazy. With sick eyes, Bob studied the oxygen indicator. There was only five pounds pressure. Five pounds! That meant he had been floating around out here—how long? Days at least—maybe weeks! It was evident that somebody had given him a dose of spastic rays, enough to screw up every muscle in his body to the snapping point, putting him in such a condition of suspended animation that his oxygen needs were small. He closed his eyes, trying to fight against panic. He was glad he couldn't see any part of his body. He was probably scrawny. And he was hungry! "I'll starve," he thought. "Or suffocate to death first!" He couldn't keep himself from taking in great gulps of air. Minutes, then hours passed. He was breathing abnormally, and there wasn't enough air in the first place. He pleaded continually for Queazy, hoping that somehow Queazy could help, when probably Queazy was in the same condition. He ripped out wild curses directed at the Saylor brothers. Murderers, both of them! Up until this time, he had merely thought of them as business rivals. If he ever got out of this— He groaned. He never would get out of it! After another hour, he was gasping weakly, and yellow spots danced in his eyes. He called Queazy's name once more, knowing that was the last time he would have strength to call it. And this time the headset spoke back! Bob Parker made a gurgling sound. A voice came again, washed with static, far away, burbling, but excited. Bob made a rattling sound in his throat. Then his eyes started to close, but he imagined that he saw a ship, shiny and small, driving toward him, growing in size against the backdrop of the Milky Way. He relapsed, a terrific buzzing in his ears. He did not lose consciousness. He heard voices, Queazy's and the girl's, whoever she was. Somebody grabbed hold of his foot. His "aquarium" was unbuckled and good air washed over his streaming face. The sudden rush of oxygen to his brain dizzied him. Then he was lying on a bunk, and gradually the world beyond his sick body focussed in his clearing eyes and he knew he was alive—and going to stay that way, for awhile anyway. "Thanks, Queazy," he said huskily. Queazy was bending over him, his anxiety clearing away from his suddenly brightening face. "Don't thank me," he whispered. "We'd have both been goners if it hadn't been for her. The Saylor brothers left her paralyzed like us, and when she woke up she was on a slow orbit around her ship. She unstrapped her holster and threw it away from her and it gave her enough reaction to reach the ship. She got inside and used the direction-finder on the telaudio and located me first. The Saylors scattered us far and wide." Queazy's broad, normally good-humored face twisted blackly. "The so and so's didn't care if we lived or died." Bob saw the girl now, standing a little behind Queazy, looking down at him curiously, but unhappily. Her space-suit was off. She was wearing lightly striped blue slacks and blue silk blouse and she had a paper flower in her hair. Something in Bob's stomach caved in as his eyes widened on her. The girl said glumly, "I guess you men won't much care for me when you find out who I am and what I've done. I'm Starre Lowenthal—Andrew S. Burnside's granddaughter!" Bob came slowly to his feet, and matched Queazy's slowly growing anger. "Say that again?" he snapped. "This is some kind of dirty trick you and your grandfather cooked up?" "No!" she exclaimed. "No. My grandfather didn't even know there was an asteroid like this. But I did, long before he ordered it from you—or from the Saylor brothers. You see—well, my granddad's about the stubbornest old hoot-owl in this universe! He's always had his way, and when people stand in his way, that's just a challenge to him. He's been badgering me for years to marry Mac, and so has Mac—" "Who's Mac?" Queazy demanded. "My fiancé, I guess," she said helplessly. "He's one of my granddad's protégés. Granddad's always financing some likely young man and giving him a start in life. Mac has become pretty famous for his Mercurian water-colors—he's an artist. Well, I couldn't hold out any longer. If you knew my grandfather, you'd know how absolutely impossible it is to go against him when he's got his mind set! I was just a mass of nerves. So I decided to trick him and I came out to the asteroid belt and picked out an asteroid that was shaped so a wedding could take place on it. I took the measurements and the composition, then I told my grandfather I'd marry Mac if the wedding was in the back yard on top of an asteroid with those measurements and made of iron ore, tungsten, and so forth. He agreed so fast he scared me, and just to make sure that if somebody did find the asteroid in time they wouldn't be able to get it back to Earth, I came out here and decided to live here. Asteroids up to a certain size belong to whoever happens to be on them, by common law.... So I had everything figured out—except," she added bitterly, "the Saylor brothers! I guess Granddad wanted to make sure the asteroid was delivered, so he gave the order to several companies." Bob swore under his breath. He went reeling across to a port, and was gratified to see his and Queazy's big interplanetary hauler floating only a few hundred feet away. He swung around, looked at Queazy. "How long were we floating around out there?" "Three weeks, according to the chronometer. The Saylor boys gave us a stiff shot." " Ouch! " Bob groaned. Then he looked at Starre Lowenthal with determination. "Miss, pardon me if I say that this deal you and your granddad cooked up is plain screwy! With us on the butt end. But I'm going to put this to you plainly. We can catch up with the Saylor brothers even if they are three weeks ahead of us. The Saylor ship and ours both travel on the HH drive—inertia-less. But the asteroid has plenty of inertia, and so they'll have to haul it down to Earth by a long, spiraling orbit. We can go direct and probably catch up with them a few hundred thousand miles this side of Earth. And we can have a fling at getting the asteroid back!" Her eyes sparkled. "You mean—" she cried. Then her attractive face fell. "Oh," she said. " Oh! And when you get it back, you'll land it." "That's right," Bob said grimly. "We're in business. For us, it's a matter of survival. If the by-product of delivering the asteroid is your marriage—sorry! But until we do get the asteroid back, we three can work as a team if you're willing. We'll fight the other problem out later. Okay?" She smiled tremulously. "Okay, I guess." Queazy looked from one to another of them. He waved his hand scornfully at Bob. "You're plain nuts," he complained. "How do you propose to go about convincing the Saylor brothers they ought to let us have the asteroid back? Remember, commercial ships aren't allowed to carry long-range weapons. And we couldn't ram the Saylor brothers' ship—not without damaging our own ship just as much. Go ahead and answer that." Bob looked at Queazy dismally. "The old balance-wheel," he groaned at Starre. "He's always pulling me up short when I go off half-cocked. All I know is, that maybe we'll get a good idea as we go along. In the meantime, Starre—ahem—none of us has eaten in three weeks...?" Starre got the idea. She smiled dazzlingly and vanished toward the galley. Bob Parker was in love with Starre Lowenthal. He knew that after five days out, as the ship hurled itself at breakneck speed toward Earth; probably that distracting emotion was the real reason he couldn't attach any significance to Starre's dumbbell-shaped ship, which trailed astern, attached by a long cable. Starre apparently knew he was in love with her, too, for on the fifth day Bob was teaching her the mechanics of operating the hauler, and she gently lifted his hand from a finger-switch. "Even I know that isn't the control to the Holloway vacuum-feeder, Bob. That switch is for the—ah—the anathern tube, you told me. Right?" "Right," he said unsteadily. "Anyway, Starre, as I was saying, this ship operates according to the reverse Fitzgerald Contraction Formula. All moving bodies contract in the line of motion. What Holloway and Hammond did was to reverse that universal law. They caused the contraction first—motion had to follow! The gravitonic field affects every atom in the ship with the same speed at the same time. We could go from zero speed to our top speed of two thousand miles a second just like that!" He snapped his fingers. "No acceleration effects. This type of ship, necessary in our business, can stop flat, back up, ease up, move in any direction, and the passengers wouldn't have any feeling of motion at—Oh, hell!" Bob groaned, the serious glory of her eyes making him shake. He took her hand. "Starre," he said desperately, "I've got to tell you something—" She jerked her hand away. "No," she exclaimed in an almost frightened voice. "You can't tell me. There's—there's Mac," she finished, faltering. "The asteroid—" "You have to marry him?" Her eyes filled with tears. "I have to live up to the bargain." "And ruin your whole life," he ground out. Suddenly, he turned back to the control board, quartered the vision plate. He pointed savagely to the lower left quarter, which gave a rearward view of the dumbbell ship trailing astern. "There's your ship, Starre." He jabbed his finger at it. "I've got a feeling—and I can't put the thought into concrete words—that somehow the whole solution of the problem of grabbing the asteroid back lies there. But how? How? " Starre's blue eyes followed the long cable back to where it was attached around her ship's narrow midsection. She shook her head helplessly. "It just looks like a big yo-yo to me." "A yo-yo?" "Yes, a yo-yo. That's all." She was belligerent. "A yo-yo !" Bob Parker yelled the word and almost hit the ceiling, he got out of the chair so fast. "Can you imagine it! A yo-yo!" He disappeared from the room. "Queazy!" he shouted. " Queazy, I've got it! " It was Queazy who got into his space-suit and did the welding job, fastening two huge supra-steel "eyes" onto the dumbbell-shaped ship's narrow midsection. Into these eyes cables which trailed back to two winches in the big ship's nose were inserted, welded fast, and reinforced. The nose of the hauler was blunt, perfectly fitted for the job. Bob Parker practiced and experimented for three hours with this yo-yo of cosmic dimensions, while Starre and Queazy stood over him bursting into strange, delighted squeals of laughter whenever the yo-yo reached the end of its double cable and started rolling back up to the ship. Queazy snapped his fingers. "It'll work!" His gray eyes showed satisfaction. "Now, if only the Saylor brothers are where we calculated!" They weren't where Bob and Queazy had calculated, as they had discovered the next day. They had expected to pick up the asteroid on their mass-detectors a few hundred thousand miles outside of the Moon's orbit. But now they saw the giant ship attached like a leech to the still bigger asteroid—inside the Moon's orbit! A mere two hundred thousand miles from Earth! "We have to work fast," Bob stammered, sweating. He got within naked-eye distance of the Saylor brothers' ship. Below, Earth was spread out, a huge crescent shape, part of the Eastern hemisphere vaguely visible through impeding clouds and atmosphere. The enemy ship was two miles distant, a black shadow occulting part of the brilliant sky. It was moving along a down-spiraling path toward Earth. Queazy's big hand gripped his shoulder. "Go to it, Bob!" Bob nodded grimly. He backed the hauler up about thirty miles, then sent it forward again, directly toward the Saylor brothers' ship at ten miles per second. And resting on the blunt nose of the ship was the "yo-yo." There was little doubt the Saylors' saw their approach. But, scornfully, they made no attempt to evade. There was no possible harm the oncoming ship could wreak. Or at least that was what they thought, for Bob brought the hauler's speed down to zero—and Starre Lowenthal's little ship, possessing its own inertia, kept on moving! It spun away from the hauler's blunt nose, paying out two rigid lengths of cable behind it as it unwound, hurled itself forward like a fantastic spinning cannon ball. "It's going to hit!" The excited cry came from Starre. But Bob swore. The dumbbell ship reached the end of its cables, falling a bare twenty feet short of completing its mission. It didn't stop spinning, but came winding back up the cable, at the same terrific speed with which it had left. Bob sweated, having only fractions of seconds in which to maneuver for the "yo-yo" could strike a fatal blow at the hauler too. It was ticklish work completely to nullify the "yo-yo's" speed. Bob used exactly the same method of catching the "yo-yo" on the blunt nose of the ship as a baseball player uses to catch a hard-driven ball in his glove—namely, by matching the ball's speed and direction almost exactly at the moment of impact. And now Bob's hours of practice paid dividends, for the "yo-yo" came to rest snugly, ready to be released again. All this had happened in such a short space of time that the Saylor brothers must have had only a bare realization of what was going on. But by the time the "yo-yo" was flung at them again, this time with better calculations, they managed to put the firmly held asteroid between them and the deadly missile. But it was clumsy evasion, for the asteroid was several times as massive as the ship which was towing it, and its inertia was great. And as soon as the little ship came spinning back to rest, Bob flung the hauler to a new vantage point and again the "yo-yo" snapped out. And this time—collision! Bob yelled as he saw the stern section of the Saylor brothers' ship crumple like tissue paper crushed between the hand. The dumbbell-shaped ship, smaller, and therefore stauncher due to the principle of the arch, wound up again, wobbling a little. It had received a mere dent in its starboard half. Starre was chortling with glee. Queazy whispered, "Attaboy, Bob! This time we'll knock 'em out of the sky!" The "yo-yo" came to rest and at the same moment a gong rang excitedly. Bob knew what that meant. The Saylor brothers were trying to establish communication. Queazy was across the room in two running strides. He threw in the telaudio and almost immediately, Wally Saylor's big body built up in the plate. Wally Saylor's face was quivering with wrath. "What do you damned fools think you're trying to do?" he roared. "You've crushed in our stern section. You've sliced away half of our stern jets. Air is rushing out! You'll kill us!" "Now," Bob drawled, "you're getting the idea." "I'll inform the Interplanetary Commission!" screamed Saylor. " If you're alive," Bob snarled wrathfully. "And you won't be unless you release the asteroid." "I'll see you in Hades first!" "Hades," remarked Bob coldly, "here you come!" He snapped the hauler into its mile-a-second speed again, stopped it at zero. And the "yo-yo" went on its lone, destructive sortie. For a fraction of a second Wally Saylor exhibited the countenance of a doomed man. In the telaudio plate, he whirled, and diminished in size with a strangled yell. The "yo-yo" struck again, but Bob Parker maneuvered its speed in such a manner that it struck in the same place as before, but not as heavily, then rebounded and came spinning back with perfect, sparkling precision. And even before it snugged itself into its berth, it was apparent that the Saylor brothers had given up. Like a wounded terrier, their ship shook itself free of the asteroid, hung in black space for a second, then vanished with a flaming puff of released gravitons from its still-intact jets. The battle was won!
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D. His granddaughter had requested one for her wedding.
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What is the relationship between Captain Branson and Harrel Critten?
A. They both just wanted to get the expedition done so they could settle on a new planet
B. They let their tension grew between them with their opposite goals
C. They were old friends working together for the good of the ship
D. They were colleagues in multiple capacities
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COUNTERWEIGHT By JERRY SOHL Every town has crime—but especially a town that is traveling from star to star! [Transcriber's Note: This etext was produced from Worlds of If Science Fiction, November 1959. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Sure I'm a Nilly, and I've died seven times, always in the blackness of the outer reaches, and I'm not alone, although there aren't very many of us, never were. It made sense. Interstellar was new and they wanted him on the ship because he was a trained observer. They wanted facts, not gibberish. But to ask a man to give up two years of his life—well, that was asking a lot. Two years in a sardine can. Still, it had an appeal Keith Ellason knew he couldn't deny, a newsman's joy of the clean beat, a planetary system far afield, a closeup view of the universe, history in the making. Interstellar Chief Rexroad knocked the dottle from his pipe in a tray, saying, "Transworld Press is willing to let you have a leave of abscence, if you're interested." He knew Secretary Phipps from years of contacting, and now Phipps said, "Personally, I don't want to see anybody else on the job. You've got a fine record in this sort of thing." Keith Ellason smiled, but just barely. "You should have called me for the first trip." Phipps nodded. "I wish we had had you on the Weblor I ." "Crewmen," Rexroad said, "make poor reporters." The Weblor I had taken off on the first trip to Antheon five years before with a thousand families, reached the planet with less than five hundred surviving colonists. Upon the return to Earth a year later, the crew's report of suffering and chaos during the year's outgoing voyage was twisted, distorted and fragmentary. Ellason remembered it well. The decision of Interstellar was that the colonists started a revolution far out in space, that it was fanned by the ignorance of Captain Sessions in dealing with such matters. "Space affects men in a peculiar way," Phipps said. "We have conquered the problem of small groups in space—witness the discovery of Antheon, for example—but when there are large groups, control is more difficult." "Sessions," Rexroad said, "was a bully. The trouble started at about the halfway point. It ended with passengers engaging in open warfare with each other and the crew. Sessions was lucky to escape with his life." "As I recall," Ellason said, "there was something about stunners." Phipps rubbed his chin. "No weapons were allowed on the ship, but you must remember the colonists were selected for their intelligence and resourcefulness. They utilized these attributes to set up weapon shops to arm themselves." "The second trip is history," Rexroad said. "And a puzzle." Ellason nodded. "The ship disappeared." "Yes. We gave control to the colonists." "Assuming no accident in space," Phipps said, "it was a wrong decision. They probably took over the ship." "And now," Ellason said, "you're going to try again." Rexroad said very gravely, "We've got the finest captain in Interplanetary. Harvey Branson. No doubt you've heard of him. He's spent his life in our own system, and he's handpicking his own crew. We have also raised prerequisites for applicants. We don't think anything is going to happen, but if it does, we want to get an impersonal, unprejudiced view. That's where you come in. You do the observing, the reporting. We'll evaluate it on your return." "If I return," said Ellason. "I suppose that's problematical," Phipps said, "but I think you will. Captain Branson and his fifty crewmen want to return as badly as you do." He grinned. "You can write that novel you're always talking about on your return trip on the Weblor II ." Being a Nilly is important, probably as important as running the ship, and I think it is this thought that keeps us satisfied, willing to be what we are. The Weblor II had been built in space, as had its predecessor, the Weblor I , at a tremendous cost. Basically, it was an instrument which would open distant vistas to colonization, reducing the shoulder-to-shoulder pressure of a crowded solar system. A gigantic, hollow spike, the ship would never land anywhere, but would circle Antheon as it circled Earth, shuttling its cargo and passengers to the promised land, the new frontier. A space-borne metropolis, it would be the home for three thousand persons outward bound, only the crew on the return trip. It was equipped with every conceivable facility and comfort—dining rooms, assembly hall, individual and family compartments, recreation areas, swimming pool, library, theater. Nothing had been overlooked. The captain's briefing room was crowded, the air was heavy with the breathing of so many men, and the ventilators could not quite clear the air of tobacco smoke that drifted aimlessly here and there before it was caught and whisked away. In the tradition of newspaperman and observer, Keith Ellason tried to be as inconspicuous as possible, pressing against a bulkhead, but Captain Branson's eyes sought his several times as Branson listened to final reports from his engineers, record keepers, fuel men, computermen, and all the rest. He grunted his approval or disapproval, made a suggestion here, a restriction there. There was no doubt that Branson was in charge, yet there was a human quality about him that Ellason liked. The captain's was a lean face, well tanned, and his eyes were chunks of blue. "Gentlemen," Branson said at last, as Ellason knew he would, "I want to introduce Keith Ellason, whose presence Interstellar has impressed upon us. On loan from Transworld, he will have an observer status." He introduced him to the others. All of them seemed friendly; Ellason thought it was a good staff. Branson detained him after the others had gone. "One thing, Mr. Ellason. To make it easier for you, I suggest you think of this journey strictly from the observer viewpoint. There will be no story for Transworld at the end." Ellason was startled. While he had considered the possibility, he had not dwelt on it. Now it loomed large in his mind. "I don't understand, Captain Branson. It seems to me—" "Let me put it differently. Let me say that you will not understand why I say that until the journey ends." He smiled. "Perhaps I shouldn't have mentioned it." Ellason left the captain's quarters with an odd taste in his mouth. Now why had Branson said that? Why hadn't Rexroad or Phipps said something, if it was important? He made himself comfortable in his seven-foot-by-seven-foot cubicle, which is to say he dropped on his bed, found it more comfortable than he thought it would be, put his arms behind his head, stared at the ceiling. Metal walls, no windows, one floor vent, one ceiling vent, and a solitary ceiling molding tube-light. This would be his home for a year, just as there were homes like it for three thousand others, except that the family rooms would be larger. His quarters were near the front of the spike near the officers' quarters. He felt rather than heard the dull rumble. It was a sound he knew would be with him for two years—one year going and one year returning. He looked at his watch, picked up his notebook and made an entry. The ship right now would be slipping ever so slowly away from Earth. He got up. He'd have to go forward to the observation dome to see that. Last view of Earth for two years. The penetration of space by large groups is the coming out from under the traditions of thousands of years, and as these planet-orginated rules fall away, the floundering group seeks a new control, for they are humanity adrift, rudderless, for whom the stars are no longer bearings but nonexistent things, and values are altered if they are not shown the way. The theft of Carver Janssen's attache case occurred on the thirty-first day out. In Ellason's mind the incident, though insignificant from the standpoint of the ship as a whole, could very well be the cause of dissension later on. His notes covering it were therefore very thorough. Janssen's case contained vegetable and flower seeds—thousands of them, according to the Captain's Bulletin, the ship's daily newsletter which went to all hands and passengers. In the Bulletin the captain appealed to the thief to return the case to Mr. Janssen. He said it was significant that all en route had passed stability tests, and that it was to the ship's discredit that someone with criminal tendencies should have been permitted aboard. Ellason had to smile at that. What did Captain Branson think of those colonists who killed each other on the Weblor I ? They had passed stability tests too. This, then, was what happened when you took three thousand strangers and stuck them in a can for a year. When Ellason saw Branson about it, the captain said, "Of course I realize it takes only a little thing like this to set things off. I know people get tired of seeing each other, playing the same tapes, looking at the stars from the observation dome, walking down the same corridors, reading the same books, eating the same meals, though God knows we try to vary it as much as we can. Space creates rough edges. But the point is, we know all this, and knowing it, we shouldn't let it happen. We've got to find that thief." "What would he want seeds for? Have you thought of that?" "Of course. They'd have real value on Antheon." Ellason sought out Carver Janssen. He was a middle-aged man with a tired face and sad eyes. He said, "Now what am I going to Antheon for? I could only take along so much baggage and I threw out some comfort items to make room for the seeds. I'm a horticulturist, and Interstellar asked me to go along. But what use am I now? Where am I going to get seeds like those? Do you know how long it took me to collect them? They're not ordinary seeds, Mr. Ellason." There was an appeal from Janssen in the next day's newsletter describing the seeds, telling of their value, and requesting their return in the interests of the Antheon colony and of humanity. On the thirty-fourth day a witness turned up who said he had seen a man emerging from Janssen's compartment with the black case. "I didn't think anything of it at the time," Jamieson Dievers said. Branson asked him to describe the man. "Oh, he was about six feet tall, stocky build, and he wore a red rubber mask that covered his head completely." "Didn't you think that was important?" Branson asked in an outraged voice. "A man wearing a red mask?" Dievers shrugged. "This is a spaceship. How would I know whether a red mask—or a blue or green one—does or doesn't belong on a spaceship?" Although Dievers' account appeared in the newsletter, it was largely discounted. "If it is true," Branson told Ellason, "the theft must be the work of a psychotic. But I don't believe Jamieson Dievers. It may well be he's the psychotic." He snorted. "Red rubber mask! I think I'll have Dievers put through psychiatry." Attendant to taking notes on this incident, Ellason noted a strange thing. Janssen lived in that part of the ship known as the First Quadrant, and those who lived in that quadrant—more than seven hundred men, women and children—felt that the thief must surely live in Quadrant Two or Four. Elias Cromley, who had the compartment next to Janssen's, sounded the consensus when he said, "Surely a man wouldn't steal from his own quadrant, now would he, Mr. Ellason?" And so, Ellason observed in his notebook, are wars created. Seen in space, stars are unmoving, silent, sterile bright eyes ever watchful and accusing. To men unused to it, such a sight numbs, compresses, stultifies. He introduces a countermeasure, proof he exists, which is any overt act, sometimes violent. On the forty-fifth day June Failright, the young wife of one of the passenger meteorologists, ran screaming down one of the long corridors of the Third Quadrant. She told the captain she had been attacked in her compartment while her husband was in the ship's library. She was taken to one of the ship's doctors, who confirmed it. She said the culprit was a husky man wearing a red rubber mask, and though her description of what he had done did not appear in the story in the newsletter, it lost no time in penetrating every compartment of the ship. Ellason was present when a delegation from the Third Quadrant called on Captain Branson, demanding action. Branson remained seated behind his desk, unperturbed, saying, "I have no crewmen to spare for police duty." The delegation commenced speaking vehemently, to be quieted by Branson's raised hand. "I sympathize," Branson said, "but it is up to each quadrant to deal with its problems, whatever they may be. My job is to get us to Antheon." The group left in a surly mood. "You wonder at my reluctance, Mr. Ellason," Captain Branson said. "But suppose I assign the crew to patrol duties, the culprit isn't caught, and further incidents occur. What then? It soon becomes the crew's fault. And soon the colonists will begin thinking these things might be the crew's doing in the first place." "Yes," Ellason said, "but what if the intruder is a crewman?" "I know my men," Branson said flatly. "You could have a shake-down for the mask and the seed case." "Do you think it is a member of the crew?" Branson's eyes were bright. "No, I trust my men. I won't violate that trust." Ellason left, feeling uneasy. If he were Branson, he'd initiate an investigation, if nothing else than to prove the crew guiltless. Why couldn't Branson see the wisdom of setting an example for the colonists? As a Nilly, I knew that space breeds hate. There is a seed of malevolence in every man. It sometimes blossoms out among the stars. On the Weblor II it was ready for ripening. Raymond Palugger was killed in the ship's hospital on the sixty-first day. Palugger, a Fourth Quadrant passenger, had complained of feeling ill, had been hospitalized with a diagnosis of ileus. He had put his money belt in the drawer of the small stand beside his bed. A man in a red mask was seen hurrying from the hospital area, and a staff investigation revealed that Palugger had died trying to prevent the theft of the belt. Captain Branson did not wait for the newsletter. Through the ship's speaker system, he reported that Palugger had a fortune in credits in the belt and had died of a severe beating. He said that since the incident occurred in the staff section of the ship, his crew would be forced to submit to a thorough inspection in an effort to find the mask, the seed case, the money and the man. "I will not countenance such an act by a crewman," Branson said. "If and when he is found, he will be severely dealt with. But he might not be a member of the crew. I am ordering an assembly of all passengers at nine tomorrow morning in the auditorium. I will speak to you all then." Faces were angry, tongues were sharp at the meeting, eyes suspicious and tempers short. Above it all was the overpowering presence of Captain Branson speaking to them. "It is not my desire to interfere in passenger affairs," he said. "Insofar as the ship is concerned, it is my duty to make certain no crewman is guilty. This I am doing. But my crew is not and cannot be a police force for you. It is up to you people to police and protect yourselves." "How can we protect ourselves without stunners?" one colonist called out. "Has Red Mask a gun?" Branson retorted. "It seems to me you have a better weapon than any gun." "What's that?" "This ship is only so wide, so long and so deep. If every inch is searched, you'll find your man. He has to be somewhere aboard." The colonists quieted. Benjamin Simpson, one of the older men, was elected president of the newly formed Quadrant Council. One man from each of the quadrants was named to serve under him. Each of these men in turn selected five others from his own group. Those assembled waited in the hall while each team of six inspected the compartments of the others. These compartments were then locked, everyone returned to his compartment, and the larger search was conducted. It took twenty hours. No mask was found. No mask, no case, no money, no man. The captain reported that his search had been equally fruitless. At another assembly the following day it was decided to make the inspection teams permanent, to await further moves on the part of Red Mask. The Quadrant Council held periodic meetings to set up a method of trial for him when he was caught. It was all recorded in the newsletter and by Keith Ellason. We Nillys know about hate and about violence. We know too that where there is hate there is violence, and where there is violence there is death. During sleep time on the seventy-ninth day Barbara Stoneman, awakened by a strange sound, sat up in the bed of her compartment to find a man in a red mask in her room. Her cries brought neighbors into the corridor. The flight of the man was witnessed by many, and several men tried to stop him. But the intruder was light on his feet and fast. He escaped. The Quadrant Council confronted the captain, demanding weapons. "Are you out of your minds?" Branson exclaimed. Tom Tilbury, Fourth Quadrant leader, said, "We want to set up a police force, Captain. We want stunners." "There's no law against it," Branson said, "but it's a rule of mine that no weapons are to be issued en route." "If we had had a gun, we'd have got Red Mask," Tilbury said. "And I might have a murder on my conscience." Tilbury said, "We've also thought of that. Suppose you supply us with half-power stunners? That way we can stun but not kill." They got their guns. Now there were twenty-four policemen on duty in the corridors—eight on at a time. Ellason observed that for the first time the passengers seemed relaxed. Let Red Mask move against armed men, they said. Yeah, let him see what happens now. Red Mask did. On the 101st day he was seen in a corridor in Quadrant Four. Emil Pierce, policeman on duty, managed to squeeze off several shots at his retreating figure. Red Mask was seen again on the 120th day, on the 135th day, and the 157th day. He was seen, shot at, but not hit. He was also unable to commit any crime. We've got him on the run, the colonists said. He's afraid to do anything, now that we've got police protection, they said smugly. The Quadrant Council congratulated itself. The passengers were proud of themselves. A special congratulatory message from Captain Branson appeared one day in the Bulletin newsletter. The colonists settled down to living out the rest of the voyage until the landing on Antheon. But on the 170th day calamity struck. Red Mask appropriated one of the stunners, made his way down one whole corridor section in Quadrant Two, put occupants to sleep as he went, taking many articles of value and leaving disorder behind. Ellason interviewed as many victims as he could, noted it all in his book. The things taken were keepsakes, photographs and items of personal value. It seemed to be the work of a madman. If Red Mask wanted to make everyone furious, he certainly succeeded. "What does he want that stuff for?" Casey Stromberg, a passenger doctor, asked. "I can see him taking my narcotics, my doctor's kit—but my dead wife's picture? That I don't understand." It was the same with others. "The man's insane, Mr. Ellason. Positively insane." Many people said it. The council issued orders that all passengers from now on would be required to lock their compartments at all times. More guns were obtained from the captain. More policemen were appointed. Ellason was busy noting it all in his book. It became filled with jottings about innocent people being accidentally stunned when trigger-happy policemen thought their movements suspicious, about one man's suspicion of another and the ensuing search of compartments, people who saw Red Mask here, saw him there. Hardly a day went by without some new development. "Oh, yes, Mr. Ellason, we're going to get him," said Tilbury, now chief of police, cracking his knuckles, his eyes glowing at the thought. "We're bound to get him. We've got things worked out to the finest detail. He won't be able to get through our fingers now. Just let him make so much as a move." "And what will you do when you get him?" "Kill him," Tilbury said, licking his lips, his eyes glowing more fiercely than ever. "Without a trial?" "Oh, there'll be a trial, Mr. Ellason, but you don't think any jury'd let him live after all the things he's done, do you?" Red Mask was stunned in Quadrant Four in a corridor by a policeman named Terryl Placer on the 201st day. The criminal was carried to the assembly room surrounded by guards, for he surely would have been mauled, if not killed, by angry colonists who crowded around. In the assembly hall his mask was whipped off. The crowd gasped. Nobody knew him. Ellason's first thought was that he must be a stowaway, but then he remembered the face, and Captain Branson, who came to have a look at him, unhappily admitted the man was a member of the crew. His name was Harrel Critten and he was a record keeper third class. "Well, Critten," Branson roared at him, "what have you got to say for yourself?" "Go to hell," Critten said quietly. As if it were an afterthought, he spat at the captain. Branson looked as if he were going to kill the man himself right there and then. It was a long trial—from the 220th to the 241st day—and there didn't seem to be much doubt about the outcome, for Critten didn't help his own cause during any of it. Lemuel Tarper, who was appointed prosecutor, asked him, "What did you do with the loot, Critten?" Critten looked him square in the eye and said, "I threw it out one of the escape chutes. Does that answer your question?" "Threw it away?" Tarper and the crowd were incredulous. "Sure," Critten said. "You colonists got the easy life as passengers, just sitting around. I had to work my head off keeping records for you lazy bastards." The verdict was, of course, death. They executed Harrel Critten on the morning of the 270th day with blasts from six stunners supplied with full power. It was witnessed by a great crowd in the assembly hall. A detail from the ship's crew disposed of his body through a chute. It was all duly recorded in Keith Ellason's notebooks. Dying is easy for a Nilly. Especially if it's arranged for beforehand, which it always is. The Weblor II was only one day out of orbit when Captain Branson sent for Ellason and introduced him to the executed man. "Hello," Critten said, grinning from ear to ear. "I figured as much," Ellason said. "I've been doing a lot of thinking." "You're perhaps a little too good as an observer," Branson said. "Or maybe it was because you really weren't one of the colonists. But no matter, Critten did a good job. He was trained by an old friend of mine for this job, Gelthorpe Nill. Nill used to be in counter-espionage when there were wars." "You were excellent," Ellason said. "Can't say I enjoyed the role," said Critten, "but I think it saved lives." "Let me get this straight. Interstellar thought that it was idleness and boredom that caused the killings on the Weblor I , so they had you trained to be a scapegoat. Is that right?" Critten nodded. "When great numbers are being transported, they are apt to magnify each little event because so little happens. It was my job to see that they directed none of their venom against each other or the crew, only toward me." Branson smiled. "It made the time pass quickly and interestingly for the passengers." "To say nothing of me," Critten said. "And you, Mr. Ellason, were along to observe it all," Captain Branson put in. "Interstellar wanted an accurate picture of this. If it worked, they told me they'd use it on other trips to Antheon." Ellason nodded. "No time for brooding, for differences of opinion on small matters. Just time to hate Mr. Critten. Unanimously." "Probably," Critten said, "you are wondering about the execution." "Naturally." "We removed the charges before the guns were used." "And Carver Janssen's case?" "He'll get it back when he's shuttled to Antheon. And all the other items will be returned. They're all tagged with their owner's names. Captain Branson will say they were found somewhere on the ship. You see, I was a liar." "How about that assault on June Failright?" Critten grinned again. "She played right into our hands. She ran out into the hall claiming I'd attacked her, which I did not. She was certainly amazed when the ship's physicians agreed with her. Of course Captain Branson told them to do that." "And the murder?" "Raymond Palugger died in the hospital all right, but he died from his illness on the operating table. We turned it into an advantage by making it look suspicious." Ellason brightened. "And by that time everybody was seeing Red Mask everywhere and the colonists organized against him." "Gave them something to do," Branson said. "Every time things got dull, I livened them up. I got a stunner and robbed along the corridor. That really stirred them. Lucky nobody got hurt during any of it, including that Stoneman woman. I was trying to rob her when she woke up." Branson cleared his throat. "Ah, Ellason about that story. You understand you can't write it, don't you?" Ellason said regretfully that he did understand. "The colonists will never know the truth," Branson went on. "There will be other ships outward bound." Critten sighed. "And I'll have to be caught again." Yes, we're anonymous, nameless, we Nillys, for that's what we call each other, and are a theme, with variations, in the endless stretches of deep space, objects of hatred and contempt, professional heels, dying once a trip when the time is ripe, antidote to boredom, and we'll ply our trade, our little tragedies, on a thousand ships bringing humanity to new worlds.
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D. They were colleagues in multiple capacities
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What happened to Les when he held the eyeball from the detective kit?
A. It caused him to leave black finger-marks on everything he touched.
B. It left his hands sticky even after repeatedly washing.
C. It burned his hands.
D. His hands started to turn bright green.
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RATTLE OK By HARRY WARNER, JR. Illustrated by FINLAY [Transcriber's Note: This etext was produced from Galaxy Science Fiction December 1956. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] What better way to use a time machine than to handle department store complaints? But pleasing a customer should have its limits! The Christmas party at the Boston branch of Hartshorne-Logan was threatening to become more legendary than usual this Christmas. The farm machinery manager had already collapsed. When he slid under the table containing the drinks, Miss Pringle, who sold millinery, had screamed: "He'll drown!" One out of every three dirty stories started by party attendees had remained unfinished, because each had reminded someone else of another story. The recently developed liquors which affected the bloodstream three times faster had driven away twinges of conscience about untrimmed trees and midnight church services. The star salesman for mankies and the gentleman who was in charge of the janitors were putting on a display of Burmese foot-wrestling in one corner of the general office. The janitor foreman weighed fifty pounds less than the Burma gentleman, who was the salesman's customary opponent. So the climax of one tactic did not simply overturn the foreman. He glided through the air, crashing with a very loud thump against the wall. He wasn't hurt. But the impact knocked the hallowed portrait of H. H. Hartshorne, co-founder, from its nail. It tinkled imposingly as its glass splintered against the floor. The noise caused a temporary lull in the gaiety. Several employes even felt a passing suspicion that things might be getting out of hand. "It's all in the spirit of good, clean fun!" cried Mr. Hawkins, the assistant general manager. Since he was the highest executive present, worries vanished. Everyone felt fine. There was a scurry to shove the broken glass out of sight and to turn more attention to another type of glasses. Mr. Hawkins himself, acting by reflex, attempted to return the portrait to its place until new glass could be obtained. But the fall had sprung the frame at one corner and it wouldn't hang straight. "We'd better put old H. H. away for safekeeping until after the holiday," he told a small, blonde salesclerk who was beneath his attention on any working day. With the proper mixture of respect and bonhommie, he lifted the heavy picture out of its frame. A yellowed envelope slipped to the floor as the picture came free. Hawkins rolled the picture like a scroll and put it into a desk drawer, for later attention. Then he looked around for a drink that would make him feel even better. A sorting clerk in the mail order department wasn't used to liquor. She picked up the envelope and looked around vaguely for the mail-opening machine. "Hell, Milly, you aren't working!" someone shouted at her. "Have another!" Milly snapped out of it. She giggled, suppressed a ladylike belch and returned to reality. Looking at the envelope, she said: "Oh, I see. They must have stuck it in to tighten the frame. Gee, it's old." Mr. Hawkins had refreshed himself. He decided that he liked Milly's voice. To hear more of it, he said to her: "I'll bet that's been in there ever since the picture was framed. There's a company legend that that picture was put up the day this branch opened, eighty years ago." "I didn't know the company ever used buff envelopes like this." Milly turned it over in her hands. The ancient glue crackled as she did so. The flap popped open and an old-fashioned order blank fell out. Mr. Hawkins' eyes widened. He bent, reached painfully over his potbelly and picked up the order form. "This thing has never been processed!" Raising his voice, he shouted jovially, "Hey, people! You're all fired! Here's an order that Hartshorne-Logan never filled! We can't have such carelessness. This poor woman has waited eighty years for her merchandise!" Milly was reading aloud the scrawled words on the order form: "Best electric doorbell. Junior detective kit. Disposable sacks for vacuum cleaner. Dress for three-year-old girl." She turned to the assistant general manager, struck with an idea for the first time in her young life. "Let's fill this order right now!" "The poor woman must be dead by now," he objected, secretly angry that he hadn't thought of such a fine party stunt himself. Then he brightened. "Unless—" he said it loud enough for the employes to scent a great proposal and the room grew quiet—"unless we broke the rules just once and used the time warp on a big mission!" There was a silence. Finally, from an anonymous voice in one corner: "Would the warp work over eighty years? We were always told that it must be used only for complaints within three days." "Then let's find out!" Mr. Hawkins downed the rest of his drink and pulled a batch of keys from his pocket. "Someone scoot down to the warehouse. Tell the watchman that it's on my authority. Hunt up the stuff that's on the order. Get the best of everything. Ignore the catalogue numbers—they've changed a hundred times in all these years." Milly was still deciphering the form. Now she let out a little squeal of excitement. "Look, Mr. Hawkins! The name on this order—it's my great-grandmother! Isn't that wonderful? I was just a little girl when she died. I can barely remember her as a real old woman. But I remember that my grandmother never bought anything from Hartshorne-Logan because of some trouble her mother had once with the firm. My mother didn't want me to come to work here because of that." Mr. Hawkins put his arm around Milly in a way that he intended to look fatherly. It didn't. "Well, now. Since it's your relative, let's thrill the old girl. We wouldn't have vacuum sacks any more. So we'll substitute a manky!" Ann Hartley was returning from mailing the letter when she found the large parcel on her doorstep. She put her hands on her hips and stared pugnaciously at the bundle. "The minute I write a letter to complain about you, you turn up!" she told the parcel. She nudged her toe peevishly against the brown paper wrappings that were tied with a half-transparent twine she had never seen before. The label was addressed in a wandering scrawl, a sharp contrast to the impersonal typing on the customary Hartshorne-Logan bundles. But the familiar RATTLE OK sticker was pasted onto the box, indicating to the delivery man that the contents would make a rattling sound and therefore hadn't been broken in shipment. Ann sighed and picked up her bundle. With a last look at the lovely spring afternoon and the quiet suburban landscape, she went into the house. Two-year-old Sally heard the box rattling. She waddled up on chubby legs and grabbed her mother's skirt. "Want!" she said decisively. "Your dress ought to be here," Ann said. She found scissors in her sewing box, tossed a cushion onto the floor, sat on it, and began to open the parcel. "Now I'll have to write another letter to explain that they should throw away my letter of complaint," she told her daughter. "And by the time they get my second letter, they'll have answered my first letter. Then they'll write again." Out of consideration for Sally, she omitted the expletives that she wanted to add. The translucent cord was too tough for the scissors. Ann was about to hunt for a razor blade when Sally clutched at an intersection of the cord and yanked. The twine sprang away from the carton as if it were alive. The paper wrappings flapped open. "There!" Sally said. Ann repressed an irrational urge to slap her daughter. Instead, she tossed the wrappings aside and removed the lid from the carton. A slightly crushed thin cardboard box lay on top. Ann pulled out the dress and shook it into a freely hanging position. Then she groaned. It was green and she had ordered blue. It didn't remotely resemble the dress she had admired from the Hartshorne-Logan catalogue illustration. Moreover, the shoulders were lumpier than any small girl's dress should be. But Sally was delighted. "Mine!" she shrilled, grabbing for the dress. "It's probably the wrong size, too," Ann said, pulling off Sally's dress to try it on. "Let's find as many things to complain about as we can." The dress fitted precisely, except for the absurd shoulder bumps. Sally was radiant for a moment. Then her small face sobered and she started to look vacantly at the distant wall. "We'll have to send it back," Ann said, "and get the one we ordered." She tried to take it off, but the child squawked violently. Ann grabbed her daughter's arms, held them above her head and pulled at the dress. It seemed to be stuck somewhere. When Ann released the child's arms to loosen the dress, Sally squirmed away. She took one step forward, then began to float three inches above the ground. She landed just before she collided with the far wall. Sally looked scared until she saw her mother's face. Then she squealed in delight. Ann's legs were rubber. She was shaking her head and wobbling uncertainly toward her daughter when the door opened behind her. "It's me," her husband said. "Slow day at the office, so I came home early." "Les! I'm going crazy or something. Sally just—" Sally crouched to jump at her father. Before she could leap, he grabbed her up bodily and hugged her. Then he saw the box. "Your order's here? Good. What's this thing?" He was looking at a small box he had pulled from the carton. Its lid contained a single word: MANKY. The box rattled when he shook it. Les pulled off the lid and found inside a circular, shiny metal object. A triangular trio of jacks stuck out from one end. "Is this the doorbell? I've never seen a plug like this. And there's no wire." "I don't know," Ann said. "Les, listen. A minute ago, Sally—" He peered into the box for an instruction sheet, uselessly. "They must have made a mistake. It looks like some kind of farm equipment." He tossed the manky onto the hassock and delved into the carton again. Sally was still in his arms. "That's the doorbell, I think," he said, looking at the next object. It had a lovely, tubular shape, a half-dozen connecting rods and a plug for a wall socket. "That's funny," Ann mused, her mind distracted from Sally for a moment. "It looks terribly expensive. Maybe they sent door chimes instead of the doorbell." The bottom of the carton contained the detective outfit that they had ordered for their son. Ann glanced at its glaringly lithographed cover and said: "Les, about Sally. Put her down a minute and watch what she does." Les stared at his wife and put the child onto the rug. Sally began to walk, then rose and again floated, this time toward the hassock on which the manky lay. His jaw dropped. "My God! Ann, what—" Ann was staring, too, but not at her daughter. "Les! The hassock! It used to be brown!" The hassock was a livid shade of green. A neon, demanding, screaming green that clashed horribly with the soft browns and reds in which Ann had furnished the room. "That round thing must be leaking," Les said. "But did you see Sally when she—" Ann's frazzled nerves carried a frantic order to her muscles. She jumped up, strode to the hassock and picked up the manky with two fingers. She tossed it to Les. Immediately, she regretted her action. "Drop it!" she yelled. "Maybe it'll turn you green, too!" Les kicked the hassock into the hall closet, tossed the manky in after it and shut the door firmly. As the door closed, he saw the entire interior of the dark closet brighten into a wet-lettuce green. When he turned back to Ann, she was staring at her left hand. The wedding band that Les had put there a dozen years ago was a brilliant green, shedding its soft glow over the finger up to the first knuckle. Ann felt the scream building up inside her. She opened her mouth to let it out, then put her hand in front of her mouth to keep it in, finally jerked the hand away to prevent the glowing ring from turning her front teeth green. She collapsed into Les's arms, babbling incomprehensibly. He said: "It's all right. There must be balloons or something in the shoulders of that dress. I'll tie a paperweight to Sally's dress and that'll hold her down until we undress her. Don't worry. And that green dye or whatever it is will wash off." Ann immediately felt better. She put her hands behind her back, pulled off her ring and slipped it into her apron pocket. Les was sentimental about her removing it. "I'll get dinner," she said, trying to keep her voice on an even keel. "Maybe you'd better start a letter to Hartshorne-Logan. Let's go into the kitchen, Sally." Ann strode resolutely toward the rear of the house. She kept her eyes determinedly off the tinge of green that was showing through the apron pocket and didn't dare look back at her daughter's unsettling means of propulsion. A half-hour later, when the meal was almost ready, two things happened: Bob came home from school through the back door and a strange voice said from the front of the house, "Don't answer the front door." Ann stared at her son. He stared back at her, the detective outfit under his arm. She went into the front room. Her husband was standing with fists on hips, looking at the front door, chuckling. "Neatest trick I've seen in a long time. That voice you heard was the new doorbell. I put it up while you were in the kitchen. Did you hear what happened when old lady Burnett out there pushed the button?" "Oh. Something like those name cards with something funny printed on them, like 'Another hour shot.' Well, if there's a little tape in there repeating that message, you'd better shut that part off. It might get boring after a while. And it might insult someone." Ann went to the door and turned the knob. The door didn't open. The figure of Mrs. Burnett, half-visible through the heavy curtain, shifted impatiently on the porch. Les yanked at the doorknob. It didn't yield for him, either. He looked up at the doorbell, which he had installed just above the upper part of the door frame. "Queer," he said. "That isn't in contact with the door itself. I don't see how it can keep the door from opening." Ann put her mouth close to the glass, shouting: "Won't you come to the back door, Mrs. Burnett? This one is stuck." "I just wanted to borrow some sugar," the woman cried from the porch. "I realize that I'm a terrible bother." But she walked down the front steps and disappeared around the side of the house. "Don't open the back door." The well-modulated voice from the small doorbell box threatened to penetrate every corner of the house. Ann looked doubtfully at her husband's lips. They weren't moving. "If this is ventriloquism—" she began icily. "I'll have to order another doorbell just like this one, for the office," Les said. "But you'd better let the old girl in. No use letting her get peeved." The back door was already open, because it was a warm day. The screen door had no latch, held closed by a simple spring. Ann pushed it open when Mrs. Burnett waddled up the three back steps, and smiled at her neighbor. "I'm so sorry you had to walk around the house. It's been a rather hectic day in an awful lot of ways." Something seemed to impede Mrs. Burnett as she came to the threshold. She frowned and shoved her portly frame against something invisible. It apparently yielded abruptly, because she staggered forward into the kitchen, nearly falling. She stared grimly at Ann and looked suspiciously behind her. "The children have some new toys," Ann improvised hastily. "Sally is so excited over a new dress that she's positively feverish. Let's see now—it was sugar that you want, wasn't it?" "I already have it," Bob said, handing a filled cup to his mother. The boy turned back to the detective set which he had spread over the kitchen table. "Excitement isn't good for me," Mrs. Burnett said testily. "I've had a lot of troubles in my life. I like peace and quiet." "Your husband is better?" "Worse. I'm sure I don't know why everything happens to me." Mrs. Burnett edged toward the hall, trying to peer into the front of the house. Ann stood squarely in front of the door leading to the hall. Defeated, Mrs. Burnett left. A muffled volley of handclapping, mixed with a few faint cheers, came from the doorbell-box when she crossed the threshold. Ann went into the hall to order Les to disconnect the doorbell. She nearly collided with him, coming in the other direction. "Where did this come from?" Les held a small object in the palm of his hand, keeping it away from his body. A few drops of something unpleasant were dripping from his fingers. The object looked remarkably like a human eyeball. It was human-size, complete with pupil, iris and rather bloodshot veins. "Hey, that's mine," Bob said. "You know, this is a funny detective kit. That was in it. But there aren't instructions on how it works." "Well, put it away," Ann told Bob sharply. "It's slimy." Les laid the eyeball on the table and walked away. The eyeball rolled from the smooth, level table, bounced twice when it hit the floor, then rolled along, six inches behind him. He turned and kicked at it. The eyeball rolled nimbly out of the path of the kick. "Les, I think we've made poor Mrs. Burnett angry," Ann said. "She's so upset over her poor husband's health and she thinks we're insulting her." Les didn't hear her. He strode to the detective set, followed at a safe distance by the eyeball, and picked up the box. "Hey, watch out!" Bob cried. A small flashlight fell from the box, landed on its side and its bulb flashed on, throwing a pencil of light across Les's hands. Bob retrieved the flashlight and turned it off while Les glanced through an instruction booklet, frowning. "This toy is too complicated for a ten-year-old boy," Les told his wife. "I don't know why you ordered such a thing." He tossed the booklet into the empty box. "I'm going to return it, if you don't smudge it up," she replied. "Look at the marks you made on the instructions." The black finger-marks stood out clearly against the shiny, coated paper. Les looked at his hands. "I didn't do it," he said, pressing his clean fingertips against the kitchen table. Black fingerprints, a full set of them, stood out against the sparkling polished table's surface. "I think the Detectolite did it," Bob said. "The instructions say you've got to be very careful with it, because its effects last for a long time." Les began scrubbing his hands vigorously at the sink. Ann watched him silently, until she saw his fingerprints appear on the faucet, the soap and the towel. She began to yell at him for making such a mess, when Sally floated into the kitchen. The girl was wearing a nightgown. "My God!" Ann forgot her tongue before the children. "She got out of that dress herself. Where did she get that nightgown?" Ann fingered the garment. She didn't recognize it as a nightgown. But in cut and fold, it was suspiciously like the dress that had arrived in the parcel. Her heart sank. She picked up the child, felt the hot forehead, and said: "Les, I think it's the same dress. It must change color or something when it's time for a nap. It seems impossible, but—" She shrugged mutely. "And I think Sally's running a temperature. I'm going to put her to bed." She looked worriedly into the reddened eyes of the small girl, who whimpered on the way to the bedroom. Ann carried her up the stairs, keeping her balance with difficulty, as Sally threatened to pop upward out of her arms. The whole family decided that bed might be a good idea, soon after dinner. When the lights went out, the house seemed to be nearly normal. Les put on a pair of gloves and threw a pillowcase over the eyeball. Bob rigged up trestles to warn visitors from the front porch. Ann put small wads of cotton into her ears, because she didn't like the rhythmic rattle, soft but persistent, that emerged from the hall closet where the manky sat. Sally was whining occasionally in her sleep. When daylight entered her room, Sally's nightgown had turned back into the new dress. But the little girl was too sick to get out of bed. She wasn't hungry, her nose was running, and she had a dry cough. Les called the doctor before going to work. The only good thing about the morning for Ann was the fact that the manky had quieted down some time in the night. After she got Bob to school, she gingerly opened the closet door. The manky was now glowing a bright pink and seemed slightly larger. Deep violet lettering stood out on its side: " Today is Wednesday. For obvious reasons, the manky will not operate today. " The mailman brought a letter from Hartshorne-Logan. Ann stared stupidly at the envelope, until she realized that this wasn't an impossibly quick answer to the letter she had written yesterday. It must have crossed in the mail her complaint about the non-arrival of the order. She tore open the envelope and read: "We regret to inform you that your order cannot be filled until the balance you owe us has been reduced. From the attached form, you will readily ascertain that the payment of $87.56 will enable you to resume the purchasing of merchandise on credit. We shall fill your recent order as soon...." Ann crumpled the letter and threw it into the imitation fireplace, knowing perfectly well that it would need to be retrieved for Les after work tonight. She had just decided to call Hartshorne-Logan's complaint department when the phone rang. "I'm afraid I must ask you to come down to the school, Mrs. Morris," a voice said. "Your son is in trouble. He claims that it's connected with something that his parents gave him." "My son?" Ann asked incredulously. "Bob?" "Yes. It's a little gadget that looks like a water pistol. Your son insists that he didn't know it would make clothing transparent. He claims it was just accident that he tried it out when he was walking by the gym during calisthenics. We've had to call upon every family in the neighborhood for blankets. Bob has always been a good boy and we believe that we can expel him quietly without newspaper publicity involving his name, if you'll—" "I'll be right down," Ann said. "I mean I won't be right down. I've got a sick baby here. Don't do anything till I telephone my husband. And I'm sorry for Bob. I mean I'm sorry for the girls, and for the boys, too. I'm sorry for—for everything. Good-by." Just as she hung up the telephone, the doorbell rang. It rang with a normal buzz, then began to play soft music. Ann opened the door without difficulty, to admit Dr. Schwartz. "You aren't going to believe me, Doctor," Ann said while he took the child's temperature, "but we can't get that dress off Sally." "Kids are stubborn sometimes." Dr. Schwartz whistled softly when he looked at the thermometer. "She's pretty sick. I want a blood count before I try to move her. Let me undress her." Sally had been mumbling half-deliriously. She made no effort to resist as the doctor picked her up. But when he raised a fold of the dress and began to pull it back, she screamed. The doctor dropped the dress and looked in perplexity at the point where it touched Sally's skin. "It's apparently an allergy to some new kind of material. But I don't understand why the dress won't come off. It's not stuck tight." "Don't bother trying," Ann said miserably. "Just cut it off." Dr. Schwartz pulled scissors from his bag and clipped at a sleeve. When he had cut it to the shoulder, he gently began to peel back the edges of the cloth. Sally writhed and kicked, then collapsed in a faint. The physician smoothed the folds hastily back into place. He looked helpless as he said to Ann: "I don't know quite what to do. The flesh starts to hemorrhage when I pull at the cloth. She'd bleed to death if I yanked it off. But it's such an extreme allergy that it may kill her, if we leave it in contact with the skin." The manky's rattle suddenly began rhythmically from the lower part of the house. Ann clutched the side of the chair, trying to keep herself under control. A siren wailed somewhere down the street, grew louder rapidly, suddenly going silent at the peak of its crescendo. Dr. Schwartz glanced outside the window. "An ambulance. Looks as if they're stopping here." "Oh, no," Ann breathed. "Something's happened to Les." "It sure will," Les said grimly, walking into the bedroom. "I won't have a job if I can't get this stuff off my fingers. Big black fingerprints on everything I touch. I can't handle correspondence or shake hands with customers. How's the kid? What's the ambulance doing out front?" "They're going to the next house down the street," the physician said. "Has there been sickness there?" Les held up his hands, palms toward the doctor. "What's wrong with me? My fingers look all right. But they leave black marks on everything I touch." The doctor looked closely at the fingertips. "Every human has natural oil on the skin. That's how detectives get results with their fingerprint powder. But I've never heard of nigrification, in this sense. Better not try to commit any crimes until you've seen a skin specialist." Ann was peering through the window, curious about the ambulance despite her own troubles. She saw two attendants carry Mr. Burnett, motionless and white, on a stretcher from the house next door into the ambulance. A third member of the crew was struggling with a disheveled Mrs. Burnett at the door. Shrieks that sounded like "Murder!" came sharply through the window. "I know those bearers," Dr. Schwartz said. He yanked the window open. "Hey, Pete! What's wrong?" The front man with the stretcher looked up. "I don't know. This guy's awful sick. I think his wife is nuts." Mrs. Burnett had broken free. She dashed halfway down the sidewalk, gesticulating wildly to nobody in particular. "It's murder!" she screamed. "Murder again! He's been poisoned! He's going to die! It means the electric chair!" The orderly grabbed her again. This time he stuffed a handkerchief into her mouth to quiet her. "Come back to this house as soon as you deliver him," Dr. Schwartz shouted to the men. "We've got a very sick child up here." "I was afraid this would happen," Les said. "The poor woman already has lost three husbands. If this one is sick, it's no wonder she thinks that somebody is poisoning him." Bob stuck his head around the bedroom door. His mother stared unbelievingly for a moment, then advanced on him threateningly. Something in his face restrained her, just as she was about to start shaking him. "I got something important to tell you," Bob said rapidly, ready to duck. "I snuck out of the principal's office and came home. I got to tell you what I did." "I heard all about what you did," Ann said, advancing again. "And you're not going to slip away from me." "Give me a chance to explain something. Downstairs. So he won't hear," Bob ended in a whisper, nodding toward the doctor. Ann looked doubtfully at Les, then followed Bob down the stairs. The doorbell was monotonously saying in a monotone: "Don't answer me, don't answer me, don't go to the door." "Why did you do it?" Ann asked Bob, her anger suddenly slumping into weary sadness. "People will suspect you of being a sex maniac for the rest of your life. You can't possibly explain—" "Don't bother about the girls' clothing," Bob said, "because it was only an accident. The really important thing is something else I did before I left the house." Les, cursing softly, hurried past them on the way to answer the knocking. He ignored the doorbell's pleas. "I forgot about it," Bob continued, "when that ray gun accidentally went off. Then when they put me in the principal's office, I had time to think, and I remembered. I put some white stuff from the detective kit into that sugar we lent Mrs. Burnett last night. I just wanted to see what would happen. I don't know exactly what effect—" "He put stuff in the sugar?" A deep, booming voice came from the front of the house. Mother and son looked through the hall. A policeman stood on the threshold of the front door. "I heard that! The woman next door claims that her husband is poisoned. Young man, I'm going to put you under arrest." The policeman stepped over the threshold. A blue flash darted from the doorbell box, striking him squarely on the chest. The policeman staggered back, sitting down abruptly on the porch. A scent of ozone drifted through the house. "Close the door, close the door," the doorbell was chanting urgently. "Where's that ambulance?" Dr. Schwartz yelled from the top of the steps. "The child's getting worse."
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A. It caused him to leave black finger-marks on everything he touched.
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How can a neural model be used for a retrieval if the input is the entire Wikipedia?
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### Introduction
Natural language based consumer products, such as Apple Siri and Amazon Alexa, have found wide spread use in the last few years. A key requirement for these conversational systems is the ability to answer factual questions from the users, such as those about movies, music, and artists. Most of the current approaches for Question Answering (QA) are based on structured Knowledge Bases (KB) such as Freebase BIBREF0 and Wikidata BIBREF1 . In this setting the question is converted to a logical form using semantic parsing, which is queried against the KB to obtain the answer BIBREF2 , BIBREF3 . However, recent studies have shown that even large curated KBs, such as Freebase, are incomplete BIBREF4 . Further, KBs support only certain types of answer schemas, and constructing and maintaining them is expensive. On the other hand, there is a vast amount of unstructured knowledge available in textual form from web pages such as Wikipedia, and hence an alternative is to directly answer questions from these documents. In this approach, shown in Figure 1 , articles relevant to the question are first selected (retrieval step). Then, the retrieved articles and question are jointly processed to extract the answer (comprehension step). This retrieval based approach has a longer history than the KB based approach BIBREF5 . It can potentially provide a much wider coverage over questions, and is not limited to specific answer schemas. However, there are still gaps in its performance compared to the KB-based approach BIBREF6 . The comprehension step, which requires parsing information from natural language, is the main bottleneck, though suboptimal retrieval can also lead to lower performance. Several large-scale datasets introduced recently BIBREF7 , BIBREF8 have facilitated the development of powerful neural models for reading comprehension. These models fall into one of two categories: (1) those which extract answers as a span of text from the document BIBREF9 , BIBREF10 , BIBREF11 (Figure 2 top); (2) those which select the answer from a fixed vocabulary BIBREF12 , BIBREF6 (Figure 2 bottom). Here we argue that depending on the type of question, either (1) or (2) may be more appropriate, and introduce a latent variable mixture model to combine the two in a single end-to-end framework. We incorporate the above mixture model in a simple Recurrent Neural Network (RNN) architecture with an attention mechanism BIBREF13 for comprehension. In the second part of the paper we focus on the retrieval step for the QA system, and introduce a neural network based ranking model to select the articles to feed the comprehension model. We evaluate our model on WikiMovies dataset, which consists of 200K questions about movies, along with 18K Wikipedia articles for extracting the answers. KV:16 applied Key-Value Memory Neural Networks (KV-MemNN) to the dataset, achieving 76.2% accuracy. Adding the mixture model for answer selection improves the performance to 85.4%. Further, the ranking model improves both precision and recall of the retrieved articles, and leads to an overall performance of 85.8%. ### WikiMovies Dataset
We focus on the WikiMovies dataset, proposed by BIBREF6 . The dataset consists of pairs of questions and answers about movies. Some examples are shown in Table 1 . As a knowledge source approximately 18K articles from Wikipedia are also provided, where each article is about a movie. Since movie articles can be very long, we only use the first paragraph of the article, which typically provides a summary of the movie. Formally, the dataset consists of question-answer pairs $\lbrace (q_j, A_j)\rbrace _{j=1}^J$ and movie articles $\lbrace d_k\rbrace _{k=1}^K$ . Additionally, the dataset includes a list of entities: movie titles, actor names, genres etc. Answers to all the questions are in the entity list. The questions are created by human annotators using SimpleQuestions BIBREF14 , an existing open-domain question answering dataset, and the annotated answers come from facts in two structured KBs: OMDb and MovieLens. There are two splits of the dataset. The “Full” dataset consists of 200K pairs of questions and answers. In this dataset, some questions are difficult to answer from Wikipedia articles alone. A second version of the dataset, “Wiki Entity” is constructed by removing those QA pairs where the entities in QAs are not found in corresponding Wikipedia articles. We call these splits WikiMovies-FL and WikiMovies-WE, respectively. The questions are divided into train, dev and test such that the same question template does not appear in different splits. Further, they can be categorized into 13 categories, including movie_to_actors, director_to_movies, etc. The basic statistics of the dataset are summarized in Table 2 . We also note that more than 50% of the entities appear less than 5 times in the training set. This makes it very difficult to learn the global statistics of each entity, necessitating the need to use an external knowledge source. ### Comprehension Model
Our QA system answers questions in two steps, as shown in Figure 1 . The first step is retrieval, where articles relevant to the question are retrieved. The second step is comprehension, where the question and retrieved articles are processed to derive answers. In this section we focus on the comprehension model, assuming that relevant articles have already been retrieved and merged into a context document. In the next section, we will discuss approaches for retrieving the articles. BIBREF6 , who introduced WikiMovies dataset, used an improved variant of Memory Networks called Key-Value Memory Networks. Instead, we use RNN based network, which has been successfully used in many reading comprehension tasks BIBREF10 , BIBREF9 , BIBREF12 . WikiMovies dataset has two notable differences from many of the existing comprehension datasets, such as CNN and SQuAD BIBREF10 , BIBREF9 , BIBREF12 . First, with imperfect retrieval, the answer may not be present in the context. We handle this case by using the proposed mixture model. Second, there may be multiple answers to a question, such as a list of actors. We handle this by optimizing a sum of the cross-entropy loss over all possible answers. We also use attention sum architecture proposed by BIBREF10 , which has been shown to give high performance for comprehension tasks. In this approach, attention scores over the context entities are used as the output. We term this the attention distribution $p_{att}$ , defined over the entities in the context. The mixture model combines this distribution with another output probability distribution $p_{vocab}$ over all the entities in the vocabulary. The intuition behind this is that named entities (such as actors and directors) can be better handled by the attention part, since there are few global statistics available for these, and other entities (such as languages and genres) can be captured by vocabulary part, for which global statistics can be leveraged. ### Comprehension model detail
Let $\mathcal {V}$ be the vocabulary consisting of all tokens in the corpus, and $\mathcal {E}$ be the set of entities in the corpus The question is converted to a sequence of lower cased word ids, $(w_i) \in \mathcal {V}$ and a sequence of 0-1 flags for word capitalization, $(c_i) \in \lbrace 0,1\rbrace $ . For each word position $i$ , we also associate an entity id if the i-th word is part of an entity, $e_i \in \mathcal {E}$ (see Figure 3 ). Then, the combined embedding of the i-th position is given by $$x_i = W_w(w_i) + W_c(c_i) \Vert W_e(e_i), \hspace{7.22743pt} (i=1,\ldots ,L_q), $$ (Eq. 12) where $\Vert $ is the concatenation of two vectors, $L_q$ is the number of words in a question $q$ , and $W_w, W_c$ and $W_e$ are embedding matrices. Note that if there are no entities at i-th position, $W_e(e_i)$ is set to zero. The context is composed of up to $M$ movie articles concatenated with a special separation symbol. The contexts are embedded in exactly the same way as questions, sharing the embedding matrices. To avoid overfitting, we use another technique called anonymization. We limit the number of columns of $W_e$ to a relatively small number, $n_e$ , and entity ids are mapped to one of $n_e$ columns randomly (without collision). The map is common for each question/context pair but randomized across pairs. The method is similar to the anonymization method used in CNN / Daily Mail datasets BIBREF8 . emergent:16 showed that such a procedure actually helps readers since it adds coreference information to the system. Next, the question embedding sequence $(x_i)$ is fed into a bidirectional GRU (BiGRU) BIBREF15 to obtain a fixed length vector $v$ $$v = \overrightarrow{h}_{q}(L_q) \Vert \overleftarrow{h}_{q}(0), $$ (Eq. 13) where $\overrightarrow{h}_{q}$ and $\overleftarrow{h}_{q}$ are the final hidden states of forward and backward GRUs respectively. The context embedding sequence is fed into another BiGRU, to produce the output $H_c = [h_{c,1}, h_{c,2}, \ldots h_{c,L_c}]$ , where $L_c$ is the length of the context. An attention score for each word position $i$ is given by $$s_i \propto \exp ( v^T h_{c,i} ).$$ (Eq. 14) The probability over the entities in the context is then given by $$p_{att}(e) \propto \sum _{i \in I(e, c)} s_i,$$ (Eq. 15) where $I(e,c)$ is the set of word positions in the entity $e$ within the context $c$ . We next define the probability $p_{vocab}$ to be the probability over the complete set of entities in the corpus, given by $$p_{vocab}(e) = {\rm Softmax}(V u), $$ (Eq. 16) where the vector $u$ is given by $u = \sum _{i} s_i h_{c, i}$ . Each row of the matrix $V$ is the coefficient vector for an entity in the vocabulary. It is computed similar to Eq. ( 12 ). $$V(e) = \sum _{w \in e} W_w(w) + \sum _{c \in e} W_c(c) \Vert W_e(e). $$ (Eq. 17) The embedding matrices are shared between question and context. The final probability that an entity $e$ answers the question is given by the mixture $p(e) = (1-g) p_{att}(e) + g p_{vocab}(e)$ , with the mixture coefficient $g$ defined as $$g = \sigma (W_g g_0), \hspace{7.22743pt} g_0 = v^T u \Vert \max V u.$$ (Eq. 18) The two components of $g_0$ correspond to the attention part and vocabulary part respectively. Depending on the strength of each, the value of $g$ may be high or low. Since there may be multiple answers for a question, we optimize the sum of the probabilities: $$\textrm {loss} = - \log \Big ( \sum _{a \in A_j} p(a|q_j,c_j) \Big ) $$ (Eq. 19) Our overall model is displayed in Figure 4 . We note that KV-MemNN BIBREF6 employs “Title encoding” technique, which uses the prior knowledge that movie titles are often in answers. BIBREF6 showed that this technique substantially improves model performance by over 7% for WikiMovies-WE dataset. In our work, on the other hand, we do not use any data specific feature engineering. ### Retrieval Model
Our QA system answers questions by two steps as in Figure 1 . Accurate retrieval of relevant articles is essential for good performance of the comprehension model, and in this section we discuss three approaches for it. We use up to $M$ articles as context. A baseline approach for retrieval is to select articles which contain at least one entity also present in the question. We identify maximal intervals of words that match entities in questions and articles. Capitalization of words is ignored in this step because some words in the questions are not properly capitalized. Out of these (say $N$ ) articles we can randomly select $M$ . We call this approach (r0). For some movie titles, however, this method retrieves too many articles that are actually not related to questions. For example, there is a movie titled “Love Story” which accidentally picks up the words “love story”. This degrades the performance of the comprehension step. Hence, we describe two more retrieval models – (1) a dataset specific hand-crafted approach, and (2) a general learning based approach. ### Hand-Crafted Model (r1)
In this approach, the $N$ articles retrieved using entity matching are assigned scores based on certain heuristics. If the movie title matches an entity in the question, the article is given a high score, since it is very likely to be relevant. A similar heuristic was also employed in BIBREF6 . In addition, the number of matching entities is also used to score each article. The top $M$ articles based on these scores are selected for comprehension. This hand-crafted approach already gives strong performance for the WikiMovies dataset, however the heuristic for matching article titles may not be appropriate for other QA tasks. Hence we also study a general learning based approach for retrieval. ### Learning Model (R2)
The learning model for retrieval is trained by an oracle constructed using distant supervision. Using the answer labels in the training set, we can find appropriate articles that include the information requested in the question. For example, for x_to_movie question type, the answer movie articles are the correct articles to be retrieved. On the other hand, for questions in movie_to_x type, the movie in the question should be retrieved. Having collected the labels, we train a retrieval model for classifying a question and article pair as relevant or not relevant. Figure 5 gives an overview of the model, which uses a Word Level Attention (WLA) mechanism. First, the question and article are embedded into vector sequences, using the same method as the comprehension model. We do not use anonymization here, to retain simplicity. Otherwise, the anonymization procedure would have to be repeated several times for a potentially large collection of documents. These vector sequences are next fed to a Bi-GRU, to produce the outputs $v$ (for the question) and $H_c$ (for the document) similar to the previous section. To classify the article as relevant or not, we introduce a novel attention mechanism to compute the score, $$s = \sum _{i} ((w \tilde{v} + b)^T \tilde{h}_{c,i})^4$$ (Eq. 25) Each term in the sum above corresponds to the match between the query representation and a token in the context. This is passed through a 4-th order non-linearity so that relevant tokens are emphasized more. Next, we compute the probability that the article is relevant using a sigmoid: $$o = \sigma (w^{\prime } s + b^{\prime })$$ (Eq. 27) In the above, $\tilde{x}$ is the normalized version (by L2-norm) of vector $x$ , $w, b, w^{\prime }, b^{\prime }$ are scalar learnable parameters to control scales. ### Experiments
We evaluate the comprehension model on both WikiMovies-FL and WikiMovies-WE datasets. The performance is evaluated using the accuracy of the top hit (single answer) over all possible answers (all entities). This is called hits@1 metric. For the comprehension model, we use embedding dimension 100, and GRU dimension 128. We use up to $M=10$ retrieved articles as context. The order of the articles are randomly shuffled for each training instance to prevent over-fitting. The size of the anonymized entity set $n_e$ is 600, since in most of the cases, number of entities in a question and context pair is less than 600. For training the comprehension model, the Adam BIBREF16 optimization rule is used with batch size 32. We stop the optimization based on dev-set performance, and training takes around 10 epochs. For WikiMovies-FL (resp. WikiMovies-WE) dataset, each epoch took approximately 4 (resp. 2) hours on an Nvidia GTX1080 GPU. For training the retrieval model R2, we use a binary cross entropy objective. Since most articles are not relevant to a question, the ration of positive and negative samples is tuned to $1:10$ . Each epoch for training the retrieval model takes about 40 minutes on an Nvidia GTX1080 GPU. ### Performance of Retrieval Models
We evaluate the retrieval models based on precision and recall of the oracle articles. The evaluation is done on the test set. R@k is the ratio of cases where the highest ranked oracle article is in the top k retrieved articles. P@k is the ratio of oracle articles which are in the top k retrieved results. These numbers are summarized in Table 3 . We can see that both (r1) and (R2) significantly outperform (r0), with (R2) doing slightly better. We emphasize that (R2) uses no domain specific knowledge, and can be readily applied to other datasets where articles may not be about specific types of entities. We have also tested simpler models based on inner product of question and article vectors. In these models, a question $q_j$ and article $d_k$ are converted to vectors $\Phi (q_j), \Psi (d_k)$ , and the relevance score is given by their inner product: $${\rm score}(j,k) = \Phi (q_j)^T \Psi (d_k).$$ (Eq. 32) In the view of computation, those models are attractive because we can compute the article vectors offline, and do not need to compute the attention over words in the article. Maximum Inner Product Search algorithms may also be utilized here BIBREF17 , BIBREF18 . However, as shown in upper block of Table 4 , those models perform much worse in terms of scoring. The “Sum of Hidden State” and “Query Free Attention” models are similar to WLA model, using BiGRUs for question and article. In both of those models, $\Phi (q)$ is defined the same way as WLA model, Eq ( 13 ). For the “Sum of Hidden States” model, $\Psi (d)$ is given by the sum of BiGRU hidden states. This is the same as the proposed model by replacing the fourth order of WLA to one. For the “Query Free Attention” model, $\Psi (d)$ is given by the sum of BiGRU hidden states. We compare our model and several ablations with the KV-MemNN model. Table 5 shows the average performance across three evaluations. The (V) “Vocabulary Model” and (A) “Attention Model” are simplified versions of the full (AV) “Attention and Vocabulary Model”, using only $p_{vocab}$ and $p_{att}$ , respectively. Using a mixture of $p_{att}$ and $p_{vocab}$ gives the best performance. Interestingly, for WE dataset the Attention model works better. For FL dataset, on the other hand, it is often impossible to select answer from the context, and hence the Vocab model works better. The number of entities in the full vocabulary is 71K, and some of these are rare. Our intuition to use the Vocab model was to only use it for common entities, and hence we next constructed a smaller vocabulary consisting of all entities which appear at least 10 times in the corpus. This results in a subset vocabulary $\mathcal {V}_S$ of 2400 entities. Using this vocabulary in the mixture model (AsV) further improves the performance. Table 5 also shows a comparison between (r0), (r1), and (R2) in terms of the overall task performance. We can see that improving the quality of retrieved articles benefits the downstream comprehension performance. In line with the results of the previous section, (r1) and (R2) significantly outperform (r0). Among (r1) and (R2), (R2) performs slightly better. ### Benefit of training methods
Table 6 shows the impact of anonymization of entities and shuffling of training articles before the comprehension step, described in Section "Comprehension Model" . Shuffling the context article before concatenating them, works as a data augmentation technique. Entity anonymization helps because without it each entity has one embedding. Since most of the entities appear only a few times in the articles, these embeddings may not be properly trained. Instead, the anonymous embedding vectors are trained to distinguish different entities. This technique is motivated by a similar procedure used in the construction of CNN / Daily Mail BIBREF8 , and discussed in detail in BIBREF19 . ### Visualization
Figure 6 shows a test example from the WikiMovies-FL test data. In this case, even though the answers “Hindi” and “English” are not in the context, they are correctly estimated from $p_{vocab}$ . Note the high value of $g$ in this case. Figure 7 shows another example of how the mixture model works. Here the the answer is successfully selected from the document instead of the vocabulary. Note the low value of $g$ in this case. ### Performance in each category
Table 7 shows the comparison for each category of questions between our model and KV-MemNN for the WikiMovies-WE dataset . We can see that performance improvements in the movie_to_x category is relatively large. The KV-MemNN model has a dataset specific “Title encoding” feature which helps the model x_to_movie question types. However without this feature performance in other categories is poor. ### Analysis of the mixture gate
The benefit of the mixture model comes from the fact that $p_{pointer}$ works well for some question types, while $p_{vocab}$ works well for others. Table 8 shows how often for each category $p_{vocab}$ is used ( $g > 0.5$ ) in AsV model. For question types “Movie to Language” and “Movie to Genre” (the so called “choice questions”) the number of possible answers is small. For this case, even if the answer can be found in the context, it is easier for the model to select answer from an external vocabulary which encodes global statistics about the entities. For other “free questions”, depending on the question type, one approach is better than the other. Our model is able to successfully estimate the latent category and switch the model type by controlling the coefficient $g$ . ### Related Work
hierarchical:16 solve the QA problem by selecting a sentence in the document. They show that joint training of selection and comprehension slightly improves the performance. In our case, joint training is much harder because of the large number of movie articles. Hence we introduce a two-step retrieval and comprehension approach. Recently architecture:16 proposed a framework to use the performance on a downstream task (e.g. comprehension) as a signal to guide the learning of neural network which determines the input to the downstream task (e.g. retrieval). This motivates us to introduce neural network based approach for both retrieval and comprehension, since in this case the retrieval step can be directly trained to maximize the downstream performance. In the context of language modeling, the idea of combining of two output probabilities is given in BIBREF20 , however, our equation to compute the mixture coefficient is slightly different. More recently, ahn2016neural used a mixture model to predict the next word from either the entire vocabulary, or a set of Knowledge Base facts associated with the text. In this work, we present the first application of such a mixture model to reading comprehension. ### Conclusion and Future Work
We have developed QA system using a two-step retrieval and comprehension approach. The comprehension step uses a mixture model to achieve state of the art performance on WikiMovies dataset, improving previous work by a significant margin. We would like to emphasize that our approach has minimal heuristics and does not use dataset specific feature engineering. Efficient retrieval while maintaining representation variation is a challenging problem. While there has been a lot of research on comprehension, little focus has been given to designing neural network based retrieval models. We present a simple such model, and emphasize the importance of this direction of research. Figure 1: Overview of a retrieval + comprehension (r+c) QA system. First, movie articles relevant to a question are retrieved. Then, the retrieved articles along with the question are processed to obtain an answer. Figure 2: Example of comprehension step from WIKIMOVIES dataset. Top: answer is a span of text in article. Bottom: answer is not explicitly written in article. Table 1: Example of questions and answers. Table 2: Basic statistics of WIKIMOVIES dataset. Figure 3: Example of embedded vectors for a question “who directed the movie Blade Runner?” Figure 4: Visualization of our model. A question is encoded to a vector by a BiGRU. With this vector, attention is computed over another BiGRU. Output probabilities patt, pvocab and the mixture coefficient g are computed from those attentions and BiGRU states. Figure 5: Overview of retrieval model. Similar to the comprehension model, a question is encoded to a fixed length vector. Attention is computed over the words of the movie article. Table 5: Performance (hits@1) comparison over different models and datasets. Table 3: Performance of retrieval methods. (WikiMovies-WE) Figure 7: Model behavior of a question “Martin Zandvliet directed which movies?” Martin Zandvliet is a writer of Teddy Bear, not a director. Table 7: Hits@1 scores for each question type. Our model gets > 80% in all cases but two. Table 8: Ratio of the gate being open. (g > 0.5) If the answer is named entity, the model need to select answer from text. Therefore, g = 0. Bold font indicates winning model. Vocabulary Only model wins when g is high.
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Using the answer labels in the training set, we can find appropriate articles that include the information requested in the question.
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What is Jeffers’ opinion about taking graft?
A. Taking extra is stealing and is wrong.
B. He takes extra in order to spend it on improvements for the crew.
C. He takes extra as part of a hazard duty pay package.
D. Taking extra is expected and nobody would notice.
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TOLLIVER'S ORBIT was slow—but it wasn't boring. And it would get you there—as long as you weren't going anywhere anyhow! By H. B. FYFE [Transcriber's Note: This etext was produced from Worlds of If Science Fiction, September 1961. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Johnny Tolliver scowled across the desk at his superior. His black thatch was ruffled, as if he had been rubbed the wrong way. "I didn't ask you to cut out your own graft, did I?" he demanded. "Just don't try to sucker me in on the deal. I know you're operating something sneaky all through the colony, but it's not for me." The big moon-face of Jeffers, manager of the Ganymedan branch of Koslow Spaceways, glowered back at him. Its reddish tinge brightened the office noticeably, for such of Ganymede's surface as could be seen through the transparent dome outside the office window was cold, dim and rugged. The glowing semi-disk of Jupiter was more than half a million miles distant. "Try not to be simple—for once!" growled Jeffers. "A little percentage here and there on the cargoes never shows by the time figures get back to Earth. The big jets in the home office don't care. They count it on the estimates." "You asked any of them lately?" Tolliver prodded. "Now, listen ! Maybe they live soft back on Earth since the mines and the Jovian satellite colonies grew; but they were out here in the beginning, most of them. They know what it's like. D'ya think they don't expect us to make what we can on the side?" Tolliver rammed his fists into the side pockets of his loose blue uniform jacket. He shook his head, grinning resignedly. "You just don't listen to me ," he complained. "You know I took this piloting job just to scrape up money for an advanced engineering degree back on Earth. I only want to finish my year—not get into something I can't quit." Jeffers fidgeted in his chair, causing it to creak under the bulk of his body. It had been built for Ganymede, but not for Jeffers. "Aw, it's not like that," the manager muttered. "You can ease out whenever your contract's up. Think we'd bend a good orbit on your account?" Tolliver stared at him silently, but the other had difficulty meeting his eye. "All right, then!" Jeffers snapped after a long moment. "If you want it that way, either you get in line with us or you're through right now!" "You can't fire me," retorted the pilot pityingly. "I came out here on a contract. Five hundred credits a week base pay, five hundred for hazardous duty. How else can you get pilots out to Jupiter?" "Okay I can't fire you legally—as long as you report for work," grumbled Jeffers, by now a shade more ruddy. "We'll see how long you keep reporting. Because you're off the Callisto run as of now! Sit in your quarters and see if the company calls that hazardous duty!" "Doesn't matter," answered Tolliver, grinning amiably. "The hazardous part is just being on the same moon as you for the next six months." He winked and walked out, deliberately leaving the door open behind him so as to enjoy the incoherent bellowing that followed him. Looks like a little vacation , he thought, unperturbed. He'll come around. I just want to get back to Earth with a clean rep. Let Jeffers and his gang steal the Great Red Spot off Jupiter if they like! It's their risk. Tolliver began to have his doubts the next day; which was "Tuesday" by the arbitrary calender constructed to match Ganymede's week-long journey around Jupiter. His contract guaranteed a pilot's rating, but someone had neglected to specify the type of craft to be piloted. On the bulletin board, Tolliver's name stood out beside the number of one of the airtight tractors used between the dome city and the spaceport, or for hauling cross-country to one of the mining domes. He soon found that there was nothing for him to do but hang around the garage in case a spaceship should land. The few runs to other domes seemed to be assigned to drivers with larger vehicles. The following day was just as boring, and the next more so. He swore when he found the assignment unchanged by "Friday." Even the reflection that it was payday was small consolation. "Hey, Johnny!" said a voice at his shoulder. "The word is that they're finally gonna trust you to take that creeper outside." Tolliver turned to see Red Higgins, a regular driver. "What do you mean?" "They say some home-office relative is coming in on the Javelin ." "What's wrong with that?" asked Tolliver. "Outside of the way they keep handing out soft jobs to nephews, I mean." "Aah, these young punks just come out for a few months so they can go back to Earth making noises like spacemen. Sometimes there's no reason but them for sending a ship back with a crew instead of in an economy orbit. Wait till you see the baggage you'll have to load!" Later in the day-period, Tolliver recalled this warning. Under a portable, double-chambered plastic dome blown up outside the ship's airlock, a crewman helped him load two trunks and a collection of bags into the tractor. He was struggling to suppress a feeling of outrage at the waste of fuel involved when the home-office relative emerged. She was about five feet four and moved as if she walked lightly even in stronger gravity than Ganymede's. Her trim coiffure was a shade too blonde which served to set off both the blue of her eyes and the cap apparently won from one of the pilots. She wore gray slacks and a heavy sweater, like a spacer. "Sorry to keep you waiting," she said, sliding into the seat beside Tolliver. "By the way, just call me Betty." "Sure," agreed Tolliver thinking, Ohmigod! Trying already to be just one of the gang, instead of Lady Betty! Is her old man the treasurer, or does he just know where bodies are buried? "They were making dates," said the girl. "Were they ribbing me, or is it true that none of the four of them goes back with the ship?" "It's true enough," Tolliver assured her. "We need people out here, and it costs a lot to make the trip. They found they could send back loaded ships by 'automatic' flight—that is, a long, slow, economical orbit and automatic signalling equipment. Then they're boarded approaching Earth's orbit and landed by pilots who don't have to waste their time making the entire trip." He followed the signals of a spacesuited member of the port staff and maneuvered out of the dome. Then he headed the tractor across the frozen surface of Ganymede toward the permanent domes of the city. "How is it here?" asked the girl. "They told me it's pretty rough." "What did you expect?" asked Tolliver. "Square dances with champagne?" "Don't be silly. Daddy says I'm supposed to learn traffic routing and the business management of a local branch. They probably won't let me see much else." "You never can tell," said the pilot, yielding to temptation. "Any square inch of Ganymede is likely to be dangerous." I'll be sorry later , he reflected, but if Jeffers keeps me jockeying this creeper, I'm entitled to some amusement. And Daddy's little girl is trying too hard to sound like one of the gang. "Yeah," he went on, "right now, I don't do a thing but drive missions from the city to the spaceport." "Missions! You call driving a mile or so a mission ?" Tolliver pursed his lips and put on a shrewd expression. "Don't sneer at Ganymede, honey!" he warned portentously. "Many a man who did isn't here today. Take the fellow who used to drive this mission!" "You can call me Betty. What happened to him?" "I'll tell you some day," Tolliver promised darkly. "This moon can strike like a vicious animal." "Oh, they told me there was nothing alive on Ganymede!" "I was thinking of the mountain slides," said the pilot. "Not to mention volcanic puffballs that pop out through the frozen crust where you'd least expect. That's why I draw such high pay for driving an unarmored tractor." "You use armored vehicles?" gasped the girl. She was now sitting bolt upright in the swaying seat. Tolliver deliberately dipped one track into an icy hollow. In the light gravity, the tractor responded with a weird, floating lurch. "Those slides," he continued. "Ganymede's only about the size of Mercury, something like 3200 miles in diameter, so things get heaped up at steep angles. When the rock and ice are set to sliding, they come at you practically horizontally. It doesn't need much start, and it barrels on for a long way before there's enough friction to stop it. If you're in the way—well, it's just too bad!" Say, that's pretty good! he told himself. What a liar you are, Tolliver! He enlarged upon other dangers to be encountered on the satellite, taking care to impress the newcomer with the daredeviltry of John Tolliver, driver of "missions" across the menacing wastes between dome and port. In the end, he displayed conclusive evidence in the form of the weekly paycheck he had received that morning. It did not, naturally, indicate he was drawing the salary of a space pilot. Betty looked thoughtful. "I'm retiring in six months if I'm still alive," he said bravely, edging the tractor into the airlock at their destination. "Made my pile. No use pushing your luck too far." His charge seemed noticeably subdued, but cleared her throat to request that Tolliver guide her to the office of the manager. She trailed along as if with a burden of worry upon her mind, and the pilot's conscience prickled. I'll get hold of her after Jeffers is through and set her straight , he resolved. It isn't really funny if the sucker is too ignorant to know better. Remembering his grudge against the manager, he took pleasure in walking in without knocking. "Jeffers," he announced, "this is ... just call her Betty." The manager's jowled features twisted into an expression of welcome as jovial as that of a hungry crocodile. "Miss Koslow!" he beamed, like a politician the day before the voting. "It certainly is an honor to have you on Ganymede with us! That's all, Tolliver, you can go. Yes, indeed! Mr. Koslow—the president, that is: your father—sent a message about you. I repeat, it will be an honor to show you the ropes. Did you want something else, Tolliver?" "Never mind him, Mr. Jeffers," snapped the girl, in a tone new to Tolliver. "We won't be working together, I'm afraid. You've already had enough rope." Jeffers seemed to stagger standing still behind his desk. His loose lips twitched uncertainly, and he looked questioningly to Tolliver. The pilot stared at Betty, trying to recall pictures he had seen of the elder Koslow. He was also trying to remember some of the lies he had told en route from the spaceport. "Wh-wh-what do you mean, Miss Koslow?" Jeffers stammered. He darted a suspicious glare at Tolliver. "Mr. Jeffers," said the girl, "I may look like just another spoiled little blonde, but the best part of this company will be mine someday. I was not allowed to reach twenty-two without learning something about holding on to it." Tolliver blinked. He had taken her for three or four years older. Jeffers now ignored him, intent upon the girl. "Daddy gave me the title of tenth vice-president mostly as a joke, when he told me to find out what was wrong with operations on Ganymede. I have some authority, though. And you look like the source of the trouble to me." "You can't prove anything," declared Jeffers hoarsely. "Oh, can't I? I've already seen certain evidence, and the rest won't be hard to find. Where are your books, Mr. Jeffers? You're as good as fired!" The manager dropped heavily to his chair. He stared unbelievingly at Betty, and Tolliver thought he muttered something about "just landed." After a moment, the big man came out of his daze enough to stab an intercom button with his finger. He growled at someone on the other end to come in without a countdown. Tolliver, hardly thinking about it, expected the someone to be a secretary, but it turned out to be three members of Jeffers' headquarters staff. He recognized one as Rawlins, a warehouse chief, and guessed that the other two might be his assistants. They were large enough. "No stupid questions!" Jeffers ordered. "Lock these two up while I think!" Tolliver started for the door immediately, but was blocked off. "Where should we lock—?" the fellow paused to ask. Tolliver brought up a snappy uppercut to the man's chin, feeling that it was a poor time to engage Jeffers in fruitless debate. In the gravity of Ganymede, the man was knocked off balance as much as he was hurt, and sprawled on the floor. "I told you no questions!" bawled Jeffers. The fallen hero, upon arising, had to content himself with grabbing Betty. The others were swarming over Tolliver. Jeffers came around his desk to assist. Tolliver found himself dumped on the floor of an empty office in the adjoining warehouse building. It seemed to him that a long time had been spent in carrying him there. He heard an indignant yelp, and realized that the girl had been pitched in with him. The snapping of a lock was followed by the tramp of departing footsteps and then by silence. After considering the idea a few minutes, Tolliver managed to sit up. He had his wind back. But when he fingered the swelling lump behind his left ear, a sensation befuddled him momentarily. "I'm sorry about that," murmured Betty. Tolliver grunted. Sorrow would not reduce the throbbing, nor was he in a mood to undertake an explanation of why Jeffers did not like him anyway. "I think perhaps you're going to have a shiner," remarked the girl. "Thanks for letting me know in time," said Tolliver. The skin under his right eye did feel a trifle tight, but he could see well enough. The abandoned and empty look of the office worried him. "What can we use to get out of here?" he mused. "Why should we try?" asked the girl. "What can he do?" "You'd be surprised. How did you catch on to him so soon?" "Your paycheck," said Betty. "As soon as I saw that ridiculous amount, it was obvious that there was gross mismanagement here. It had to be Jeffers." Tolliver groaned. "Then, on the way over here, he as good as admitted everything. You didn't hear him, I guess. Well, he seemed to be caught all unaware, and seemed to blame you for it." "Sure!" grumbled the pilot. "He thinks I told you he was grafting or smuggling, or whatever he has going for him here. That's why I want to get out of here—before I find myself involved in some kind of fatal accident!" "What do you know about the crooked goings-on here?" asked Betty after a startled pause. "Nothing," retorted Tolliver. "Except that there are some. There are rumors, and I had a halfway invitation to join in. I think he sells things to the mining colonies and makes a double profit for himself by claiming the stuff lost in transit. You didn't think you scared him that bad over a little slack managing?" The picture of Jeffers huddled with his partners in the headquarters building, plotting the next move, brought Tolliver to his feet. There was nothing in the unused office but an old table and half a dozen plastic crates. He saw that the latter contained a mess of discarded records. "Better than nothing at all," he muttered. He ripped out a double handful of the forms, crumpled them into a pile at the doorway, and pulled out his cigarette lighter. "What do you think you're up to?" asked Betty with some concern. "This plastic is tough," said Tolliver, "but it will bend with enough heat. If I can kick loose a hinge, maybe we can fool them yet!" He got a little fire going, and fed it judiciously with more papers. "You know," he reflected, "it might be better for you to stay here. He can't do much about you, and you don't have any real proof just by yourself." "I'll come along with you, Tolliver," said the girl. "No, I don't think you'd better." "Why not?" "Well ... after all, what would he dare do? Arranging an accident to the daughter of the boss isn't something that he can pull off without a lot of investigation. He'd be better off just running for it." "Let's not argue about it," said Betty, a trifle pale but looking determined. "I'm coming with you. Is that stuff getting soft yet?" Tolliver kicked at the edge of the door experimentally. It seemed to give slightly, so he knocked the burning papers aside and drove his heel hard at the corner below the hinge. The plastic yielded. "That's enough already, Tolliver," whispered the girl. "We can crawl through!" Hardly sixty seconds later, he led her into a maze of stacked crates in the warehouse proper. The building was not much longer than wide, for each of the structures in the colony had its own hemispherical emergency dome of transparent plastic. They soon reached the other end. "I think there's a storeroom for spacesuits around here," muttered Tolliver. "Why do you want them?" "Honey, I just don't think it will be so easy to lay hands on a tractor. I bet Jeffers already phoned the garage and all the airlocks with some good lie that will keep me from getting through." After a brief search, he located the spacesuits. Many, evidently intended for replacements, had never been unpacked, but there were a dozen or so serviced and standing ready for emergencies. He showed Betty how to climb into one, and checked her seals and valves after donning a suit himself. "That switch under your chin," he said, touching helmets so she could hear him. "Leave it turned off. Anybody might be listening!" He led the way out a rear door of the warehouse. With the heavy knife that was standard suit equipment, he deliberately slashed a four-foot square section out of the dome. He motioned to Betty to step through, then trailed along with the plastic under his arm. He caught up and touched helmets again. "Just act as if you're on business," he told her. "For all anyone can see, we might be inspecting the dome." "Where are you going?" asked Betty. "Right through the wall, and then head for the nearest mine. Jeffers can't be running everything !" "Is there any way to get to a TV?" asked the girl. "I ... uh ... Daddy gave me a good number to call if I needed help." "How good?" "Pretty official, as a matter of fact." "All right," Tolliver decided. "We'll try the ship you just came in on. They might have finished refueling and left her empty." They had to cross one open lane between buildings, and Tolliver was very conscious of moving figures in the distance; but no one seemed to look their way. Reaching the foot of the main dome over the establishment, he glanced furtively about, then plunged his knife into the transparent material. From the corner of his eye, he thought he saw Betty make a startled gesture, but he had his work cut out for him. This was tougher than the interior dome. Finally, he managed to saw a ragged slit through which they could squeeze. There was room to walk between the inner and outer layer, so he moved along a few yards. A little dust began to blow about where they had gone through. He touched helmets once more. "This time," he said, "the air will really start to blow, so get through as fast as you can. If I can slap this piece of plastic over the rip, it may stow down the loss of pressure enough to give us quite a lead before the alarms go off." Through the faceplates, he saw the girl nod, wide-eyed. As soon as he plunged the knife into the outer layer, he could see dusty, moist air puffing out into the near-vacuum of Ganymede's surface. Fumbling, he cut as fast as he could and shoved Betty through the small opening. Squeezing through in his turn, he left one arm inside to spread the plastic sheet as best he could. The internal air pressure slapped it against the inside of the dome as if glued, although it immediately showed an alarming tendency to balloon through the ruptured spot. They'll find it, all right , Tolliver reminded himself. Don't be here when they do! He grabbed Betty by the wrist of her spacesuit and headed for the nearest outcropping of rock. It promptly developed that she had something to learn about running on ice in such low gravity. Until they were out of direct line of sight from the settlement, Tolliver simply dragged her. Then, when he decided that it was safe enough to pause and tell her how to manage better, the sight of her outraged scowl through the face-plate made him think better of it. By the time we reach the ship, she'll have learned , he consoled himself. It was a long mile, even at the pace human muscles could achieve on Ganymede. They took one short rest, during which Tolliver was forced to explain away the dangers of slides and volcanic puffballs. He admitted to having exaggerated slightly. In the end, they reached the spaceship. There seemed to be no one about. The landing dome had been collapsed and stored, and the ship's airlock port was closed. "That's all right," Tolliver told the girl. "We can get in with no trouble." It was when he looked about to make sure that they were unobserved that he caught a glimpse of motion back toward the city. He peered at the spot through the dim light. After a moment, he definitely recognized the outline of a tractor breasting a rise in the ground and tilting downward again. "In fact, we have to get in to stay out of trouble," he said to Betty. He located the switch-cover in the hull, opened it and activated the mechanism that swung open the airlock and extended the ladder. It took him considerable scrambling to boost the girl up the ladder and inside, but he managed. They passed through the airlock, fretting at the time required to seal, pump air and open the inner hatch; and then Tolliver led the way up another ladder to the control room. It was a clumsy trip in their spacesuits, but he wanted to save time. In the control room, he shoved the girl into an acceleration seat, glanced at the gauges and showed her how to open her helmet. "Leave the suit on," he ordered, getting in the first word while she was still shaking her head. "It will help a little on the takeoff." "Takeoff!" shrilled Betty. "What do you think you're going to do? I just want to use the radio or TV!" "That tractor will get here in a minute or two. They might cut your conversation kind of short. Now shut up and let me look over these dials!" He ran a practiced eye over the board, reading the condition of the ship. It pleased him. Everything was ready for a takeoff into an economy orbit for Earth. He busied himself making a few adjustments, doing his best to ignore the protests from his partner in crime. He warned her the trip might be long. "I told you not to come," he said at last. "Now sit back!" He sat down and pushed a button to start the igniting process. In a moment, he could feel the rumble of the rockets through the deck, and then it was out of his hands for several minutes. "That wasn't so bad," Betty admitted some time later. "Did you go in the right direction?" "Who knows?" retorted Tolliver. "There wasn't time to check everything . We'll worry about that after we make your call." "Oh!" Betty looked helpless. "It's in my pocket." Tolliver sighed. In their weightless state, it was no easy task to pry her out of the spacesuit. He thought of inquiring if she needed any further help, but reminded himself that this was the boss's daughter. When Betty produced a memo giving frequency and call sign, he set about making contact. It took only a few minutes, as if the channel had been monitored expectantly, and the man who flickered into life on the screen wore a uniform. "Space Patrol?" whispered Tolliver incredulously. "That's right," said Betty. "Uh ... Daddy made arrangements for me." Tolliver held her in front of the screen so she would not float out of range of the scanner and microphone. As she spoke, he stared exasperatedly at a bulkhead, marveling at the influence of a man who could arrange for a cruiser to escort his daughter to Ganymede and wondering what was behind it all. When he heard Betty requesting assistance in arresting Jeffers and reporting the manager as the head of a ring of crooks, he began to suspect. He also noticed certain peculiarities about the remarks of the Patrolman. For one thing, though the officer seemed well acquainted with Betty, he never addressed her by the name of Koslow. For another, he accepted the request as if he had been hanging in orbit merely until learning who to go down after. They really sent her out to nail someone , Tolliver realized. Of course, she stumbled onto Jeffers by plain dumb luck. But she had an idea of what to look for. How do I get into these things? She might have got me killed! "We do have one trouble," he heard Betty saying. "This tractor driver, Tolliver, saved my neck by making the ship take off somehow, but he says it's set for a six-month orbit, or economy flight. Whatever they call it. I don't think he has any idea where we're headed." Tolliver pulled her back, holding her in mid-air by the slack of her sweater. "Actually, I have a fine idea," he informed the officer coldly. "I happen to be a qualified space pilot. Everything here is under control. If Miss Koslow thinks you should arrest Jeffers, you can call us later on this channel." "Miss Koslow?" repeated the spacer. "Did she tell you—well, no matter! If you'll be okay, we'll attend to the other affair immediately." He signed off promptly. The pilot faced Betty, who looked more offended than reassured at discovering his status. "This 'Miss Koslow' business," he said suspiciously. "He sounded funny about that." The girl grinned. "Relax, Tolliver," she told him. "Did you really believe Daddy would send his own little girl way out here to Ganymede to look for whoever was gypping him?" "You ... you...?" "Sure. The name's Betty Hanlon. I work for a private investigating firm. If old Koslow had a son to impersonate—" "I'd be stuck for six months in this orbit with some brash young man," Tolliver finished for her. "I guess it's better this way," he said meditatively a moment later. "Oh, come on ! Can't they get us back? How can you tell where we're going?" "I know enough to check takeoff time. It was practically due anyhow, so we'll float into the vicinity of Earth at about the right time to be picked up." He went on to explain something of the tremendous cost in fuel necessary to make more than minor corrections to their course. Even though the Patrol ship could easily catch the slow freighter, bringing along enough fuel to head back would be something else again. "We'll just have to ride it out," he said sympathetically. "The ship is provisioned according to law, and you were probably going back anyhow." "I didn't expect to so soon." "Yeah, you were pretty lucky. They'll think you're a marvel to crack the case in about three hours on Ganymede." "Great!" muttered Betty. "What a lucky girl I am!" "Yes," admitted Tolliver, "there are problems. If you like, we might get the captain of that Patrol ship to legalize the situation by TV." "I can see you're used to sweeping girls off their feet," she commented sourly. "The main problem is whether you can cook." Betty frowned at him. "I'm pretty good with a pistol," she offered, "or going over crooked books. But cook? Sorry." "Well, one of us had better learn, and I'll have other things to do." "I'll think about it," promised the girl, staring thoughtfully at the deck. Tolliver anchored himself in a seat and grinned as he thought about it too. After a while , he promised himself, I'll explain how I cut the fuel flow and see if she's detective enough to suspect that we're just orbiting Ganymede!
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D. Taking extra is expected and nobody would notice.
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Had Trillium known the outcome of her stowing away, would she have likely still stowed away?
A. Yes, because she was able to accomplish her mission.
B. Yes, because she had already shown that she was selfish and lonely.
C. No, because she was jeopardizing being condemned to a Uranus moon.
D. No, because she wasn't able to prove her point and was sent back to Venus.
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IMAGE OF SPLENDOR By LU KELLA From Venus to Earth, and all the way between, it was a hell of a world for men ... and Apprentice Burnerman O'Rielly particularly. [Transcriber's Note: This etext was produced from Planet Stories Summer 1955. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] The intercom roared fit to blow O'Rielly back to Venus. "Burner Four!" "On my way, sir!" At the first flash of red on the bank of meters Apprentice Burnerman O'Rielly had slammed the safety helmet on his head; he was already throwing open the lock to the burner room. The hot, throbbing rumble whipped around him and near crushed his breath away. Power! Power of the universe trapped here and ready to destroy its captors given one chance! Swiftly O'Rielly unlocked the controls and reset them. The throbbing rumble changed tone. Old Callahan's voice crackled now through the helmet's ear contact. "Well, Mr. O'Rielly?" "Fusion control two points low, sir." O'Rielly wondered had Callahan passed out, was so long before the old Burner Chief demanded hoarsely, "Didn't you lock them controls before blast-off?" "If every control hadn't been locked in correct setting," O'Rielly answered from his own angry bewilderment, "the error would have registered before blast-off—wouldn't it, sir?" "So a control reset itself in flight, hey?" "I don't know yet, sir." "Well, Mr. O'Rielly, you better know before we orbit Earth!" The icy knot in O'Rielly's stomach jerked tighter. A dozen burners on this ship; why did something crazy have to happen to O'Rielly's? In a hundred years, so the instructors—brisk females all—had told O'Rielly in pre-flight school, no control had ever been known to slip. But one had moved here. Not enough to cause serious trouble this far out from Earth. On blast-down, though, with one jet below peak, the uneven thrust could throw the ship, crash it, the whole lovely thing and all aboard gone in a churning cloud. Sweat pouring off him, O'Rielly prowled around his burner. Design of the thing had been bossed by dames of course; what on Earth wasn't any more? Anyway, nobody could get to a burner except through its watch room. Anyone entered or left there, a bell clanged, lights flashed and a meter registered beside the Burnerman's bunk and on the Burner Chief's console up in the flight room full of beautifully efficient officers. Ever since Venus blast-off O'Rielly had been in Four's watch room. Nobody had passed through. O'Rielly knew it. Callahan knew it. By now the Old Woman herself, Captain Millicent Hatwoody, had probably inquired what was in charge of Burner Four. Well, ma'am, O'Rielly searched every cranny where even a three-tailed mouse of Venus could have stowed away. His first flight, and O'Rielly saw himself washed out, busted to sweeper on the blast-off stands of some God-forsaken satellite. He staggered back into his watch room. And his brain was suddenly taken apart and slapped together again. Felt that way. She was sitting on his bunk. No three-tailed mouse. No Old Woman either. Oh, she was a female human, though, this creature at which O'Rielly stood gaping. Yes, ma'am! "I was in your burner room." Her voice matched the rest of her, a blend of loveliness unlike anything outside a guy's most secret dreams. "I couldn't stand the heat any longer and I couldn't open that big door. So I moved one of your controls a tiny bit. All the noise in there, naturally you couldn't hear me walk out while your back was turned resetting the control." O'Rielly suddenly felt like turning her over his knee and whaling her until she couldn't sit for a year. This, mind you, he felt in an age where no Earth guy for a thousand years had dared raise so much as a breath against woman's supremacy in all matters. That male character trait, however, did not seem to be the overpowering reason why O'Rielly, instead of laying violent hands upon this one's person, heard himself saying in sympathetic outrage, "A shame you had to go to all that bother to get out here!" "You're so kind. But I'm afraid I became rather sticky and smelly in there." "They ought to cool the air in there with perfume! I'll drop a suggestion in the Old Woman's box first chance I get." "You're so thoughtful. And do you have bathing facilities?" "That door right there. Oh, let me open it for you!" "You're so sweet." Her big dark eyes glowed with such pure innocence that O'Rielly could have torn down the universe and rebuilt it just for her. Yes, ma'am, O'Rielly was floating on a pink cloud with heavenly music in his head. Never felt so fine before. Except on the Venus layover when he'd been roped into a dice game with a bunch of Venus lads who had a jug to cheer one's parting with one's money. A bell suddenly clanged fit to wake the dead while the overhead lights flashed wildly. Only the watch room door. Only Callahan here now. Old buzzard had a drooped nose like a pick, chin like a shovel. When he talked he was like digging a hole in front of himself. "Well, what about that control?" "What control?" "Your fusion control that got itself two points low!" "Oh, that little thing." Callahan said something through his teeth, then studied O'Rielly sharply. "Hey, you been wetting your whistle on that Venus vino again? Lemme smell your breath! Bah. Loaded yourself full of chlorophyll again probably. All right, stand aside whilst I see your burner." "Charmed to, Burner Chief Callahan, sir," O'Rielly said while bowing gracefully. "Higher than a swacked skunk's tail again," Callahan muttered, then snapped back over his shoulder, "Use your shower!" O'Rielly stood considering his shower door. Somehow he doubted that Burner Chief Terrence Callahan's mood, or Captain Millicent Hatwoody's, would be improved by knowledge of she who was in O'Rielly's shower now. Not that the dear stowaway was less than charming. Quite the contrary. Oh, very quite! "You rockhead!" Only Callahan back from the burner. "Didn't I tell you to shower the stink off yourself? Old Woman's taking a Venus bigwig on tour the ship. Old Woman catches you like you been rassling skunks she'll peel both our hides off. Not to mention what she'll do anyway about your fusion control!" "Burner Chief Callahan, sir," O'Rielly responded courteously, "I have been thinking." "With what? Never mind, just keep on trying whilst I have a shower for myself here." Wherewith Callahan reached hand for O'Rielly's shower door. "Venus dames," O'Rielly said dreamily, "don't boss anything, do they?" Callahan yelped like he'd been bit in the pants by a big Jupiter ant. "O'Rielly! You trying to get both of us condemned to a Uranus moon?" Callahan also shot a wild look to the intercom switch. It was in OFF position; the flight room full of fancy gold-lace petticoats could not have overheard from here. Nevertheless Callahan's eyes rolled like the devil was behind him with the fork ready. "O'Rielly, open your big ears whilst for your own good and mine I speak of certain matters. "Thousand years ago, it was, the first flight reached Venus. Guys got one look at them dames. Had to bring some home or bust. So then everybody on Earth got a look, mostly by TV only of course. That did it. Every guy on Earth began blowing his fuse over them dames. Give up the shirt off his back, last buck in the bank, his own Earth dame or family—everything. "Well, that's when Earth dames took over like armies of wild cats with knots in their tails. Before the guys who'd brought the Venus dames to Earth could say anything they was taken apart too small to pick up with a blotter. Earth dames wound up by flying the Venus ones back where they come from and serving notice if one ever set foot on Earth again there wouldn't be enough left of Venus to find with an electron microscope. "Venus boys rared up and served notice that if Earth ever got any funny notions, right away there wouldn't be enough Earth left to hide in an atom's eyebrow. Touchy as hornets on a hot griddle, them Venus guys. Crazier than bed bugs about war. Could smell a loose dollar a million light years away too. Finagled around until they finally cooked up a deal. "No Venus dames allowed within fifty miles of their port. Earth guys stay inside the high-voltage fence. Any dame caught trying to leave Venus thrown to the tigers for supper. Same for any Earth guy caught around a Venus dame. In return, Earth could buy practically everything at bargain basement prices." "Oh, I was shown the history films in pre-flight," O'Rielly said, still dreamily. "But not a peek of any Venus dame." "Pray heaven you'll never lay eyes on one nor have one get within ten foot of you! Even though you'd know she'd be your damnation wouldn't make a whit difference—you'd still act sappier than thirty-seven angels flying on vino." Callahan suddenly stared at O'Rielly. "Holy hollering saints!" "Now, now, Burner Chief Callahan, sir," O'Rielly responded with an airy laugh. "No Earth guy for a hundred twenty-five years been near one and lived to tell it, has he?" "So the whispers run," Callahan murmured with a queer flame dancing into his eyes. "So the old whispers still run." "Never a name, though. Never how it was done." O'Rielly snorted. "Probably just a goofy tale set loose by some old space bum." "Oh?" Callahan bristled up like a bad name had been bandied about. "Seen them ditty bags Venus bigwigs have, ain't you? Some big enough to stuff a cow in. Notice how nobody ever dares question a bigwig's bags, even through customs? Just run 'em through the big Geiger that tells whether there's any fusionable junk inside. Well, our boy got himself one of them bags, stuffed himself inside and joined a bigwig's pile of 'em. "Didn't pull it whilst on the Venus port during a layover either, when a crew check would of turned him up missing. Pulled it on vacation. Started on the Earth end. Made himself a pair of beards to paste on his ears of course. Wove Jupiter wiggle worms in to keep the beards moving. Wasn't like the real thing, but good enough to flimflam Venus guys." With suddenly enlivened interest O'Rielly looked at Callahan. "Hey, how come you know so much?" "Hah? What?" Callahan blinked like waking from a trance; even groaned to himself, something that sounded like, "Blabbering like I'd had a nip myself—or one of them dillies was radiating nearby." Then Callahan glared fit to drill holes in O'Rielly's head. "Look! I was a full Burnerman before you was born. Been flying the spaces hundred twenty-five years now. Had more chances to hear more—just hear more, you hear! Only tried to clear your mind about Venus dames so you could put your brain on your control mess. So now put it! If you ain't high on vino and ain't been made nuts by a Venus dame, what answer do we feed the Old Woman?" "Search me," Apprentice Burnerman O'Rielly responded cheerfully. "Of all the loony apprentices I ever had to answer the Old Woman for! Awp, lemme out where I can think of something to save me own neck at least!" Was all O'Rielly could do to keep from rolling on the deck with glee. Old Callahan had been flimflammed for fair! The dear little stowaway was saved! And O'Rielly would now think of grand ways to save her lovely neck and his own forever. O'Rielly's shower door, however, opened abruptly. O'Rielly had not opened it. O'Rielly, however, suffered a cruel stab of dismay. Surely his dear stowaway had been listening through the door. Why didn't she have brains enough to stay hid until Callahan was gone! At sight of her, of course, Callahan's eyes near popped from his old head. "Berta!" "Oh, I'm Trillium," she assured Callahan sweetly. "But Grandmamma's name is Berta and people say I'm just like she was a hundred and twenty-five years ago." "Hah? What?" Callahan blinked like his brain had been taken apart and was being slapped together again. "O'Rielly! Awp, you angel-faced pirate, couldn't you hide her somewheres better than that? Shut up, you don't have to explain to me, but God help the whole universe if we don't flimflam the Old Woman!" With which ominous remark, rendered in a zesty devil-may-care manner, however, Callahan threw himself into O'Rielly's shower. O'Rielly stood looking thoughtfully at lovely, womanly, exquisite Trillium. Just like that, O'Rielly felt as sparkling of mind as a spiral nebula. "My locker!" he crowed with inspiration and yanked open the doors under his bunk. He glimpsed a black ditty bag, also the cap and coverall uniform of a baggage boy. "I threw them in there before you came on duty before blast-off," Trillium explained. "I knew the burner room would be warm." Trillium—with her shape—passing as a boy hustling bags through this ship. O'Rielly chortled as he tucked her under his bunk. "Now don't you worry about another thing!" "Oh, I'm not," she assured him happily. "Everything is going just the way Grandmamma knew it would!" O'Rielly's shower opened and Callahan, glowing like a young bucko, bounced onto the bunk. "Well, did you hide her good this time? No, don't tell me! I want to be surprised if the Old Woman ever finds her." "If what old woman finds whom?" a voice like thin ice crackling wanted to know. The watch room's door had opened. Wouldn't think the Old Woman was a day over seventy-five, let alone near two hundred. Cut of her uniform probably lent a helping hand or three to the young snap of her figure. Frosty blue of fancy hair-do, she was, though, and icy of eye as she looked at O'Rielly and Callahan still lolling on the bunk. Her voice was an iceberg exploding. "At attention!" Never in his right mind would any crewman dare fail to come stiffly erect the instant the Old Woman appeared. Behind her stood a colorfully robed specimen of Venus man. Handsome as the devil himself. Fit to snap lesser men in two with his highly bejeweled hands. Fuzzy beards trailed from his ears and kept twitching lazily as he sneered at the spectacle of two men meekly acknowledging the superiority of a woman. She was fit to put frost on a hydrogen burner. "Mr. Callahan, I asked you a question, did I not?" "Believe you did, ma'am," Callahan responded cheerfully. "And the answer is, ma'am, that Apprentice Burnerman O'Rielly and me was discussing—ah—matrimony, ma'am. Mr. Apprentice Burnerman O'Rielly here is considering it, ma'am." Wasn't too bad a fib. The more O'Rielly thought of Trillium, the more ideas he got of doing things he'd never dreamt of before in his life. Yes, ma'am! "Wasting your time talking nonsense!" Old Woman's look was fit to freeze O'Rielly's brain, then she gave Callahan the look. "I sent you down here to find the answer to that fusion control slippage!" "Oh, you'll have the best answer you ever heard of before long, ma'am!" Callahan assured her heartily. "The subject of nonsense—I mean, women—merely chanced to arise whilst we was scientifically analyzing the control phenomenon, ma'am. Naturally I offered this innocent young Burnerman the benefit of me long years of experience. Why," Callahan said with a jaunty laugh, "dames mean nothing to me. Indeed 'twouldn't bother me none if there wasn't one of the things left in the world! Present company excepted, of course," Callahan hastened to say with a courtly bow. "Stay at attention!" Old Woman sniffed the air near Callahan's face, then in O'Rielly's vicinity. "Smothered it with chlorophyll probably," she muttered through her teeth, "if it is that vino." Something horrible as a plague flickered in her eyes, then the old ice was there again. "Apprentice Burnerman, don't you know what your shower is for? Then use it! Mr. Callahan, remain at attention while I inspect this burner!" She tendered a cool glance at the Venus bigwig. "Care to join me, Your Excellency?" "May as well." His Excellency glanced at O'Rielly and Callahan much as he might at a couple of worms. Could bet your last old sox no female ever told any Venus man what to do. The shower units were equipped so no Burnerman need be more than two steps from his responsibility. To keep the Old Woman from possibly blowing her gaskets completely, O'Rielly simply stepped in, shut the door, flipped a switch and tingled as he was electronically cleansed of person and clothes. By time he finished, the Old Woman and His Excellency were already coming out of the burner room, dripping with sweat. Old Woman opened the shower with her customary commanding air. "You first, Your Excellency." "My dear Captain," His Excellency replied like a smoothly drawn dagger, "always the lesser gender enjoys precedence." No Earth dame ever admitted any guy was even equal to any female. Old Woman, a prime symbol of her gender's superiority, whipped a razor edge onto her own words. "Facilities of the Captain's quarters are more satisfactory." "No more so than those of the Ambassadorial Suite." Seeming to grind her teeth, the Old O Woman turned abruptly to leave O'Rielly's watch room. Was all O'Rielly could do to keep from busting out laughing for joy. Old Woman had been flimflammed for fair! Dear Trillium was saved! And betwixt O'Rielly's grand brain and Callahan's great experience she'd be happy forever. A fine loud "thump," however, was now heard. Old Woman whirled back and yanked open the doors under O'Rielly's bunk. "Of all the sappy hiding places!" Callahan yelped, in surprise of course. "Trillium?" His Excellency bellowed as if stung by one of the sabre-tailed hornets of his native planet. "Trillium!" "Trillium," O'Rielly pleaded in loving anguish, "why do you have to keep coming out of hiding just when nobody's going to find you?" Her eyes merely became deep pools in which O'Rielly would have gladly drowned himself if he could. "There are rewards," the Old Woman said with the deadly coldness of outer space, "for Earthmen found in a Venus woman's company, and for her leaving her planet." "Shut up!" His Excellency's ear beards were standing straight out sideways. "I'll handle this!" "May I remind His Excellency," the Old Woman snapped, "that I represent Earth and her dominion of space gained by right of original flight!" "May I remind the Captain," His Excellency declared fit to be heard back to his planet, "that I am the Personal Ambassador of the President of Venus and this thing can mean war!" "Yes! War in which people will actually die!" As His Excellency paled at that grisly remark, the Old Woman spoke through her teeth at O'Rielly, Callahan and Trillium. "All right, come along!" O'Rielly joined the death march gladly. He felt the way Callahan looked: ready to wrap his arms around Trillium's brave loveliness and protect it to his last breath of life. Old Woman led the way to her office. Jabbed some buttons on her desk. Panels on opposite walls lit up. "Presidents of Earth and Venus, please," the Old Woman stated evenly. "Interplanetary emergency." Highly groomed flunkies appeared on the panels and were impersonally pleasant. "Madame President's office. She is in a Cabinet meeting." "Mr. President's office. He is in personal command of our glorious war efforts." Old Woman sighed through her teeth. "Venus woman aboard this ship. Stowaway. Rattle that around your belfries." The flunkies' faces went slack with shock, then were replaced by a blizzard of scrambled faces and torrents of incoherent voices. Finally on the Earth panel appeared the famous classic features. "The facts, if you please, Captain Hatwoody." The Venus panel finally held steady on universally notorious features, that were as fierce as an eagle's, in a fancy war helmet. "Trillium! My own granddaughter? Impossible! Dimdooly," Mr. President roared at his Excellency, "what's this nonsense?" "Some loud creature is interfering," Madame President snapped with annoyance. "Blasted fools still have the circuits crossed," Mr. President swore. "Some silly female cackling now!" The parties in the panels saw each other now. Each one's left hand on a desk moved toward a big red button marked, ROCKETS. "So," Mr. President said evenly. "Another violation by your Earthmen." "By your granddaughter, at least," Madame President replied coolly. "An innocent child," Mr. President snapped, "obviously kidnapped by those two idiotic Earthmen there!" "Oh, no, Grandpapa," Trillium said swiftly; "I stole away all by myself, and Mr. O'Rielly and Callahan have been very helpful." "Impossible!" Grandpapa President's ear beards stood near straight up as he roared, "You couldn't have stolen away by yourself! Trillium, tell the truth!" "Very well. Grandmamma told me how." "Obviously Trillium's poor little brain has been drugged," His Excellency Dimdooly declared. "Grandmamma Berta wouldn't know the first thing about such things!" "Impossible!" Grandpapa President agreed. "I've been married to her for a hundred and twenty-four and a half years and she's the finest rattle-brain I ever knew!" "She learned," Trillium stated emphatically, "a hundred and twenty-five years ago." "Hundred twenty-five," Grandpapa president growled like a boiling volcano. "The year some Earthman.... Never did catch the devil.... Berta? Impossible!" Madame President's shapely finger now rested full on the button that could launch the fleets of war rockets that had been pre-aimed for a thousand years. "I'm afraid your Ambassador is unwelcome now," Madame President stated coolly. "Your granddaughter's actions have every mark of an invasion tactic by your government." "What do you mean, her actions?" Grandpapa President's finger now lay poised on the button that had been waiting a thousand years to blow Earth out of the universe. "My grandchild was kidnapped by men under your official command! Weren't you, Trillium dear?" "No. One of us stowing away was the only way we Venus women could bring our cause to the attention of Earth's President. If Earth will only stop buying from Venus, you won't have any money to squander on your wars any longer no matter what happens to we revolutionaries!" "Revolutionaries? Such claptrap! And what's wrong with my wars? People have to have something to keep their minds off their troubles! Nobody around here gets hurt. Oh, maybe a few scratches here and there. But nobody on Venus dies from the things any more." "But Venus men are so excited all the time about going to war they haven't time for us women. That's why we always radiated such a fatal attraction for Earthmen. We want to be loved! We want our own men home doing useful work!" "Well, they do come home and do useful work! Couple weeks every ten months. Proven to be a highly efficient arrangement." "More boys to run off to your old wars and more girls to stay home and be lonely!" "Now you just listen to me, Trillium!" Grandpapa President was all Venus manhood laying down the law. "That's the way things have been on Venus for ten thousand years and all the women in the universe can't change it!" "I have been in constant contact with my Cabinet during these conversations," Madame President said crisply. "Earth is terminating all trade agreements with Venus as of this instant." "What?" Grandpapa's beards near pulled his ears off. "It's not legal! You can't get away with this!" "Take your finger off that trigger, boy!" a heavenly voice similar to Trillium's advised from the Venus panel. Whereupon Grandpapa glared to one side. "Berta! What are you doing here? I am deciding matters of the gravest interplanetary nature!" "Were." Features more beautifully mature than Trillium's crowded onto the panel too. "From now on I'm doing the deciding." "Nonsense! You're only my wife!" "And new President of Venus, elected by unanimous vote of all women." "Impossible! The men run Venus! Nobody's turning this planet into another Earth where a man can't even sneeze unless some woman says so!" "Take him away, girls," Berta ordered coolly, whereupon her spouse was yanked from view. His bellows, however, could be heard yet. "Unhand me, you fool creatures! Guards! Guards!" "Save your breath," Berta advised him. "And while you're in the cooler, enjoy this latest batch of surrender communiques. We women are in control everywhere now." "Dimmy," Trillium was saying firmly to His Excellency, "you have beat around the bush with me long enough. Now say it!" Dimdooly—the mighty, the lordly, who had sneered at the sight of mere Earthmen kowtowing to a mere woman—swelled up fit to blow his gaskets, then all the gas went out of him. His ear beards, however, still had enough zip left to flutter like butterflies. "Yes, Trillium dear. I love only you. Please marry me at your earliest convenience." "Well, Grandmamma," Trillium said with a highly self-satisfied air, "it works. And just like you said, Earthmen meant nothing once I knew we Venus women had our own men in our power." "Those crewmen there," Grandmamma President said, "seem to be proof enough that we Venus women no longer radiate any threat to Earth's tranquility." Yes, ma'am, O'Rielly sure felt like proof of something all of a sudden. Worse than the hangover from that crap game with Venus vino. He looked away from Trillium and took a look at Callahan. Old guy looked away from Grandmamma President like he was packing the second biggest headache in history. "Hmmmm, yes," Madame President of Earth observed. "Reactions agree perfectly with the psychoanalytical research project we have been conducting on the subject of the Venus female influence. Madame President of Venus, congratulations on your victory! "Long may the superior sex reign on Venus too! We shall be delighted to receive an Ambassadoress to discuss a new trade treaty at your earliest convenience." "Thank you for cancelling the old trade agreements at the psychological moment," Grandmamma President said cordially. "What with the communications mixup, we managed to have the scenes on these panels broadcast throughout all Venus. When the rug went out from under the top man, the tide really turned in our favor. Now, Trillium, you take over Dimmy's credentials." "The Ambassadorial Suite, too," Madame President of Earth said graciously. "Anything else now, Berta?" "I should like," Grandmamma President Berta said charmingly, "that Mr. O'Rielly and Mr. Callahan be suitably rewarded for assisting our revolution better than they knew." "Of course," Madame President of Earth was delighted to oblige. "No doubt Captain Hatwoody knows what reward would satisfy their needs best." The Madame Presidents switched to a private circuit, Trillium dragged Dimdooly off somewhere and the Old Woman eyed O'Rielly and Callahan. Especially she eyed Callahan, like running chilled drills through his old conniving brain. "I award the pair of you five minutes leisure before returning to your stations." "Oh, well," O'Rielly muttered, once he and Callahan were safely beyond earshot, "could have been rewarded worse, I suppose." "What you expect for being flimflammed by a foreign dame, the rings of Saturn? Lucky we ain't programmed to be hung, shot and thrown to the crows for breakfast." Callahan's old pick-and-shovel face wore a little grin like the cat that nobody could prove ate the canary. "You—I mean, that Earth guy a hundred twenty-five years ago," O'Rielly said in sudden thought. "If Venus dames wanted to be loved so bad, why did Trillium's Grandmamma let him go?" "Venus guys wasn't so busy playing war all the time," Callahan mumbled, like to himself, "they'd of found out the answer centuries ago. Yep, guess our boy was the only guy on Earth or Venus to find out and live. Dames bossing both planets now, though, his old secret won't be one much longer. Venus dames could of let it out centuries ago themselves but didn't, just to spite Earth probably. Later, was part of organizing to take over Venus, I guess." O'Rielly still had memories of the way he had felt about Trillium before her revolution. "All right, Callahan, why did 'our boy' leave Grandmamma?" "Yes, ma'am," Callahan sighed like he hadn't heard a word O'Rielly said, "you could sweet-talk 'em, kiss 'em and hold 'em tighter'n Billy-be-damned. And that's all." "I'm not sure," O'Rielly said, "what you mean by, 'that's all.'" "Anybody ever seen anybody but a Venus guy come built with ear beards? Course not." "But I thought our boy was wearing the best fakes ever." "Ain't nothing can match the natural growed-on variety, no, ma'am. Venus guy kisses a Venus dame, his beards grabs her roundst the ears." "So what?" "Tickles 'em, boy, tickles 'em!"
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A. Yes, because she was able to accomplish her mission.
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What was the new editor trying to convince Ross into doing?
A. Re-joining the magazine
B. Leaving Shawn for good
C. Retiring from the magazine
D. Booting out Mehta
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Goings On About Town One of the funniest moments in Brendan Gill's 1975 memoir, Here at "The New Yorker ," comes during a luncheon at the now vanished Ritz in Manhattan. At the table are Gill; William Shawn, then editor of The New Yorker ; and the reclusive English writer Henry Green. Green's new novel, Loving , has just received a very favorable review in The New Yorker . Shawn--"with his usual hushed delicacy of speech and manner"--inquires of the novelist whether he could possibly reveal what prompted the creation of such an exquisite work. Green obliges. "I once asked an old butler in Ireland what had been the happiest times of his life," he says. "The butler replied, 'Lying in bed on Sunday morning, eating tea and toast with cunty fingers.' " This was not the explanation Shawn was expecting, Gill tells us. "Discs of bright red begin to burn in his cheeks." Was Shawn blushing out of prudishness, as we are meant to infer? This was, after all, a man renowned for his retiring propriety, a man who sedulously barred anything smacking of the salacious--from lingerie ads to four-letter words--from the magazine he stewarded from 1952 until 1987, five years before his death. But after reading these two new memoirs about Shawn, I wonder. "He longed for the earthiest and wildest kinds of sexual adventures," Lillian Ross discloses in hers, adding that he lusted after Hannah Arendt, Evonne Goolagong, and Madonna. As for Ved Mehta, he reports that Shawn's favorite thing to watch on television was "people dancing uninhibitedly" ( Soul Train , one guesses). I suspect Shawn did not blush at the "cunty fingers" remark out of prudery. He blushed because it had hit too close to home. Both these memoirs must be read by everyone--everyone, that is, who takes seriously the important business of sorting out precisely how he or she feels about The New Yorker , then and now. Of the two, Mehta's is far and away the more entertaining. This may seem odd, for Mehta is reputed to be a very dull writer whereas Ross is a famously zippy one. Moreover, Mehta writes as Shawn's adoring acolyte, whereas Ross writes as his longtime adulterous lover. Just knowing that Mrs. Shawn is still alive adds a certain tension to reading much of what this Other Woman chooses to divulge. Evidently, "Bill" and Lillian loved each other with a fine, pure love, a love that was more than love, a love coveted by the winged seraphs of heaven. "We had indeed become one," she tells us, freely venting the inflations of her heart. Shawn was managing editor of The New Yorker when he hired Ross in 1945 as the magazine's second woman reporter (the first was Andy Logan). He was short and balding but had pale blue eyes to die for. As for Ross, "I was aware of the fact that I was not unappealing." During a late-night editorial session, she says, Shawn blurted out his love. A few weeks later at the office, their eyes met. Without a word--even, it seems, to the cab driver--they hied uptown to the Plaza, where matters were consummated. Thereafter, the couple set up housekeeping together in an apartment 20 blocks downtown from the Shawn residence on upper Fifth Avenue and stoically endured the sufferings of Shawn's wife, who did not want a divorce. Now, Ross seems like a nice lady, and I certainly have nothing against adultery, which I hear is being carried on in the best circles these days. But the public flaunting of adultery--especially when spouses and children are around--well, it brings out the bourgeois in me. It also made me feel funny about William Shawn, whom I have always regarded as a great man. I loved his New Yorker . The prose it contained--the gray stuff around the cartoons--was balm for the soul: unfailingly clear, precise, logical, and quietly stylish. So what if the articles were occasionally boring? It was a sweet sort of boredom, serene and restorative, not at all like the kind induced by magazines today, which is more akin to nervous exhaustion. Besides, the moral tone of the magazine was almost wholly admirable--it was ahead of the pack on Hiroshima, civil rights, Vietnam, Watergate, the environment--and this was very much Shawn's doing. I do not like to think of him in an illicit love nest, eating tea and toast with cunty fingers. Happily, Ross has sprinkled her memoir with clues that it is not to be taken as entirely factual. To say that Shawn was "a man who grieved over all living creatures" is forgivable hyperbole; but later to add that he "mourned" for Si Newhouse when Newhouse unceremoniously fired him in 1987 (a couple of years after buying the magazine)--well, that's a bit much. Even Jesus had his limits. Elsewhere, Ross refers to her lover's "very powerful masculinity," only to note on the very next page that "if he suffered a paper cut on a finger and saw blood, he would come into my office, looking pale." She declares that "Bill was incapable of engendering a cliché, in deed as well as in word." But then she puts the most toe-curling clichés into his mouth: "Why am I more ghost than man?" Or: "We must arrest our love in midflight. And we fix it forever as of today, a point of pure light that will reach into eternity." (File that under Romantic Effusions We Doubt Ever Got Uttered.) Nor is Ross incapable of a melodramatic cliché herself. "Why can't we just live, just live ?" she cries in anguish when she and Shawn, walking hand in hand out of Central Park, chance to see Shawn's wife slowly making her way down the block with a burden of packages. And what does she think of Mrs. Shawn? "I found her to be sensitive and likeable." Plus, she could "do a mean Charleston." There is nothing more poignant than the image of an openly cheated-upon and humiliated wife doing "a mean Charleston." William Shawn's indispensability as an editor is amply manifest in Ross' memoir. Word repetition? "Whatever reporting Bill asked me to do turned out to be both challenging and fun. ... For me, reporting and writing for the magazine was fun, pure fun. ... It was never 'work' for me. It was fun." Even in praising his skill as an editor, she betrays the presence of its absence. "All writers, of course, have needed the one called the 'editor,' who singularly, almost mystically, embodies the many-faceted, unique life force infusing the entire enchilada." Nice touch, that enchilada. When cocktail party malcontents mocked Shawn's New Yorker in the late '70s and early '80s, they would make fun of such things as E.J. Kahn's five-part series on "Grains of the World" or Elizabeth Drew's supposedly soporific reporting from Washington. But Ved Mehta was always the butt of the worst abuse. Shawn was allowing him to publish an autobiography in the pages of the magazine that was mounting up to millions of words over the years, and the very idea of it seemed to bore people silly. After the publication of two early installments, "Daddyji" and "Mamaji," each the length of a book, one critic cried: "Enoughji!" But it kept coming. And I, for one, was grateful. Here was a boy growing up in Punjab during the fall of the Raj and the Partition, a boy who had been blinded by meningitis at the age of 3, roller-skating through the back streets of Lahore as Sikhs slaughtered Hindus and Hindus slaughtered Muslims and civilization was collapsing and then, decades later, having made his way from India to an Arkansas school for the blind to Balliol College, Oxford, to The New Yorker , re-creating the whole thing in Proustian detail and better-than-Proustian prose ... ! Mehta's multivolume autobiography, titled Continents of Exile , has loss as its overarching theme: loss of sight, of childhood, of home and country, and now--with this volume--loss of Mr. Shawn's New Yorker . The memoir takes us from the time the author was hired as a staff writer in the early '60s up to 1994, when he was "terminated" by the loathed Tina Brown in her vandalization of his cherished magazine. Mehta evidently loved William Shawn at least as much as Lillian Ross did, although his love was not requited in the same way. He likens the revered editor to the character Prince Myshkin in The Idiot : innocent and vulnerable, someone who must be protected. And long-suffering, one might infer: "He was so careful of not hurting anyone's feelings that he often listened to utterly fatuous arguments for hours on end." Like Ross, Mehta struggles to express William Shawn's ineffable virtues. "It is as if, Mehta, he were beyond our human conception," Janet Flanner tells him once to calm him down. At times I wondered whether the author, in his ecstasies of devotion, had not inadvertently committed plagiarism. His words on Mr. Shawn sound suspiciously like those of Mr. Pooter on his boss Mr. Perkupp in The Diary of a Nobody . Compare. Mehta on Shawn: "His words were so generous that I could scarcely find my tongue, even to thank him." Pooter on Perkupp: "My heart was too full to thank him." Mehta: "I started saying to myself compulsively, 'I wish Mr. Shawn would ring,' at the oddest times of the day or night. ... How I longed for the parade of proofs, the excitement of rewriting and perfecting!" Pooter: "Mr. Perkupp, I will work night and day to serve you!" I am not sure I have made it sound this way so far, but Mehta's book is completely engrossing--the most enjoyable book, I think, I have ever reviewed. It oozes affection and conviction, crackles with anger, and is stuffed with thumping good stories. Many are about Mehta's daft colleagues at The New Yorker , such as the guy in the next office: His door was always shut, but I could hear him through the wall that separated his cubicle from mine typing without pause. ... Even the changing of the paper in the typewriter seemed somehow to be incorporated into the rhythmic rat-tat-tat ... year after year went by to the sound of his typing but without a word from his typewriter appearing in the magazine. Or the great and eccentric Irish writer Maeve Breenan, who fetched up as a bag lady. Or the legendary St. Clair McKelway, whose decisive breakdown came when he hailed a cab and prevailed upon the driver to take him to the New Yorker office at 24 West 43 rd St. "O.K., Mac, if that's what you want." He was in Boston at the time. (McKelway later told Mehta that if the cabby had not called him "Mac," his nickname, an alarm might have gone off in his head.) Mehta's writerly persona, a disarming mixture of the feline and the naive, is perfect for relating the little scandals that worried The New Yorker in the late '70s (plagiarism, frozen turbot), the drama of finding a worthy candidate to succeed the aging Shawn as editor, the purchase of the magazine by the evil Si Newhouse ("We all took fright") and the resultant plague of Gottliebs and Florios visited upon it, and what he sees as the final debacle: Tinaji. Lillian Ross, by contrast, takes a rather cheerful view of the Brown dispensation. Indeed, the new editor even coaxed Ross into re-joining the magazine, just as she was booting Mehta out. "I found that she possessed--under the usual disguises--her own share of Bill's kind of naivete, insight, and sensitivity," Ross says of Brown. "She, too, 'got it.' " A few months after Brown was appointed editor, Shawn died at the age of 85. He had long since stopped reading his beloved magazine, in sorrow and relief. That's if you believe Mehta. Ross assures us that Mr. Shawn was reading Tina Brown's New Yorker "with new interest" in the weeks prior to his death. Has Tina Brown betrayed the legacy of William Shawn, as Mehta fiercely believes, or has she continued and built upon it, as Ross is evidently convinced? Have the changes she has wrought enlivened a stodgy magazine or vulgarized a dignified one--or both? These are weighty questions, and one is of course loath to compromise one's life chances by hazarding unripe opinions in a public forum such as this.
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A. Re-joining the magazine
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What is significant about Wayne’s averse reaction to witnessing the stewbum beating?
A. It foreshadows that Wayne will not be able to go through with his kill
B. It is symbolic for the inner rage bubbling within Wayne’s teenage brain.
C. It references the rage he feels toward his cowardly and stupid father
D. It foreshadows the violence Wayne will do to Red
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THE RECRUIT BY BRYCE WALTON It was dirty work, but it would make him a man. And kids had a right to grow up—some of them! [Transcriber's Note: This etext was produced from Worlds of If Science Fiction, July 1962. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Wayne, unseen, sneered down from the head of the stairs. The old man with his thick neck, thick cigar, evening highball, potgut and bald head without a brain in it. His slim mother with nervously polite smiles and voice fluttering, assuring the old man by her frailty that he was big in the world. They were squareheads one and all, marking moron time in a gray dream. Man, was he glad to break out. The old man said, "He'll be okay. Let him alone." "But he won't eat. Just lies there all the time." "Hell," the old man said. "Sixteen's a bad time. School over, waiting for the draft and all. He's in between. It's rough." Mother clasped her forearms and shook her head once slowly. "We got to let him go, Eva. It's a dangerous time. You got to remember about all these dangerous repressed impulses piling up with nowhere to go, like they say. You read the books." "But he's unhappy." "Are we specialists? That's the Youth Board's headache, ain't it? What do we know about adolescent trauma and like that? Now get dressed or we'll be late." Wayne watched the ritual, grinning. He listened to their purposeless noises, their blabbing and yakking as if they had something to say. Blab-blab about the same old bones, and end up chewing them in the same old ways. Then they begin all over again. A freak sideshow all the way to nowhere. Squareheads going around either unconscious or with eyes looking dead from the millennium in the office waiting to retire into limbo. How come he'd been stuck with parental images like that? One thing—when he was jockeying a rocket to Mars or maybe firing the pants off Asiatic reds in some steamy gone jungle paradise, he'd forget his punkie origins in teeveeland. But the old man was right on for once about the dangerous repressed impulses. Wayne had heard about it often enough. Anyway there was no doubt about it when every move he made was a restrained explosion. So he'd waited in his room, and it wasn't easy sweating it out alone waiting for the breakout call from HQ. "Well, dear, if you say so," Mother said, with the old resigned sigh that must make the old man feel like Superman with a beerbelly. They heard Wayne slouching loosely down the stairs and looked up. "Relax," Wayne said. "You're not going anywhere tonight." "What, son?" his old man said uneasily. "Sure we are. We're going to the movies." He could feel them watching him, waiting; and yet still he didn't answer. Somewhere out in suburban grayness a dog barked, then was silent. "Okay, go," Wayne said. "If you wanta walk. I'm taking the family boltbucket." "But we promised the Clemons, dear," his mother said. "Hell," Wayne said, grinning straight into the old man. "I just got my draft call." He saw the old man's Adam's apple move. "Oh, my dear boy," Mother cried out. "So gimme the keys," Wayne said. The old man handed the keys over. His understanding smile was strained, and fear flicked in his sagging eyes. "Do be careful, dear," his mother said. She ran toward him as he laughed and shut the door on her. He was still laughing as he whoomed the Olds between the pale dead glow of houses and roared up the ramp onto the Freeway. Ahead was the promising glitter of adventure-calling neon, and he looked up at the high skies of night and his eyes sailed the glaring wonders of escape. He burned off some rubber finding a slot in the park-lot. He strode under a sign reading Public Youth Center No. 947 and walked casually to the reception desk, where a thin man with sergeant's stripes and a pansy haircut looked out of a pile of paperwork. "Where you think you're going, my pretty lad?" Wayne grinned down. "Higher I hope than a typewriter jockey." "Well," the sergeant said. "How tough we are this evening. You have a pass, killer?" "Wayne Seton. Draft call." "Oh." The sergeant checked his name off a roster and nodded. He wrote on a slip of paper, handed the pass to Wayne. "Go to the Armory and check out whatever your lusting little heart desires. Then report to Captain Jack, room 307." "Thanks, sarge dear," Wayne said and took the elevator up to the Armory. A tired fat corporal with a naked head blinked up at tall Wayne. Finally he said, "So make up your mind, bud. Think you're the only kid breaking out tonight?" "Hold your teeth, pop," Wayne said, coolly and slowly lighting a cigarette. "I've decided." The corporal's little eyes studied Wayne with malicious amusement. "Take it from a vet, bud. Sooner you go the better. It's a big city and you're starting late. You can get a cat, not a mouse, and some babes are clever hellcats in a dark alley." "You must be a genius," Wayne said. "A corporal with no hair and still a counterboy. I'm impressed. I'm all ears, Dad." The corporal sighed wearily. "You can get that balloon head ventilated, bud, and good." Wayne's mouth twitched. He leaned across the counter toward the shelves and racks of weapons. "I'll remember that crack when I get my commission." He blew smoke in the corporal's face. "Bring me a Smith and Wesson .38, shoulder holster with spring-clip. And throw in a Skelly switchblade for kicks—the six-inch disguised job with the double springs." The corporal waddled back with the revolver and the switchblade disguised in a leather comb case. He checked them on a receipt ledger, while Wayne examined the weapons, broke open the revolver, twirled the cylinder and pushed cartridges into the waiting chamber. He slipped the knife from the comb case, flicked open the blade and stared at its gleam in the buttery light as his mouth went dry and the refracted incandescence of it trickled on his brain like melted ice, exciting and scary. He removed his leather jacket. He slung the holster under his left armpit and tested the spring clip release several times, feeling the way the serrated butt dropped into his wet palm. He put his jacket back on and the switchblade case in his pocket. He walked toward the elevator and didn't look back as the corporal said, "Good luck, tiger." Captain Jack moved massively. The big stone-walled office, alive with stuffed lion and tiger and gunracks, seemed to grow smaller. Captain Jack crossed black-booted legs and whacked a cane at the floor. It had a head shaped like a grinning bear. Wayne felt the assured smile die on his face. Something seemed to shrink him. If he didn't watch himself he'd begin feeling like a pea among bowling balls. Contemptuously amused little eyes glittered at Wayne from a shaggy head. Shoulders hunched like stuffed sea-bags. "Wayne Seton," said Captain Jack as if he were discussing something in a bug collection. "Well, well, you're really fired up aren't you? Really going out to eat 'em. Right, punk?" "Yes, sir," Wayne said. He ran wet hands down the sides of his chinos. His legs seemed sheathed in lead as he bit inwardly at shrinking fear the way a dog snaps at a wound. You big overblown son, he thought, I'll show you but good who is a punk. They made a guy wait and sweat until he screamed. They kept a guy on the fire until desire leaped in him, ran and billowed and roared until his brain was filled with it. But that wasn't enough. If this muscle-bound creep was such a big boy, what was he doing holding down a desk? "Well, this is it, punk. You go the distance or start a butterfly collection." The cane darted up. A blade snicked from the end and stopped an inch from Wayne's nose. He jerked up a shaky hand involuntarily and clamped a knuckle-ridged gag to his gasping mouth. Captain Jack chuckled. "All right, superboy." He handed Wayne his passcard. "Curfew's off, punk, for 6 hours. You got 6 hours to make out." "Yes, sir." "Your beast is primed and waiting at the Four Aces Club on the West Side. Know where that is, punk?" "No, sir, but I'll find it fast." "Sure you will, punk," smiled Captain Jack. "She'll be wearing yellow slacks and a red shirt. Black hair, a cute trick. She's with a hefty psycho who eats punks for breakfast. He's butchered five people. They're both on top of the Undesirable list, Seton. They got to go and they're your key to the stars." "Yes, sir," Wayne said. "So run along and make out, punk," grinned Captain Jack. A copcar stopped Wayne as he started over the bridge, out of bright respectable neon into the murky westside slum over the river. Wayne waved the pass card, signed by Captain Jack, under the cop's quivering nose. The cop shivered and stepped back and waved him on. The Olds roared over the bridge as the night's rain blew away. The air through the open window was chill and damp coming from Slumville, but Wayne felt a cold that wasn't of the night or the wind. He turned off into a rat's warren of the inferiors. Lights turned pale, secretive and sparse, the uncared-for streets became rough with pitted potholes, narrow and winding and humid with wet unpleasant smells. Wayne's fearful exhilaration increased as he cruised with bated breath through the dark mazes of streets and rickety tenements crawling with the shadows of mysterious promise. He found the alley, dark, a gloom-dripping tunnel. He drove cautiously into it and rolled along, watching. His belly ached with expectancy as he spotted the sick-looking dab of neon wanly sparkling. FOUR ACES CLUB He parked across the alley. He got out and stood in shadows, digging the sultry beat of a combo, the wild pulse of drums and spinning brass filtering through windows painted black. He breathed deep, started over, ducked back. A stewbum weaved out of a bank of garbage cans, humming to himself, pulling at a rainsoaked shirt clinging to a pale stick body. He reminded Wayne of a slim grub balanced on one end. The stewbum stumbled. His bearded face in dim breaking moonlight had a dirty, greenish tinge as he sensed Wayne there. He turned in a grotesque uncoordinated jiggling and his eyes were wide with terror and doom. "I gotta hide, kid. They're on me." Wayne's chest rose and his hands curled. The bum's fingers drew at the air like white talons. "Help me, kid." He turned with a scratchy cry and retreated before the sudden blast of headlights from a Cad bulleting into the alley. The Cad rushed past Wayne and he felt the engine-hot fumes against his legs. Tires squealed. The Cad stopped and a teener in black jacket jumped out and crouched as he began stalking the old rummy. "This is him! This is him all right," the teener yelled, and one hand came up swinging a baseball bat. A head bobbed out of the Cad window and giggled. The fumble-footed rummy tried to run and plopped on wet pavement. The teener moved in, while a faint odor of burnt rubber hovered in the air as the Cad cruised in a slow follow-up. Wayne's breath quickened as he watched, feeling somehow blank wonder at finding himself there, free and breaking out at last with no curfew and no law but his own. He felt as though he couldn't stop anything. Living seemed directionless, but he still would go with it regardless, until something dropped off or blew to hell like a hot light-bulb. He held his breath, waiting. His body was tensed and rigid as he moved in spirit with the hunting teener, an omniscient shadow with a hunting license and a ghetto jungle twenty miles deep. The crawling stewbum screamed as the baseball bat whacked. The teener laughed. Wayne wanted to shout. He opened his mouth, but the yell clogged up somewhere, so that he remained soundless yet with his mouth still open as he heard the payoff thuds where the useless wino curled up with stick arms over his rheumy face. The teener laughed, tossed the bat away and began jumping up and down with his hobnailed, mail-order air force boots. Then he ran into the Cad. A hootch bottle soared out, made a brittle tink-tink of falling glass. "Go, man!" The Cad wooshed by. It made a sort of hollow sucking noise as it bounced over the old man twice. Then the finlights diminished like bright wind-blown sparks. Wayne walked over and sneered down at the human garbage lying in scummed rain pools. The smell of raw violence, the scent of blood, made his heart thump like a trapped rubber ball in a cage. He hurried into the Four Aces, drawn by an exhilarating vision ... and pursued by the hollow haunting fears of his own desires. He walked through the wavering haze of smoke and liquored dizziness and stood until his eyes learned the dark. He spotted her red shirt and yellow legs over in the corner above a murky lighted table. He walked toward her, watching her little subhuman pixie face lift. The eyes widened with exciting terror, turned even paler behind a red slash of sensuous mouth. Briefed and waiting, primed and eager for running, she recognized her pursuer at once. He sat at a table near her, watching and grinning and seeing her squirm. She sat in that slightly baffled, fearful and uncomprehending attitude of being motionless, as though they were all actors performing in a weirdo drama being staged in that smoky thick-aired dive. Wayne smiled with wry superiority at the redheaded psycho in a dirty T-shirt, a big bruiser with a gorilla face. He was tussling his mouse heavy. "What's yours, teener?" the slug-faced waiter asked. "Bring me a Crusher, buddyroo," Wayne said, and flashed his pass card. "Sure, teener." Red nuzzled the mouse's neck and made drooly noises. Wayne watched and fed on the promising terror and helplessness of her hunted face. She sat rigid, eyes fixed on Wayne like balls of frozen glass. Red looked up and stared straight at Wayne with eyes like black buttons imbedded in the waxlike skin of his face. Then he grinned all on one side. One huge hand scratched across the wet table top like a furious cat's. Wayne returned the challenging move but felt a nervous twitch jerk at his lips. A numbness covered his brain like a film as he concentrated on staring down Red the psycho. But Red kept looking, his eyes bright but dead. Then he began struggling it up again with the scared little mouse. The waiter sat the Crusher down. Wayne signed a chit; tonight he was in the pay of the state. "What else, teener?" "One thing. Fade." "Sure, teener," the waiter said, his breathy words dripping like syrup. Wayne drank. Liquored heat dripped into his stomach. Fire tickled his veins, became hot wire twisting in his head. He drank again and forced out a shaky breath. The jazz beat thumped fast and muted brass moaned. Drumpulse, stabbing trumpet raped the air. Tension mounted as Wayne watched her pale throat convulsing, the white eyelids fluttering. Red fingered at her legs and salivated at her throat, glancing now and then at Wayne, baiting him good. "Okay, you creep," Wayne said. He stood up and started through the haze. The psycho leaped and a table crashed. Wayne's .38 dropped from its spring-clip holster and the blast filled the room. The psycho screamed and stumbled toward the door holding something in. The mouse darted by, eluded Wayne's grasp and was out the door. Wayne went out after her in a laughing frenzy of release. He felt the cold strange breath of moist air on his sweating skin as he sprinted down the alley into a wind full of blowing wet. He ran laughing under the crazy starlight and glimpsed her now and then, fading in and out of shadows, jumping, crawling, running with the life-or-death animation of a wild deer. Up and down alleys, a rat's maze. A rabbit run. Across vacant lots. Through shattered tenement ruins. Over a fence. There she was, falling, sliding down a brick shute. He gained. He moved up. His labored breath pumped more fire. And her scream was a rejuvenation hypo in his blood. She quivered above him on the stoop, panting, her eyes afire with terror. "You, baby," Wayne gasped. "I gotcha." She backed into darkness, up there against the sagging tenement wall, her arms out and poised like crippled wings. Wayne crept up. She gave a squeaking sob, turned, ran. Wayne leaped into gloom. Wood cracked. He clambered over rotten lumber. The doorway sagged and he hesitated in the musty dark. A few feet away was the sound of loose trickling plaster, a whimpering whine. "No use running," Wayne said. "Go loose. Give, baby. Give now." She scurried up sagging stairs. Wayne laughed and dug up after her, feeling his way through debris. Dim moonlight filtered through a sagging stairway from a shattered skylight three floors up. The mouse's shadow floated ahead. He started up. The entire stair structure canted sickeningly. A railing ripped and he nearly went with it back down to the first floor. He heard a scream as rotten boards crumbled and dust exploded from cracks. A rat ran past Wayne and fell into space. He burst into the third-floor hallway and saw her half-falling through a door under the jagged skylight. Wayne took his time. He knew how she felt waiting in there, listening to his creeping, implacable footfalls. Then he yelled and slammed open the door. Dust and stench, filth so awful it made nothing of the dust. In the corner he saw something hardly to be called a bed. More like a nest. A dirty, lumpy pile of torn mattress, felt, excelsior, shredded newspapers and rags. It seemed to crawl a little under the moon-streaming skylight. She crouched in the corner panting. He took his time moving in. He snickered as he flashed the switchblade and circled it like a serpent's tongue. He watched what was left of her nerves go to pieces like rotten cloth. "Do it quick, hunter," she whispered. "Please do it quick." "What's that, baby?" "I'm tired running. Kill me first. Beat me after. They won't know the difference." "I'm gonna bruise and beat you," he said. "Kill me first," she begged. "I don't want—" She began to cry. She cried right up in his face, her wide eyes unblinking, and her mouth open. "You got bad blood, baby," he snarled. He laughed but it didn't sound like him and something was wrong with his belly. It was knotting up. "Bad, I know! So get it over with, please. Hurry, hurry." She was small and white and quivering. She moaned but kept staring up at him. He ripped off his rivet-studded belt and swung once, then groaned and shuffled away from her. He kept backing toward the door. She crawled after him, begging and clutching with both arms as she wriggled forward on her knees. "Don't run. Please. Kill me! It'll be someone else if you don't. Oh, God, I'm so tired waiting and running!" "I can't," he said, and sickness soured in his throat. "Please." "I can't, I can't!" He turned and ran blindly, half-fell down the cracking stairs. Doctor Burns, head of the readjustment staff at the Youth Center, studied Wayne with abstract interest. "You enjoyed the hunt, Seton? You got your kicks?" "Yes, sir." "But you couldn't execute them?" "No, sir." "They're undesirables. Incurables. You know that, Seton?" "Yes, sir." "The psycho you only wounded. He's a five-times murderer. And that girl killed her father when she was twelve. You realize there's nothing can be done for them? That they have to be executed?" "I know." "Too bad," the doctor said. "We all have aggressive impulses, primitive needs that must be expressed early, purged. There's murder in all of us, Seton. The impulse shouldn't be denied or suppressed, but educated . The state used to kill them. Isn't it better all around, Seton, for us to do it, as part of growing up? What was the matter, Seton?" "I—felt sorry for her." "Is that all you can say about it?" "Yes, sir." The doctor pressed a buzzer. Two men in white coats entered. "You should have got it out of your system, Seton, but now it's still in there. I can't turn you out and have it erupt later—and maybe shed clean innocent blood, can I?" "No, sir," Wayne mumbled. He didn't look up. "I'm sorry I punked out." "Give him the treatment," the doctor said wearily. "And send him back to his mother." Wayne nodded and they led him away. His mind screamed still to split open some prison of bone and lay bare and breathing wide. But there was no way out for the trapped. Now he knew about the old man and his poker-playing pals. They had all punked out. Like him.
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A. It foreshadows that Wayne will not be able to go through with his kill
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What is the size of the dataset?
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### Introduction
Kurdish language processing requires endeavor by interested researchers and scholars to overcome with a large gap which it has regarding the resource scarcity. The areas that need attention and the efforts required have been addressed in BIBREF0. The Kurdish speech recognition is an area which has not been studied so far. We were not able to retrieve any resources in the literature regarding this subject. In this paper, we present a dataset based on CMUShpinx BIBREF1 for Sorani Kurdish. We call it a Dataset for Sorani Kurdish Automatic Speech Recognition (BD-4SK-ASR). Although other technologies are emerging, CMUShpinx could still be used for experimental studies. The rest of this paper is organized as follows. Section SECREF2 reviews the related work. Section SECREF3 presents different parts of the dataset, such as the dictionary, phoneset, transcriptions, corpus, and language model. Finally, Section SECREF4 concludes the paper and suggests some areas for future work. ### Related work
The work on Automatic Speech Recognition (ASR) has a long history, but we could not retrieve any literature on Kurdish ASR at the time of compiling this article. However, the literature on ASR for different languages is resourceful. Also, researchers have widely used CMUSphinx for ASR though other technologies have been emerging in recent years BIBREF1. We decided to use CMUSphinx because we found it a proper and well-established environment to start Kurdish ASR. ### The BD-4SK-ASR Dataset
To develop the dataset, we extracted 200 sentences from Sorani Kurdish books of grades one to three of the primary school in the Kurdistan Region of Iraq. We randomly created 2000 sentences from the extracted sentences. In the following sections, we present the available items in the dataset. The dataset ia available on https://github.com/KurdishBLARK/BD-4SK-ASR. ### The BD-4SK-ASR Dataset ::: Phoeset
The phoneset includes 34 phones for Sorani Kurdish. A sample of the file content is given below. R RR S SIL SH T V W WW Figure FIGREF3 shows the Sorani letters in Persian-Arabic script, the suggested phoneme (capital English letters), and an example of the transformation of words in the developed corpus. ### The BD-4SK-ASR Dataset ::: Filler phones
The filler phone file usually contains fillers in spoken sentences. In our basic sentences, we have only considered silence. Therefore it only includes three lines to indicate the possible pauses at the beginning and end of the sentences and also after each word. ### The BD-4SK-ASR Dataset ::: The File IDs
This file includes the list of files in which the narrated sentences have been recorded. The recorded files are in wav formats. However, in the file IDs, the extension is omitted. A sample of the file content is given below. The test directory is the directory in which the files are located. test/T1-1-50-01 test/T1-1-50-02 test/T1-1-50-03 test/T1-1-50-04 test/T1-1-50-05 test/T1-1-50-06 ### The BD-4SK-ASR Dataset ::: The Transcription
This file contains the transcription of each sentence based on the phoneset along with the file ID in which the equivalent narration has been saved. The following is a sample of the content of the file. <s> BYR RRAAMAAN DAARISTAANA AMAANAY </s> (T1-1-50-18) <s> DWWRA HAWLER CHIRAAYA SARDAAN NABWW </s> (T1-1-50-19) <s> SAALL DYWAAR QWTAABXAANA NACHIN </s> (T1-1-50-20) <s> XWENDIN ANDAAMAANY GASHA </s> (T1-1-50-21) <s> NAMAAM WRYAA KIRD PSHWWDAA </s> (T1-1-50-22) <s> DARCHWWY DAKAN DAKAWET </s> (T1-1-50-23) <s> CHAND BIRAAT MAQAST </s> (T1-1-50-24) <s> BAAXCHAKAY DAAYK DARCHWWY </s> (T1-1-50-25) <s> RROZH JWAAN DAKAWET ZYAANYAAN </s> (T1-1-50-26) ### The BD-4SK-ASR Dataset ::: The Corpus
The corpus includes 2000 sentences. Theses sentence are random renderings of 200 sentences, which we have taken from Sorani Kurdish books of the grades one to three of the primary school in the Kurdistan Region of Iraq. The reason that we have taken only 200 sentences is to have a smaller dictionary and also to increase the repetition of each word in the narrated speech. We transformed the corpus sentences, which are in Persian-Arabic script, into the format which complies with the suggested phones for the related Sorani letters (see Section SECREF6). ### The BD-4SK-ASR Dataset ::: The Narration Files
Two thousand narration files were created. We used Audacity to record the narrations. We used a normal laptop in a quiet room and minimized the background noise. However, we could not manage to avoid the noise of the fan of the laptop. A single speaker narrated the 2000 sentences, which took several days. We set the Audacity software to have a sampling rate of 16, 16-bit bit rate, and a mono (single) channel. The noise reduction db was set to 6, the sensitivity to 4.00, and the frequency smoothing to 0. ### The BD-4SK-ASR Dataset ::: The Language Model
We created the language from the transcriptions. The model was created using CMUSphinx in which (fixed) discount mass is 0.5, and backoffs are computed using the ratio method. The model includes 283 unigrams, 5337 bigrams, and 6935 trigrams. ### Conclusion
We presented a dataset, BD-4SK-ASR, that could be used in training and developing an acoustic model for Automatic Speech Recognition in CMUSphinx environment for Sorani Kurdish. The Kurdish books of grades one to three of primary schools in the Kurdistan Region of Iraq were used to extract 200 sample sentences. The dataset includes the dictionary, the phoneset, the transcriptions of the corpus sentences using the suggested phones, the recorded narrations of the sentences, and the acoustic model. The dataset could be used to start experiments on Sorani Kurdish ASR. As it was mentioned before, research and development on Kurdish ASR require a huge amount of effort. A variety of areas must be explored, and various resources must be collected and developed. The multi-dialect characteristic of Kurdish makes these tasks rather demanding. To participate in these efforts, we are interested in the expansion of Kurdish ASR by developing a larger dataset based on larger Sorani corpora, working on the other Kurdish dialects, and using new environments for ASR such as Kaldi. Figure 1: The Sorani sounds along with their phoneme representation.
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2000 sentences
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Why did Jig and Bucky rarely come in through the front door?
A. They wanted to avoid the screams of Gertrude
B. They wanted to avoid the debt collectors
C. They preferred the back entrance as to be closer to the action
D. They wanted to avoid the Vapor snakes
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The Blue Behemoth By LEIGH BRACKETT Shannon's Imperial Circus was a jinxed space-carny leased for a mysterious tour of the inner worlds. It made a one-night pitch on a Venusian swamp-town—to find that death stalked it from the jungle in a tiny ball of flame. [Transcriber's Note: This etext was produced from Planet Stories May 1943. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Bucky Shannon leaned forward across the little hexagonal table. He knocked over the pitcher of thil , but it didn't matter. The pitcher was empty. He jabbed me in the breastbone with his forefinger, not very hard. Not hard enough to jar the ribs clean loose, just enough to spring them. "We," he said, "are broke. We are finished, through. Washed up and down the drain." He added, as an afterthought, "Destitute." I looked at him. I said sourly, "You're kidding!" "Kidding." Shannon put his elbows on the table and peered at me through a curtain of very blond hair that was trying hard to be red. "He says I'm kidding! With Shannon's Imperial Circus, the Greatest Show in Space, plastered so thick with attachments...." "It's no more plastered than you are." I was sore because he'd been a lot quicker grabbing the pitcher. "The Greatest Show in Space. Phooey! I've wet-nursed Shannon's Imperial Circus around the Triangle for eleven years, and I know. It's lousy, it's mangy, it's broken-down! Nothing works, from the ship to the roustabouts. In short, it stinks!" I must have had the pitcher oftener than I thought. Nobody insults Buckhalter Shannon's Imperial Circus to Buckhalter Shannon's face unless he's tired and wants a long rest in a comfy fracture-frame. Shannon got up. He got up slowly. I had plenty of time to see his grey-green eyes get sleepy, and hear the quarter-Earth-blood Martian girl wailing about love over by the battered piano, and watch the slanting cat-eyes of the little dark people at the tables swing round toward us, pleased and kind of hungry. I had plenty of time to think how I only weigh one-thirty-seven to Shannon's one-seventy-five, and how I'm not as young as I used to be. I said, "Bucky. Hold on, fella. I...." Somebody said, "Excuse me, gentlemen. Is one of you Mister Buckhalter Shannon?" Shannon put his hands down on his belt. He closed his eyes and smiled pleasantly and said, very gently: "Would you be collecting for the feed bill, or the fuel?" I shot a glance at the newcomer. He'd saved me from a beating, even if he was a lousy bill-collecter; and I felt sorry for him. Bucky Shannon settled his shoulders and hips like a dancer. The stranger was a little guy. He even made me look big. He was dressed in dark-green synthesilk, very conservative. There was a powdering of grey in his hair and his skin was pink, soft, and shaved painfully clean. He had the kind of a face that nice maiden-ladies will trust with their last dime. I looked for his strong-arm squad. There didn't seem to be any. The little guy looked at Shannon with pale blue eyes like a baby, and his voice was softer than Bucky's. He said, "I don't think you understand." I felt cold, suddenly, between the shoulders. Somebody scraped a chair back. It sounded like he'd ripped the floor open, it was so quiet. I got my brassies on, and my hands were sweating. Bucky Shannon sighed, and let his fist start traveling, a long, deceptive arc. Then I saw what the little guy was holding in his hand. I yelled and knocked the table over into Bucky. It made a lot of noise. It knocked him sideways and down, and the little dark men jumped up, quivering and showing their teeth. The Martian girl screamed. Bucky heaved the table off his lap and cursed me. "What's eating you, Jig? I'm not going to hurt him." "Shut up," I said. "Look what he's got there. Money!" The little guy looked at me. He hadn't turned a hair. "Yes," he said. "Money. Quite a lot of it. Would you gentlemen permit me to join you?" Bucky Shannon got up. He grinned his pleasantest grin. "Delighted. I'm Shannon. This is Jig Bentley, my business manager." He looked down at the table. "I'm sorry about that. Mistaken identity." The little guy smiled. He did it with his lips. The rest of his face stayed placid and babyish, almost transparent. I realized with a start that it wasn't transparent at all. It was the most complete dead-pan I ever met, and you couldn't see into those innocent blue eyes any more than you could see through sheet metal. I didn't like him. I didn't like him at all. But he had money. I said, "Howdy. Let's go find a booth. These Marshies make me nervous, looking like hungry cats at a mouse-hole." The little guy nodded. "Excellent idea. My name is Beamish. Simon Beamish. I wish to—ah—charter your circus." I looked at Bucky. He looked hungrier than the Marshies did. We didn't say anything until we got Beamish into a curtained booth with a fresh pitcher of thil on the table. Then I cleared my throat. "What exactly did you have in mind, Mr. Beamish?" Beamish sipped his drink, made a polite face, and put it down. "I have independent means, gentlemen. It has always been my desire to lighten the burden of life for those less fortunate...." Bucky got red around the ears. "Just a minute," he murmured, and started to get up. I kicked him under the table. "Shut up, you lug. Let Mister Beamish finish." He sat down, looking like a mean dog waiting for the postman. Beamish ignored him. He went on, quietly, "I have always held that entertainment, of the right sort, is the most valuable aid humanity can have in its search for the alleviation of toil and boredom...." I said, "Sure, sure. But what was your idea?" "There are many towns along the Venusian frontiers where no entertainment of the— proper sort has been available. I propose to remedy that. I propose to charter your circus, Mister Shannon, to make a tour of several settlements along the Tehara Belt." Bucky had relaxed. His grey-green eyes began to gleam. He started to speak, and I kicked him again. "That would be expensive, Mister Beamish," I said. "We'd have to cancel several engagements...." He looked at me. I was lying, and he knew it. But he said, "I quite understand that. I would be prepared...." The curtains were yanked back suddenly. Beamish shut up. Bucky and I glared at the head and shoulders poking in between the drapes. It was Gow, our zoo-man—a big, ugly son-of-a-gun from a Terran colony on Mercury. I was there once. Gow looks a lot like the scenery—scowling, unapproachable, and tough. His hands, holding the curtains apart, had thick black hair on them and were not much larger than the hams of a Venusian swamp-rhino. He said, "Boss, Gertrude's actin' up again." "Gertrude be blowed," growled Bucky. "Can't you see I'm busy?" Gow's black eyes were unpleasant. "I'm tellin' you, Boss, Gertrude ain't happy. She ain't had the right food. If something...." I said, "That'll all be taken care of, Gow. Run along now." He looked at me like he was thinking it wouldn't take much timber to fit me for a coffin. "Okay! But Gertrude's unhappy. She's lonesome, see? And if she don't get happier pretty soon I ain't sure your tin-pot ship'll hold her." He pulled the curtains to and departed. Bucky Shannon groaned. Beamish cleared his throat and said, rather stiffly, "Gertrude?" "Yeah. She's kind of temperamental." Bucky took a quick drink. I finished for him. "She's the star attraction of our show, Mr. Beamish. A real blue-swamp Venusian cansin . The only other one on the Triangle belongs to Savitt Brothers, and she's much smaller than Gertrude." She was also much younger, but I didn't go into that. Gertrude may be a little creaky, but she's still pretty impressive. I only hoped she wouldn't die on us, because without her we'd have a sicker-looking circus than even I could stand. Beamish looked impressed. "A cansin . Well, well! The mystery surrounding the origin and species of the cansin is a fascinating subject. The extreme rarity of the animal...." We were getting off the subject. I said tactfully, "We'd have to have at least a hundred U.C.'s." It was twice what we had any right to ask. I was prepared to dicker. Beamish looked at me with that innocent dead pan. For a fraction of a second I thought I saw something back of his round blue eyes, and my stomach jumped like it was shot. Beamish smiled sweetly. "I'm not much of a bargainer. One hundred Universal Credits will be agreeable to me." He dragged out a roll as big as my two fists, peeled off half a dozen credit slips, and laid them on the table. "By way of a retainer, gentleman. My attorney and I will call on you in the morning with a contract and itinerary. Good night." We said good night, trying not to drool. Beamish went away. Bucky made grab for the money, but I beat him to it. "Scram," I said. "There are guys waiting for this. Big guys with clubs. Here." I gave him a small-denomination slip I'd been holding out. "We can get lushed enough on this." Shannon has a good vocabulary. He used it. When he got his breath back he said suddenly, "Beamish is pulling some kind of a game." "Yeah." "It may be crooked." "Sure. And he may be screwball and on the level. For Pete's sake!" I yelled. "You want to sit here till we all dry up and blow away?" Shannon looked at me, kind of funny. He looked at the bulge in my tunic where the roll was. He raked back his thick light hair. "Yeah," he said. "I hope there'll be enough left to bribe the jury." He poked his head outside. "Hey, boy! More thildatum !" It was pretty late when we got back to the broken-down spaceport where Shannon's Imperial Circus was crouching beneath its attachments. Late as it was, they were waiting for us. About twenty of them, sitting around and smoking and looking very ugly. It was awfully lonesome out there, with the desert cold and restless under the two moons. There's a smell to Mars, like something dead and dried long past decay, but still waiting. An unhappy smell. The blown red dust gritted in my teeth. Bucky Shannon walked out into the glare of the light at the entrance to the roped-off space around the main lock. He was pretty steady on his feet. He waved and said, "Hiya, boys." They got up off the steps, and the packing cases, and came toward us. I grinned and got into my brassies. We felt we owed those boys a lot more than money. It grates on a man's pride to have to sneak in and out of his own property through the sewage lock. This was the first time in weeks we'd come in at the front door. I waved the money in their faces. That stopped them. Very solemnly, Bucky and I checked the bills, paid them, and pocketed the receipts. Bucky yawned and stretched sleepily. "Now?" he said. "Now," I said. We had a lot of fun. Some of the boys inside the ship came out to join in. We raised a lot of dust and nobody got killed, quite. We all went home happy. They had their money, and we had their blood. The news was all over the ship before we got inside. The freaks and the green girl from Tethys who could roll herself like a hoop, and Zurt the muscle man from Jupiter, and all the other assorted geeks and kinkers and joeys that make up the usual corny carnie were doing nip-ups in the passageways and drooling over the thought of steer and toppings. Bucky Shannon regarded them possessively, wiping blood from his nose. "They're good guys, Jig. Swell people. They stuck by me, and I've rewarded them." I said, "Sure," rather sourly. Bucky hiccoughed. "Let's go see Gertrude." I didn't want to see Gertrude. I never got over feeling funny going into the brute tank, especially at night or out in space. I'm a city guy, myself. The smell and sound of wildness gives me goose bumps. But Bucky was looking stubborn, so I shrugged. "Okay. But just for a minute. Then we go beddy-bye." "You're a pal, Jif. Bes' li'l' guy inna worl'...." The fight had just put the topper on him. I was afraid he'd fall down the ladder and break his neck. That's why I went along. If I hadn't.... Oh, well, what's a few nightmares among friends? It was dark down there in the tank. Way off at the other end, there was a dim glow. Gow was evidently holding Gertrude's hand. We started down the long passageway between the rows of cages and glassed-in tanks and compression units. Our footsteps sounded loud and empty on the iron floor. I wasn't near as happy as Shannon, and my skin began to crawl a little. It's the smell, I think; rank and sour and wild. And the sound of them, breathing and rustling in the dark, with the patient hatred walled around them as strong as the cage bars. Bucky Shannon lurched against me suddenly. I choked back a yell, and then wiped the sweat off my forehead and cursed. The scream came again. A high, ragged, whistling screech like nothing this side of hell, ripping through the musty darkness. Gertrude, on the wailing wall. It had been quiet. Now every brute in the place let go at the same time. My stomach turned clear over. I called Gertrude every name I could think of, and I couldn't hear myself doing it. Presently a great metallic clash nearly burst my eardrums, and the beasts shut up. Gow had them nicely conditioned to that gong. But they didn't quiet down. Not really. They were uneasy. You can feel them inside you when they're uneasy. I think that's why I'm scared of them. They make me feel like I'm not human as I thought—like I wanted to put my back-hair up and snarl. Yeah. They were uneasy that night, all of a sudden.... Gow glared at us as we came up into the lantern light. "She's gettin' worse," he said. "She's lonesome." "That's tough," said Bucky Shannon. His grey-green eyes looked like an owl's. He swayed slightly. "That's sure tough." He sniffled. I looked at Gertrude. Her cage is the biggest and strongest in the tank and even so she looked as though she could break it open just taking a deep breath. I don't know if you've ever seen a cansin . There's only two of them on the Triangle. If you haven't, nothing I can say will make much difference. They're what the brain gang calls an "end of evolution." Seems old Dame Nature had an idea that didn't jell. The cansins were pretty successful for a while, it seems, but something gummed up the works and now there's only a few left, way in the deep-swamp country, where even the Venusians hardly ever go. Living fossils. I wouldn't know, of course, but Gertrude looks to me like she got stuck some place between a dinosaur and a grizzly bear, with maybe a little bird blood thrown in. Anyway, she's big. I couldn't help feeling sorry for her. She was crouched in the cage with her hands—yeah, hands—hanging over her knees and her snaky head sunk into her shoulders, looking out. Just looking. Not at anything. Her eyes were way back in deep horny pits, like cold green fire. The lantern light was yellow on her blue-black skin, but it made the mane, or crest, of coarse wide scales that ran from between her eyes clear down to her flat, short tail, burn all colors. She looked like old Mother Misery herself, from way back before time began. Gow said softly, "She wants a mate. And somebody better get her one." Bucky Shannon sniffled again. I said irritably, "Be reasonable, Gow! Nobody's ever seen a male cansin . There may not even be any." Gertrude screamed again. She didn't move, not even to raise her head. The sadness just built up inside her until it had to come out. That close, the screech was deafening, and it turned me all limp and cold inside. The loneliness, the sheer stark, simple pain.... Bucky Shannon began to cry. I snarled, "You'll have to snap her out of this, Gow. She's driving the rest of 'em nuts." He hammered on his gong, and things quieted down again. Gow stood looking out over the tank, sniffing a little, like a hound. Then he turned to Gertrude. "I saved her life," he said. "When we bought her out of Hanak's wreck and everybody thought she was too hurt to live, I saved her. I know her. I can do things with her. But this time...." He shrugged. He was huge and tough and ugly, and his voice was like a woman's talking about a sick child. "This time," he said, "I ain't sure." "Well for Pete's sake, do what you can. We got a charter, and we need her." I took Shannon's arm. "Come to bed, Bucky darlin'." He draped himself over my shoulder and we went off. Gow didn't look at us. Bucky sobbed. "You were right, Jig," he mumbled. "Circus is no good. I know it. But it's all I got. I love it, Jig. Unnerstan' me? Like Gow there with Gertrude. She's ugly and no good, but he loves her. I love...." "Sure, sure," I told him. "Stop crying down my neck." We were a long way from the light, then. The cages and tanks loomed high and black over us. It was still. The secret, uneasy motion all around us and the scruffing of our feet only made it stiller. Bucky was almost asleep on me. I started to slap him. And then the mist rose up out of the darkness in little lazy coils, sparkling faintly with blue, cold fire. I yelled, "Gow! Gow, the Vapor snakes! Gow—for God's sake!" I started to run, back along the passageway. Bucky weighed on me, limp and heavy. The noise burst suddenly in a deafening hell of moans and roars and shrieks, packed in tight by the metal walls, and above it all I could hear Gertrude's lonely, whistling scream. I thought, " Somebody's down here. Somebody let 'em out. Somebody wants to kill us! " I tried to yell again. It strangled in my throat. I sobbed, and the sweat was thick and cold on me. One of Bucky's dragging, stumbling feet got between mine. We fell. I rolled on top of him, covering his face, and buried my own face in the hollow of his shoulder. The first snake touched me. It was like a live wire, sliding along the back of my neck. I screamed. It came down along my cheek, hunting my mouth. There were more of them, burning me through my clothes. Bucky moaned and kicked under me. I remember hanging on and thinking, "This is it. This is it, and oh God, I'm scared!" Then I went out. II Kanza the Martian croaker, was bending over me when I woke up. His little brown face was crinkled with laughter. He'd lost most of his teeth, and he gummed thak -weed. It smelt. "You pretty, Mis' Jig," he giggled. "You funny like hell." He slapped some cold greasy stuff on my face. It hurt. I cursed him and said, "Where's Shannon? How is he?" "Mis' Bucky okay. You save life. You big hero, Mis' Jig. Mis' Gow come nickuhtime get snakes. You hero. Haw! You funny like hell!" I said, "Yeah," and pushed him away and got up. I almost fell down a couple of times, but presently I made it to the mirror over the washstand—I was in my own cell—and I saw what Kanza meant. The damned snakes had done a good job. I looked like I was upholstered in Scotch plaid. I felt sick. Bucky Shannon opened the door. He looked white and grim, and there was a big burn across his neck. He said: "Beamish is here with his lawyer." I picked up my shirt. "Right with you." Kanza went out, still giggling. Bucky closed the door. "Jig," he said, "those vapor worms were all right when we went in. Somebody followed us down and let them out. On purpose." I hurt all over. I growled, "With that brain, son, you should go far. Nobody saw anything, of course?" Bucky shook his head. "Question is, Jig, who wants to kill us, and why?" "Beamish. He realizes he's been gypped." "One hundred U.C.'s," said Bucky softly, "for a few lousy swampedge mining camps. It stinks, Jig. You think we should back out?" I shrugged. "You're the boss man. I'm only the guy that beats off the creditors." "Yeah," Bucky said reflectively. "And I hear starvation isn't a comfortable death. Okay, Jig. Let's go sign." He put his hand on the latch and looked at my feet. "And—uh—Jig, I...." I said, "Skip it. The next time, just don't trip me up, that's all!" We had a nasty trip to Venus. Gertrude kept the brute tank on edge, and Gow, on the rare occasions he came up for air, went around looking like a disaster hoping to happen. To make it worse, Zurt the Jovian strong-man got hurt during the take-off, and the Mercurian cave-cat had kittens. Nobody would have minded that, only one of 'em had only four legs. It lived just long enough to scare that bunch of superstitious dopes out of their pants. Circus people are funny that way. Shannon and I did a little quiet sleuthing, but it was a waste of time. Anybody in the gang might have let those electric worms out on us. It didn't help any to know that somebody, maybe the guy next to you at dinner, was busy thinking ways to kill you. By the time we hit Venus, I was ready to do a Brodie out the refuse chute. Shannon set the crate down on the edge of Nahru, the first stop on our itinerary. I stood beside him, looking out the ports at the scenery. It was Venus, all right. Blue mud and thick green jungle and rain, and a bunch of ratty-looking plastic shacks huddling together in the middle of it. Men in slickers were coming out for a look. I saw Beamish's sleek yacht parked on a cradle over to the left, and our router's runabout beside it. Bucky Shannon groaned. "A blue one, Jig. A morgue if I ever saw one!" I snarled, "What do you want, with this lousy dog-and-pony show!" and went out. He followed. The gang was converging on the lock, but they weren't happy. You get so you can feel those things. The steamy Venus heat was already sneaking into the ship. While we passed the hatchway to the brute tank, I could hear Gertrude, screaming. The canvasmen were busy setting up the annex, slopping and cursing in the mud. The paste brigade was heading for the shacks. Shannon and I stood with the hot rain running off our slickers, looking. I heard a noise behind me and looked around. Ahra the Nahali woman was standing in the mud with her arms up and her head thrown back, and her triangular mouth open like a thirsty dog. She didn't have anything on but her blue-green, hard scaled hide, and she was chuckling. It didn't sound nice. You find a lot of Nahali people in side-shows, doing tricks with the electric power they carry in their own bodies. They're Venusian middle-swampers, they're not human, and they never forget it. Ahra opened her slitted red eyes and looked at me and laughed with white reptilian teeth. "Death," she whispered. "Death and trouble. The jungle tells me. I can smell it in the swamp wind." The hot rain sluiced over her. She shivered, and the pale skin under her jaw pulsed like a toad's, and her eyes were red. "The deep swamps are angry," she whispered. "Something has been taken. They are angry, and I smell death in the wind!" She turned away, laughing, and I cursed her, and my stomach was tight and cold. Bucky said, "Let's eat if they have a bar in this dump." We weren't half way across the mud puddle that passed as a landing field when a man came out of a shack on the edge of the settlement. We could see him plainly, because he was off to one side of the crowd. He fell on his knees in the mud, making noises. It took him three or four tries to get our names out clear enough to understand. Bucky said, "Jig—it's Sam Kapper." We started to run. The crowd, mostly big unshaken miners, wheeled around to see what was happening. People began to close in on the man who crawled and whimpered in the mud. Sam Kapper was a hunter, supplying animals to zoos and circuses and carnivals. He'd given us good deals a couple of times, when we weren't too broke, and we were pretty friendly. I hadn't seen him for three seasons. I remembered him as a bronzed, hard-bitten guy, lean and tough as a twist of tung wire. I felt sick, looking down at him. Bucky started to help him up. Kapper was crying, and he jerked all over like animals I've seen that were scared to death. Some guy leaned over and put a cigarette in his mouth and lighted it for him. I was thinking about Kapper, then, and I didn't pay much attention. I only caught a glimpse of the man's face as he straightened up. I didn't realize until later that he looked familiar. We got Kapper inside the shack. It turned out to be a cheap bar, with a couple of curtained booths at the back. We got him into one and pulled the curtain in a lot of curious faces. Kapper dragged hard on the cigarette. The man that gave it to him was gone. Bucky said gently, "Okay, Sam. Relax. What's the trouble?" Kapper tried to straighten up. He hadn't shaved. The lean hard lines of his face had gone slack and his eyes were bloodshot. He was covered with mud, and his mouth twitched like a sick old man's. He said thickly, "I found it. I said I'd do it, and I did. I found it and brought it out." The cigarette stub fell out of his mouth. He didn't notice it. "Help me," he said simply. "I'm scared." His mouth drooled. "I got it hidden. They want to find out, but I won't tell 'em. It's got to go back. Back where I found it. I tried to take it, but they wouldn't let me, and I was afraid they'd find it...." He reached suddenly and grabbed the edge of the table. "I don't know how they found out about it, but they did. I've got to get it back. I've got to...." Bucky looked at me. Kapper was blue around the mouth. I was scared, suddenly. I said, "Get what back where?" Bucky got up. "I'll get a doctor," he said. "Stick with him." Kapper grabbed his wrist. Kapper's nails were blue and the cords in his hands stood out like guy wires. "Don't leave me. Got to tell you—where it is. Got to take it back. Promise you'll take it back." He gasped and struggled over his breathing. "Sure," said Bucky. "Sure, well take it back. What is it?" Kapper's face was horrible. I felt sick, listening to him fight for air. I wanted to go for a doctor anyway, but somehow I knew it was no use. Kapper whispered, " Cansin . Male. Only one. You don't know...! Take him back." "Where is it, Sam?" I reached across Bucky suddenly and jerked the curtain back. Beamish was standing there. Beamish, bent over, with his ear cocked. Kapper made a harsh strangling noise and fell across the table. Beamish never changed expression. He didn't move while Bucky felt Kapper's pulse. Bucky didn't need to say anything. We knew. "Heart?" said Beamish finally. "Yeah," said Bucky. He looked as bad as I felt. "Poor Sam." I looked at the cigarette stub smoldering on the table. I looked at Beamish with his round dead baby face. I climbed over Shannon and pushed Beamish suddenly down into his lap. "Keep this guy here till I get back," I said. Shannon stared at me. Beamish started to get indignant. "Shut up," I told him. "We got a contract." I yanked the curtains shut and walked over to the bar. I began to notice something, then. There were quite a lot of men in the place. At first glance they looked okay—a hard-faced, muscular bunch of miners in dirty shirts and high boots. Then I looked at their hands. They were dirty enough. But they never did any work in a mine, on Venus or anywhere else. The place was awfully quiet, for that kind of a place. The bartender was a big pot-bellied swamp-edger with pale eyes and thick white hair coiled up on top of his bullet head. He was not happy. I leaned on the bar. " Lhak ," I said. He poured it, sullenly, out of a green bottle. I reached for it, casually. "That guy we brought in," I said. "He sure has a skinful. Passed out cold. What's he been spiking his drinks with?" " Selak ," said a voice in my ear. "As if you didn't know." I turned. The man who had given Kapper the cigarette was standing behind me. And I remembered him, then.
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B. They wanted to avoid the debt collectors
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How does Lin feel about Extrone?
A. Mia is frightened of Extrone, but he doesn't think Extrone will kill him.
B. Lin hates Extrone and is planning on killing him at the first opportunity.
C. Lin thinks Extrone is the kind of ruler the system needs.
D. Lin is frightened that Extrone is going to kill him.
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HUNT the HUNTER BY KRIS NEVILLE Illustrated by ELIZABETH MacINTYRE [Transcriber's Note: This etext was produced from Galaxy Science Fiction June 1951. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Of course using live bait is the best way to lure dangerous alien animals ... unless it turns out that you are the bait! "We're somewhat to the south, I think," Ri said, bending over the crude field map. "That ridge," he pointed, "on our left, is right here." He drew a finger down the map. "It was over here," he moved the finger, "over the ridge, north of here, that we sighted them." Extrone asked, "Is there a pass?" Ri looked up, studying the terrain. He moved his shoulders. "I don't know, but maybe they range this far. Maybe they're on this side of the ridge, too." Delicately, Extrone raised a hand to his beard. "I'd hate to lose a day crossing the ridge," he said. "Yes, sir," Ri said. Suddenly he threw back his head. "Listen!" "Eh?" Extrone said. "Hear it? That cough? I think that's one, from over there. Right up ahead of us." Extrone raised his eyebrows. This time, the coughing roar was more distant, but distinct. "It is!" Ri said. "It's a farn beast, all right!" Extrone smiled, almost pointed teeth showing through the beard. "I'm glad we won't have to cross the ridge." Ri wiped his forehead on the back of his sleeve. "Yes, sir." "We'll pitch camp right here, then," Extrone said. "We'll go after it tomorrow." He looked at the sky. "Have the bearers hurry." "Yes, sir." Ri moved away, his pulse gradually slowing. "You, there!" he called. "Pitch camp, here!" He crossed to Mia, who, along with him, had been pressed into Extrone's party as guides. Once more, Ri addressed the bearers, "Be quick, now!" And to Mia, "God almighty, he was getting mad." He ran a hand under his collar. "It's a good thing that farn beast sounded off when it did. I'd hate to think of making him climb that ridge." Mia glanced nervously over his shoulder. "It's that damned pilot's fault for setting us down on this side. I told him it was the other side. I told him so." Ri shrugged hopelessly. Mia said, "I don't think he even saw a blast area over here. I think he wanted to get us in trouble." "There shouldn't be one. There shouldn't be a blast area on this side of the ridge, too." "That's what I mean. The pilot don't like businessmen. He had it in for us." Ri cleared his throat nervously. "Maybe you're right." "It's the Hunting Club he don't like." "I wish to God I'd never heard of a farn beast," Ri said. "At least, then, I wouldn't be one of his guides. Why didn't he hire somebody else?" Mia looked at his companion. He spat. "What hurts most, he pays us for it. I could buy half this planet, and he makes me his guide—at less than I pay my secretary." "Well, anyway, we won't have to cross that ridge." "Hey, you!" Extrone called. The two of them turned immediately. "You two scout ahead," Extrone said. "See if you can pick up some tracks." "Yes, sir," Ri said, and instantly the two of them readjusted their shoulder straps and started off. Shortly they were inside of the scrub forest, safe from sight. "Let's wait here," Mia said. "No, we better go on. He may have sent a spy in." They pushed on, being careful to blaze the trees, because they were not professional guides. "We don't want to get too near," Ri said after toiling through the forest for many minutes. "Without guns, we don't want to get near enough for the farn beast to charge us." They stopped. The forest was dense, the vines clinging. "He'll want the bearers to hack a path for him," Mia said. "But we go it alone. Damn him." Ri twisted his mouth into a sour frown. He wiped at his forehead. "Hot. By God, it's hot. I didn't think it was this hot, the first time we were here." Mia said, "The first time, we weren't guides. We didn't notice it so much then." They fought a few yards more into the forest. Then it ended. Or, rather, there was a wide gap. Before them lay a blast area, unmistakable. The grass was beginning to grow again, but the tree stumps were roasted from the rocket breath. "This isn't ours!" Ri said. "This looks like it was made nearly a year ago!" Mia's eyes narrowed. "The military from Xnile?" "No," Ri said. "They don't have any rockets this small. And I don't think there's another cargo rocket on this planet outside of the one we leased from the Club. Except the one he brought." "The ones who discovered the farn beasts in the first place?" Mia asked. "You think it's their blast?" "So?" Ri said. "But who are they?" It was Mia's turn to shrug. "Whoever they were, they couldn't have been hunters. They'd have kept the secret better." "We didn't do so damned well." "We didn't have a chance," Mia objected. "Everybody and his brother had heard the rumor that farn beasts were somewhere around here. It wasn't our fault Extrone found out." "I wish we hadn't shot our guide, then. I wish he was here instead of us." Mia shook perspiration out of his eyes. "We should have shot our pilot, too. That was our mistake. The pilot must have been the one who told Extrone we'd hunted this area." "I didn't think a Club pilot would do that." "After Extrone said he'd hunt farn beasts, even if it meant going to the alien system? Listen, you don't know.... Wait a minute." There was perspiration on Ri's upper lip. " I didn't tell Extrone, if that's what you're thinking," Mia said. Ri's mouth twisted. "I didn't say you did." "Listen," Mia said in a hoarse whisper. "I just thought. Listen. To hell with how he found out. Here's the point. Maybe he'll shoot us, too, when the hunt's over." Ri licked his lips. "No. He wouldn't do that. We're not—not just anybody. He couldn't kill us like that. Not even him . And besides, why would he want to do that? It wouldn't do any good to shoot us. Too many people already know about the farn beasts. You said that yourself." Mia said, "I hope you're right." They stood side by side, studying the blast area in silence. Finally, Mia said, "We better be getting back." "What'll we tell him?" "That we saw tracks. What else can we tell him?" They turned back along their trail, stumbling over vines. "It gets hotter at sunset," Ri said nervously. "The breeze dies down." "It's screwy. I didn't think farn beasts had this wide a range. There must be a lot of them, to be on both sides of the ridge like this." "There may be a pass," Mia said, pushing a vine away. Ri wrinkled his brow, panting. "I guess that's it. If there were a lot of them, we'd have heard something before we did. But even so, it's damned funny, when you think about it." Mia looked up at the darkening sky. "We better hurry," he said. When it came over the hastily established camp, the rocket was low, obviously looking for a landing site. It was a military craft, from the outpost on the near moon, and forward, near the nose, there was the blazoned emblem of the Ninth Fleet. The rocket roared directly over Extrone's tent, turned slowly, spouting fuel expensively, and settled into the scrub forest, turning the vegetation beneath it sere by its blasts. Extrone sat on an upholstered stool before his tent and spat disgustedly and combed his beard with his blunt fingers. Shortly, from the direction of the rocket, a group of four high-ranking officers came out of the forest, heading toward him. They were spruce, the officers, with military discipline holding their waists in and knees almost stiff. "What in hell do you want?" Extrone asked. They stopped a respectful distance away. "Sir...." one began. "Haven't I told you gentlemen that rockets frighten the game?" Extrone demanded, ominously not raising his voice. "Sir," the lead officer said, "it's another alien ship. It was sighted a few hours ago, off this very planet, sir." Extrone's face looked much too innocent. "How did it get there, gentlemen? Why wasn't it destroyed?" "We lost it again, sir. Temporarily, sir." "So?" Extrone mocked. "We thought you ought to return to a safer planet, sir. Until we could locate and destroy it." Extrone stared at them for a space. Then, indifferently, he turned away, in the direction of a resting bearer. "You!" he said. "Hey! Bring me a drink!" He faced the officers again. He smiled maliciously. "I'm staying here." The lead officer licked his firm lower lip. "But, sir...." Extrone toyed with his beard. "About a year ago, gentlemen, there was an alien ship around here then, wasn't there? And you destroyed it, didn't you?" "Yes, sir. When we located it, sir." "You'll destroy this one, too," Extrone said. "We have a tight patrol, sir. It can't slip through. But it might try a long range bombardment, sir." Extrone said, "To begin with, they probably don't even know I'm here. And they probably couldn't hit this area if they did know. And you can't afford to let them get a shot at me, anyway." "That's why we'd like you to return to an inner planet, sir." Extrone plucked at his right ear lobe, half closing his eyes. "You'll lose a fleet before you'll dare let anything happen to me, gentlemen. I'm quite safe here, I think." The bearer brought Extrone his drink. "Get off," Extrone said quietly to the four officers. Again they turned reluctantly. This time, he did not call them back. Instead, with amusement, he watched until they disappeared into the tangle of forest. Dusk was falling. The takeoff blast of the rocket illuminated the area, casting weird shadows on the gently swaying grasses; there was a hot breath of dry air and the rocket dwindled toward the stars. Extrone stood up lazily, stretching. He tossed the empty glass away, listened for it to shatter. He reached out, parted the heavy flap to his tent. "Sir?" Ri said, hurrying toward him in the gathering darkness. "Eh?" Extrone said, turning, startled. "Oh, you. Well?" "We ... located signs of the farn beast, sir. To the east." Extrone nodded. After a moment he said, "You killed one, I believe, on your trip?" Ri shifted. "Yes, sir." Extrone held back the flap of the tent. "Won't you come in?" he asked without any politeness whatever. Ri obeyed the order. The inside of the tent was luxurious. The bed was of bulky feathers, costly of transport space, the sleep curtains of silken gauze. The floor, heavy, portable tile blocks, not the hollow kind, were neatly and smoothly inset into the ground. Hanging from the center, to the left of the slender, hand-carved center pole, was a chain of crystals. They tinkled lightly when Extrone dropped the flap. The light was electric from a portable dynamo. Extrone flipped it on. He crossed to the bed, sat down. "You were, I believe, the first ever to kill a farn beast?" he said. "I.... No, sir. There must have been previous hunters, sir." Extrone narrowed his eyes. "I see by your eyes that you are envious—that is the word, isn't it?—of my tent." Ri looked away from his face. "Perhaps I'm envious of your reputation as a hunter. You see, I have never killed a farn beast. In fact, I haven't seen a farn beast." Ri glanced nervously around the tent, his sharp eyes avoiding Extrone's glittering ones. "Few people have seen them, sir." "Oh?" Extrone questioned mildly. "I wouldn't say that. I understand that the aliens hunt them quite extensively ... on some of their planets." "I meant in our system, sir." "Of course you did," Extrone said, lazily tracing the crease of his sleeve with his forefinger. "I imagine these are the only farn beasts in our system." Ri waited uneasily, not answering. "Yes," Extrone said, "I imagine they are. It would have been a shame if you had killed the last one. Don't you think so?" Ri's hands worried the sides of his outer garment. "Yes, sir. It would have been." Extrone pursed his lips. "It wouldn't have been very considerate of you to—But, still, you gained valuable experience. I'm glad you agreed to come along as my guide." "It was an honor, sir." Extrone's lip twisted in wry amusement. "If I had waited until it was safe for me to hunt on an alien planet, I would not have been able to find such an illustrious guide." "... I'm flattered, sir." "Of course," Extrone said. "But you should have spoken to me about it, when you discovered the farn beast in our own system." "I realize that, sir. That is, I had intended at the first opportunity, sir...." "Of course," Extrone said dryly. "Like all of my subjects," he waved his hand in a broad gesture, "the highest as well as the lowest slave, know me and love me. I know your intentions were the best." Ri squirmed, his face pale. "We do indeed love you, sir." Extrone bent forward. " Know me and love me." "Yes, sir. Know you and love you, sir," Ri said. "Get out!" Extrone said. "It's frightening," Ri said, "to be that close to him." Mia nodded. The two of them, beneath the leaf-swollen branches of the gnarled tree, were seated on their sleeping bags. The moon was clear and cold and bright in a cloudless sky; a small moon, smooth-surfaced, except for a central mountain ridge that bisected it into almost twin hemispheres. "To think of him. As flesh and blood. Not like the—well; that—what we've read about." Mia glanced suspiciously around him at the shadows. "You begin to understand a lot of things, after seeing him." Ri picked nervously at the cover of his sleeping bag. "It makes you think," Mia added. He twitched. "I'm afraid. I'm afraid he'll.... Listen, we'll talk. When we get back to civilization. You, me, the bearers. About him. He can't let that happen. He'll kill us first." Ri looked up at the moon, shivering. "No. We have friends. We have influence. He couldn't just like that—" "He could say it was an accident." "No," Ri said stubbornly. "He can say anything," Mia insisted. "He can make people believe anything. Whatever he says. There's no way to check on it." "It's getting cold," Ri said. "Listen," Mia pleaded. "No," Ri said. "Even if we tried to tell them, they wouldn't listen. Everybody would know we were lying. Everything they've come to believe would tell them we were lying. Everything they've read, every picture they've seen. They wouldn't believe us. He knows that." "Listen," Mia repeated intently. "This is important. Right now he couldn't afford to let us talk. Not right now. Because the Army is not against him. Some officers were here, just before we came back. A bearer overheard them talking. They don't want to overthrow him!" Ri's teeth, suddenly, were chattering. "That's another lie," Mia continued. "That he protects the people from the Army. That's a lie. I don't believe they were ever plotting against him. Not even at first. I think they helped him, don't you see?" Ri whined nervously. "It's like this," Mia said. "I see it like this. The Army put him in power when the people were in rebellion against military rule." Ri swallowed. "We couldn't make the people believe that." "No?" Mia challenged. "Couldn't we? Not today, but what about tomorrow? You'll see. Because I think the Army is getting ready to invade the alien system!" "The people won't support them," Ri answered woodenly. " Think. If he tells them to, they will. They trust him." Ri looked around at the shadows. "That explains a lot of things," Mia said. "I think the Army's been preparing for this for a long time. From the first, maybe. That's why Extrone cut off our trade with the aliens. Partly to keep them from learning that he was getting ready to invade them, but more to keep them from exposing him to the people. The aliens wouldn't be fooled like we were, so easy." "No!" Ri snapped. "It was to keep the natural economic balance." "You know that's not right." Ri lay down on his bed roll. "Don't talk about it. It's not good to talk like this. I don't even want to listen." "When the invasion starts, he'll have to command all their loyalties. To keep them from revolt again. They'd be ready to believe us, then. He'll have a hard enough time without people running around trying to tell the truth." "You're wrong. He's not like that. I know you're wrong." Mia smiled twistedly. "How many has he already killed? How can we even guess?" Ri swallowed sickly. "Remember our guide? To keep our hunting territory a secret?" Ri shuddered. "That's different. Don't you see? This is not at all like that." With morning came birds' songs, came dew, came breakfast smells. The air was sweet with cooking and it was nostalgic, childhoodlike, uncontaminated. And Extrone stepped out of the tent, fully dressed, surly, letting the flap slap loudly behind him. He stretched hungrily and stared around the camp, his eyes still vacant-mean with sleep. "Breakfast!" he shouted, and two bearers came running with a folding table and chair. Behind them, a third bearer, carrying a tray of various foods; and yet behind him, a fourth, with a steaming pitcher and a drinking mug. Extrone ate hugely, with none of the delicacy sometimes affected in his conversational gestures. When he had finished, he washed his mouth with water and spat on the ground. "Lin!" he said. His personal bearer came loping toward him. "Have you read that manual I gave you?" Lin nodded. "Yes." Extrone pushed the table away. He smacked his lips wetly. "Very ludicrous, Lin. Have you noticed that I have two businessmen for guides? It occurred to me when I got up. They would have spat on me, twenty years ago, damn them." Lin waited. "Now I can spit on them, which pleases me." "The farn beasts are dangerous, sir," Lin said. "Eh? Oh, yes. Those. What did the manual say about them?" "I believe they're carnivorous, sir." "An alien manual. That's ludicrous, too. That we have the only information on our newly discovered fauna from an alien manual—and, of course, two businessmen." "They have very long, sharp fangs, and, when enraged, are capable of tearing a man—" "An alien?" Extrone corrected. "There's not enough difference between us to matter, sir. Of tearing an alien to pieces, sir." Extrone laughed harshly. "It's 'sir' whenever you contradict me?" Lin's face remained impassive. "I guess it seems that way. Sir." "Damned few people would dare go as far as you do," Extrone said. "But you're afraid of me, too, in your own way, aren't you?" Lin shrugged. "Maybe." "I can see you are. Even my wives are. I wonder if anyone can know how wonderful it feels to have people all afraid of you." "The farn beasts, according to the manual...." "You are very insistent on one subject." "... It's the only thing I know anything about. The farn beast, as I was saying, sir, is the particular enemy of men. Or if you like, of aliens. Sir." "All right," Extrone said, annoyed. "I'll be careful." In the distance, a farn beast coughed. Instantly alert, Extrone said, "Get the bearers! Have some of them cut a path through that damn thicket! And tell those two businessmen to get the hell over here!" Lin smiled, his eyes suddenly afire with the excitement of the hunt. Four hours later, they were well into the scrub forest. Extrone walked leisurely, well back of the cutters, who hacked away, methodically, at the vines and branches which might impede his forward progress. Their sharp, awkward knives snickered rhythmically to the rasp of their heavy breathing. Occasionally, Extrone halted, motioned for his water carrier, and drank deeply of the icy water to allay the heat of the forest, a heat made oppressive by the press of foliage against the outside air. Ranging out, on both sides of the central body, the two businessmen fought independently against the wild growth, each scouting the flanks for farn beasts, and ahead, beyond the cutters, Lin flittered among the tree trunks, sometimes far, sometimes near. Extrone carried the only weapon, slung easily over his shoulder, a powerful blast rifle, capable of piercing medium armor in sustained fire. To his rear, the water carrier was trailed by a man bearing a folding stool, and behind him, a man carrying the heavy, high-powered two-way communication set. Once Extrone unslung his blast rifle and triggered a burst at a tiny, arboreal mammal, which, upon the impact, shattered asunder, to Extrone's satisfied chuckle, in a burst of blood and fur. When the sun stood high and heat exhaustion made the near-naked bearers slump, Extrone permitted a rest. While waiting for the march to resume, he sat on the stool with his back against an ancient tree and patted, reflectively, the blast rifle, lying across his legs. "For you, sir," the communications man said, interrupting his reverie. "Damn," Extrone muttered. His face twisted in anger. "It better be important." He took the head-set and mike and nodded to the bearer. The bearer twiddled the dials. "Extrone. Eh?... Oh, you got their ship. Well, why in hell bother me?... All right, so they found out I was here. You got them, didn't you?" "Blasted them right out of space," the voice crackled excitedly. "Right in the middle of a radio broadcast, sir." "I don't want to listen to your gabbling when I'm hunting!" Extrone tore off the head-set and handed it to the bearer. "If they call back, find out what they want, first. I don't want to be bothered unless it's important." "Yes, sir." Extrone squinted up at the sun; his eyes crinkled under the glare, and perspiration stood in little droplets on the back of his hands. Lin, returning to the column, threaded his way among reclining bearers. He stopped before Extrone and tossed his hair out of his eyes. "I located a spoor," he said, suppressed eagerness in his voice. "About a quarter ahead. It looks fresh." Extrone's eyes lit with passion. Lin's face was red with heat and grimy with sweat. "There were two, I think." "Two?" Extrone grinned, petting the rifle. "You and I better go forward and look at the spoor." Lin said, "We ought to take protection, if you're going, too." Extrone laughed. "This is enough." He gestured with the rifle and stood up. "I wish you had let me bring a gun along, sir," Lin said. "One is enough in my camp." The two of them went forward, alone, into the forest. Extrone moved agilely through the tangle, following Lin closely. When they came to the tracks, heavily pressed into drying mud around a small watering hole, Extrone nodded his head in satisfaction. "This way," Lin said, pointing, and once more the two of them started off. They went a good distance through the forest, Extrone becoming more alert with each additional foot. Finally, Lin stopped him with a restraining hand. "They may be quite a way ahead. Hadn't we ought to bring up the column?" The farn beast, somewhere beyond a ragged clump of bushes, coughed. Extrone clenched the blast rifle convulsively. The farn beast coughed again, more distant this time. "They're moving away," Lin said. "Damn!" Extrone said. "It's a good thing the wind's right, or they'd be coming back, and fast, too." "Eh?" Extrone said. "They charge on scent, sight, or sound. I understand they will track down a man for as long as a day." "Wait," Extrone said, combing his beard. "Wait a minute." "Yes?" "Look," Extrone said. "If that's the case, why do we bother tracking them? Why not make them come to us?" "They're too unpredictable. It wouldn't be safe. I'd rather have surprise on our side." "You don't seem to see what I mean," Extrone said. " We won't be the—ah—the bait." "Oh?" "Let's get back to the column." "Extrone wants to see you," Lin said. Ri twisted at the grass shoot, broke it off, worried and unhappy. "What's he want to see me for?" "I don't know," Lin said curtly. Ri got to his feet. One of his hands reached out, plucked nervously at Lin's bare forearm. "Look," he whispered. "You know him. I have—a little money. If you were able to ... if he wants," Ri gulped, "to do anything to me—I'd pay you, if you could...." "You better come along," Lin said, turning. Ri rubbed his hands along his thighs; he sighed, a tiny sound, ineffectual. He followed Lin beyond an outcropping of shale to where Extrone was seated, petting his rifle. Extrone nodded genially. "The farn beast hunter, eh?" "Yes, sir." Extrone drummed his fingers on the stock of the blast rifle. "Tell me what they look like," he said suddenly. "Well, sir, they're ... uh...." "Pretty frightening?" "No, sir.... Well, in a way, sir." "But you weren't afraid of them, were you?" "No, sir. No, because...." Extrone was smiling innocently. "Good. I want you to do something for me." "I ... I...." Ri glanced nervously at Lin out of the tail of his eye. Lin's face was impassive. "Of course you will," Extrone said genially. "Get me a rope, Lin. A good, long, strong rope." "What are you going to do?" Ri asked, terrified. "Why, I'm going to tie the rope around your waist and stake you out as bait." "No!" "Oh, come now. When the farn beast hears you scream—you can scream, by the way?" Ri swallowed. "We could find a way to make you." There was perspiration trickling down Ri's forehead, a single drop, creeping toward his nose. "You'll be safe," Extrone said, studying his face with amusement. "I'll shoot the animal before it reaches you." Ri gulped for air. "But ... if there should be more than one?" Extrone shrugged. "I—Look, sir. Listen to me." Ri's lips were bloodless and his hands were trembling. "It's not me you want to do this to. It's Mia, sir. He killed a farn beast before I did, sir. And last night—last night, he—" "He what?" Extrone demanded, leaning forward intently. Ri breathed with a gurgling sound. "He said he ought to kill you, sir. That's what he said. I heard him, sir. He said he ought to kill you. He's the one you ought to use for bait. Then if there was an accident, sir, it wouldn't matter, because he said he ought to kill you. I wouldn't...." Extrone said, "Which one is he?" "That one. Right over there." "The one with his back to me?" "Yes, sir. That's him. That's him, sir." Extrone aimed carefully and fired, full charge, then lowered the rifle and said, "Here comes Lin with the rope, I see." Ri was greenish. "You ... you...." Extrone turned to Lin. "Tie one end around his waist." "Wait," Ri begged, fighting off the rope with his hands. "You don't want to use me, sir. Not after I told you.... Please, sir. If anything should happen to me.... Please, sir. Don't do it." "Tie it," Extrone ordered. "No, sir. Please. Oh, please don't, sir." "Tie it," Extrone said inexorably. Lin bent with the rope; his face was colorless. They were at the watering hole—Extrone, Lin, two bearers, and Ri. Since the hole was drying, the left, partially exposed bank was steep toward the muddy water. Upon it was green, new grass, tender-tuffed, half mashed in places by heavy animal treads. It was there that they staked him out, tying the free end of the rope tightly around the base of a scaling tree. "You will scream," Extrone instructed. With his rifle, he pointed across the water hole. "The farn beast will come from this direction, I imagine." Ri was almost slobbering in fear. "Let me hear you scream," Extrone said. Ri moaned weakly. "You'll have to do better than that." Extrone inclined his head toward a bearer, who used something Ri couldn't see. Ri screamed. "See that you keep it up that way," Extrone said. "That's the way I want you to sound." He turned toward Lin. "We can climb this tree, I think." Slowly, aided by the bearers, the two men climbed the tree, bark peeling away from under their rough boots. Ri watched them hopelessly. Once at the crotch, Extrone settled down, holding the rifle at alert. Lin moved to the left, out on the main branch, rested in a smaller crotch. Looking down, Extrone said, "Scream!" Then, to Lin, "You feel the excitement? It's always in the air like this at a hunt." "I feel it," Lin said. Extrone chuckled. "You were with me on Meizque?" "Yes." "That was something, that time." He ran his hand along the stock of the weapon. The sun headed west, veiling itself with trees; a large insect circled Extrone's head. He slapped at it, angry. The forest was quiet, underlined by an occasional piping call, something like a whistle. Ri's screams were shrill, echoing away, shiveringly. Lin sat quiet, hunched. Extrone's eyes narrowed, and he began to pet the gun stock with quick, jerky movements. Lin licked his lips, keeping his eyes on Extrone's face. The sun seemed stuck in the sky, and the heat squeezed against them, sucking at their breath like a vacuum. The insect went away. Still, endless, hopeless, monotonous, Ri screamed. A farn beast coughed, far in the matted forest. Extrone laughed nervously. "He must have heard." "We're lucky to rouse one so fast," Lin said. Extrone dug his boot cleats into the tree, braced himself. "I like this. There's more excitement in waiting like this than in anything I know." Lin nodded. "The waiting, itself, is a lot. The suspense. It's not only the killing that matters." "It's not only the killing," Lin echoed. "You understand?" Extrone said. "How it is to wait, knowing in just a minute something is going to come out of the forest, and you're going to kill it?" "I know," Lin said. "But it's not only the killing. It's the waiting, too." The farn beast coughed again; nearer. "It's a different one," Lin said. "How do you know?" "Hear the lower pitch, the more of a roar?" "Hey!" Extrone shouted. "You, down there. There are two coming. Now let's hear you really scream!" Ri, below, whimpered childishly and began to retreat toward the tether tree, his eyes wide. "There's a lot of satisfaction in fooling them, too," Extrone said. "Making them come to your bait, where you can get at them." He opened his right hand. "Choose your ground, set your trap. Bait it." He snapped his hand into a fist, held the fist up before his eyes, imprisoning the idea. "Spring the trap when the quarry is inside. Clever. That makes the waiting more interesting. Waiting to see if they really will come to your bait." Lin shifted, staring toward the forest. "I've always liked to hunt," Extrone said. "More than anything else, I think." Lin spat toward the ground. "People should hunt because they have to. For food. For safety." "No," Extrone argued. "People should hunt for the love of hunting." "Killing?" "Hunting," Extrone repeated harshly. The farn beast coughed. Another answered. They were very near, and there was a noise of crackling underbrush. "He's good bait," Extrone said. "He's fat enough and he knows how to scream good." Ri had stopped screaming; he was huddled against the tree, fearfully eying the forest across from the watering hole. Extrone began to tremble with excitement. "Here they come!" The forest sprang apart. Extrone bent forward, the gun still across his lap. The farn beast, its tiny eyes red with hate, stepped out on the bank, swinging its head wildly, its nostrils flaring in anger. It coughed. Its mate appeared beside it. Their tails thrashed against the scrubs behind them, rattling leaves. "Shoot!" Lin hissed. "For God's sake, shoot!" "Wait," Extrone said. "Let's see what they do." He had not moved the rifle. He was tense, bent forward, his eyes slitted, his breath beginning to sound like an asthmatic pump. The lead farn beast sighted Ri. It lowered its head. "Look!" Extrone cried excitedly. "Here it comes!" Ri began to scream again. Still Extrone did not lift his blast rifle. He was laughing. Lin waited, frozen, his eyes staring at the farn beast in fascination. The farn beast plunged into the water, which was shallow, and, throwing a sheet of it to either side, headed across toward Ri. "Watch! Watch!" Extrone cried gleefully. And then the aliens sprang their trap.
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C. Lin thinks Extrone is the kind of ruler the system needs.
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By how much do they outperform existing state-of-the-art VQA models?
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### Introduction
We are interested in the problem of visual question answering (VQA), where an algorithm is presented with an image and a question that is formulated in natural language and relates to the contents of the image. The goal of this task is to get the algorithm to correctly answer the question. The VQA task has recently received significant attention from the computer vision community, in particular because obtaining high accuracies would presumably require precise understanding of both natural language as well as visual stimuli. In addition to serving as a milestone towards visual intelligence, there are practical applications such as development of tools for the visually impaired. The problem of VQA is challenging due to the complex interplay between the language and visual modalities. On one hand, VQA algorithms must be able to parse and interpret the input question, which is provided in natural language BIBREF0 , BIBREF1 , BIBREF2 . This may potentially involve understanding of nouns, verbs and other linguistic elements, as well as their visual significance. On the other hand, the algorithms must analyze the image to identify and recognize the visual elements relevant to the question. Furthermore, some questions may refer directly to the contents of the image, but may require external, common sense knowledge to be answered correctly. Finally, the algorithms should generate a textual output in natural language that correctly answers the input visual question. In spite of the recent research efforts to address these challenges, the problem remains largely unsolved BIBREF3 . We are particularly interested in giving VQA algorithms the ability to identify the visual elements that are relevant to the question. In the VQA literature, such ability has been implemented by attention mechanisms. Such attention mechanisms generate a heatmap over the input image, which highlights the regions of the image that lead to the answer. These heatmaps are interpreted as groundings of the answer to the most relevant areas of the image. Generally, these mechanisms have either been considered as latent variables for which there is no supervision, or have been treated as output variables that receive direct supervision from human annotations. Unfortunately, both of these approaches have disadvantages. First, unsupervised training of attention tends to lead to models that cannot ground their decision in the image in a human interpretable manner. Second, supervised training of attention is difficult and expensive: human annotators may consider different regions to be relevant for the question at hand, which entails ambiguity and increased annotation cost. Our goal is to leverage the best of both worlds by providing VQA algorithms with interpretable grounding of their answers, without the need of direct and explicit manual annotation of attention. From a practical point of view, as autonomous machines are increasingly finding real world applications, there is an increasing need to provide them with suitable capabilities to explain their decisions. However, in most applications, including VQA, current state-of-the-art techniques operate as black-box models that are usually trained using a discriminative approach. Similarly to BIBREF4 , in this work we show that, in the context of VQA, such approaches lead to internal representations that do not capture the underlying semantic relations between textual questions and visual information. Consequently, as we show in this work, current state-of-the-art approaches for VQA are not able to support their answers with a suitable interpretable representation. In this work, we introduce a methodology that provides VQA algorithms with the ability to generate human interpretable attention maps which effectively ground the answer to the relevant image regions. We accomplish this by leveraging region descriptions and object annotations available in the Visual Genome dataset, and using these to automatically construct attention maps that can be used for attention supervision, instead of requiring human annotators to manually provide grounding labels. Our framework achieves competitive state-of-the-art VQA performance, while generating visual groundings that outperform other algorithms that use human annotated attention during training. The contributions of this paper are: (1) we introduce a mechanism to automatically obtain meaningful attention supervision from both region descriptions and object annotations in the Visual Genome dataset; (2) we show that by using the prediction of region and object label attention maps as auxiliary tasks in a VQA application, it is possible to obtain more interpretable intermediate representations. (3) we experimentally demonstrate state-of-the-art performances in VQA benchmarks as well as visual grounding that closely matches human attention annotations. ### Related Work
Since its introduction BIBREF0 , BIBREF1 , BIBREF2 , the VQA problem has attracted an increasing interest BIBREF3 . Its multimodal nature and more precise evaluation protocol than alternative multimodal scenarios, such as image captioning, help to explain this interest. Furthermore, the proliferation of suitable datasets and potential applications, are also key elements behind this increasing activity. Most state-of-the-art methods follow a joint embedding approach, where deep models are used to project the textual question and visual input to a joint feature space that is then used to build the answer. Furthermore, most modern approaches pose VQA as a classification problem, where classes correspond to a set of pre-defined candidate answers. As an example, most entries to the VQA challenge BIBREF2 select as output classes the most common 3000 answers in this dataset, which account for 92% of the instances in the validation set. The strategy to combine the textual and visual embeddings and the underlying structure of the deep model are key design aspects that differentiate previous works. Antol et al. BIBREF2 propose an element-wise multiplication between image and question embeddings to generate spatial attention map. Fukui et al. BIBREF5 propose multimodal compact bilinear pooling (MCB) to efficiently implement an outer product operator that combines visual and textual representations. Yu et al. BIBREF6 extend this pooling scheme by introducing a multi-modal factorized bilinear pooling approach (MFB) that improves the representational capacity of the bilinear operator. They achieve this by adding an initial step that efficiently expands the textual and visual embeddings to a high-dimensional space. In terms of structural innovations, Noh et al. BIBREF7 embed the textual question as an intermediate dynamic bilinear layer of a ConvNet that processes the visual information. Andreas et al. BIBREF8 propose a model that learns a set of task-specific neural modules that are jointly trained to answer visual questions. Following the successful introduction of soft attention in neural machine translation applications BIBREF9 , most modern VQA methods also incorporate a similar mechanism. The common approach is to use a one-way attention scheme, where the embedding of the question is used to generate a set of attention coefficients over a set of predefined image regions. These coefficients are then used to weight the embedding of the image regions to obtain a suitable descriptor BIBREF10 , BIBREF11 , BIBREF5 , BIBREF12 , BIBREF6 . More elaborated forms of attention has also been proposed. Xu and Saenko BIBREF13 suggest use word-level embedding to generate attention. Yang et al. BIBREF14 iterates the application of a soft-attention mechanism over the visual input as a way to progressively refine the location of relevant cues to answer the question. Lu et al. BIBREF15 proposes a bidirectional co-attention mechanism that besides the question guided visual attention, also incorporates a visual guided attention over the input question. In all the previous cases, the attention mechanism is applied using an unsupervised scheme, where attention coefficients are considered as latent variables. Recently, there have been also interest on including a supervised attention scheme to the VQA problem BIBREF4 , BIBREF16 , BIBREF17 . Das et al. BIBREF4 compare the image areas selected by humans and state-of-the-art VQA techniques to answer the same visual question. To achieve this, they collect the VQA human attention dataset (VQA-HAT), a large dataset of human attention maps built by asking humans to select images areas relevant to answer questions from the VQA dataset BIBREF2 . Interestingly, this study concludes that current machine-generated attention maps exhibit a poor correlation with respect to the human counterpart, suggesting that humans use different visual cues to answer the questions. At a more fundamental level, this suggests that the discriminative nature of most current VQA systems does not effectively constraint the attention modules, leading to the encoding of discriminative cues instead of the underlying semantic that relates a given question-answer pair. Our findings in this work support this hypothesis. Related to the work in BIBREF4 , Gan et al. BIBREF16 apply a more structured approach to identify the image areas used by humans to answer visual questions. For VQA pairs associated to images in the COCO dataset, they ask humans to select the segmented areas in COCO images that are relevant to answer each question. Afterwards, they use these areas as labels to train a deep learning model that is able to identify attention features. By augmenting a standard VQA technique with these attention features, they are able to achieve a small boost in performance. Closely related to our approach, Qiao et al. BIBREF17 use the attention labels in the VQA-HAT dataset to train an attention proposal network that is able to predict image areas relevant to answer a visual question. This network generates a set of attention proposals for each image in the VQA dataset, which are used as labels to supervise attention in the VQA model. This strategy results in a small boost in performance compared with a non-attentional strategy. In contrast to our approach, these previous works are based on a supervised attention scheme that does not consider an automatic mechanism to obtain the attention labels. Instead, they rely on human annotated groundings as attention supervision. Furthermore, they differ from our work in the method to integrate attention labels to a VQA model. ### VQA Model Structure
Figure FIGREF2 shows the main pipeline of our VQA model. We mostly build upon the MCB model in BIBREF5 , which exemplifies current state-of-the-art techniques for this problem. Our main innovation to this model is the addition of an Attention Supervision Module that incorporates visual grounding as an auxiliary task. Next we describe the main modules behind this model. Question Attention Module: Questions are tokenized and passed through an embedding layer, followed by an LSTM layer that generates the question features INLINEFORM0 , where INLINEFORM1 is the maximum number of words in the tokenized version of the question and INLINEFORM2 is the dimensionality of the hidden state of the LSTM. Additionally, following BIBREF12 , a question attention mechanism is added that generates question attention coefficients INLINEFORM3 , where INLINEFORM4 is the so-called number of “glimpses”. The purpose of INLINEFORM5 is to allow the model to predict multiple attention maps so as to increase its expressiveness. Here, we use INLINEFORM6 . The weighted question features INLINEFORM7 are then computed using a soft attention mechanism BIBREF9 , which is essentially a weighted sum of the INLINEFORM8 word features followed by a concatenation according to INLINEFORM9 . Image Attention Module: Images are passed through an embedding layer consisting of a pre-trained ConvNet model, such as Resnet pretrained with the ImageNet dataset BIBREF18 . This generates image features INLINEFORM0 , where INLINEFORM1 , INLINEFORM2 and INLINEFORM3 are depth, height, and width of the extracted feature maps. Fusion Module I is then used to generate a set of image attention coefficients. First, question features INLINEFORM4 are tiled as the same spatial shape of INLINEFORM5 . Afterwards, the fusion module models the joint relationship INLINEFORM6 between questions and images, mapping them to a common space INLINEFORM7 . In the simplest case, one can implement the fusion module using either concatenation or Hadamard product BIBREF19 , but more effective pooling schemes can be applied BIBREF5 , BIBREF20 , BIBREF12 , BIBREF6 . The design choice of the fusion module remains an on-going research topic. In general, it should both effectively capture the latent relationship between multi-modal features meanwhile be easy to optimize. The fusion results are then passed through an attention module that computes the visual attention coefficient INLINEFORM8 , with which we can obtain attention-weighted visual features INLINEFORM9 . Again, INLINEFORM10 is the number of “glimpses”, where we use INLINEFORM11 . Classification Module: Using the compact representation of questions INLINEFORM0 and visual information INLINEFORM1 , the classification module applies first the Fusion Module II that provides the feature representation of answers INLINEFORM2 , where INLINEFORM3 is the latent answer space. Afterwards, it computes the logits over a set of predefined candidate answers. Following previous work BIBREF5 , we use as candidate outputs the top 3000 most frequent answers in the VQA dataset. At the end of this process, we obtain the highest scoring answer INLINEFORM4 . Attention Supervision Module: As a main novelty of the VQA model, we add an Image Attention Supervision Module as an auxiliary classification task, where ground-truth visual grounding labels INLINEFORM0 are used to guide the model to focus on meaningful parts of the image to answer each question. To do that, we simply treat the generated attention coefficients INLINEFORM1 as a probability distribution, and then compare it with the ground-truth using KL-divergence. Interestingly, we introduce two attention maps, corresponding to relevant region-level and object-level groundings, as shown in Figure FIGREF3 . Sections SECREF4 and SECREF5 provide details about our proposed method to obtain the attention labels and to train the resulting model, respectively. ### Mining Attention Supervision from Visual Genome
Visual Genome (VG) BIBREF21 includes the largest VQA dataset currently available, which consists of 1.7M QA pairs. Furthermore, for each of its more than 100K images, VG also provides region and object annotations by means of bounding boxes. In terms of visual grounding, these region and object annotations provide complementary information. As an example, as shown in Figure FIGREF3 , for questions related to interaction between objects, region annotations result highly relevant. In contrast, for questions related to properties of specific objects, object annotations result more valuable. Consequently, in this section we present a method to automatically select region and object annotations from VG that can be used as labels to implement visual grounding as an auxiliary task for VQA. For region annotations, we propose a simple heuristic to mine visual groundings: for each INLINEFORM0 we enumerate all the region descriptions of INLINEFORM1 and pick the description INLINEFORM2 that has the most (at least two) overlapped informative words with INLINEFORM3 and INLINEFORM4 . Informative words are all nouns and verbs, where two informative words are matched if at least one of the following conditions is met: (1) Their raw text as they appear in INLINEFORM5 or INLINEFORM6 are the same; (2) Their lemmatizations (using NLTK BIBREF22 ) are the same; (3) Their synsets in WordNet BIBREF23 are the same; (4) Their aliases (provided from VG) are the same. We refer to the resulting labels as region-level groundings. Figure FIGREF3 (a) illustrates an example of a region-level grounding. In terms of object annotations, for each image in a INLINEFORM0 triplet we select the bounding box of an object as a valid grounding label, if the object name matches one of the informative nouns in INLINEFORM1 or INLINEFORM2 . To score each match, we use the same criteria as region-level groundings. Additionally, if a triplet INLINEFORM3 has a valid region grounding, each corresponding object-level grounding must be inside this region to be accepted as valid. As a further refinement, selected objects grounding are passed through an intersection over union filter to account for the fact that VG usually includes multiple labels for the same object instance. As a final consideration, for questions related to counting, region-level groundings are discarded after the corresponding object-level groundings are extracted. We refer to the resulting labels as object-level groundings. Figure FIGREF3 (b) illustrates an example of an object-level grounding. As a result, combining both region-level and object-level groundings, about 700K out of 1M INLINEFORM0 triplets in VG end up with valid grounding labels. We will make these labels publicly available. ### Implementation Details
We build the attention supervision on top of the open-sourced implementation of MCB BIBREF5 and MFB BIBREF12 . Similar to them, We extract the image feature from res5c layer of Resnet-152, resulting in INLINEFORM0 spatial grid ( INLINEFORM1 , INLINEFORM2 , INLINEFORM3 ). We construct our ground-truth visual grounding labels to be INLINEFORM4 glimpse maps per QA pair, where the first map is object-level grounding and the second map is region-level grounding, as discussed in Section SECREF4 . Let INLINEFORM5 be the coordinate of INLINEFORM6 selected object bounding box in the grounding labels, then the mined object-level attention maps INLINEFORM7 are: DISPLAYFORM0 where INLINEFORM0 is the indicator function. Similarly, the region-level attention maps INLINEFORM1 are: DISPLAYFORM0 Afterwards, INLINEFORM0 and INLINEFORM1 are spatially L1-normalized to represent probabilities and concatenated to form INLINEFORM2 . The model is trained using a multi-task loss, DISPLAYFORM0 where INLINEFORM0 denotes cross-entropy and INLINEFORM1 denotes KL-divergence. INLINEFORM2 corresponds to the learned parameters. INLINEFORM3 is a scalar that weights the loss terms. This scalar decays as a function of the iteration number INLINEFORM4 . In particular, we choose to use a cosine-decay function: DISPLAYFORM0 This is motivated by the fact that the visual grounding labels have some level of subjectivity. As an example, Figure FIGREF11 (second row) shows a case where the learned attention seems more accurate than the VQA-HAT ground truth. Hence, as the model learns suitable parameter values, we gradually loose the penalty on the attention maps to provide more freedom to the model to selectively decide what attention to use. It is important to note that, for training samples in VQA-2.0 or VG that do not have region-level or object-level grounding labels, INLINEFORM0 in Equation EQREF6 , so the loss is reduced to the classification term only. In our experiment, INLINEFORM1 is calibrated for each tested model based on the number of training steps. In particular, we choose INLINEFORM2 for all MCB models and INLINEFORM3 for others. ### Datasets
VQA-2.0: The VQA-2.0 dataset BIBREF2 consists of 204721 images, with a total of 1.1M questions and 10 crowd-sourced answers per question. There are more than 20 question types, covering a variety of topics and free-form answers. The dataset is split into training (82K images and 443K questions), validation (40K images and 214K questions), and testing (81K images and 448K questions) sets. The task is to predict a correct answer INLINEFORM0 given a corresponding image-question pair INLINEFORM1 . As a main advantage with respect to version 1.0 BIBREF2 , for every question VQA-2.0 includes complementary images that lead to different answers, reducing language bias by forcing the model to use the visual information. Visual Genome: The Visual Genome (VG) dataset BIBREF21 contains 108077 images, with an average of 17 QA pairs per image. We follow the processing scheme from BIBREF5 , where non-informative words in the questions and answers such as “a” and “is” are removed. Afterwards, INLINEFORM0 triplets with answers to be single keyword and overlapped with VQA-2.0 dataset are included in our training set. This adds 97697 images and about 1 million questions to the training set. Besides the VQA data, VG also provides on average 50 region descriptions and 30 object instances per image. Each region/object is annotated by one sentence/phrase description and bounding box coordinates. VQA-HAT: VQA-HAT dataset BIBREF4 contains 58475 human visual attention heat (HAT) maps for INLINEFORM0 triplets in VQA-1.0 training set. Annotators were shown a blurred image, a INLINEFORM1 pair and were asked to “scratch” the image until they believe someone else can answer the question by looking at the blurred image and the sharpened area. The authors also collect INLINEFORM2 HAT maps for VQA-1.0 validation sets, where each of the 1374 INLINEFORM3 were labeled by three different annotators, so one can compare the level of agreement among labels. We use VQA-HAT to evaluate visual grounding performance, by comparing the rank-correlation between human attention and model attention, as in BIBREF4 , BIBREF24 . VQA-X: VQA-X dataset BIBREF24 contains 2000 labeled attention maps in VQA-2.0 validation sets. In contrast to VQA-HAT, VQA-X attention maps are in the form of instance segmentations, where annotators were asked to segment objects and/or regions that most prominently justify the answer. Hence the attentions are more specific and localized. We use VQA-X to evaluate visual grounding performance by comparing the rank-correlation, as in BIBREF4 , BIBREF24 . ### Results
We evaluate the performance of our proposed method using two criteria: i) rank-correlation BIBREF25 to evaluate visual grounding and ii) accuracy to evaluate question answering. Intuitively, rank-correlation measures the similarity between human and model attention maps under a rank-based metric. A high rank-correlation means that the model is `looking at' image areas that agree to the visual information used by a human to answer the same question. In terms of accuracy of a predicted answer INLINEFORM0 is evaluated by: DISPLAYFORM0 Table TABREF10 reports our main results. Our models are built on top of prior works with the additional Attention Supervision Module as described in Section SECREF3 . Specifically, we denote by Attn-* our adaptation of the respective model by including our Attention Supervision Module. We highlight that MCB model is the winner of VQA challenge 2016 and MFH model is the best single model in VQA challenge 2017. In Table TABREF10 , we can observe that our proposed model achieves a significantly boost on rank-correlation with respect to human attention. Furthermore, our model outperforms alternative state-of-art techniques in terms of accuracy in answer prediction. Specifically, the rank-correlation for MFH model increases by 36.4% when is evaluated in VQA-HAT dataset and 7.7% when is evaluated in VQA-X. This indicates that our proposed methods enable VQA models to provide more meaningful and interpretable results by generating more accurate visual grounding. Table TABREF10 also reports the result of an experiment where the decaying factor INLINEFORM0 in Equation EQREF7 is fixed to a value of 1. In this case, the model is able to achieve higher rank-correlation, but accuracy drops by 2%. We observe that as training proceeds, attention loss becomes dominant in the final training steps, which affects the accuracy of the classification module. Figure FIGREF11 shows qualitative results of the resulting visual grounding, including also a comparison with respect to no-attn model. ### Conclusions
In this work we have proposed a new method that is able to slightly outperform current state-of-the-art VQA systems, while also providing interpretable representations in the form of an explicitly trainable visual attention mechanism. Specifically, as a main result, our experiments provide evidence that the generated visual groundings achieve high correlation with respect to human-provided attention annotations, outperforming the correlation scores of previous works by a large margin. As further contributions, we highlight two relevant insides of the proposed approach. On one side, by using attention labels as an auxiliary task, the proposed approach demonstrates that is able to constraint the internal representation of the model in such a way that it fosters the encoding of interpretable representations of the underlying relations between the textual question and input image. On other side, the proposed approach demonstrates a method to leverage existing datasets with region descriptions and object labels to effectively supervise the attention mechanism in VQA applications, avoiding costly human labeling. As future work, we believe that the superior visual grounding provided by the proposed method can play a relevant role to generate natural language explanations to justify the answer to a given visual question. This scenario will help to demonstrate the relevance of our technique as a tool to increase the capabilities of AI based technologies to explain their decisions. Acknowledgements: This work was partially funded by Oppo, Panasonic and the Millennium Institute for Foundational Research on Data. Figure 1. Interpretable VQA algorithms must ground their answer into image regions that are relevant to the question. In this paper, we aim at providing this ability by leveraging existing region descriptions and object annotations to construct grounding supervision automatically. Figure 2. Schematic diagram of the main parts of the VQA model. It is mostly based on the model presented in [6]. Main innovation is the Attention Supervision Module that incorporates visual grounding as an auxiliary task. This module is trained through the use of a set of image attention labels that are automatically mined from the Visual Genome dataset. Figure 3. (a) Example region-level groundings from VG. Left: image with region description labels; Right: our mined results. Here “men” in the region description is firstly lemmatized to be “man”, whose aliases contain “people”; the word “talking” in the answer also contributes to the matching. So the selected regions have two matchings which is the most among all candidates. (b) Example object-level grounding from VG. Left: image with object instance labels; Right: our mined results. Note that in this case region-level grounding will give us the same result as in (a), but object-level grounding is clearly more localized. Table 1. Evaluation of different VQA models on visual grounding and answer prediction. All the listed models are trained on VQA2.0 and Visual Genome. The reported accuracies are evaluated using the VQA-2.0 test-standard set. Note that the results of MCB, MFB and MFH are taken directly from the author’s public best single model. Figure 4. Visual grounding comparison: the first column is the ground-truth human attention in VQA-HAT [5]; the second column shows the results from pretrained MFH model [26]; the last column are our Attn-MFH trained with attention supervision. We can see that the attention areas considered by our model mimic the attention areas used by humans, but they are more localized in space. Figure 5. Qualitative Results on complementary pairs generated by our Attn-MFH model; the model learns to attend to different regions even if the questions are the same.
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the rank-correlation for MFH model increases by 36.4% when is evaluated in VQA-HAT dataset and 7.7% when is evaluated in VQA-X
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What are the features of used to customize target user interaction?
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### Introduction
Recent advances in visual language field enabled by deep learning techniques have succeeded in bridging the gap between vision and language in a variety of tasks, ranging from describing the image BIBREF0 , BIBREF1 , BIBREF2 , BIBREF3 to answering questions about the image BIBREF4 , BIBREF5 . Such achievements were possible under the premise that there exists a set of ground truth references that are universally applicable regardless of the target, scope, or context. In real-world setting, however, image descriptions are prone to an infinitely wide range of variabilities, as different viewers may pay attention to different aspects of the image in different contexts, resulting in a variety of descriptions or interpretations. Due to its subjective nature, such diversity is difficult to obtain with conventional image description techniques. In this paper, we propose a customized image narrative generation task, in which we attempt to actively engage the users in the description generation process by asking questions and directly obtaining their answers, thus learning and reflecting their interest in the description. We use the term image narrative to differentiate our image description from conventional one, in which the objective is fixed as depicting factual aspects of global elements. In contrast, image narratives in our model cover a much wider range of topics, including subjective, local, or inferential elements. We first describe a model for automatic image narrative generation from single image without user interaction. We develop a self Q&A model to take advantage of wide array of contents available in visual question answering (VQA) task, and demonstrate that our model can generate image descriptions that are richer in contents than previous models. We then apply the model to interactive environment by directly obtaining the answers to the questions from the users. Through a wide range of experiments, we demonstrate that such interaction enables us not only to customize the image description by reflecting the user's choice in the current image of interest, but also to automatically apply the learned preference to new images (Figure 1 ). ### Related Works
Visual Language: The workflow of extracting image features with convolutional neural network (CNN) and generating captions with long short-term memory (LSTM) BIBREF6 has been consolidated as a standard for image captioning task. BIBREF0 generated region-level descriptions by implementing alignment model of region-level CNN and bidirectional recurrent neural network (RNN). BIBREF7 proposed DenseCap that generates multiple captions from an image at region-level. BIBREF8 built SIND dataset whose image descriptions display a more casual and natural tone, involving aspects that are not factual and visually apparent. While this work resembles the motivation of our research, it requires a sequence of images to fully construct a narrative. Visual question answering (VQA) has escalated the interaction of language and vision to a new stage, by enabling a machine to answer a variety of questions about the image, not just describe certain aspects of the image. A number of different approaches have been proposed to tackle VQA task, but classification approach has been shown to outperform generative approach BIBREF9 , BIBREF10 . BIBREF11 proposed multimodal compact bilinear pooling to compactly combine the visual and textual features. BIBREF12 proposed an attention-based model to select a region from the image based on text query. BIBREF13 introduced co-attention model, which not only employs visual attention, but also question attention. User Interaction: Incorporating interaction with users into the system has rapidly become a research interest. Visual Dialog BIBREF5 actively involves user interaction, which in turn affects the responses generated by the system. Its core mechanism, however, functions in an inverse direction from our model, as the users ask the questions about the image, and the system answers them. Thus, the focus is on extending the VQA system to a more context-dependent, and interactive direction. On the other hand, our model's focus is on generating customized image descriptions, and user interaction is employed to learn the user's interest, whereas Visual Dialog is not concerned about the users themselves. BIBREF14 introduces an interactive game, in which the system attempts to localize the object that the user is paying attention to by asking relevant questions that narrow down the potential candidates, and obtaining answers from the users. This work is highly relevant to our work in that user's answers directly influence the performance of the task, but our focus is on contents generation instead of object localization or gaming. Also, our model not only utilizes user's answer for current image, but further attempts to apply it to new images. Recent works in reinforcement learning (RL) have also employed interactive environment by allowing the agents to be taught by non-expert humans BIBREF15 . However, its main purpose is to assist the training of RL agents, while our goal is to learn the user's interest specifically. ### Automatic Image Narrative Generation
We first describe a model to generate image narrative that covers a wide range of topics without user interaction. We propose a self Q&A model where questions are generated from multiple regions, and VQA is applied to answer the questions, thereby generating image-relevant contents. Region Extraction: Following BIBREF16 , we first extract region candidates from the feature map of an image, by applying linear SVM trained on annotated bounding boxes at multiple scales, and applying non-maximal suppression. The region candidates then go through inverse cascade from upper, fine layer to lower, coarser layers of CNN, in order to better-localize the detected objects. This results in region proposals that are more contents-oriented than selective search BIBREF17 or Edge Boxes BIBREF18 . We first extracted top 10 regions per image. Figure 2 shows an example of the regions extracted in this way. In the experiments to follow, we set the number of region proposals K as 5, since the region proposals beyond top 5 tended to be less congruent, thus generating less relevant questions. Visual Question Generation: In image captioning task, it is conventional to train an LSTM with human-written captions as ground truth annotations. On the other hand, in VQA task, questions are frequently inserted to LSTM in series with fixed image features, and the answers to the questions become the ground truth labels to be classified. Instead, we replace the human-written captions with human-written questions, so that LSTM is trained to predict the question, rather than caption. Given an image I and a question Q = (q0,...qN), the training proceeds as in BIBREF2 : $$\begin{aligned}
x_{-1} = CNN(I),x_t = W_eq_t,p_{t+1}=LSTM(x_t)\\
\end{aligned}$$ (Eq. 3) where We is a word embedding, xt is the input features to LSTM at t, and pt+1 is the resulting probability distribution for the entire dictionary at t. In the actual generation of questions, it will be performed over all region proposals r0,...,rN $\in $ I: $$\begin{aligned}
x_{-1} = CNN(r_i), x_t = W_eq_{t-1}\\
q_{t}=\mathrm {max}_{q\in p} p_{t+1}=\mathrm {argmax} LSTM(x_t)
\end{aligned}$$ (Eq. 4) for q0,...qN $\in $ Qri. Figure 2 shows examples of questions generated from each region including the entire image. As shown in the figure, by focusing on different regions and extracting different image features, we can generate multiple image-relevant questions from single image. So far, we were concerned with generating “visual” questions. We also seek to generate “non-visual" questions. BIBREF19 generated questions that a human may naturally ask and require common-sense and inference. We examined whether we can train a network to ask multiple questions of such type by visual cues. We replicated the image captioning process described above, with 10,000 images of MS COCO and Flickr segments of VQG dataset, with 5 questions per image as the annotations. Examples of questions generated by training the network solely with non-visual questions are shown in Table 1 . Visual Question Answering: We now seek to answer the questions generated. We train the question answering system with VQA dataset BIBREF4 . Question words are sequentially encoded by LSTM as one-hot vector. Hyperbolic tangent non-linearity activation was employed, and element-wise multiplication was used to fuse the image and word features, from which softmax classifies the final label as the answer for visual question. We set the number of possible answers as 1,250. As we augmented the training data with “non-visual” questions, we also need to train the network to “answer” those non-visual answers. Since BIBREF19 provides the questions only, we collected the answers to these questions on Amazon Mechanical Turk. Since many of these questions cannot be answered without specific knowledge beyond what is seen in the image (e.g. “what is the name of the dog?”), we encouraged the workers to use their imagination, but required them to come up with answers that an average person might also think of. For example, people frequently answered the question “what is the name of the man?” with “John” or “Tom.” Such non-visual elements add vividness and story-like characteristics to the narrative as long as they are compatible with the image, even if not entirely verifiable. [table]skip=1pt Natural Language Processing: We are now given multiple pairs of questions and answers about the image. By design of the VQA dataset, which mostly comprises simple questions regarding only one aspect with the answers mostly being single words, the grammatical structure of most questions and answers can be reduced to a manageable pool of patterns. Exploiting these design characteristics, we combine the obtained pairs of questions and answers to a declarative sentence by application of rule-based transformations, as in BIBREF20 , BIBREF21 . We first rephrase the question to a declarative sentence by switching word positions, and then insert the answers to its appropriate position, mostly replacing wh-words. For example, a question “What is the man holding?" is first converted to a declarative statement “The man is holding what" and the corresponding answer “frisbee” replaces “what" to make “The man is holding frisbee." Part-of-speech tags with limited usage of parse tree were used to guide the process, particularly conjugation according to tense and plurality. Figure 3 illustrates the workflow of converting question and answer to a declarative sentence. See Supplemental Material for specific conversion rules. Part-of-speech tag notation is as used in PennTree I Tags BIBREF22 . We applied the model described in Section "Automatic Image Narrative Generation" to 40,775 images in test 2014 split of MS COCO BIBREF24 . We compare our proposed model to three baselines as following: Baseline 1 (COCO): general captioning trained on MS COCO applied to both images in their entireties and the region proposals Baseline 2 (SIND): captions with model trained on MS SIND dataset BIBREF8 , applied to both images in their entireties and the region proposals Baseline 3 (DenseCap): captions generated by DenseCap BIBREF7 at both the whole images and regions with top 5 scores using their own region extraction implementation. Automatic Evaluation: It is naturally of our interest how humans would actually write image narratives. Not only can we perform automatic evaluation for reference, but we can also have a comprehension of what characteristics would be shown in actual human-written image narratives. We collected image narratives for a subset of MS COCO dataset . We asked the workers to write a 5-sentence narrative about the image in a story-like way. We made it clear that the description can involve not only factual description of the main event, but also local elements, sentiments, inference, imagination, etc., provided that it can relate to the visual elements shown in the image. Table 2 shows examples of actual human-written image narratives collected and they display a number of intriguing remarks. On top of the elements and styles we asked for, the participants actively employed many other elements encompassing humor, question, suggestion, etc. in a highly creative way. It is also clear that conventional captioning alone will not be able to capture or mimic the semantic diversity present in them. We performed automatic evaluation with BLEU BIBREF25 with collected image narratives as ground truth annotations. Table 3 shows the results. While resemblance to human-written image narratives may not necessarily guarantee better qualities, our model, along with DenseCap, showed highest resemblance to human-written image narratives. As we will see in human evaluation, such tendency turns out to be consistent, suggesting that resemblance to human-written image narratives may indeed provide a meaningful reference. Human Evaluation: We asked the workers to rate each model's narrative with 5 metrics that we find essential in evaluating narratives; Diversity, Interestingness, Accuracy, Naturalness, and Expressivity (DIANE). Evaluation was performed for 5,000 images with 2 workers per image, and all metrics were rated in the scale of 1 to 5 with 5 being the best performance in each metric. We asked each worker to rate all 4 models for the image on all metrics. Table 6 shows example narratives from each model. Table 4 shows the performance of each model on the evaluation metrics, along with the percentage of each model receiving the highest score for a given image, including par with other models. Our model obtained the highest score on Diversity, Interestingness and Expressivity, along with the highest overall score and the highest percentage of receiving best scores. In all other metrics, our model was the second highest, closely trailing the models with highest scores. Table 5 shows our model's performance against each baseline model, in terms of the counts of wins, losses, and pars. ${\chi }^2$ values on 2 degrees of freedom are evaluated against the null hypothesis that all models are equally preferred. The rightmost column in Table 5 corresponds to the one-sided p-values obtained from binomial probability against the same null hypothesis. Both significance tests provide an evidence that our model is clearly preferred over others. Discussion: General image captioning trained on MS COCO shows weaknesses in accuracy and expressivity. Lower score in accuracy is presumably due to quick diversion from the image contents as it generates captions directly from regions. Since it is restricted by an objective of describing the entire image, it frequently generates irrelevant description on images whose characteristics differ from typical COCO images, such as regions within an image as in our case. Story-like captioning trained on MS SIND obtained the lowest scores in all metrics. In fact, examples in Table 6 display that the narratives from this model are almost completely irrelevant to the corresponding images, since the correlation between single particular image and assigned caption is very low. DenseCap turns out to be the most competitive among the baseline models. It demonstrates the highest accuracy among all models, but shows weaknesses in interestingness and expressivity, due to their invariant tone and design objective of factual description. Our model, highly ranked in all metrics, demonstrates superiority in many indispensable aspects of narrative, while not sacrificing the descriptive accuracy. ### Interactive Image Narrative Generation
We now extend the automatic image narrative generation model described in Section "Automatic Image Narrative Generation" to interactive environment, in which users participate in the process by answering questions about the image, so that generated narrative varies depending on the user input provided. We first need to obtain data that reflect personal tendencies of different users. Thus, we not only need to collect data from multiple users so that individual differences exist, but also to collect multiple responses from each user so that individual tendency of each user can be learned. We generated 10,000 questions that allow for multiple responses following the procedure described in Section "Interactive Image Narrative Generation" . We grouped every 10 questions into one task, and allowed 3 workers per task so that up to 3,000 workers can participate. Since multiple people are participating for the same group of images, we end up obtaining different sets of responses that reflect each individual's tendency. We have permutation of 10 choose 2, $P(10,2)=90$ pairs of triplets for each user, adding up to 270,000 pairs of training data. Note that we are assuming a source-to-target relation within the pair, so the order within the pair does matter. We randomly split these data into 250,000 and 20,000 for training and validation splits, and performed 5-fold validation with training procedure described in Section "Interactive Image Narrative Generation" . With 705 labels as possible choices, we had an average of 68.72 accuracy in predicting the choice on new image, given the previous choice by the same user. Randomly matching the pairs with choices from different users seemingly drops the average score down to 45.17, confirming that the consistency in user choices is a key point in learning preference. Question Generation: For question generation, our interest is whether our model can generate questions that allow for various responses, rather than single fixed response. We asked the workers on Amazon Mechanical Turk to decide whether the question can be answered in various ways or has multiple answers, given an image. 1,000 questions were generated with our proposed model using both VQG and VQA, and another 1,000 questions were generated using VQG only. Table 7 shows the number of votes for each model. It is very clear that the questions generated from our proposed model of parallel VQG and VQA outperformed by far the questions generated from VQG only. This is inevitable in a sense that VQG module was trained with human-written questions that were intended to train the VQA module, i.e. with questions that mostly have clear answers. On the other hand, our model deliberately chose the questions from VQG that have evenly distributed probabilities for answer labels, thus permitting multiple possible responses. Table 8 shows examples of visual questions generated from our model and VQG only respectively. In questions generated from our model, different responses are possible, whereas the questions generated from VQG only are restricted to single obvious answer. Reflection of User's Choice on the Same Image: Our next experiment is on the user-dependent image narrative generation. We presented the workers with 3,000 images and associated questions, with 3 possible choices as a response to each question. Each worker freely chooses one of the choices, and is asked to rate the image narrative that corresponds to the answer they chose, considering how well it reflects their answer choices. As a baseline model, we examined a model where the question is absent in the learning and representation, so that only the image and the user input are provided. Rating was performed over scale of 1 to 5, with 5 indicating highly reflective of their choice. Table 11 shows the result. Agreement score among the workers was calculated based on BIBREF26 . Agreement score for our model falls into the range of `moderate' agreement, whereas, for baseline model, it is at the lower range of `fair' agreement, as defined by BIBREF27 , demonstrating that the users more frequently agreed upon the reliability of the image narratives for our model. Our model clearly has an advantage over using image features only with a margin considerably over standard deviation. Table 9 shows examples of images, generated question, and image narratives generated depending on the choice made for the question respectively. Reflection of User's Choice on New Images: Finally, we experiment with applying user's interest to new images. As in the previous experiment, each worker is presented with an image and a question, with 3 possible choices as an answer to the question. After they choose an answer, they are presented with a new image and a new image narrative. Their task is to determine whether the newly presented image narrative reflects their choice and interest. As a baseline, we again examined a model where the question is absent in the learning and representation stages. In addition, we performed an experiment in which we trained preference learning module with randomly matched choices. This allows us to examine whether there exists a consistency in user choices that enables us to apply the learned preferences to new image narratives. Table 12 shows the result. As in previous experiment, our model clearly has an advantage over using image features only. Inter-rater agreement score is also more stable for our model. Training preference learning module with randomly matched pairs of choices resulted in a score below our proposed model, but above using the image features only. This may imply that, even with randomly matched pairs, it is better to train with actual choices made by the users with regards to specific questions, rather than with conspicuous objects only. Overall, the result confirms that it is highly important to provide a context, in our case by generating visual questions, for the system to learn and reflect the user's specific preferences. It also shows that it is important to train with consistent choices made by identical users. Table 10 shows examples of image narratives generated for new images, depending on the choice the users made for the original image, given the respective questions. ### Applying Interaction within the Same Images
As discussed earlier, we attempt to reflect user's interest by asking questions that provide visual context. The foremost prerequisite for the interactive questions to perform that function is the possibility of various answers or interpretations. In other words, a question whose answer is so obvious that it can be answered in an identical way would not be valid as an interactive question. In order to make sure that each generated question allows for multiple possible answers, we internally utilize the VQA module. The question generated by the VQG module is passed on to VQA module, where the probability distribution $p_{ans}$ for all candidate answers $C$ is determined. If the most likely candidate $c_i=\max p_{ans}$ , where $c_i \in C$ , has a probability of being answer over a certain threshold $\alpha $ , then the question is considered to have a single obvious answer, and is thus considered ineligible. The next question generated by VQG is passed on to VQA to repeat the same process until the the following requirement is met: $$\begin{aligned}
c_i<\alpha , c_i= \max p_{ans} \\
\end{aligned}$$ (Eq. 10) In our experiments, we set $\alpha $ as 0.33. We also excluded the yes/no type of questions. Figure 4 illustrates an example of a question where the most likely answer had a probability distribution over the threshold (and is thus ineligible), and another question whose probability distribution over the candidate answers was more evenly distributed (and thus proceeds to narrative generation stage). Once the visual question that allows for multiple responses is generated, a user inputs his answer to the question, which is assumed to reflect his interest. We then need to extract a region within the image that corresponds to the user's response. We slightly modify the attention networks introduced in BIBREF23 in order to obtain the coordinates of the region that correspond to the user response. In BIBREF23 , the question itself was fed into the network, so that the region necessary to answer that question is “attended to.” On the other hand, we are already given the answer to the question by the user. We take advantage of this by making simple yet efficient modification, in which we replace the wh- question terms with the response provided by the user. For example, a question “what is on the table?” with a user response “pizza” will be converted to a phrase “pizza is on the table,” which is fed into attention network. This is similar to the rule-based NLP conversion in Section "Automatic Image Narrative Generation" . We obtain the coordinates of the region from the second attention layer, by obtaining minimum and maximum values for x-axis and y-axis in which the attention layer reacts to the input phrase. Since the regions are likely to contain the objects of interest at very tight scale, we extracted the regions at slightly larger sizes than coordinates. A region $r_i$ of size ( $w_{r_i},h_{r_i}$ ) with coordinates $x_{0_i},y_{0_i},x_{max_i},y_{max_i}$ for image I of size $(W,H)$ is extracted with a magnifying factor $\alpha $ (set as 0.25): $$\begin{aligned}
r^{\prime }_i=(\max (0,x_{0_i}-w_{r_i}\alpha ),\max (0,y_{0_i}-h_{r_i}\alpha ),\\
\min (W,x_{max_i}+w_{r_i}\alpha ),\min (H,y_{max_i}+h_{r_i}\alpha ))\\
\end{aligned}$$ (Eq. 12) Given the region and its features, we can now apply the image narrative generation process described in Section "Automatic Image Narrative Generation" with minor modifications in setting. Regions are further extracted, visual questions are generated and answered, and rule-based natural language processing techniques are applied to organize them. Figure 4 shows an overall workflow of our model. ### Applying Interaction to New Images
We represent each instance of image, question, and user choice as a triplet consisting of image feature, question feature, and the label vector for the user's answer. In addition, collecting multiple choices from identical users enables us to represent any two instances by the same user as a pair of triplets, assuming source-target relation. With these pairs of triplets, we can train the system to predict a user's choice on a new image and a new question, given the same user's choice on the previous image and its associated question. User's choice $x_{ans_i}$ is represented as one-hot vector where the size of the vector is equal to the number of possible choices. We refer to the fused feature representation of this triplet consisting of image, question, and the user's choice as choice vector. We now project the image feature $x_{img_j}$ and question feature $x_{q_j}$ for the second triplet onto the same embedding space as the choice vector. We can now train a softmax classification task in which the feature from the common embedding space predicts the user's choice $x_{ans_j}$ on new question. In short, we postulate that the answer with index $u$ , which maximizes the probability calculated by LSTM, is to be chosen as $x_{ans_l}$ by the user who chose $x_{ans_k}$ , upon seeing a tuple $(x_{img_l},x_{q_l})$ of new image and new question: $$\begin{aligned}
u=\arg \max _v P(v;c_k,x_{img_l},x_{q_l})
\end{aligned}$$ (Eq. 15) where P is a probability distribution determined by softmax over the space of possible choices, and $c_k$ is the choice vector corresponding to $(x_{img_k},x_{q_k},x_{ans_k})$ . This overall procedure and structure are essentially identical as in VQA task, except we augment the feature space to include choice vector. Figure 5 shows the overall workflow for training. ### Conclusion
We proposed a customized image narrative generation task, where we proposed a model to engage the users in image description generation task, by directly asking questions to the users, and collecting answers. Experimental results demonstrate that our model can successfully diversify the image description by reflecting the user's choice, and that user's interest learned can be further applied to new images. ### Acknowledgments
This work was partially funded by the ImPACT Program of the Council for Science, Technology, and Innovation (Cabinet Office, Government of Japan), and was partially supported by CREST, JST. ### Why generate quesetions?
A question may arise as to why not to simply ask the users to select the region or part of the image that stands out the most to them. In such case, there would be no need to generate the questions for each image, as the question `what stands out the most?' would suffice for all images. This, however, would be equivalent to a simple saliency annotation task, and would not allow for any meaningful customization or optimization per user. Thus, as discussed above, generating a question for each image is intended to provide a context in which each user can apply their own specific interest. Figure 6 shows how providing context via questions can diversify people's attention. Apart from simply generating diverse image narratives based on the user input, many potential applications can be conceived of. For example, in cases where thorough description of an entire scene results in a redundant amount of information both quality and quantity-wise, application of our model can be applied to describe just the aspect that meets the user's interest that was learned. [table]skip=1pt ### Clarification of DIANE
Few works tackled the task of narrative evaluation, hardly taking visual information into consideration. Although we could not find an authoritative work on the topic of narrative evaluation, this was our best attempt at not only reflecting precision/recall, but various aspects contributing to the integrity of the image narrative. Diversity deals with the coverage of diction and contents in the narrative, roughly corresponding to recall. Interestingness measures the extent to which the contents of the narrative grasp the user's attention. Accuracy measures the degree to which the description is relevant to the image, corresponding to precision. Contents that are not visually verifiable are considered accurate only if they are compatible with salient parts of the image. Naturalness refers to the narrative's overall resemblance to human-written text or human-spoken dialogue. Expressivity deals with the range of syntax and tones in the narrative. ### Additional Experiments
We also performed an experiment in which we generate image narratives by following conventional image captioning procedure with human-written image narratives collected on Amazon Mechanical Turk. In other words, we trained LSTM with CNN features of images and human-written image narratives as ground truth captions. If such setting turns out to be successful, our model would not have much comparative merit. We trained an LSTM with collected image-narratives for training split of MS COCO. We retained the experimental conditions identically as previous experiments, and trained for 50 epochs. Table 19 shows example narratives generated. Not only does it utterly fail to learn the structure of image narratives, but it hardly generates text over one sentence, and even so, its descriptive accuracy is very poor. Since LSTM now has to adjust its memory cells' dependency on much longer text, it struggles to even form a complete sentence, not to mention inaccurate description. This tells us that simply training with human-written image narratives does not result in reliable outcomes. With reference human-written image narratives, we further performed CIDEr BIBREF29 evaluation as shown in Table 25 . ### Discussion
It was shown via the experiments above that there exists a certain consistency over the choices made by the same user, and that it is thus beneficial to train with the choices made by the same users. Yet, we also need to investigate whether such consistency exists across different categories of images. We ran Fast-RCNN BIBREF28 on the images used in our experiment, and assigned the classes with probability over 0.7 as the labels for each image. We then define any two images to be in the same category if any of the assigned labels overlaps. Of 3,000 pairs of images used in the experiment, 952 pairs had images with at least one label overlapping. Our proposed model had average human evaluation score of 4.35 for pairs with overlapping labels and 2.98 for pairs without overlapping labels. Baseline model with image features only had 2.57 for pairs with overlapping labels and 2.10 for pairs without overlapping labels. Thus, it is shown that a large portion of the superior performance of our model comes from the user's consistency for the images of the same category, which is an intuitively correct conclusion. However, our model also has superiority over baseline model for pairs without overlapping labels. This may seem more difficult to explain intuitively, as it is hard to see any explicit correlation between, for example, a car and an apple, other than saying that it is somebody's preference. We manually examined a set of such examples, and frequently found a pattern in which the color of the objects of choices was identical; for example, a red car and an apple. It is difficult to attribute it to a specific cause, but it is likely that there exists some degree of consistency in user choices over different categories, although to a lesser extent than for images in the same category. Also, it is once again confirmed that it is better to train with actual user choices made on specific questions, rather than simply with most conspicuous objects. ### Additional Figures & Tables
Table 13 shows the contrast between semantic diversity of captions and questions. Figure 7 shows overall architecture each of image captioning, visual question answering, and visual question generation task. Table 14 shows statistics for crowd-sourcing task on collecting answers to non-visual questions in VQG dataset. Table 15 shows examples of answers to VQG questions collected on crowd-sourcing. Table 1 shows examples of generated questions using VQG dataset. Table 17 shows examples of human-written image narratives. Table 18 shows statistics for human-written image narratives collection. Table 21 shows conversion rules for natural language processing stage for narrative generation process as used in Section 3. Table 22 to Table 24 show more examples of image narratives. Table 8 shows examples of questions for user interaction that were generated using our proposed model of combining VQG and VQA, and the baseline of using VQG only. Table 9 shows another example of customized image narratives generated depending on the choices made by user upon the question. Table 10 shows examples of how the choices made by user upon the question were reflected in new images. ### Additional Clarifications
Why were yes/no questions excluded? Yes/no questions are less likely to induce multiple answers. The number of possible choices is limited to 2 in most cases, and rarely correspond well to particular regions. Failure cases for rule-based conversion: Since both questions and answers are human-written, our conversion rule frequently fails with typos, abridgments, words with multiple POS tags, and grammatically incorrect questions. We either manually modified them or left them as they are. Experiments with different VQA models. Most of well-known VQA models' performances are currently in a relatively tight range. In fact, we tried BIBREF11 , SOTA at the time of experiment, but did not see any noticeable improvement. Is attention network retrained to handle sentences? No, but we found that attention network trained for questions works surprisingly well for sentences, which makes sense since key words that provide attention-wise clue are likely limited, and hardly inquisitive words. Why not train with “I don’t know?” We were concerned that answers like “I don't know" would likely overfit. It would also undermine creative aspect of image narrative, without adding much to functional aspect. Figure 1: Example of conventional image description (top) and customized image narrative (bottom). Figure 2: Example of regions extracted from the image, and the questions generated from each region. Figure 3: Example of question and answer converted to a declarative sentence by conversion rule. Table 1: Examples of questions generated using non-visual questions in VQG dataset. Figure 4: Questions that allow for multiple responses are generated to reflect user’s interest and corresponding regions proceed to image narrative generation process. Figure 5: Training with pair of choices made by the same user. Given the choice vector for image 1 and new image feature and question feature for image 2, it is trained to predict the answer for the question on image 2. Table 2: Examples of human-written image narratives collected on Amazon Mechanical Turk. Table 4: Each model’s performance on DIANE. Table 5: Against each model on χ2 with 2 degrees of freedom, and one-sided p-value from binomial probability. Table 6: Examples of image narratives. See Supplemental Material for many more examples. Table 8: Examples of generated questions using our proposed model and VQG respectively. Table 10: Examples of image narratives generated on new images, depending on the choices made. Table 14: Statistics from the crowd-sourcing task on collecting answers to non-visual questions. Table 15: Examples of answers collected on VQG. Figure 6: Viewer’s attention varies depending on the context provided. Table 13: Examples of captions and questions for the same image. While captions essentially describe the same contents, questions widely vary in terms of the topics. Figure 7: Illustration of the overall workflow for each task. Table 16: Examples of questions generated using nonvisual questions in VQG dataset. Table 17: Examples of human-written image narratives collected on Amazon Mechanical Turk. Table 18: Statistics for human-written image narratives collected on Amazon Mechanical Turk. Table 19: Examples of image narratives generated by training with human-written image narratives. Table 20: Examples of generated questions for user interaction using our proposed model and VQG only respectively. Table 21: Conversion rules for transforming question and answer pairs to declarative sentences. Table 22: More examples of image narratives. Table 23: More examples of image narratives. Table 24: More examples of image narratives. Table 26: Examples of image narratives generated depending on the user choices. Table 27: Examples of image narratives generated on new images, depending on the choices made.
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image feature, question feature, label vector for the user's answer
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According to the reviewer, which motif seems to represent the precariousness of reality?
A. The rose petals in Angela's bathtub
B. The undulating plastic bag
C. The grainy texture of Ricky's camera film
D. The raindrops falling on top of the Colonel
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A Good Year for the Roses? Early in American Beauty , Lester Burnham (Kevin Spacey), a weary reporter for a media magazine, masturbates in the shower while informing us in voice-over that we're witnessing the highlight of his day. He peers through tired eyes out the window at his manicured suburban tract-house lawn, where his wife, Carolyn (Annette Bening)--whose gardening clogs, he points out, are color-coordinated with the handles of her shears--snips roses (American beauties) and twitters about Miracle-Gro to a gay yuppie (Scott Bakula) on the other side of a white picket fence. "I have lost something," says Lester. "I'm not exactly sure what it is but I know I didn't always feel this ... sedated." Apparently, Lester doesn't realize that snipped roses are garden-variety symbols of castration, or he'd know what he has lost. But the makers of American Beauty are about to give Lester his roses back. At a high-school basketball game, Lester is transfixed by a blonde cheerleader named Angela (Mena Suvari), who is twirling alongside his daughter, Jane (Thora Burch). Ambient noise falls away, the crowd disappears, and there she is, Lester's angel, writhing in slow motion--just for him. She opens her jacket (she's naked underneath) and red rose petals drift out. Later, Lester envisions her on a bed of red petals, then immersed in a bath of red petals. Back in the roses for the first time in years, he's soon pumping iron, smoking pot, and telling off his frigid wife and faceless bosses, convinced that whatever he has lost he's getting back, baby. The movie is convinced, too--which is odd, since the fantasy of an underage cheerleader making a middle-aged man's wilted roses bloom is a tad ... primitive. But American Beauty doesn't feel primitive. It feels lustrously hip and aware, and a lot of critics are making big claims for it. The script, by Alan Ball, a playwright and former sitcom writer, carries an invigorating blast of counterculture righteousness, along with the kind of pithily vicious marital bickering that makes some viewers (especially male) say, "Yeah! Tell that bitch off!" More important, it has a vein of metaphysical yearning, which the director, Sam Mendes, mines brilliantly. A hotshot English theater director (his Cabaret revival is still on the boards in New York), Mendes gives the film a patina of New Age lyricism and layer upon layer of visual irony. The movie's surface is velvety and immaculate--until the action is abruptly viewed through the video camera of the teen-age voyeur next door (Wes Bentley), and the graininess of the video image (along with the plangent music) suggests how unstable the molecules that constitute our "reality" really are. Mendes can distend the real into the surreal with imperceptible puffs. Aided by his cinematographer, Conrad Hall, and editors, Tariq Anwar and Chris Greenbury, he creates an entrancing vision of the American nuclear family on the verge of a meltdown. A merican Beauty is so wittily written and gorgeously directed that you might think you're seeing something archetypal--maybe even the Great American Movie. But when you stop and smell the roses ... Well, that scent isn't Miracle-Gro. The hairpin turns from farce to melodrama, from satire to bathos, are fresh and deftly navigated, but almost every one of the underlying attitudes is smug and easy: from the corporate flunky named "Brad" to the interchangeable gay neighbors (they're both called "Jim") to the brutally homophobic patriarch next door, an ex-Marine colonel (Chris Cooper) who has reduced his wife (the normally exuberant Allison Janney) to a catatonic mummy and his son, Ricky (Bentley), to a life of subterranean deception. (The colonel's idea of bliss is watching an old Ronald Reagan military picture on television: How's that for subtle?) Lester's wife, Carolyn, is even more stridently caricatured. A real-estate broker who fails to sell a big house (her only potential customers are blank-faced African-Americans, Indian-Americans, and surly lesbians), she wears a mask of perky efficiency and insists on listening to Muzak while she and her husband and daughter eat her "nutritious yet savory" dinners. It's amazing that Mendes and Ball get away with recycling so many stale and reactionary ideas under the all-purpose rubric of "black comedy." But it's also possible that those ideas have rarely been presented so seductively. Several months ago, Daniel Menaker in Slate in contemporary film in which the protagonist attempts to break through our cultural and technological anesthetization into "the real." That's the theme here, too, and it's extraordinarily potent, at times even heartbreaking. The symbols, however, have been cunningly reversed. In movies like sex, lies, and videotape (1989), the protagonist has to put away the video camera to "get real"; in American Beauty , it's Ricky Fitts, the damaged stoner videomaker next door, who sees beauty where nonartists see only horror or nothingness. In the film's most self-consciously poetic set piece, Ricky shows Lester's dour daughter Jane--in whom he recognizes a kindred spirit--a video of a plastic bag fluttering up, down, and around on invisible currents of wind. Ricky speaks of glimpsing in the bag's trajectory an "entire life behind things"--a "benevolent force" that holds the universe together. The teen-ager, who likes to train his lenses on dead bodies of animals and people, sells wildly expensive marijuana to Lester and somehow passes on this notion of "beauty." By the end, Lester is mouthing the same sentiments and has acquired the same deadpan radiance. That must be some really good shit they're smoking. It's not the druggy philosophizing, however, that makes American Beauty an emotional workout. It's that the caricatures are grounded in sympathy instead of derision. Everyone on screen is in serious pain. The manipulative sexpot Angela, who taunts her friend Jane with the idea of seducing her dad, acts chiefly out of a terror of appearing ordinary. As the military martinet, Cooper goes against the grain, turning Col. Fitts into a sour bulldog whose capaciously baggy eyes are moist with sadness over his inability to reach out. (When he stands helplessly in the rain at the end, the deluge completes him.) The character of Carolyn is so shrill as to constitute a libel on the female sex, but there isn't a second when Bening sends the woman up. She doesn't transcend the part, she fills it to the brim, anatomizes it. You can't hate Carolyn because the woman is trying so hard--to appear confident, composed, in control. When she fails to sell that house, she closes the shades and lets go with a naked wail--it's the sound of a vacuum crying to be filled--then furiously slaps herself while sputtering, "Shut up--you're weak--shut up. " Then she breathes, regains her go-get-'em poise, replaces her mask. Carolyn isn't a complicated dramatic construction, but Bening gives her a primal force. An actress who packs more psychological detail into a single gesture than others get into whole scenes, Bening was barreling down the road to greatness before she hit a speed bump called Warren. It's a joy to observe her--both here and in Neil Jordan's In Dreams (1999)--back at full throttle. American Beauty is Spacey's movie, though. He gives it--how weird to write this about Spacey, who made his name playing flamboyantly self-involved psychopaths--a heart. Early on, he lets his face and posture go slack and his eyes blurry. He mugs like crazy, telegraphing Lester's "loserness." But Spacey's genius is for mugging in character. He makes us believe that it's Lester who's caricaturing himself , and that bitter edge paves the way for the character's later, more comfortably Spacey-like scenes of insult and mockery. He even makes us take Lester's final, improbably rhapsodic moments straight. But do the filmmakers take them straight? If I read it correctly, the movie is saying that American society is unjust and absurd and loveless--full of people so afraid of seeming ordinary that they lose their capacity to see. It's saying that our only hope is to cultivate a kind of stoned aesthetic detachment whereby even a man with his brains blown out becomes an object of beauty and a signpost to a Higher Power. But to scrutinize a freshly dead body and not ask how it got that way--or if there's anyone nearby with a gun who might want to add to the body count--strikes me as either moronic or insane or both. The kind of detachment the movie is peddling isn't artistic, it isn't life--it's nihilism at its most fatuous. In the end, American Beauty is New Age Nihilism. Kevin Costner is 11 years older than he was as Crash Davis, the over-the-hill minor-league catcher in Bull Durham (1988), but he can still get away with playing a professional ballplayer. He moves and acts like a celebrity jock, and he can make his narcissistic self-containment look as if he's keeping something in reserve--to protect his "instrument," as it were. In For Love of the Game , he's a 40ish Detroit Tigers pitcher having his last hurrah: The team has been sold and the new owners don't necessarily want him back. For about half an hour, it's a great sports movie. Costner stands on the mound shaking off the signals of his longtime catcher (John C. Reilly); he forces himself to tune out the huge Yankee Stadium crowd (the background blurs before our eyes and the sound drops out); and he mutters darkly at a succession of batters, some old nemeses, some old buddies. He also thinks about his Manhattan-based ex-girlfriend (Kelly Preston), who tearfully told him that morning that things were absolutely over and she was moving to London. There's an appealing flashback to how they met (he stopped to fix her car while on the way to Yankee Stadium), then it's back to the game for more nail-biting at bats. But pretty soon the relationship flashbacks start coming thick and fast, and the balance of the movie shifts to whether Kevin can commit to Kelly and Kelly can commit to Kevin or whether his only commitment could ever be to the ball and the diamond and the game. Maybe it's because I'm a baseball nut that I hated to leave the mound. But maybe it's also because the relationships scenes are soft-focus, generic, and woozily drawn-out, whereas the stuff in the stadium is sharply edited and full of texture. The rhythms of the game feel right; the rhythms of the romance feel embarrassingly Harlequin, and the picture drags on for over two hours. I can't believe that the director, Sam Raimi ( The Evil Dead , 1983; last year's A Simple Plan ) thought that all those scenes of Costner and Preston staring into space while the piano plinks would end up in the final cut, but Raimi apparently gave up control of the final cut for the sake of making his first, real mainstream picture. He might as well have stuck his head over the plate and said, "Bean me."
|
C. The grainy texture of Ricky's camera film
|
On what date was a CT scan of the chest/abdomen/pelvis with contrast agent performed in Laura Miller?
Choose the correct answer from the following options:
A. May 28th 2020
B. June 13th 2020
C. June 18th 2020
D. June 15th 2020
E. June 19th 2020
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### Patient Report 0
**Dear colleague, **
We are writing to report on the outpatient treatment of Mrs. Laura
Miller, born on 04/03/1967, on 05/22/2020.
**Diagnosis**: Osteoporotic vertebral body sintering (lumbar vertebra 2
and thoracic vertebra 8).
**Medical History**: Mrs. Miller presents with pain in her back, legs
radiating, after fall on the back 6 weeks ago. The complaints were
progressive with intermittent paresthesia in both legs.
**Other Diagnoses** (not fully collectible):
- Status post apoplexy
**Current Medication (**not ascertainable):
- Blood pressure medication
- Osteoporosis medication
- No anticoagulation.
**Physical Examination: Lumbar spine:** Skin without pathological
findings. No redness, no evidence of infection.
Tapping pain over thoracic spine/lumbar spine, no compression pain, no
torsion pain, no pressure pain over spinous process.
Radiation of pain into the right and left leg, paravertebral muscle
hardness.
No paresthesias in the genital area, no breech anesthesia, no peripheral
neurologic deficits, No bladder or rectal dysfunction.
Peripheral Circulation/Motor function/Sensitivity intact.
Strength grade on all sides: Hip Flex/Ex: 5/5, Knee Flex/Ex: 5/5,
Foot extensor muscles of the lower leg/flexor muscles of the lower leg:
3/5.
Big toe extensor muscles of the lower leg/big toe flexor muscles of the
lower leg: 2/5.
**Thoracic Spine 2 levels from 05/22/2020, Lumbar spine in 2 planes from
05/22/2020:**
Clinical indication: Status post fall
Question: new fracture?
Preliminary images: none comparable
**Findings**
1\) [Thoracic Spine]{.underline}: Multiple thoracic vertebral bodies
exhibit decreased height, most notably at the central region where a
measurement of approximately 17 mm suggests significant height loss and
potential acute fracture. Additionally, there are endplate impressions
in individual vertebrae of the lower thoracic spine. Aortic sclerosis is
present, along with degenerative changes throughout the thoracic
vertebrae. The osseous structure presents osteoporotic features. A
suspected hemangioma is identified in a vertebral body of the lower
thoracic spine.
2\) [Lumbar Spine]{.underline}: In a presumed five-segment lumbar spine,
the L1 vertebra shows a subtle reduction in height with a questionable
endplate impression. Osteoporotic features are evident in the bony
structure.
**Assessment:** Multiple fractures are evident in both thoracic
vertebrae and the first lumbar vertebra, some of which may be acute. MRI
is recommended for further evaluation. Osseous structure displays
pronounced osteoporotic features.
Grade III esophageal varices present without definitive high-risk
stigmata. Varices also noted at the gastroesophageal junction,
classified as GOV 1 according to Sarin\'s classification. Band ligation
of the varices is not performed, as no unambiguous source of bleeding is
identifiable and a significant portion of the stomach remains outside
the field of view.
**Recommendation**: Terlipressin, monitor surveillance, Erythromycin
**Computed Tomography Thoracic spine from 05/22/2020:**
Fracture at the base plate of lumbar vertebra 2 with involvement of the
posterior margin. Left lateral, no significant reduction in height of
the vertebral body. No tension of the spine.
Suspicion of new small fracture also at the cover plate at thoracic
vertebra 8.
Multiple, older, osteoporotic compression fractures at the thoracic
spine and
upper lumbar spine.
**Additional Finding:**
Liver cirrhosis with multiple nodules, low ascites, and portal vein
congestion. Splenomegaly. If not already known, further workup of liver
lesions is recommended. Hydrops of the gallbladder.
**Current Recommendations**: There is a general indication for admission
of the patient and further diagnostics before surgical treatment of the
fractures. Mrs. Miller is generally opposed to surgical care. She was
thoroughly informed about the risks (progression, cross-section, death).
Re-presentation with current bone densitometry and update of
osteoporosis medication, as well as current holospinal MRI. In the
meantime, analgesia as needed using Acetaminophen 500mg 1-1-1 under
gastric protection.
**Esophagogastroduodenoscopy from 05/22/2020:**
[Esophagus]{.underline}: Unobstructed intubation of the esophageal
opening was achieved under direct visualization. In the upper third of
the esophagus, multiple prominent varices protrude into the lumen,
unaltered by air insufflation. In the middle third, there are areas with
whitish overlying material that do not resemble the typical white nipple
sign. Despite meticulous inspection, no active bleeding sites were
identified. The Z-line reveals isolated minor erosions. Cardiac
sphincter closure is complete.
[Stomach]{.underline}: Full distension of the gastric lumen was
accomplished with air insufflation. The major curvature of the stomach
contained food mixed with hematin. The mucosal surface was similarly
coated with hematin, but no active bleeding was discernible in the
visualized areas. Peristaltic movement was widespread. Upon
retroflexion, pronounced varices were noted near the cardiac region on
the lesser curvature. The pylorus was unremarkable and easily
traversable.
[Duodenum]{.underline}: Adequate distension of the duodenal bulb was
achieved, providing a clear view up to the descending part of the
duodenum. Overall, the mucosa appeared normal with minor remnants of
hematin, and no source of bleeding was identified.
### Patient Report 1
**Dear colleague, **
We report to you about Mrs. Laura Miller, born on 04/03/1967, who was in
our inpatient treatment from 05/27/2020 to 06/22/2020.
**Diagnoses**: Initial diagnosis of hepatocellular carcinoma.
- MRI liver: disseminated HCC foci in all segments, the largest foci
is localized in segments 5 / 7 / 8
- Hydropic, decompensated liver cirrhosis Child B, first diagnosis:
05/20, ethyltoxic genesis
- Anemia requiring transfusion
- EGD of 05/28/20: sophageal varices III° without risk signs, rubber
band ligation; cardia varices I°, Histoacryl injection
- EGD of 06/13/20: Residual varices in the esophagus, application of 3
rubber band ligations, injection of 0.5 ml. Histoacryl; portal
hypertensive gastropathy
- Transfusion of 2 ECs
- Fresh osteoporotic thoracic vertebra 8 fracture
- Kyphoplasty thoracic vertebra 8 under C-arm fluoroscopy
- Portal hypertension with bypass circuits
- Splenomegaly
- Cholecystolithiasis
- Arterial hypertension
- Osteoporosis
- Status post stroke
- Allergies: None known
**Physical Examination:** Patient in mildly reduced general and normal
nutritional status (BMI 20.3).
- Lungs: Vesicular breath sound, no pathological secondary sounds.
SpO2 96%.
- Heart: Pure, rhythmic. Systolic with maximum at Erb\'s point and
continuation into the carotids. HR: 87/min. BP: 124/54mmHg
- Abdomen: Lively bowel sounds, no tenderness, no guarding, no
resistance, no peritonism. Soft abdomen. Liver not enlarged,
palpable. Renal bed not palpable.
- Extremities: Edema of the lower extremities on both sides, foot
pulses bilaterally well palpable.
- Spine: No tap pain.
- Orienting neurological examination: Right leg weakness, known
paresis of the extensor muscles of the lower leg/flexor muscles of
the lower leg.
**Therapy and Progression:** Mrs. Miller was taken over for suspected
upper GI bleeding. Initially, the patient had presented with increasing
back pain since approximately 6 weeks at status post fall in the Park
Clinic on 04/26/2020. The patient was known there for her stroke in
2016. On the day of admission to the Park Clinic, normochromic
normocytic anemia (Hemoglobin 3 g/dL) was noticed, which is why the
transfer to our clinic was made.
On inpatient admission, the patient presented in slightly reduced
general condition. She reported having black stools once. In addition,
Ms. Miller had coffee ground-like emesis once. Dyspnea, angina pectoris
complaints, and B symptoms were denied. There were no problems with
micturition. Recently, there were no abnormalities in bowel movements.
So far, no colonoscopy has been performed. There were no known
intestinal diseases in the family.
[Noxae]{.underline}: Ex-nicotine use (since 1996, previously cumulative
ca. 3 PY), occasional alcohol consumption (probably abstinent for about
5 years).
Laboratory results showed that the patient had elevated infectious
parameters. The
urinalysis was unremarkable. X-ray chest showed no clear picture of
pneumonia. In a first emergency esophagogastroduodenoscopy on
05/28/2020, esophageal varices °III were found without clear signs of
risk. Furthermore, varices in the area of the cardia (GOV 1 after Sarin)
were seen. When the source of bleeding was inconclusive, it was referred
to a banding initially waived. In a renewed esophagogastroduodenoscopy
in the morning of 05/30/2020, 2 ampoules of Histoacryl were applied to
the cardia varices. In addition, the picture of an incipient
portal-hypertensive gastropathy. Antibiotic intravenous therapy with
ceftriaxone was initiated. At 06/13/2020, a
re-esophagogastroduodenoscopy took place, during which a renewed twofold
banding of the esophageal varices was performed with injection of 0.5 ml
Histoacryl. Abdominal ultrasound showed a picture of liver cirrhosis
with splenomegaly and perihepatic ascites. In addition, the liver showed
multiple echo-poor nodes in the right lobe and a suspicious
2.4x3.6x4.4cm echo-poor area with a halo in SII. This was followed by an
MRI of the liver, in which the HCC in segment II was confirmed by
imaging.
Multiple additional arterial hypervascularized areas/round foci in all
liver lobes without definite washout. There is no evidence of suspicious
nodular changes on CT chest/abdomen/pelvis. At an in-house liver
conference, systemic therapy (Lenvatinib or Sorafenib in Child B7) was
recommended.
Due to the back pain, a holospinal MRI was performed, which showed a
subacute cover plate compression fracture in the thoracic vertebra 8 as
well as multiple older compression fractures of the thoracic spine and
upper lumbar spine. The colleagues of neurosurgery were consulted, who
gave the indication for surgery. On 06/14/2020, the planned surgery with
kyphoplasty thoracic vertebra 8 under C-arm fluoroscopy could be
performed without complications. Postoperatively, the patient remained
circulatory stable.
Due to auscultatory suspicion of aortic valve stenosis, further
clarification was performed by cardiac echography, showing no
higher-grade valvular vitiation.
We are transferring Mrs. Miller in improved general condition to the
Senior Citizens\' Residence Seaview. If you have any questions, please
do not hesitate to contact us.
**Addition:**
**Ultrasound of the upper abdomen on 05/27/2020:**
Limited assessable due to meteorism.
**Liver**: Liver dimensions are within normal limits, measuring 15.9 cm
in the craniocaudal axis. Echotexture demonstrates inhomogeneous
granularity. There is hepatic margin convexity and nodular surface
appearance. Rarification of hepatic veins. Segment III reveals two
hypoechoic lesions measuring 3 cm and 1 cm in diameter. Portal vein
demonstrates orthograde flow with a maximum velocity of 17 cm/s.
**Gallbladder:** Gallbladder is partially contracted; its wall appears
unremarkable without sonographic evidence of cholecystitis. No
tenderness elicited upon sonographic examination.
**Biliary Tract**: Intrahepatic bile ducts are patent. Common hepatic
duct measures 6 mm in diameter. Common bile duct appears transiently
dilated up to 9 mm and is otherwise unremarkable as far as can be
visualized prepapillary.
**Pancreas**: Limited visualization of the pancreas; however, the
visible parenchyma appears homogeneously echoic.
**Spleen**: Spleen is enlarged, measuring 13 x 4 cm, with homogeneous
parenchyma.
**Kidneys**: Kidneys are morphologically unremarkable, without evidence
of pelvicalyceal system dilation.
**Abdominal Vessels**: Aorta is partially visualized and appears within
normal calibers.
Intestinal/Peritoneal Cavity: No evidence of free intraperitoneal fluid.
Urinary Bladder/Genitalia: Urinary bladder is adequately distended,
appearing unremarkable upon limited assessment. Uterus is not
visualized.
**Virology from 05/28/2020:**
- SARS CoV-2 PCR PCR negative Geq/ml
- Findings: No detection of SARS-CoV-2 by PCR in the submitted
material.
**Chest X-ray a.p. from 05/28/2020:**
Limited assessability in supine position, malrotation. The diaphragmatic
crests are smooth. The marginal sinuses are free of effusions and
calluses. Heart and mediastinum lie cryptically. The aorta is sclerosed.
Cranialization of the vessels as well as slightly elevated vascular
markings in the supine position, especially in the right upper field.
Dystelectasis on the right. Sharply defined vertical shadowing in the
left upper field. The upper mediastinum is narrow, the trachea is in the
midline and is not constricted. Degenerative changes in the cervical
spine. Overlying foreign material.
**Assessment**: Sharply defined vertical shadowing in the left upper
field. Dystelectasis on the right side. Conventional radiographic
examination No evidence of a mass. No effusion.
**Esophagogastroduodenoscopy of 05/28/2020:**
**Esophagus**: Successful intubation of the esophageal orifice under
direct visualization. Multiple intraluminal protrusions noted in the
upper third of the esophagus. Non-collapsible variceal strands observed
upon air insufflation, beginning from the middle third. Whitish
proliferations seen at multiple sites, not consistent with typical white
nipple signs. No evidence of active bleeding on close inspection. Z-line
observed with isolated minor erosions. Cardiac sphincter fully
competent.
**Stomach**: Gastric lumen fully distended under air insufflation.
Corpus predominantly contains hematin-laden food remnants. Mucosal
surface also stained with hematin but without visible active bleeding.
Peristalsis noted throughout. Distinct coronary vasculature observed on
the lesser curvature. Pylorus unremarkable, offering no resistance to
passage.
**Duodenum**: Bulbus duodeni well-formed. Pars descendens duodeni
visualized clearly. Overall mucosa appears unremarkable, with scattered
hematin remnants observed without an identifiable bleeding source.
**Assessment**: Esophageal varices graded as °III, with no definitive
high-risk stigmata. Varices also noted in the cardia, classified as GOV
1 according to Sarin\'s classification. Ligation of varices was not
performed due to the absence of an identifiable bleeding source and
incomplete visualization of the gastric lumen.
**Ultrasound of the abdomen on 05/29/2020:**
**Quality of Exam**: Limited due to patient non-cooperation and
meteorism.
**Liver**: Liver size is paradoxically reported both as normal at 15.9
cm and enlarged at 18.7 cm. Margins are rounded. Echotexture is markedly
inhomogeneous with nodular surface. Multiple hypoechoic nodules are
present in the right lobe, along with a suspicious hypoechoic area
measuring 2.4 x 3.6 x 4.4 cm with peripheral halo in segment II. Hepatic
veins are rarified. Portal vein shows orthograde flow with a vmax of 28
cm/s.
**Gallbladder**: Morphologically unremarkable with no wall thickening.
Cholelithiasis noted with concretions measuring at least 2 to 1.6 cm.
**Biliary Tract:** Intrahepatic bile ducts are not dilated; Common
hepatic duct measures up to 8.5 mm and common bile duct measures 6.6 mm
in diameter.
**Pancreas**: Partially visualized; adequacy of assessment is
compromised.
**Spleen**: Enlarged with homogeneous internal echotexture.
**Kidneys**: Morphologically unremarkable; no evidence of
hydronephrosis.
**Abdominal Vessels:** Aorta is not dilated.
**Gastrointestinal**: Perihepatic ascites noted. Both small and large
intestines appear unremarkable upon limited assessment.
**Urinary Bladder/Genitalia:** Bladder is moderately filled and
unremarkable in shape and size.
**Assessment**: Limited study due to patient non-cooperation and
meteorism. Findings are suggestive of liver cirrhosis and grade I
ascites. Additional findings include suspected hepatic space-occupying
lesions, splenomegaly, and cholelithiasis. Mild dilation of DHC and DC
observed without signs of intrahepatic cholestasis.
**Virology from 06/01/2020:**
**Parameter** **Result** **Interpretation**
--------------- ------------ --------------------
Anti HAV IgG 0.73 negative
Anti HAV IgM \<0.1 negative
**Interpretation:** Serologically no evidence of fresh or expired
infection with
Hepatitis A virus, no immunity.
**Parameter** **Result** **Interpretation**
--------------- ------------ --------------------
HBs antigen 0.21 negative
Anti HBs \<0.1 negative
Anti HBc 0.1 negative
**Interpretation:** Serologically no evidence of acute, chronic or
expired Hepatitis B virus infection. No immunity.
**Parameter** **Result** **Interpretation**
--------------- ------------ --------------------
Anti HCV 0.06 negative
**Interpretation:** Serologically no evidence of hepatitis C virus
infection. At possible fresh infection resubmission in 2-4 weeks and HCV
PCR recommended.
**MRI total spine plain from 06/04/2020:**
**Technique**: T2 Dixon Sagittal and T2 Axial MRI Sequences. Coverage
extends from the craniocervical junction to the sacrum.
**Findings:**
**General Spine:** Full extent from craniocervical junction to sacrum
visualized. Conus medullaris appropriately located at T12-L1 level.
Myelon demonstrates uniform width and homogeneous signal. Evaluation of
thoracolumbar transition and lumbar spine is compromised by artifact
superimposition from ascites.
**Cervical Spine:** Irregular alignment of the posterior vertebral body
margins noted, with evidence of disc protrusions and ligamentum flavum
hypertrophy. Focal T2 hyperintensity observed at C5 level. No evidence
of prevertebral soft tissue proliferation.
**Thoracic Spine**: Maintained alignment of the posterior vertebral body
margins. Multiple anterior endplate compression fractures noted at T5,
T8, T9, T11, T12 levels. Focal T2 hyperintensity near the anterior
endplate of T8 involving the posterior margin, indicative of a
non-displaced fracture without spinal canal compromise. Hypertrophic
facet joint arthrosis at T10-T11 levels resulting in relative spinal
narrowing. Bilateral pleural effusions noted, more pronounced on the
right, with a maximum width of approximately 2 cm. No evidence of
significant neuroforaminal stenosis.
**Lumbar Spine:** Maintained alignment of posterior vertebral body
margins. Known anterior endplate compression fractures at L1 and
baseplate compression fracture at L2. No evidence of pathological T2
edema within the vertebral bodies, although assessment is limited due to
superimposed artifacts from ascites. Spinal canal dimensions appear
adequate throughout. Moderate fatty degeneration of sacral bone noted.
**Assessment**: Evaluation limited due to ascites-related artifacts.
Subacute anterior endplate compression fracture at T8, along with
several other likely older compression fractures in the thoracic and
upper lumbar spine. Bilateral pleural effusions observed. Multiple
neuroforaminal narrowings as detailed above.
**MR Liver plain + contast agent from 06/06/2020**
**Findings:**
1) [Lesion 1]{.underline}
- Size of the lesion 41 mm
- Segment 2
- Behavior arterial strongly enriching: yes
- Portal venous early washing out: yes
- Pseudocapsule: yes
- Behavior delayed leaching: yes
- pseudocapsule macrovascular invasion: no
2) [Lesion 2]{.underline}
- Size of the lesion 104 mm
- Segment 5 / 7 / 8
- Behavior arterial strongly enriching: yes
- Portal venous early washing out: no
- Pseudocapsule: no
- Behavior delayed washing out: no
- Pseudocapsule: no
- Macrovascular invasion: yes
**Comments:**
- MRI with Gadovist intravenous.
- Multiple other satellite foci in all liver segments.
- Signs of liver cirrhosis with nodular liver parenchyma and
hypertrophy of the left lobe.
- Cholecystolithiasis and gallbladder hydrops. No cholestasis.
- Varices of the esophagus and fundus. Splenomegaly. Ascites. Pleural
effusions on both sides.
- Lymph node (approximately 8 mm) between the small curvature of the
Stomach and S1 of the liver.
- Axial hernia.
**Assessment:** Milan fulfilled**.** Dissiminated HCC foci in all
segments, the largest foci being in segments 5 / 7 / 8 localized. Portal
hypertension with bypass circulation and splenomegaly. Ascites and
pleural effusions.
**Microbiology from 06/09/2020:**
[Material]{.underline}: Ascites in blood culture bottles
[Microscopic]{.underline}: No cells, no germs
- Anaerobic culture negative after 48 hours
- So far, no growth in the anaerobic cultures. The cultures are
incubated for a total of 5 days. In case of growth of anaerobes we
will send you a follow-up report.
- No growth after 48 hours
**Esophagogastroduodenoscopy of 06/11/2020:**
**Esophagus**: In the distal esophagus, multiple band-like ulcerations
as well as residual varices with risk signs that may not completely pass
air insufflation. Z-line without erosions.
**Stomach**: Mosaic-like occupancy of the gastric mucosa. With inversion
the
known small-curved lateral cardiavarii, which is hard on palpation with
closed forceps after histoacryl injection. Directly next to it, another
cardiavarice can now be seen, which has not yet been injected with
histoacryl and is soft on palpation.
**Duodenum**: Endoscopic therapy: Injection of 0.5 mL Histoacryl (+0.5
mL Lipoidol) in the new cardiavarice. Application of 3 rubber band
ligatures to the residual varices in the esophagus.
**Assessment:** Residual varices in the esophagus, application of 3
rubber band ligations; portal hypertensive gastropathy
**Spine-whole: 2 planes from 06/13/2020**
The perpendicular of C7 protrudes about 15 mm laterally to the left of
sacral vertebra 1 in the anterior-posterior image and about 9.3 cm in
front of sacral vertebra 1 in the lateral ray path. Slight left convex
scoliosis thoracolumbally with thoracic counter-swing (Cobb angle \< 10°
in each case). The lungs are unremarkable as far as technically
assessable.
**Assessment**: decompensated positive sagittal spinal imbalance. There
is no relevant lateral trunk overhang.
**Critical Findings Report:**
A conspicuous single cell population of cells with partial signet ring
cell character is detected in the smears. A cell block is prepared from
the remaining liquid material for further typing of these cells. A
follow-up report will follow.
**Thoracic spine in 2 planes from 06/15/2020:**
**Findings**: Thoracic vertebra 8: Post-kyphoplasty status with notable
improvement in vertebral height, now measuring 21 mm compared to a
preoperative height of 13 mm. Mild straightening of the vertebral column
observed at this level.
Thoracic vertebra 9: Known older anterior endplate collapse.
Thoracolumbar spine: Multisegmental height reduction in vertebral bodies
consistent with osteoporotic changes. No signs of contrast
extravasation.
Additional Finding: Pre-existing calcified structure projecting onto the
left upper abdomen; likely unrelated to current surgical site.
**Assessment**: Unremarkable postoperative imaging following kyphoplasty
of T8. No evidence of postoperative sintering or newly identifiable
fractures. Overall, the surgical intervention appears successful in
increasing vertebral height and stabilizing the fracture site.
**CT Chest/Abdomen/Pelvis with contrast agent from 06/18/2020:**
**Technique**: Multislice spiral CT of the chest, abdomen, and pelvis
was performed post-bolus intravenous injection of 120 ml of Imeron 400.
Imaging conducted in arterial, portal venous, and venous phases. Oral
contrast agent administered with Micropaque 1:7 in water and Gastrolux
1:33 in water. Thin-slice reconstructions and secondary coronal and
sagittal reformats were performed.
**Chest**: Presence of struma nodosa. Bilateral minor pleural effusions
with adjacent atelectasis, more pronounced on the right and extending
into the interlobar region. No signs of infiltrative changes. Isolated
small nodular opacities in the right lung. Few small bullae noted.
Mediastinal lymph nodes mildly enlarged up to 0.5 cm; axillary and hilar
nodes are not enlarged. No pericardial effusion observed.
**Abdomen/Pelvis**: Known esophageal and fundal varices present. Liver
demonstrates nodular changes in the context of known Child-Pugh B stage
cirrhosis. A solid hepatic cellular carcinoma lesion in segment II and
diffuse HCC nodules in segments V/VII/VIII visualized, corroborating
prior MRI findings. They show pronounced arterial enhancement and
central washout. Splenomegaly noted. Adrenal glands unremarkable. Renal
and urinary systems are inconspicuous. No intestinal motility
abnormalities detected. Marked ascites present; no pathologically
enlarged abdominal lymph nodes noted upon limited assessment.
**Skeletal**: Moderate coxarthrosis bilaterally. An old, minimally
displaced fracture of the right 7th rib noted. Advanced degenerative
changes in thoracic vertebrae 10, 12, and lumbar spine.
Post-vertebroplasty status at thoracic vertebra 9. Hemangioma at
thoracic vertebra 11.
**Assessment**:
- Marked ascites in the setting of liver cirrhosis with multifocal HCC
lesions, as corroborated by prior MRI. No evidence of extrahepatic
or lymphatic spread.
- Bilateral minor pleural effusions with associated atelectasis.
- Skeletal findings include moderate coxarthrosis and degenerative
changes in the spine.
Overall, the scan provides vital information that aligns with and
elaborates upon existing clinical and imaging data.
**Histology**:
**Pathology from 06/19/2020:**
[Clinical Data:]{.underline} Hepatocellular carcinoma, hydropic
decompensated liver cirrhosis Child B,
[Extraction date:]{.underline} 06/13/2020
[Material:]{.underline} 1 Liquid material 7 ml light yellow
[Editing]{.underline}: Papanicolaou and MGG staining
\+ Protein precipitation
\+ Erythrocytes
\+ Lymphocytes
(+) Granulocytes Eosinophils
\+ Histiocytic cell forms
\+ Mesothelium
\+ Active mesothelium
**Other**: Single mononuclear cells with large, eccentric nuclei with
nucleoli and a narrow cytoplasmic space, partly with signet ring cells.
**Supplementary findings from 06/19/2020**
[Processing]{.underline}: Cell block, HE
**Microscopic:**
As announced, from the remaining liquid material a cell block was
prepared. In the HE stain only isolated evidence of mononuclear Cells
and some blood. No cell atypia.
**Critical Findings Report:** After examination of the remaining liquid
material in the cell block no Extension of the initial findings in the
absence of further diagnostic cell material. The finding is thus based
exclusively on the Smear material:
- Detection of a single-cell population consisting of cells with
partial signet ring cell character. Differentially it could be The
mesothelium may be a reactive change of the approaching mesothelium.
Cells of an epithelial neoplasia are not visible on the present
material. to be ruled out with certainty.
**Diagnostic classification:** Suspicious
**Current Recommendations:**
- An appointment at our outpatient clinic to start therapy was
organized for 06/26/2020.
- An appointment for a health department check-up with varicose vein
status survey and, if necessary, repeat rubber band ligation has
been scheduled for 07/22/2020. Please come to the endoscopy on this
day at 08:30 am fasting with current lab results. incl. coagulation,
signed consent form as well as SARS-CoV-2 PCR not older than 48h.
### Patient Report 2
**Dear colleague, **
We report to you on Mrs. Laura Miller, born 04/03/1967, whom we examined
on 06/08/2020 in the course of a consultation.
**Consilar Request:**
- Liver cirrhosis, Child-Pugh B, ethyltoxic genesis
- HCC
- Laboratory albumin: 2.6
- Nutritional advice requested
**Nutritional counseling in cirrhosis of the liver:**
- Albumin at 2.6
- 70kg at admission (stable weight in recent years).
- Height: 1.72m
- BMI falsified by ascites
- Patient reports that she always a \"bad eater\"
- She reports to eat less due to numerous medication intake
- Patient is noticeably overwhelmed and seems very burdened by
diagnosis
**Assessment:**
- Protein malnutrition with inadequate oral nutrition
- Patient appears desperate and overwhelmed, questionable compliance
**Recommendations: **
- High-calorie food for more choices (already ordered)
- High-calorie drinks (contains more protein)
- Incorporate protein-rich snacks such as yogurt, sippy cups,
crispbread
- with cheese.
- A high-energy, high-protein food choice was made with the patient\'s
discussed in detail
- Contact details were handed out
### Patient Report 3
**Dear colleague, **
We are writing to inform you about Mrs. Laura Miller, born on
04/03/1967, who was under our inpatient care from 08/21/2020 to
08/23/2020.
**Diagnoses**:
- MRI of the liver: disseminated HCC foci in all segments, the largest
foci is localized in segments 5 / 7 / 8
<!-- -->
- Hydropic, decompensated liver cirrhosis Child B, first diagnosis:
05/20, ethyltoxic genesis
- Anemia requiring transfusion
- EGD of 05/28/20: esophageal varices III° without risk signs, rubber
band ligation; cardia varices I°, Histoacryl injection
- EGD of 06/13/20: residual varices in the esophagus, application of 3
rubber band ligations, injection of 0.5 ml. Histoacryl; portal
hypertensive gastropathy
- Transfusion of 2 ECs
- Fresh osteoporotic thoracic vertebra 8 fracture
- Kyphoplasty thoracic vertebra 8 under C-arm fluoroscopy
- Portal hypertension with bypass circuits
- Splenomegaly
- Cholecystolithiasis
- Arterial hypertension
- Osteoporosis
- Status post stroke
- Allergies: None known
**Current Presentation:** Mrs. Miller presented electively for
gastroscopy for variceal screening with continuation of banding therapy
due to esophageal variceal bleeding.
**Medical History**: For a detailed medical history, we refer to
previous reports from our department. In summary, we present a liver
cirrhosis due to ethyl toxicity leading to the development of multifocal
HCC. Similar to the liver board decision of 06/13/20, a recommendation
for systemic therapy with Lenvatinib or Sorafenib was made in the
setting of partially compensated Child B7 cirrhosis with multifocal HCC
in both lobes of the liver.
**Therapy and Course:** Upon admission, the patient was in
age-appropriate general condition and largely symptom-free. There were
no signs of acute infection, jaundice, encephalopathic symptoms, or GI
bleeding. No irregularities in bowel movements or urination were
reported. The patient denied abdominal pain and dyspnea. There were no
known allergies.
On the day of admission, an uncomplicated gastroscopy was performed,
including the application of 4 rubber band ligations for residual
esophageal varices. Post-interventional pain was adequately controlled
with double-standard doses of Pantoprazole and intravenous analgesic
therapy. The further inpatient course was uneventful, and the patient
tolerated the post-interventional diet without signs of GI bleeding.
Based on laboratory findings and clinical evaluation, particularly with
regressed ascites, a compensated Child A6 cirrhosis was confirmed.
Therefore, a re-presentation at our interdisciplinary liver board was
initiated for discussion of potential treatment options in the context
of compensated liver function.
As per the consensus recommendation from the liver board, a follow-up
gastroscopy is scheduled within the next two weeks. Depending on the
variceal status, systemic therapy with Atezolizumab/Bevacizumab or
Lenvatinib will follow.
Throughout the monitoring period, the patient remained stable in terms
of circulation and hemoglobin levels. Therefore, on 08/23/20, we
discharged Mrs. Miller for outpatient follow-up care. The patient was
thoroughly informed about reasons that necessitate immediate
re-presentation. Please note the listed procedural appointments.
**Physical Examination:** Awake, alert, oriented
- Heart: Regular heart tones, no murmurs
- Lungs: Clear vesicular breath sounds, no crackles or wheezes
- Abdomen: Soft, non-tender, no masses, normal bowel sounds in all
quadrants, palpable firm liver edge under the rib cage, no palpable
spleen enlargement, non-painful renal angle
- Extremities: Good peripheral pulses, no edema
- Neurology: No focal neurological deficits.
**EGD on 08/21/2020:**
**Findings:**
**Esophagus**: Unobstructed intubation of the esophagus under direct
vision. Multiple variceal cords and scarring changes due to banding were
observed in the lower half of the esophagus. Z-line at 35 cm
diaphragmatic passage at 39 cm. Two variceal cords extend along the
small curve into the stomach, two of the varices show alarm signs (red
spots). 4 rubber band ligations were performed.
**Stomach**: In the proximal corpus a picture of portal hypertensive
gastropathy, otherwise unremarkable. No fundus varices.
**Duodenum**: Good unfolding of the duodenal bulb, contact-sensitive
mucosa. Good insight into the descending part of the duodenum. Overall,
unremarkable mucosa.
**Assessment:** Esophageal varices, Gastroesophageal varices Type I.
Banding therapy.
**Current Recommendations:**
- Regular clinical and laboratory checks by the primary care
physician.
- In case of fever, acute deterioration of the general condition, or
clinical signs of bleeding such as melena or hematemesis, we request
immediate re-presentation, even at night and on weekends, through
our interdisciplinary emergency department.
- Decision of the liver board: Improvement of liver function with
alcohol abstinence, but also progression of multifocal HCC over 2
months without tumor-specific therapy. Consensus: Repeat EGD in 7-14
days, depending on variceal status, Atezolizumab/Bevacizumab, or
Lenvatinib.
- Follow-up appointment on 09/11/20 in our HCC outpatient clinic for
clinical control and explanation of the EGD.
- Follow-up in our endoscopy for EGD to determine variceal status and
possible banding -\> Please bring a COVID PCR test (maximum 48 hours
old) for inpatient admission.
If complaints persist or worsen, we recommend immediate re-presentation.
### Patient Report 4
**Dear colleague, **
We are writing to inform you about Mrs. Laura Miller, born on
04/03/1967, who was under our inpatient care from 09/18/2020 to
09/20/2020.
**Diagnoses:**
- 4-time banding therapy with 4 rubber band ligations for residual
esophageal varices without alarm signs
- Hepatocellular Carcinoma (HCC)
- MR Liver: Disseminated HCC lesions in all segments, with the largest
lesion located in segments 5/7/8
- Decompensated cirrhosis of the liver (Child B) since 05/20 due to
ethyltoxic origin.
- Transfusion-dependent anemia due to a history of variceal bleeding.
- Osteoporotic thoracic vertebral fracture of vertebra BWK8 (OF3) with
kyphoplasty.
- Portal hypertension with portosystemic collaterals
- Splenomegaly
- Cholelithiasis
- Arterial hypertension
- Osteoporosis
- History of stroke (2016)
- Allergies: Amalgam
**Presentation:** Mrs. Miller\'s elective presentation was for a
follow-up examination for known esophageal varices.
**Medical History:** For a detailed medical history, please refer to
previous reports from our department. In summary, in June 2020, the
patient was diagnosed with decompensated liver cirrhosis attributed to
ethyltoxicity. MR imaging showed multifocal HCC. According to the liver
board decision on 06/15/20, initial therapy was recommended with
Lenvatinib or Sorafenib for partially compensated Child B7 cirrhosis
with multifocal HCC in both liver lobes. Despite improvement in liver
function with alcohol cessation, there was a short-term progression of
multifocal HCC without tumor-specific therapy, leading to a
recommendation for a repeat variceal screening on 08/28/20. Depending on
the findings, therapy with Atezolizumab/Bevacizumab or Lenvatinib was
advised. The last EGD was performed on 08/21/20, revealing esophageal
varices with alarm signs, and a 4-time banding was performed.
**Physical Examination upon Admission:** Blood pressure: 80/150 mmHg,
heart rate 88/min, temperature 36.4°C, SpO2 97% in room air.
Patient in good general condition and normal mental status. Mrs. Miller
is fully oriented. Pupils are equal and reactive.
- Cardiovascular: Clear heart sounds, no murmurs.
- Lungs: Equal breath sounds bilaterally, no crackles, resonant
percussion.
- Abdomen: Soft, non-tender, no masses, normal bowel sounds in all
quadrants, liver and spleen not palpable.
- Extremities: No edema, good peripheral pulses. No focal neurological
deficits.
**Course and Therapy:** On the day of admission, the EGD was performed
without complications. Residual varices without warning signs were
observed, and a 4-time rubber band ligation was performed. Portal
hypertensive gastropathy was also diagnosed. After the procedure, the
patient was transferred to our gastroenterological normal ward.
The post-interventional course was uneventful. There were no clinical or
laboratory signs of post-interventional bleeding. The diet was
reintroduced without any issues. Therefore, on 09/20/2020, we discharged
Mrs. Miller for outpatient care. We request a follow-up appointment at
our in-house HCC outpatient clinic. Additionally, we request a follow-up
EGD with variceal control.
|
June 18th 2020
|
What is Prantera referring to when he mentions 'Quentin'?
A. a target
B. an asylum
C. an associate
D. a prison
|
Illustrated by van Dongen A gun is an interesting weapon; it can be hired, of course, and naturally doesn't care who hires it. Something much the same can be said of the gunman, too.... GUN FOR HIRE By MACK REYNOLDS Joe Prantera called softly, "Al." The pleasurable, comfortable, warm feeling began spreading over him, the way it always did. The older man stopped and squinted, but not suspiciously, even now. The evening was dark, it was unlikely that the other even saw the circle of steel that was the mouth of the shotgun barrel, now resting on the car's window ledge. "Who's it?" he growled. Joe Prantera said softly, "Big Louis sent me, Al." And he pressed the trigger. And at that moment, the universe caved inward upon Joseph Marie Prantera. There was nausea and nausea upon nausea. There was a falling through all space and through all time. There was doubling and twisting and twitching of every muscle and nerve. There was pain, horror and tumultuous fear. And he came out of it as quickly and completely as he'd gone in. He was in, he thought, a hospital and his first reaction was to think, This here California. Everything different. Then his second thought was Something went wrong. Big Louis, he ain't going to like this. He brought his thinking to the present. So far as he could remember, he hadn't completely pulled the trigger. That at least meant that whatever the rap was it wouldn't be too tough. With luck, the syndicate would get him off with a couple of years at Quentin. A door slid open in the wall in a way that Joe had never seen a door operate before. This here California. The clothes on the newcomer were wrong, too. For the first time, Joe Prantera began to sense an alienness—a something that was awfully wrong. The other spoke precisely and slowly, the way a highly educated man speaks a language which he reads and writes fluently but has little occasion to practice vocally. "You have recovered?" Joe Prantera looked at the other expressionlessly. Maybe the old duck was one of these foreign doctors, like. The newcomer said, "You have undoubtedly been through a most harrowing experience. If you have any untoward symptoms, possibly I could be of assistance." Joe couldn't figure out how he stood. For one thing, there should have been some kind of police guard. The other said, "Perhaps a bit of stimulant?" Joe said flatly, "I wanta lawyer." The newcomer frowned at him. "A lawyer?" "I'm not sayin' nothin'. Not until I get a mouthpiece." The newcomer started off on another tack. "My name is Lawrence Reston-Farrell. If I am not mistaken, you are Joseph Salviati-Prantera." Salviati happened to be Joe's mother's maiden name. But it was unlikely this character could have known that. Joe had been born in Naples and his mother had died in childbirth. His father hadn't brought him to the States until the age of five and by that time he had a stepmother. "I wanta mouthpiece," Joe said flatly, "or let me outta here." Lawrence Reston-Farrell said, "You are not being constrained. There are clothes for you in the closet there." Joe gingerly tried swinging his feet to the floor and sitting up, while the other stood watching him, strangely. He came to his feet. With the exception of a faint nausea, which brought back memories of that extreme condition he'd suffered during ... during what? He hadn't the vaguest idea of what had happened. He was dressed in a hospital-type nightgown. He looked down at it and snorted and made his way over to the closet. It opened on his approach, the door sliding back into the wall in much the same manner as the room's door had opened for Reston-Farrell. Joe Prantera scowled and said, "These ain't my clothes." "No, I am afraid not." "You think I'd be seen dead wearing this stuff? What is this, some religious crackpot hospital?" Reston-Farrell said, "I am afraid, Mr. Salviati-Prantera, that these are the only garments available. I suggest you look out the window there." Joe gave him a long, chill look and then stepped to the window. He couldn't figure the other. Unless he was a fruitcake. Maybe he was in some kind of pressure cooker and this was one of the fruitcakes. He looked out, however, not on the lawns and walks of a sanitarium but upon a wide boulevard of what was obviously a populous city. And for a moment again, Joe Prantera felt the depths of nausea. This was not his world. He stared for a long, long moment. The cars didn't even have wheels, he noted dully. He turned slowly and faced the older man. Reston-Farrell said compassionately, "Try this, it's excellent cognac." Joe Prantera stared at him, said finally, flatly, "What's it all about?" The other put down the unaccepted glass. "We were afraid first realization would be a shock to you," he said. "My colleague is in the adjoining room. We will be glad to explain to you if you will join us there." "I wanta get out of here," Joe said. "Where would you go?" The fear of police, of Al Rossi's vengeance, of the measures that might be taken by Big Louis on his failure, were now far away. Reston-Farrell had approached the door by which he had entered and it reopened for him. He went through it without looking back. There was nothing else to do. Joe dressed, then followed him. In the adjoining room was a circular table that would have accommodated a dozen persons. Two were seated there now, papers, books and soiled coffee cups before them. There had evidently been a long wait. Reston-Farrell, the one Joe had already met, was tall and drawn of face and with a chainsmoker's nervousness. The other was heavier and more at ease. They were both, Joe estimated, somewhere in their middle fifties. They both looked like docs. He wondered, all over again, if this was some kind of pressure cooker. But that didn't explain the view from the window. Reston-Farrell said, "May I present my colleague, Citizen Warren Brett-James? Warren, this is our guest from ... from yesteryear, Mr. Joseph Salviati-Prantera." Brett-James nodded to him, friendly, so far as Joe could see. He said gently, "I think it would be Mr. Joseph Prantera, wouldn't it? The maternal linage was almost universally ignored." His voice too gave the impression he was speaking a language not usually on his tongue. Joe took an empty chair, hardly bothering to note its alien qualities. His body seemed to fit into the piece of furniture, as though it had been molded to his order. Joe said, "I think maybe I'll take that there drink, Doc." Reston-Farrell said, "Of course," and then something else Joe didn't get. Whatever the something else was, a slot opened in the middle of the table and a glass, so clear of texture as to be all but invisible, was elevated. It contained possibly three ounces of golden fluid. Joe didn't allow himself to think of its means of delivery. He took up the drink and bolted it. He put the glass down and said carefully, "What's it all about, huh?" Warren Brett-James said soothingly, "Prepare yourself for somewhat of a shock, Mr. Prantera. You are no longer in Los Angeles—" "Ya think I'm stupid? I can see that." "I was about to say, Los Angeles of 1960. Mr. Prantera, we welcome you to Nuevo Los Angeles." "Ta where?" "To Nuevo Los Angeles and to the year—" Brett-James looked at his companion. "What is the date, Old Calendar?" "2133," Reston-Farrell said. "2133 A.D. they would say." Joe Prantera looked from one of them to the other, scowling. "What are you guys talking about?" Warren Brett-James said softly, "Mr. Prantera, you are no longer in the year 1960, you are now in the year 2133." He said, uncomprehendingly, "You mean I been, like, unconscious for—" He let the sentence fall away as he realized the impossibility. Brett-James said gently, "Hardly for one hundred and seventy years, Mr. Prantera." Reston-Farrell said, "I am afraid we are confusing you. Briefly, we have transported you, I suppose one might say, from your own era to ours." Joe Prantera had never been exposed to the concept of time travel. He had simply never associated with anyone who had ever even remotely considered such an idea. Now he said, "You mean, like, I been asleep all that time?" "Not exactly," Brett-James said, frowning. Reston-Farrell said, "Suffice to say, you are now one hundred and seventy-three years after the last memory you have." Joe Prantera's mind suddenly reverted to those last memories and his eyes narrowed dangerously. He felt suddenly at bay. He said, "Maybe you guys better let me in on what's this all about." Reston-Farrell said, "Mr. Prantera, we have brought you from your era to perform a task for us." Joe stared at him, and then at the other. He couldn't believe he was getting through to them. Or, at least, that they were to him. Finally he said, "If I get this, you want me to do a job for you." "That is correct." Joe said, "You guys know the kind of jobs I do?" "That is correct." "Like hell you do. You think I'm stupid? I never even seen you before." Joe Prantera came abruptly to his feet. "I'm gettin' outta here." For the second time, Reston-Farrell said, "Where would you go, Mr. Prantera?" Joe glared at him. Then sat down again, as abruptly as he'd arisen. "Let's start all over again. I got this straight, you brought me, some screwy way, all the way ... here. O.K., I'll buy that. I seen what it looks like out that window—" The real comprehension was seeping through to him even as he talked. "Everybody I know, Jessie, Tony, the Kid, Big Louis, everybody, they're dead. Even Big Louis." "Yes," Brett-James said, his voice soft. "They are all dead, Mr. Prantera. Their children are all dead, and their grandchildren." The two men of the future said nothing more for long minutes while Joe Prantera's mind whirled its confusion. Finally he said, "What's this bit about you wanting me to give it to some guy." "That is why we brought you here, Mr. Prantera. You were ... you are, a professional assassin." "Hey, wait a minute, now." Reston-Farrell went on, ignoring the interruption. "There is small point in denying your calling. Pray remember that at the point when we ... transported you, you were about to dispose of a contemporary named Alphonso Annunziata-Rossi. A citizen, I might say, whose demise would probably have caused small dismay to society." They had him pegged all right. Joe said, "But why me? Why don't you get some heavy from now? Somebody knows the ropes these days." Brett-James said, "Mr. Prantera, there are no professional assassins in this age, nor have there been for over a century and a half." "Well, then do it yourself." Joe Prantera's irritation over this whole complicated mess was growing. And already he was beginning to long for the things he knew—for Jessie and Tony and the others, for his favorite bar, for the lasagne down at Papa Giovanni's. Right now he could have welcomed a calling down at the hands of Big Louis. Reston-Farrell had come to his feet and walked to one of the large room's windows. He looked out, as though unseeing. Then, his back turned, he said, "We have tried, but it is simply not in us, Mr. Prantera." "You mean you're yella?" "No, if by that you mean afraid. It is simply not within us to take the life of a fellow creature—not to speak of a fellow man." Joe snapped: "Everything you guys say sounds crazy. Let's start all over again." Brett-James said, "Let me do it, Lawrence." He turned his eyes to Joe. "Mr. Prantera, in your own era, did you ever consider the future?" Joe looked at him blankly. "In your day you were confronted with national and international, problems. Just as we are today and just as nations were a century or a millennium ago." "Sure, O.K., so we had problems. I know whatcha mean—like wars, and depressions and dictators and like that." "Yes, like that," Brett-James nodded. The heavy-set man paused a moment. "Yes, like that," he repeated. "That we confront you now indicates that the problems of your day were solved. Hadn't they been, the world most surely would have destroyed itself. Wars? Our pedagogues are hard put to convince their students that such ever existed. More than a century and a half ago our society eliminated the reasons for international conflict. For that matter," he added musingly, "we eliminated most international boundaries. Depressions? Shortly after your own period, man awoke to the fact that he had achieved to the point where it was possible to produce an abundance for all with a minimum of toil. Overnight, for all practical purposes, the whole world was industrialized, automated. The second industrial revolution was accompanied by revolutionary changes in almost every field, certainly in every science. Dictators? Your ancestors found, Mr. Prantera, that it is difficult for a man to be free so long as others are still enslaved. Today the democratic ethic has reached a pinnacle never dreamed of in your own era." "O.K., O.K.," Joe Prantera growled. "So everybody's got it made. What I wanta know is what's all this about me giving it ta somebody? If everything's so great, how come you want me to knock this guy off?" Reston-Farrell bent forward and thumped his right index finger twice on the table. "The bacterium of hate—a new strain—has found the human race unprotected from its disease. We had thought our vaccines immunized us." "What's that suppose to mean?" Brett-James took up the ball again. "Mr. Prantera, have you ever heard of Ghengis Khan, of Tamerlane, Alexander, Caesar?" Joe Prantera scowled at him emptily. "Or, more likely, of Napoleon, Hitler, Stalin?" "Sure I heard of Hitler and Stalin," Joe growled. "I ain't stupid." The other nodded. "Such men are unique. They have a drive ... a drive to power which exceeds by far the ambitions of the average man. They are genii in their way, Mr. Prantera, genii of evil. Such a genius of evil has appeared on the current scene." "Now we're getting somewheres," Joe snorted. "So you got a guy what's a little ambitious, like, eh? And you guys ain't got the guts to give it to him. O.K. What's in it for me?" The two of them frowned, exchanged glances. Reston-Farrell said, "You know, that is one aspect we had not considered." Brett-James said to Joe Prantera, "Had we not, ah, taken you at the time we did, do you realize what would have happened?" "Sure," Joe grunted. "I woulda let old Al Rossi have it right in the guts, five times. Then I woulda took the plane back to Chi." Brett-James was shaking his head. "No. You see, by coincidence, a police squad car was coming down the street just at that moment to arrest Mr. Rossi. You would have been apprehended. As I understand Californian law of the period, your life would have been forfeit, Mr. Prantera." Joe winced. It didn't occur to him to doubt their word. Reston-Farrell said, "As to reward, Mr. Prantera, we have already told you there is ultra-abundance in this age. Once this task has been performed, we will sponsor your entry into present day society. Competent psychiatric therapy will soon remove your present—" "Waita minute, now. You figure on gettin' me candled by some head shrinker, eh? No thanks, Buster. I'm going back to my own—" Brett-James was shaking his head again. "I am afraid there is no return, Mr. Prantera. Time travel works but in one direction, with the flow of the time stream. There can be no return to your own era." Joe Prantera had been rocking with the mental blows he had been assimilating, but this was the final haymaker. He was stuck in this squaresville of a world. Joe Prantera on a job was thorough. Careful, painstaking, competent. He spent the first three days of his life in the year 2133 getting the feel of things. Brett-James and Reston-Farrell had been appointed to work with him. Joe didn't meet any of the others who belonged to the group which had taken the measures to bring him from the past. He didn't want to meet them. The fewer persons involved, the better. He stayed in the apartment of Reston-Farrell. Joe had been right, Reston-Farrell was a medical doctor. Brett-James evidently had something to do with the process that had enabled them to bring Joe from the past. Joe didn't know how they'd done it, and he didn't care. Joe was a realist. He was here. The thing was to adapt. There didn't seem to be any hurry. Once the deal was made, they left it up to him to make the decisions. They drove him around the town, when he wished to check the traffic arteries. They flew him about the whole vicinity. From the air, Southern California looked much the same as it had in his own time. Oceans, mountains, and to a lesser extent, deserts, are fairly permanent even against man's corroding efforts. It was while he was flying with Brett-James on the second day that Joe said, "How about Mexico? Could I make the get to Mexico?" The physicist looked at him questioningly. "Get?" he said. Joe Prantera said impatiently, "The getaway. After I give it to this Howard Temple-Tracy guy, I gotta go on the run, don't I?" "I see." Brett-James cleared his throat. "Mexico is no longer a separate nation, Mr. Prantera. All North America has been united into one unit. Today, there are only eight nations in the world." "Where's the nearest?" "South America." "That's a helluva long way to go on a get." "We hadn't thought of the matter being handled in that manner." Joe eyed him in scorn. "Oh, you didn't, huh? What happens after I give it to this guy? I just sit around and wait for the cops to put the arm on me?" Brett-James grimaced in amusement. "Mr. Prantera, this will probably be difficult for you to comprehend, but there are no police in this era." Joe gaped at him. "No police! What happens if you gotta throw some guy in stir?" "If I understand your idiom correctly, you mean prison. There are no prisons in this era, Mr. Prantera." Joe stared. "No cops, no jails. What stops anybody? What stops anybody from just going into some bank, like, and collecting up all the bread?" Brett-James cleared his throat. "Mr. Prantera, there are no banks." "No banks! You gotta have banks!" "And no money to put in them. We found it a rather antiquated method of distribution well over a century ago." Joe had given up. Now he merely stared. Brett-James said reasonably, "We found we were devoting as much time to financial matters in all their endless ramifications—including bank robberies—as we were to productive efforts. So we turned to more efficient methods of distribution." On the fourth day, Joe said, "O.K., let's get down to facts. Summa the things you guys say don't stick together so good. Now, first place, where's this guy Temple-Tracy you want knocked off?" Reston-Farrell and Brett-James were both present. The three of them sat in the living room of the latter's apartment, sipping a sparkling wine which seemed to be the prevailing beverage of the day. For Joe's taste it was insipid stuff. Happily, rye was available to those who wanted it. Reston-Farrell said, "You mean, where does he reside? Why, here in this city." "Well, that's handy, eh?" Joe scratched himself thoughtfully. "You got somebody can finger him for me?" "Finger him?" "Look, before I can give it to this guy I gotta know some place where he'll be at some time. Get it? Like Al Rossi. My finger, he works in Rossi's house, see? He lets me know every Wednesday night, eight o'clock, Al leaves the house all by hisself. O.K., so I can make plans, like, to give it to him." Joe Prantera wound it up reasonably. "You gotta have a finger." Brett-James said, "Why not just go to Temple-Tracy's apartment and, ah, dispose of him?" "Jest walk in, eh? You think I'm stupid? How do I know how many witnesses hangin' around? How do I know if the guy's carryin' heat?" "Heat?" "A gun, a gun. Ya think I'm stupid? I come to give it to him and he gives it to me instead." Dr. Reston-Farrell said, "Howard Temple-Tracy lives alone. He customarily receives visitors every afternoon, largely potential followers. He is attempting to recruit members to an organization he is forming. It would be quite simple for you to enter his establishment and dispose of him. I assure you, he does not possess weapons." Joe was indignant. "Just like that, eh?" he said sarcastically. "Then what happens? How do I get out of the building? Where's my get car parked? Where do I hide out? Where do I dump the heat?" "Dump the heat?" "Get rid of the gun. You want I should get caught with the gun on me? I'd wind up in the gas chamber so quick—" "See here, Mr. Prantera," Brett-James said softly. "We no longer have capital punishment, you must realize." "O.K. I still don't wanta get caught. What is the rap these days, huh?" Joe scowled. "You said they didn't have no jails any more." "This is difficult for you to understand, I imagine," Reston-Farrell told him, "but, you see, we no longer punish people in this era." That took a long, unbelieving moment to sink in. "You mean, like, no matter what they do? That's crazy. Everybody'd be running around giving it to everybody else." "The motivation for crime has been removed, Mr. Prantera," Reston-Farrell attempted to explain. "A person who commits a violence against another is obviously in need of medical care. And, consequently, receives it." "You mean, like, if I steal a car or something, they just take me to a doctor?" Joe Prantera was unbelieving. "Why would anybody wish to steal a car?" Reston-Farrell said easily. "But if I give it to somebody?" "You will be turned over to a medical institution. Citizen Howard Temple-Tracy is the last man you will ever kill, Mr. Prantera." A chillness was in the belly of Joe Prantera. He said very slowly, very dangerously, "You guys figure on me getting caught, don't you?" "Yes," Brett-James said evenly. "Well then, figure something else. You think I'm stupid?" "Mr. Prantera," Dr. Reston-Farrell said, "there has been as much progress in the field of psychiatry in the past two centuries as there has in any other. Your treatment would be brief and painless, believe me." Joe said coldly, "And what happens to you guys? How do you know I won't rat on you?" Brett-James said gently, "The moment after you have accomplished your mission, we plan to turn ourselves over to the nearest institution to have determined whether or not we also need therapy." "Now I'm beginning to wonder about you guys," Joe said. "Look, all over again, what'd'ya wanta give it to this guy for?" The doctor said, "We explained the other day, Mr. Prantera. Citizen Howard Temple-Tracy is a dangerous, atavistic, evil genius. We are afraid for our institutions if his plans are allowed to mature." "Well if you got things so good, everybody's got it made, like, who'd listen to him?" The doctor nodded at the validity of the question. "Mr. Prantera, Homo sapiens is a unique animal. Physically he matures at approximately the age of thirteen. However, mental maturity and adjustment is often not fully realized until thirty or even more. Indeed, it is sometimes never achieved. Before such maturity is reached, our youth are susceptible to romantic appeal. Nationalism, chauvinism, racism, the supposed glory of the military, all seem romantic to the immature. They rebel at the orderliness of present society. They seek entertainment in excitement. Citizen Temple-Tracy is aware of this and finds his recruits among the young." "O.K., so this guy is dangerous. You want him knocked off before he screws everything up. But the way things are, there's no way of making a get. So you'll have to get some other patsy. Not me." "I am afraid you have no alternative," Brett-James said gently. "Without us, what will you do? Mr. Prantera, you do not even speak the language." "What'd'ya mean? I don't understand summa the big words you eggheads use, but I get by O.K." Brett-James said, "Amer-English is no longer the language spoken by the man in the street, Mr. Prantera. Only students of such subjects any longer speak such tongues as Amer-English, French, Russian or the many others that once confused the race with their limitations as a means of communication." "You mean there's no place in the whole world where they talk American?" Joe demanded, aghast. Dr. Reston-Farrell controlled the car. Joe Prantera sat in the seat next to him and Warren Brett-James sat in the back. Joe had, tucked in his belt, a .45 caliber automatic, once displayed in a museum. It had been more easily procured than the ammunition to fit it, but that problem too had been solved. The others were nervous, obviously repelled by the very conception of what they had planned. Inwardly, Joe was amused. Now that they had got in the clutch, the others were on the verge of chickening out. He knew it wouldn't have taken much for them to cancel the project. It wasn't any answer though. If they allowed him to call it off today, they'd talk themselves into it again before the week was through. Besides, already Joe was beginning to feel the comfortable, pleasurable, warm feeling that came to him on occasions like this. He said, "You're sure this guy talks American, eh?" Warren Brett-James said, "Quite sure. He is a student of history." "And he won't think it's funny I talk American to him, eh?" "He'll undoubtedly be intrigued." They pulled up before a large apartment building that overlooked the area once known as Wilmington. Joe was coolly efficient now. He pulled out the automatic, held it down below his knees and threw a shell into the barrel. He eased the hammer down, thumbed on the safety, stuck the weapon back in his belt and beneath the jacketlike garment he wore. He said, "O.K. See you guys later." He left them and entered the building. An elevator—he still wasn't used to their speed in this era—whooshed him to the penthouse duplex occupied by Citizen Howard Temple-Tracy. There were two persons in the reception room but they left on Joe's arrival, without bothering to look at him more than glancingly. He spotted the screen immediately and went over and stood before it. The screen lit and revealed a heavy-set, dour of countenance man seated at a desk. He looked into Joe Prantera's face, scowled and said something. Joe said, "Joseph Salviati-Prantera to interview Citizen Howard Temple-Tracy." The other's shaggy eyebrows rose. "Indeed," he said. "In Amer-English?" Joe nodded. "Enter," the other said. A door had slid open on the other side of the room. Joe walked through it and into what was obviously an office. Citizen Temple-Tracy sat at a desk. There was only one other chair in the room. Joe Prantera ignored it and remained standing. Citizen Temple-Tracy said, "What can I do for you?" Joe looked at him for a long, long moment. Then he reached down to his belt and brought forth the .45 automatic. He moistened his lips. Joe said softly, "You know what this here is?" Temple-Tracy stared at the weapon. "It's a handgun, circa, I would say, about 1925 Old Calendar. What in the world are you doing with it?" Joe said, very slowly, "Chief, in the line you're in these days you needa heavy around with wunna these. Otherwise, Chief, you're gunna wind up in some gutter with a lotta holes in you. What I'm doin', I'm askin' for a job. You need a good man knows how to handle wunna these, Chief." Citizen Howard Temple-Tracy eyed him appraisingly. "Perhaps," he said, "you are right at that. In the near future, I may well need an assistant knowledgeable in the field of violence. Tell me more about yourself. You surprise me considerably." "Sure, Chief. It's kinda a long story, though. First off, I better tell you you got some bad enemies, Chief. Two guys special, named Brett-James and Doc Reston-Farrell. I think one of the first jobs I'm gunna hafta do for you, Chief, is to give it to those two." THE END Transcriber's Note: This etext was produced from Analog December 1960. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. Minor spelling and typographical errors have been corrected without note.
|
D. a prison
|
Of the three, who seems to keep holding secrets in more than the others?
A. Lois
B. All three equally
C. Judy
D. Lorraine
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The Haunted Fountain CHAPTER I An Unsolved Mystery “Tell Judy about it,” begged Lois. “Please, Lorraine, it can’t be as bad as it appears. There isn’t anything that Judy can’t solve.” Lorraine tilted her head disdainfully. “We’re sisters now. We’re both Farringdon-Petts and should be loyal to each other. But you always did take Judy’s part. She was the one who nearly spoiled our double wedding trying to solve a mystery. I don’t believe she’d understand—understand any better than I do. Everyone has problems, and I’m sure Judy is no exception.” “You’re right, Lorraine,” announced Judy, coming in to serve dessert to the two friends she had invited for lunch at Peter’s suggestion. “I do have problems, and there are plenty of mysteries I can’t solve.” “Name one,” charged Lois. “Just mention one single spooky thing you couldn’t explain, and I’ll believe you. I’ve seen you in action, Judy Bolton—” “Judy Dobbs, remember?” “Well, you were Judy Bolton when you solved all those mysteries. I met you when the whole valley below the big Roulsville dam was threatened by flood and you solved that—” “That,” declared Judy, “was my brother Horace, not me. He was the hero without even meaning to be. He was the one who rode through town and warned people that the flood was coming. I was off chasing a shadow.” “A vanishing shadow,” Lois said with a sigh. “What you did wasn’t easy, Judy.” “It didn’t need to be as hard as it was,” Judy confessed. “I know now that keeping that promise not to talk about the dam was a great big mistake and could have cost lives. I should have told Arthur.” “Please,” Lorraine said, a pained expression clouding her pretty face, “let’s not talk about him now.” “Very well,” Judy agreed. “What shall we talk about?” “You,” Lois said, “and all the mysteries you’ve solved. Maybe you were mistaken about a thing or two before the flood, but what about the haunted house you moved into? You were the one who tracked down the ghosts in the attic and the cellar and goodness knows where all. You’ve been chasing ghosts ever since I met you, and not one of them did you fail to explain in some sensible, logical fashion.” “Before I met you,” Judy said, thinking back, “there were plenty of them I couldn’t explain. There was one I used to call the spirit of the fountain, but what she was or how she spoke to me is more than I know. If my grandparents knew, they weren’t telling. And now they’re both dead and I can’t ask them. They left me a lot of unsolved mysteries along with this house. Maybe I’ll find the answers to some of them when I finish sorting Grandma’s things. They’re stored in one end of the attic.” “Another haunted attic? How thrilling!” exclaimed Lois. “Why don’t you have another ghost party and show up the spooks?” “I didn’t say the attic was haunted.” Judy was almost sorry she had mentioned it. She wasn’t in the mood for digging up old mysteries, but Lois and Lorraine insisted. It all began, she finally told them, the summer before they met. Horace had just started working on the paper. Judy remembered that it was Lorraine’s father, Richard Thornton Lee, who gave him his job with the Farringdon Daily Herald . He had turned in some interesting church news, convincing Mr. Lee that he had in him the makings of a good reporter. And so it was that he spent the summer Judy was remembering in Farringdon where the Farringdon-Petts had their turreted mansion, while she had to suffer the heat and loneliness of Dry Brook Hollow. Her thoughts were what had made it so hard, she confessed now as she reviewed everything that had happened. She just couldn’t help resenting the fact that her parents left her every summer while they went off on a vacation by themselves. What did they think she would do? “You’ll have plenty to read,” her father had told her. “I bought you six new books in that mystery series you like. When they’re finished there are plenty of short stories around. Your grandmother never throws anything away. She has magazines she’s saved since your mother was a girl. If you ask for them she’ll let you have the whole stack. I know how you love to read.” “I do, Dad, but if the magazines are that old—” Judy had stopped. She had seen her father’s tired eyes and had realized that a busy doctor needed a vacation much more than a schoolgirl who had too little to do. He and Judy’s mother usually went to the beach hotel where they had honeymooned. It was a precious memory. Every summer Dr. Bolton and his wife relived it. And every summer Judy went to stay with her grandmother Smeed, who scolded and fussed and tried to pretend she wasn’t glad to have her. “You here again?” she had greeted her that summer, and Judy hadn’t noticed her old eyes twinkling behind her glasses. “What do you propose to do with yourself this time?” “Read,” Judy had told her. “Mom and Dad say you have a whole stack of old magazines—” “In the attic. Go up and look them over if you can stand the heat.” Judy went, not to look over the old magazines so much as to escape to a place where she could have a good cry. It was the summer before her fifteenth birthday. In another year she would have outgrown her childish resentment of her parents’ vacation or be grown up enough to ask them to let her have a vacation of her own. In another year she would be summering among the beautiful Thousand Islands and solving a mystery to be known as the Ghost Parade . “A whole parade of ghosts,” Lois would be telling her, “and you solved everything.” But then she didn’t even know Lois. She had no idea so many thrilling adventures awaited her. There seemed to be nothing—nothing—and so the tears came and spilled over on one of the magazines. As Judy wiped it away she noticed that it had fallen on a picture of a fountain. “A fountain with tears for water. How strange!” she remembered saying aloud. Judy had never seen a real fountain. The thrill of walking up to the door of the palatial Farringdon-Pett mansion was still ahead of her. On the lawn a fountain still caught and held rainbows like those she was to see on her honeymoon at Niagara Falls. But all that was in the future. If anyone had told the freckled-faced, pigtailed girl that she would one day marry Peter Dobbs, she would have laughed in their faces. “That tease!” For then she knew Peter only as an older boy who used to tease her and call her carrot-top until one day she yelled back at him, “Carrot-tops are green and so are you!” Peter was to win Judy’s heart when he gave her a kitten and suggested the name Blackberry for him. The kitten was now a dignified family cat. But the summer Judy found the picture of a fountain and spilled tears on it she had no kitten. She had nothing, she confessed, not even a friend. It had helped to pretend the fountain in the picture was filled with all the tears lonely girls like herself had ever cried. “But that would make it enchanted!” she had suddenly exclaimed. “If I could find it I’d wish—” A step had sounded on the stairs. Judy remembered it distinctly. She had turned to see her grandmother and to hear her say in her usual abrupt fashion, “Enchanted fountain, indeed! If you let people know your wishes instead of muttering them to yourself, most of them aren’t so impossible.” “Were they?” asked Lois. She and Lorraine had listened to this much of what Judy was telling them without interruption. “That’s the unsolved mystery,” Judy replied. “There weren’t any of them impossible.” And she went on to tell them how, the very next day, her grandparents had taken her to a fountain exactly like the one in the picture. It was in the center of a deep, circular pool with steps leading up to it. Beside the steps were smaller fountains with the water spurting from the mouths of stone lions. Judy had stared at them a moment and then climbed the steps to the pool. “Am I dreaming?” she remembered saying aloud. “Is this beautiful fountain real?” A voice had answered, although she could see no one. “Make your wishes, Judy. Wish wisely. If you shed a tear in the fountain your wishes will surely come true.” “A tear?” Judy had asked. “How can I shed a tear when I’m happy? This is a wonderful place.” “Shed a tear in the fountain and your wishes will surely come true,” the voice had repeated. “But what is there to cry about?” “You found plenty to cry about back at your grandmother’s house,” the mysterious voice had reminded her. “Weren’t you crying on my picture up there in the attic?” “Then you—you are the fountain!” Judy remembered exclaiming. “But a fountain doesn’t speak. It doesn’t have a voice.” “Wish wisely,” the voice from the fountain had said in a mysterious whisper. CHAPTER II If Wishes Came True “Did you?” Lois interrupted the story to ask excitedly. “Oh, Judy! Don’t keep us in suspense any longer. What did you wish?” “Patience,” Judy said with a smile. “I’m coming to that.” First, she told her friends, she had to think of a wise wish. There had been so much she wanted in those early days before the flood. Dora Scott had been her best friend in Roulsville, but she had moved away. “You see,” she explained, “I made the mistake of having just one best friend. There wasn’t anybody in Dry Brook Hollow. I remember thinking of how lonely I was and how I wished for a friend or a sister, and suddenly a tear splashed in the water. It made little ripples. I thought I had to wish quickly before they vanished, and so I began naming the things I wanted as fast as I could. I’m not sure they were wise wishes. They seem rather selfish to me, now. I wasn’t thinking of anybody but me, Judy Bolton, and what I wanted. It wasn’t until after I began to think of others that my wishes started to come true.” “But what were they?” Lois insisted. Lorraine seemed unusually quiet and thoughtful. Judy did not notice the fear in her eyes as she replied airily, “Oh, didn’t I tell you? I wished for lots of friends and a sister, and I wished I could marry a G-man and solve a lot of mysteries and that’s as far as I got when the ripples vanished. I thought the spell was broken and so I didn’t wish for anything more.” “Wasn’t there anything more you wanted?” Lois asked. “Of course,” replied Judy. “There were lots more things. I wanted to go places, of course, and keep pets, and have a nice home, and—” “And your wishes all came true!” “Every one of them,” Judy agreed, “even the one about the sister. You see, it wasn’t a baby sister I wanted. It was a sister near my own age. That seemed impossible at the time, but the future did hold a sister for me.” “It held one for me, too,” Lois said, squeezing Lorraine’s hand under the table. “Don’t you think sisters should tell each other their problems, Judy?” “Honey and I always do,” she replied “but then it was different. I didn’t know I would marry Peter or that he would become a G-man, and he didn’t know he had a sister. It is strange, isn’t it? But the strangest thing of all was the fountain itself.” “Why?” asked Lorraine. “Do you still think it was enchanted?” Lois laughed at this, but Judy was serious as she answered, “I was still little girl enough to think so at the time. I wandered around, growing very drowsy. Then I found a hammock and climbed into it. I must have gone to sleep, because I remember waking up and wondering if the voice in the fountain had been a dream.” “A hammock?” Lois questioned. “Are you sure it wasn’t a flying carpet?” “No, it was a hammock all right,” Judy assured her, laughing. “It was hung between two trees in a beautiful garden all enclosed in rose trellises thick with roses. Did I tell you it was June?” “All the year around?” Again Lois laughed. But Lorraine said abruptly, “Let’s not talk about rose gardens in June. It’s a long way from June to December.” “Do you mean a garden changes? I know,” Judy said, “but I think this one would be beautiful at any time of the year. There were rhododendrons, too, and I don’t know how many different kinds of evergreens. I explored the garden all around the fountain.” “And then what happened?” Lorraine urged her. “Yes, yes. Go on,” entreated Lois. “I didn’t dream you’d kept anything that exciting a secret. Why didn’t you try to solve the mystery?” “I think I would have tried,” Judy admitted, “if I had been older or more experienced. I really should have investigated it more thoroughly and learned the secret of the fountain. But after the ripples went away it didn’t speak to me any more, and I didn’t really think it had heard my wishes. I was still wishing for a friend when I met you, Lois. It did seem impossible for us to be friends at first, didn’t it? Lorraine was your friend.” “I did make trouble for you,” Lorraine remembered. “It was all because of my foolish jealousy.” “It was nothing compared to the trouble caused by the Roulsville flood,” declared Judy. “After that things started happening so fast that I completely forgot about the fountain. Honestly, Lois, I don’t believe I thought about it again until after we moved to Farringdon and I walked up to your door and saw the fountain on your lawn.” “The Farringdon-Pett puddle, I always called it,” Lois said with a giggle. “I’ve seen lots nicer fountains.” “You have?” asked Judy. “Then maybe you’ve seen the one I’ve been telling you about. I think the picture of it is still in the attic. Come on up and I’ll show you.” Lois and Lorraine had finished their dessert while Judy was telling them the story of the fountain. Somehow, she wasn’t hungry for hers. She had tasted it too often while she was making it. “I’ll leave it for Blackberry,” she decided. Lois watched in amusement as the cat lapped up the chocolate pudding after Judy had mixed it generously with cream. “Sometimes,” Judy said fondly, “Blackberry thinks he’s a person. He eats everything we eat, including lettuce. Do you mind if he comes with us, Lorraine? He wants to explore the attic, too.” “He’ll remember he’s a cat fast enough if there are any mice up there,” Lois said with a giggle. Leaving the table, they all started upstairs with the cat bounding ahead of them. In modernizing her grandparents’ house to suit her own and Peter’s tastes, Judy had seen to it that the old stair door was removed. But there was still a door closing off the narrower stairs that led to the attic. Blackberry reached it first and yowled for Judy to open it. “He can read my mind. He always knows where I’m going,” Judy said as the door creaked open and the cat shot through it. A moment later a weird rolling noise came from the floor above. “Come on. There’s nothing up here to be afraid of,” Judy urged her friends. “Maybe not, but I’m beginning to get the shivers,” confessed Lois as she followed Judy to the sewing room at the top of the last flight of stairs. “So am I,” Lorraine admitted. “I’m not superstitious about black cats, but they are creepy. Does Blackberry have to roll spools across the floor?” “Now he thinks he’s a kitten,” laughed Judy. Pausing at still another door that led to the darker part of the attic, she turned and said mysteriously, “Up here we can all turn back the clock. Does anybody care to explore the past?” The exploration began enthusiastically with Judy relating still more of what she remembered about the fountain. “When I told Grandma about it she laughed and said I must have dreamed it. She said if wishes came true that easily she’d be living in a castle. But would she?” Judy wondered. “When I first remember this house she was still burning kerosene lamps like those you see on that high shelf by the window. I think she and Grandpa like the way they lived without any modern conveniences or anything.” “I think so, too,” Lois agreed, looking around the old attic with a shiver. “It is strange they both died the same winter, isn’t it?” “Maybe they wanted it that way. Maybe they wished neither of them would outlive the other. If they did wish in the fountain,” Judy went on more thoughtfully, “I’m sure that was one of their wishes. Another could have been to keep the good old days, as Grandma used to call them. That one came true in a way. They did manage to keep a little of the past when they kept all these old things. That’s what I meant about turning back the clock.” “If wishes came true I’d like to turn it back a little myself,” Lorraine began. “It would be nice if things were the way they used to be when I trusted Arthur—” “Don’t you trust him now?” Judy asked. Afterwards she was sorry for the interruption. Lois and Judy both questioned Lorraine, but that was all she would say. Judy wondered, as they searched through the old magazines, what was wrong. Lorraine was of a jealous disposition. Was the green-eyed monster coming between her and her handsome husband, Arthur Farringdon-Pett? Until now they had seemed blissfully happy. But there was no happiness in Lorraine’s face as she gazed at a picture of one of the fountains and then said in a tight little voice, “It is. It’s the very same one.” “But that’s the picture I’ve been searching for!” Judy said eagerly. “Do you know where it is?” “I can’t be sure. But if it ever was enchanted, I’m sure it isn’t now. Let’s go,” Lorraine said suddenly to Lois. Judy knew she was suggesting a fast trip home. But, apparently, Lois did not understand it that way. If she did, she pretended not to. “Where?” she asked. “To the fountain? I’d love to, wouldn’t you, Judy?” “I certainly would,” Judy replied enthusiastically. “Do you recognize it, too?” “I think so,” Lois answered after studying a little more closely the picture they had found. “It looks like the fountain on the Brandt estate.” “The department store Brandts?” Judy questioned. “Then my grandparents must have driven old Fanny all the way to Farringdon.” “Not quite all the way,” Lorraine objected. “The Brandts own that stretch of woods just before you come into the city. You’ve passed it lots of times.” “Of course,” agreed Judy. She put the magazine back in its place under the eaves and turned eagerly to her friends. “I do remember a road turning off into the woods and going on uphill,” she told them. “I never thought it led to a house, though. There isn’t even a gate. Could that be the road my grandparents took?” “Why don’t we take it ourselves and find out?” Lois suggested. CHAPTER III A Strange Encounter Lorraine was not too enthusiastic about the proposed trip to the Brandt estate. Finally she agreed to it under one condition. They were not to drive all the way to the house which, she said, was just over the hilltop. They were to park the car where no one would see it and follow the path to the fountain. “But suppose we can’t find the path?” asked Judy. “You’ll remember it, won’t you?” Judy thought she would, but she wasn’t too sure. She and Lois both argued that it would be better to inquire at the house. Lois knew Helen Brandt slightly. “She’d be glad to show us around. This way it looks as if we’re planning a crime,” Lois said as they started off in the blue car she was driving. It was a neat little car, not too conspicuous, and easy to park in out-of-the-way places. Judy laughed and said if they did find the fountain she thought she’d wish for one exactly like it. “Well, you know what your grandmother said about wishes, don’t you?” Lorraine asked. “If you let people know about them instead of muttering them to yourself most of them aren’t so impossible.” “Quite true,” Judy agreed. “I’ll let Peter know about this one. He’s my Santa Claus, and it will soon be Christmas. Maybe I should have worn the fur coat he gave me last year.” “Your reversible’s better in case it rains. It’s too warm for snow. We picked a perfect day for this trip,” Lois continued, guiding the car around curves as it climbed the steep hill beyond Dry Brook Hollow. The trip was a short one. In twenty minutes they had covered the distance that had seemed such a long way to Judy when she was riding in her grandfather’s wagon. “I’ve been thinking about it,” she said, “and I’ve just about figured out how it happened. I didn’t think my grandparents knew the Brandts well enough to pay them a visit, though. We must have looked queer driving up to a beautiful estate in Grandpa’s old farm wagon. I do remember that Grandma had some hooked rugs to deliver. But that still doesn’t explain what happened afterwards. When I woke up in the hammock I was alone in the garden. Horse, wagon, grandparents—all had disappeared.” “How could they?” asked Lois. “Anyway,” Lorraine began, “you had a chance to see how beautiful everything was before—” Again she broke off as if there were something she wanted to tell but didn’t quite dare. “Before what?” questioned Judy. “Oh, nothing. Forget I said anything about it. You were telling us how you woke up in the hammock, but you never did explain how you got back home,” Lorraine reminded her. “Didn’t I?” asked Judy. “I’d forgotten a lot of it, but it’s beginning to come back now. I do remember driving home along this road. You see, I thought my grandparents had left me in the garden for a surprise and would return for me. I told you I was all alone. There wasn’t a house in sight.” “The Brandt house is just over the top of this next hill,” Lois put in. “I know. You told me that. Now I know why I couldn’t see it. All I could see was a windowless old tower and a path leading in that direction. Naturally, I followed it. There’s something about a path in the woods that always tempts me.” “We know that, Judy. Honey told us all about your latest mystery. You followed a trail or something.” “Well, this trail led out of the rose garden where the hammock was and then through an archway,” Judy continued. “All sorts of little cupids and gnomes peered out at me from unexpected places. I was actually scared by the time I reached the old tower. There wasn’t time to explore it. Just then I heard the rumble of my grandfather’s wagon and knew he was driving off without me.” “He was!” Judy’s friends both chorused in surprise, and Lois asked, “Why would he do a thing like that?” “I think now it was just to tease me. He did stop and wait for me after a while,” Judy remembered. “The rugs were gone. Grandma must have delivered them, but I didn’t ask where. If she made them for Mrs. Brandt they may still be there.” “I wouldn’t depend on it,” Lorraine said as they turned up the narrow road to the Brandt estate. “Watch out!” Judy suddenly exclaimed. “There’s another car coming.” As Lois swerved to avoid the oncoming car, Lorraine ducked her head. She kept herself hidden behind Judy until the car had passed. The man driving it was a stranger to Judy, but she would remember his hypnotic, dark eyes and swarthy complexion for a long time. The soft brown hat he was wearing covered most of his hair. “What’s the matter with you two?” asked Lois when the car had passed. “Aren’t you a little old for playing hide and seek?” “I wasn’t—playing. Let’s not go up there,” Lorraine begged. “I don’t think the Brandts live there any more.” “Maybe not, but we can pretend we think they do, can’t we?” Judy replied a little uncertainly. She was beginning to suspect that Lorraine knew more about the Brandt estate than she was telling. Lois kept on driving along the narrow, gravelly road. Soon there were more evergreens and a hedge of rhododendrons to be seen. They looked very green next to the leafless trees in the woods beyond. The sky was gray with white clouds being driven across it by the wind. “There’s the tower!” Lorraine exclaimed. “I can see it over to the left. It looks like something out of Grimm’s Fairy Tales, doesn’t it?” “It looks grim all right,” agreed Judy. “I wonder what it is.” “I suppose it’s nothing but an old water tower. It would be fun to explore it, though,” Lois said. “But if there are new people living here they’ll never give us permission.” “We might explore it without permission,” Judy suggested daringly. “Come on!” she urged her friends as Lois parked the car in a cleared place beside the road. “Who’s going to stop us? And who wants to explore a gloomy old tower, anyway? Let’s look for the fountain.” “Do you think we should?” Lorraine asked. “It won’t be enchanted. I told you—” “You told us very little,” Lois reminded her. “If you know anything about the people who live here now, I think you ought to let us know. Otherwise, I’m afraid we won’t be very welcome.” “I don’t think they’ll welcome us, anyway. I do know who they are,” Lorraine admitted. “You remember Roger Banning from school, don’t you? I’ve seen him around here. His family must have acquired sudden wealth, or else he’s just working on the estate.” “Then you’ve been here lately? Why didn’t you tell me?” asked Lois. “We always used to go places together.” “It wasn’t important,” Lorraine replied evasively. “I was just out for a drive.” “You plutocrats!” laughed Judy. “Each with a car of your own. You’re not interested in Roger Banning, are you, Lois? I’m sure you can do better than that. I did know him slightly, but not from school. The boys and girls were separated and went to different high schools by the time we moved to Farringdon. I remember his pal, Dick Hartwell, a lot better. He was in our young people’s group at church.” “Sh!” Lois cautioned her. “Nice people no longer mention Dick Hartwell’s name. He’s doing time.” “For what?” asked Judy. Like Peter, her FBI husband, she preferred facts to gossip. “Forgery, I guess. He stole some checkbooks from his father’s desk and forged the names of a lot of important business people. I think he forged some legal documents, too. Anyway, he went to the Federal Penitentiary. It was all in the papers,” Lorraine told her. Now Judy did remember. It was something she would have preferred to forget. She liked to think she was a good judge of character, and she had taken Dick Hartwell for a quiet, refined boy who would never stoop to crime. “I don’t see what all this has to do with the fountain,” Lois said impatiently. “Are we going to look for it, or aren’t we?” “Of course we are. That’s what we came for. I just like to know what a tiger looks like before he springs at me,” Judy explained. “You seem to think there’s danger in this expedition of ours, don’t you?” asked Lorraine. “I don’t know what to think. You’re the one who seems to know the answers, but you’re not telling. Hiding your face back there gave you away. You’ve seen that character who drove down this road and, for some reason, you were afraid he would see you. Why, Lorraine? Why didn’t you want to be recognized?” Lorraine hesitated a moment and then replied evasively, “People don’t generally enter private estates without an invitation. That’s all.” “I’d better turn the car around,” Lois decided, “in case we have to leave in a hurry. I don’t expect we’ll encounter any tigers, but we may be accused of trespassing.” “I’m sure we will be,” announced Judy as two dark-coated figures strode down the road toward them. “You drove right by a NO TRESPASSING sign, and this isn’t a welcoming committee coming to meet us!”
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D. Lorraine
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Why did Charles think he was the last person alive?
A. His sickness was taking longer
B. He had some sort of immunity
C. He was the reason for the plague
D. He was meant for greater things
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"Phone Me in Central Park" By JAMES McCONNELL There should be an epitaph for every man, big or little, but a really grand and special one for Loner Charlie. [Transcriber's Note: This etext was produced from Planet Stories Fall 1954. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Charles turned over on his side to look at her. She lay quietly in the other bed, the most beautiful woman he had ever seen. She was blonde to perfection, exquisitely shaped, and the rich promise of her body was exposed to his view. "Why?" he thought as he looked at her. "Why did it have to happen like this?" The whole thing was still like a dream to him, and as yet he couldn't decide whether it was a good or a bad dream. A year ago she had been unattainable, a face to conjure with in erotic dreams, far beyond his ken. A year ago she had been a public idol, the most popular actress of the day. And he had been a nobody, full of a nobody's idle hopes and schemes. And now he was lying in the bed next to hers in her swank Manhattan apartment in the most exclusive hotel in town. The unrealness of the situation overwhelmed him. His mind was a picture of confused thoughts. Meanings and answers to his questions slithered out of his reach. "God," he said. It was not an exclamation, nor yet an expletive. It was a mere statement of fact. A thought teased at him. Charles looked at the woman again and decided that she still looked beautiful in spite of the harshness of the room's lighting. He touched buttons by the edge of the bed and the illumination quieted to a soft glow, wrapping her in a radiant halo. Charles smiled wanly and got up. He stood by the bed looking at her. "I could have fallen in love with you once. A year ago, perhaps, or longer. But not now. Not now." He turned away and walked to the window. "Now the world is dead. The whole world is dead." New York lay quietly below him. It was the hour of indecision when day has not quite made up its mind to leave and night has not yet attacked in force. The streetlights were already on, making geometric patterns through the dusk of Central Park. Some of the billboards were shining, their relays activated by darkness-sensitized solenoids. A reddish-orange pallor hung from the sky. It had been very pleasant that afternoon. She had given of herself freely, warmly, and Charles had accepted. But then he had known that she would. It was not him, it was the circumstances. Under the circumstances, she would have given herself to any man— "Why did it have to be her—or me? Why should it have to happen to anybody! Why!" She would have given herself to any man— His thoughts beat a rapid crescendo, activating emotions, stimulating sensations of angry rage. He wanted to cry, to weep angry tears of protest. To any man, WHO HAPPENED TO BE THE LAST MAN ON EARTH! Charles picked up a heavy book end off the table and crashed it through the thick pane of window glass. A gust of wind from the outside breezed through the shattered opening, attacking his olfactory patch with the retching smell of decaying flesh. Charles ignored it. Even smells had lost their customary meanings. He felt the rage build up inside again, tearing at his viscera. His stomach clenched up like an angry fist. "But I don't want to be the last man alive!" he shouted. "I don't know what to do! I don't know where to go, how to act! I just don't know—" A paroxysm of sobbing shook his body. Trembling, he dropped to his knees, his head against the cold firmness of the sill, his hands clutched tightly around the jagged edges of the window pane. In spite of the sharp pain that raced through his system, in spite of the bright, warm, red stream that trickled down his face, he knelt by the window for several minutes. " Maybe I'm not the last! " The thought struck him with suddenness, promisingly, edged with swelling comfort to fill his emptiness. Charles got up slowly, noticing for the first time that his fingers were badly cut. He wrapped a handkerchief around them and forgot them. He had to know—he had to find out. As he turned to leave, he noticed again the woman lying in radiant state upon the bed. He walked to her side and leaned over, kissing her gently on the forehead. As he straightened up, his leg caught against her arm, pushing it slightly. The woman's arm slipped from its position and dangled from the edge of the bed like a crazy pendulum. Charles picked it up and folded it across her now cold breasts. He started to pull the sheet over her nude form, then stopped, smiling at his conventionality. After all, it didn't make any difference now. The phonograph was near the door. On sudden impulse he switched it on, turned the volume up full, and in grim jest left it playing Rachmaninoff's Isle of the Dead on full automatic. The music haunted him down the hall to the elevator that he had to run himself. The lobby was littered with debris, human and otherwise. Charles ignored it. The street that led towards the Bureau of Vital Statistics was a mess of desolate carnage. Charles overlooked it. Shop fronts smashed, stores looted, gyro-cars wrecked, proud buildings defaced. "That was it," he said to himself. "Pride. We called this the 'Proud Era.' Everything was better and bigger and nicer to have. Buildings were taller, men were healthier, most of the problems of humanity seemed licked, or nearly so. It was a time of free power, each small unit of population, each section of town operating on perpetual, ever-lasting, automatic atomic piles. "We were free. We seemed, almost, to have accomplished something. The world was running well. No wonder we called it the 'Proud Era.' Life was fun, just a bowl of cherries, until...." Two years ago the animals had started dying. Strangely enough the rats had gone first, to anybody's notice. Sales of poison dropped, scientific laboratories chained to a perpetual rodent-cycle began to complain bitterly. Then the lovers who hunted out and haunted the lonely lanes through the countryside began to remark that the locusts were late that year. The Southern states joyously reported that mosquito control was working to an unprecedented degree. The largest cotton crop ever was forecast and rumors from Mexico had it that no one had died from scorpion bite in several weeks. A month later the meat animals, the birds and the household pets began dropping as rapidly as the flies which had dropped earlier. Congress was called into special session, as were all of the national governments around the world. The U.N. met at emergency sessions to cope with the situation. The president of the world-wide Society for the Prevention of Cruelty to Animals committed suicide. Within a year it was obvious to everyone that man was the only animal left on earth. The panic which had begun with the death of the animals was quieted somewhat by the fact that humans seemed immune to the pandemic. But the lakes full of dead fish caused a great stink and residents along the coasts began to move inland. Sales of perfumes and deodorants soared. Then just one year ago, the first human became infected with the strange malady. Within six months, half of the world's population was gone. Less than a month ago no more than a few thousand people remained in New York. And now.... "I've got to find out," Charles told himself. He meant it, of course, but in a sense he was afraid—afraid that his trip to the Bureau might give him an answer he didn't dare listen to. "But I've got to try." He walked on down the bloody street. Before the plague the Bureau of Vital Statistics had been one of man's crowning achievements. Housed as it was in a huge metallic globe of a building, it contained computers which kept exact account of every human on earth. Compulsory registration and the classification of each individual by means of the discrete patterns of his brain waves had accomplished for man what no ordinary census could have. The machine knew who was alive, who was dead, and where everybody was. Once a year the Bureau issued The Index, an exact accounting of Earth's four billion inhabitants. Four billion names and addresses, compressed into microprint, a tremendous achievement even for the "Proud Era." In all of his life, Charles had never once glanced at The Index. The average person had little necessity to do so since the Bureau information service would answer questions free of charge at any time. Reaching the gigantic building, Charles pushed aside the body of a young man and walked into the main foyer. Passing behind once-guarded doors, he entered the giant computer room and paused in admiration. Only once, before the plague, had he seen the interior of this room. But he still remembered it and he still recalled the powerful emotional experience it had been those many years ago. All children had to have a brain-wave recording made by the Bureau during the first month of their life. And again at the age of 10 each child returned to the Bureau for a recheck. It was for this latter recording that Charles had come to the Bureau some twenty-two years before and a friendly guard had let him peep briefly into the computer room. The impression of intense activity, of organized confusion, of mechanical wonder had remained with him the rest of his life. "So different now," he thought, surveying the room. "Now it's empty, so empty." The machine seemed to reflect the stillness, the very deadness of the world. The silence became unbearable. Charles walked to the master control panel. With newly acquired dexterity he switched the computer screens on and watched them glow to life. All around the world sensitive receiving stations pulsed to activity, sending out searching fingers, hunting for elusive patterns of neutral energy, mapping and tabulating the results. The main computer screen dominated one wall of the room. Other smaller screens clustered around it. On these screens could be graphed the population of any and every part of the globe. An illuminated counter immediately above it would give the numerical strength of the area being sampled while the screen would show population density by individual pinpoints of light that merged to form brightness patterns. "I'll try New York first," he said to himself, knowing that he was a coward, afraid to check the whole world from the start. "I'll start with New York and work up." Charles activated the switches that would flash a schematic map of New York on the screen. "There's bound to be somebody else left here. After all, there were at least twenty of us just a couple of days ago." And one of them, a beautiful woman, had invited him up to her apartment, not because she liked him, but because.... The main screen focused itself, the patterns shifting into a recognizable perceptual image. "Why, it was just yesterday (or was it the day before?) that ten of us, at least, met here to check the figures. There were lots of us alive then." Including the blond young woman who had died just this afternoon.... Charles stopped talking and forced his eyes upwards. Peripheral vision caught first the vague outlines of the lower part of the map. His eyes continued to move, slowly, reluctantly. They caught the over-all relief of Greater New York City—and then concentrated on the single, shining dot at the very heart of the map—and he understood. His eyes stabbed quickly for the counter above the screen. One. He gasped. The counter read one . Charles was by himself, the last person alive in all of New York City. He began to tremble violently. The silence of the room began to press quickly in on him. His frantic fingers searched for the computer controls. New York State. One. The entire United States. One. The western hemisphere, including islands. (Was that a point of light in Brazil? No. Just a ghost image). One. The Pacific area, Asia, Australia, Asia Minor, Russia and the Near East, Africa and then Europe. England! There was a light in England! Someone else still lived! The counter clicked forward. Two! His trembling stopped. He breathed again. "Of course. London was at least as populous as New York City before the plague. It's only logical that—" He stopped. For even as he spoke, the light winked out! The counter clicked again. One. Alone. Alone! Charles screamed. The bottom dropped out from under him! Why? Such a simple question, but in those three letters lay the essence of human nature. Why. The drive of curiosity. Stronger, in a way, than the so-called "basic" drives: hunger, thirst, sex, shelter, warmth, companionship, elimination. Certainly more decisive in the history of the race. Man began to think, to differentiate himself from the other animals, when he first asked the question: "Why?" But thinking about "why" didn't answer the question itself, Charles thought. He looked around him. He was sitting on a bench in Central Park, alone except for a few stray corpses. But the park was fairly free of bodies. "You've got about ten minutes warning," he said to himself. "I guess that most people wanted to die inside of something—inside of anything. Not out in the unprotected open." The silence was like a weight hanging around his neck. Not an insect noise, not the chirp of a bird, not the sound of a car nor the scream of a plane. Not even a breeze to whisper among the leaves, he thought. Civilization equals life equals noise. Silence equals.... Why. His mind kept returning to the question. Of all the people on earth, me. The last. Why me? Average, that's what he was. Height: 5'11". Weight: 165. Age: 32. Status: Married, once upon a time. The Norm, with no significant departures, all down the line. Church member, but not a good one. Could that be it? Could the most normal be the most perfect? Had he led the best of all possible lives? Was that it? Had God, in His infinite wisdom and mercy, spared his life, saved him, singled him out because he was most nearly a saint, most nearly Christ-like, most nearly.... Lies—His mind snapped back to reality. He half smiled. Saint? Christ? The Second Coming? He was no saint. Charles sighed. What about—? Chance. That was it! The laws of probability, the bell-shaped curve, normal distribution, rectilinear regression. More people per square foot in New York than elsewhere. The first person who died was from New York, so the last person who gave way to the disease should come from here too. Spin the wheel; throw the dice; toss the coin. So simple to explain by the laws of chance. No need for any underlying assumptions about good and evil, no need for teleological arguments concerning cause and effect. Simply explain it by chance. Somebody had to be the last to go and that was— "No," Charles said, standing up in the quiet of the spring evening. "No, chance won't do it. No man can reckon with chance. The mind rejects such things. There must be something beyond mere accident. There must be!" He sighed slowly. "So now I'm a hermit, whether or not I like it," he said in derision to the gravel path as he walked along it. "A hermit in the midst of a city of millions of—No, I forgot. There aren't any more people, are there?" It was hard to realize, even now. "A hermit, alone—and I haven't even got a cave...." Charles stopped walking suddenly. No cave, he thought. No place to sleep out the long one, no place to rest while time came to change things around and make them for the better. No place to hide. And suddenly it was the most important thing in life to him to find his "cave." It took him almost an hour to find the proper tools, and better than two hours more of hard, nighttime work to get the hole dug to his satisfaction. It took almost three hours to find the right sort of casket, durable but not too heavy for one man to handle. He carted it out to a grassy plot close to the center of the park where the grave was. He let the coffin down slowly into the depression, then piled up loose dirt on the sloping sides of the hole so that the rain would wash it down over him. "I can't very well bury myself," he said. "I guess it will rain after I'm gone." He looked carefully down at the metallic container. Wait now. There was something wrong, something missing. It was—oh, yes, he caught it. It was the stone. There wasn't any stone to go at the head of the grave. "I'll have to fix that." A sheet of metal, bent double, served for the monument proper. A nearby tool shed yielded up a can of paint and a brush. By the glow of one of the streetlights Charles worked out the inscription. "It ought to be something impressive," he thought out loud. "Something fitting the occasion." What did one say on these situations? There was so little chance to practice up for things like this. But it ought to be good, it ought to be proper. "'In this now hallowed corner of the planet Earth—' No. That sounds too ... too...." Make it simple, he thought. And he finally wrote: HERE LIES THE BODY OF THE LAST MAN ON EARTH Yes. That was it. Simple. Let whoever came afterwards figure out the rest. Let them decide. He smiled and finished the painting. Charles was hungry. He got up and started for one of the restaurants near the park. Later on, when there was more time, he'd find a piece of granite and move it to the plot. He could spend his free time carving on it, copying the inscription. He would make it into a real shrine; maybe he would practice up a bit and try to carve a statue to go with the stone. Somehow, though, since things were ready and it didn't make too much difference, it seemed to Charles that he'd probably have a long time to wait. "Maybe it's just a disease, and I'm immune. I was immune to smallpox. The vaccination never took. That's probably it." He smiled. Strange, but now he wanted very much to go on living, alone or not. There were things he could do, ways to keep occupied. He wouldn't mind it so much. But he wanted more and more desperately with each passing second to retain his foothold on the tenuous path of physical existence. The tantalizing thought of "why" puzzled its way back into his mind. But it seemed less pressing now that he had almost come to the conclusion that he would live for a long time. Later, in a few days perhaps, he would think about it. In a little while he'd have plenty of opportunity for hunting down the answer. This seemed good to him, for now he thought he almost had the answer, if there were an answer. He thought he had seen the solution peering out at him from the recesses of his mind, and he didn't like the expression on its face. Better to forget. Charles reached the broad boulevard. There was a large cafe just across from him, its front window caved in by a large truck. He stumbled and almost fell as he stepped from the curb. "Look at me, nervous as a cat." He was trembling noticeably as he started across the street. "I—" He started to say something, to think something. But some hidden part of his mind clamped down, obscuring the thought, rejecting the concept. The tremor turned to a shake before he reached the far curb, and the first burst of wild pain came as he laid his shoulder against the door to the restaurant. This was the way the plague began, but—His mind quickly repressed the idea. It couldn't be the plague. He was immune! Another burst of pulsating, shattering pain crashed through his body, tearing down the defenses of his mind, putting an end of his thoughts of immunity. Colors flared before his eyes, a persistent, irresistible susurrus flooded his ears. He wanted to protest, but there was no one to listen to him. He appealed to every divinity he knew, all the time knowing it would be useless. His body, out of his voluntary control, tried to run off in all directions at once. Charles struggled to end his body's disorganized responses, to channelize all his energy into one direction. His mind came back into action. He set up his goal; everything else seemed irrelevant: he had to get back to the park, to his hermit's cave, to his long, narrow home. He couldn't die until then. Ten minutes. He was allotted ten minutes before the end. It could have been ten years or ten seconds, for now objective time meant nothing to him. It was not a matter of measuring seconds and minutes. It was a matter of forgetting time and measuring space. He concentrated on the grave; he forced his body to become an unwilling machine. While he could, he walked, forcing himself on. When his legs gave way, he crawled. When his knees buckled, he rolled. When his stomach protested, he vomited. It made no difference. Charles refused to think. Machines, especially half-broken machines, do not think; they only work. Sweating, straining, bleeding, retching, he pushed himself towards his goal, trying to add one final touch of grace and custom to the rude irrationalness of it all. His eyes gave out a few feet from the pit. He felt his way towards it. Convulsions shook his body like a cat shakes a captive mouse. He humped his body forward between the seizures, hands outstretched, searching for the grave. And then he was upon it. One arm reached out for grass, and clutched bare space instead. He was home. He gathered energy from his final reservoirs of strength for one final movement that would throw him headlong into the shallow grave. He tensed his muscles, pulled his limbs up under him and started to roll into the hole. Instantly the thought struck him with paralyzing devastation. The answer to it all poked its face out from the recesses of his mind and sapped the last bit of his energy, corroding his nerves and dying muscles. Now he knew, and the knowing was the end of it. He collapsed at the edge of the pit. Only one arm hung loosely down into it, swinging senseless in the air, pointing accusingly at the empty coffin. The world will end, not with a bang, nor with a whimper, but with the last man's anguished cry at the unreasonableness of it all. Charles screamed. The large, invisible, ovular being that hung suspended over the Empire State Building rested from its exertion. Soon it was approached by another of its kind. "It is finished?" asked the second. "Yes. Just now. I am resting." "I can feel the emptiness of it." "It was very good. Where were you?" "On the next planet out. No beauty to it at all; no system. How was yours?" "Beautiful," said the first. "It went according to the strictest semantic relationship following the purest mathematical principles. They made it easy for me." "Good." "Well, where to now?" "There's another system about four thoughts away. We're due there soon." "All right. Let's go." "What's that you have there?" "Oh, this?" replied the first. "It's a higher neural order compendium the Things here made up. It's what I used." "You can't take it with you, you know. They don't allow souvenirs." "I know." "Well?" "All right, all right. You're so good, see if you can compute the scatter probability." The first being moved imperceptably and the heavy plastoid binding of the book disappeared. The thousands of pages dropped softly, caught at the wind like hungry sails, separated, and pulled by the fingers of gravity, went their disparate ways. Here a page scuttled into a broken window of the Chrysler Building (read the names: Aabat, Aabbs, Aabbt). Here a page landed upright on the head of one of the library lions and sloughed softly to the ground (read the names: Looman, Loomana, Loomanabsky). Here another page crept in between the cracks of a pier on the riverfront, dropping gently to the caressing eddies of the water (read the names: Smith, Smitha, Smitj). And here two pages danced down into Central Park, pirouetted, promenaded, and finally came to rest against a propped-up piece of metal (read the names: Whit, Whita, Whitacomb). It was not until the dusty morning sun stirred up the breezes that they fluttered down into the shallow hole beneath, unnoticed. The writing on the metal, until then partially obscured by the papers, became legible: HERE LIES THE BODY OF THE LAST MAN ON EARTH— CHARLES J. ZZYZST GO TO HELL!
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B. He had some sort of immunity
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What is the role of the pirate ship story that Dunbar tells?
A. It proves that he knows where he's going and he had the right choice all along
B. It is a fantastic story meant to keep the crew entertained while floating in space
C. It points to who will rescue his body when he arrives at the planet
D. It helps to clarify what is true for the reader when the aliens find his body
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Transcriber's Note: This etext was produced from Space Science Fiction May 1952. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed. TO EACH HIS STAR by BRYCE WALTON "Nothing around those other suns but ashes and dried blood," old Dunbar told the space-wrecked, desperate men. "Only one way to go, where we can float down through the clouds to Paradise. That's straight ahead to the sun with the red rim around it." But Dunbar's eyes were old and uncertain. How could they believe in his choice when every star in this forsaken section of space was surrounded by a beckoning red rim? There was just blackness, frosty glimmering terrible blackness, going out and out forever in all directions. Russell didn't think they could remain sane in all this blackness much longer. Bitterly he thought of how they would die—not knowing within maybe thousands of light years where they were, or where they were going. After the wreck, the four of them had floated a while, floated and drifted together, four men in bulbous pressure suits like small individual rockets, held together by an awful pressing need for each other and by the "gravity-rope" beam. Dunbar, the oldest of the four, an old space-buster with a face wrinkled like a dried prune, burned by cosmic rays and the suns of worlds so far away they were scarcely credible, had taken command. Suddenly, Old Dunbar had known where they were. Suddenly, Dunbar knew where they were going. They could talk to one another through the etheric transmitters inside their helmets. They could live ... if this was living ... a long time, if only a man's brain would hold up, Russell thought. The suits were complete units. 700 pounds each, all enclosing shelters, with atmosphere pressure, temperature control, mobility in space, and electric power. Each suit had its own power-plant, reprocessing continuously the precious air breathed by the occupants, putting it back into circulation again after enriching it. Packed with food concentrates. Each suit a rocket, each human being part of a rocket, and the special "life-gun" that went with each suit each blast of which sent a man a few hundred thousand miles further on toward wherever he was going. Four men, thought Russell, held together by an invisible string of gravity, plunging through a lost pocket of hell's dark where there had never been any sound or life, with old Dunbar the first in line, taking the lead because he was older and knew where he was and where he was going. Maybe Johnson, second in line, and Alvar who was third, knew too, but were afraid to admit it. But Russell knew it and he'd admitted it from the first—that old Dunbar was as crazy as a Jovian juke-bird. A lot of time had rushed past into darkness. Russell had no idea now how long the four of them had been plunging toward the red-rimmed sun that never seemed to get any nearer. When the ultra-drive had gone crazy the four of them had blanked out and nobody could say now how long an interim that had been. Nobody knew what happened to a man who suffered a space-time warping like that. When they had regained consciousness, the ship was pretty banged up, and the meteor-repeller shields cracked. A meteor ripped the ship down the center like an old breakfast cannister. How long ago that had been, Russell didn't know. All Russell knew was that they were millions of light years from any place he had ever heard about, where the galactic space lanterns had absolutely no recognizable pattern. But Dunbar knew. And Russell was looking at Dunbar's suit up ahead, watching it more and more intently, thinking about how Dunbar looked inside that suit—and hating Dunbar more and more for claiming he knew when he didn't, for his drooling optimism—because he was taking them on into deeper darkness and calling their destination Paradise. Russell wanted to laugh, but the last time he'd given way to this impulse, the results inside his helmet had been too unpleasant to repeat. Sometimes Russell thought of other things besides his growing hatred of the old man. Sometimes he thought about the ship, lost back there in the void, and he wondered if wrecked space ships were ever found. Compared with the universe in which one of them drifted, a wrecked ship was a lot smaller than a grain of sand on a nice warm beach back on Earth, or one of those specks of silver dust that floated like strange seeds down the night winds of Venus. And a human was smaller still, thought Russell when he was not hating Dunbar. Out here, a human being is the smallest thing of all. He thought then of what Dunbar would say to such a thought, how Dunbar would laugh that high piping squawking laugh of his and say that the human being was bigger than the Universe itself. Dunbar had a big answer for every little thing. When the four of them had escaped from that prison colony on a sizzling hot asteroid rock in the Ronlwhyn system, that wasn't enough for Dunbar. Hell no—Dunbar had to start talking about a place they could go where they'd never be apprehended, in a system no one else had ever heard of, where they could live like gods on a green soft world like the Earth had been a long time back. And Dunbar had spouted endlessly about a world of treasure they would find, if they would just follow old Dunbar. That's what all four of them had been trying to find all their lives in the big cold grabbag of eternity—a rich star, a rich far fertile star where no one else had ever been, loaded with treasure that had no name, that no one had ever heard of before. And was, because of that, the richest treasure of all. We all look alike out here in these big rocket pressure suits, Russell thought. No one for God only knew how many of millions of light years away could see or care. Still—we might have a chance to live, even now, Russell thought—if it weren't for old crazy Dunbar. They might have a chance if Alvar and Johnson weren't so damn lacking in self-confidence as to put all their trust in that crazed old rum-dum. Russell had known now for some time that they were going in the wrong direction. No reason for knowing. Just a hunch. And Russell was sure his hunch was right. Russell said. "Look—look to your left and to your right and behind us. Four suns. You guys see those other three suns all around you, don't you?" "Sure," someone said. "Well, if you'll notice," Russell said, "the one on the left also now has a red rim around it. Can't you guys see that?" "Yeah, I see it," Alvar said. "So now," Johnson said, "there's two suns with red rims around them." "We're about in the middle of those four suns aren't we, Dunbar?" Russell said. "That's right, boys!" yelled old Dunbar in that sickeningly optimistic voice. Like a hysterical old woman's. "Just about in the sweet dark old middle." "You're still sure it's the sun up ahead ... that's the only one with life on it, Dunbar ... the only one we can live on?" Russell asked. "That's right! That's right," Dunbar yelled. "That's the only one—and it's a paradise. Not just a place to live, boys—but a place you'll have trouble believing in because it's like a dream!" "And none of these other three suns have worlds we could live on, Dunbar?" Russell asked. Keep the old duck talking like this and maybe Alvar and Johnson would see that he was cracked. "Yeah," said Alvar. "You still say that, Dunbar?" "No life, boys, nothing," Dunbar laughed. "Nothing on these other worlds but ashes ... just ashes and iron and dried blood, dried a million years or more." "When in hell were you ever here?" Johnson said. "You say you were here before. You never said when, or why or anything!" "It was a long time back boys. Don't remember too well, but it was when we had an old ship called the DOG STAR that I was here. A pirate ship and I was second in command, and we came through this sector. That was—hell, it musta' been fifty years ago. I been too many places nobody's ever bothered to name or chart, to remember where it is, but I been here. I remember those four suns all spotted to form a perfect circle from this point, with us squarely in the middle. We explored all these suns and the worlds that go round 'em. Trust me, boys, and we'll reach the right one. And that one's just like Paradise." "Paradise is it," Russell whispered hoarsely. "Paradise and there we'll be like gods, like Mercuries with wings flying on nights of sweet song. These other suns, don't let them bother you. They're Jezebels of stars. All painted up in the darkness and pretty and waiting and calling and lying! They make you think of nice green worlds all running waters and dews and forests thick as fleas on a wet dog. But it ain't there, boys. I know this place. I been here, long time back." Russell said tightly. "It'll take us a long time won't it? If it's got air we can breath, and water we can drink and shade we can rest in—that'll be paradise enough for us. But it'll take a long time won't it? And what if it isn't there—what if after all the time we spend hoping and getting there—there won't be nothing but ashes and cracked clay?" "I know we're going right," Dunbar said cheerfully. "I can tell. Like I said—you can tell it because of the red rim around it." "But the sun on our left, you can see—it's got a red rim too now," Russell said. "Yeah, that's right," said Alvar. "Sometimes I see a red rim around the one we're going for, sometimes a red rim around that one on the left. Now, sometimes I'm not sure either of them's got a red rim. You said that one had a red rim, Dunbar, and I wanted to believe it. So now maybe we're all seeing a red rim that was never there." Old Dunbar laughed. The sound brought blood hotly to Russell's face. "We're heading to the right one, boys. Don't doubt me ... I been here. We explored all these sun systems. And I remember it all. The second planet from that red-rimmed sun. You come down through a soft atmosphere, floating like in a dream. You see the green lakes coming up through the clouds and the women dancing and the music playing. I remember seeing a ship there that brought those women there, a long long time before ever I got there. A land like heaven and women like angels singing and dancing and laughing with red lips and arms white as milk, and soft silky hair floating in the winds." Russell was very sick of the old man's voice. He was at least glad he didn't have to look at the old man now. His bald head, his skinny bobbing neck, his simpering watery blue eyes. But he still had to suffer that immutable babbling, that idiotic cheerfulness ... and knowing all the time the old man was crazy, that he was leading them wrong. I'd break away, go it alone to the right sun, Russell thought—but I'd never make it alone. A little while out here alone and I'd be nuttier than old Dunbar will ever be, even if he keeps on getting nuttier all the time. Somewhere, sometime then ... Russell got the idea that the only way was to get rid of Dunbar. You mean to tell us there are people living by that red-rimmed sun," Russell said. "Lost people ... lost ... who knows how long," Dunbar said, as the four of them hurtled along. "You never know where you'll find people on a world somewhere nobody's ever named or knows about. Places where a lost ship's landed and never got up again, or wrecked itself so far off the lanes they'll never be found except by accident for millions of years. That's what this world is, boys. Must have been a ship load of beautiful people, maybe actresses and people like that being hauled to some outpost to entertain. They're like angels now, living in a land all free from care. Every place you see green forests and fields and blue lakes, and at nights there's three moons that come around the sky in a thousand different colors. And it never gets cold ... it's always spring, always spring, boys, and the music plays all night, every night of a long long year...." Russell suddenly shouted. "Keep quiet, Dunbar. Shut up will you?" Johnson said. "Dunbar—how long'll it take us?" "Six months to a year, I'd say," Dunbar yelled happily. "That is—of our hereditary time." "What?" croaked Alvar. Johnson didn't say anything at all. Russell screamed at Dunbar, then quieted down. He whispered. "Six months to a year—out here—cooped up in these damn suits. You're crazy as hell, Dunbar. Crazy ... crazy! Nobody could stand it. We'll all be crazier than you are—" "We'll make it, boys. Trust ole' Dunbar. What's a year when we know we're getting to Paradise at the end of it? What's a year out here ... it's paradise ain't it, compared with that prison hole we were rotting in? We can make it. We have the food concentrates, and all the rest. All we need's the will, boys, and we got that. The whole damn Universe isn't big enough to kill the will of a human being, boys. I been over a whole lot of it, and I know. In the old days—" "The hell with the old days," screamed Russell. "Now quiet down, Russ," Dunbar said in a kind of dreadful crooning whisper. "You calm down now. You younger fellows—you don't look at things the way we used to. Thing is, we got to go straight. People trapped like this liable to start meandering. Liable to start losing the old will-power." He chuckled. "Yeah," said Alvar. "Someone says maybe we ought to go left, and someone says to go right, and someone else says to go in another direction. And then someone says maybe they'd better go back the old way. An' pretty soon something breaks, or the food runs out, and you're a million million miles from someplace you don't care about any more because you're dead. All frozen up in space ... preserved like a piece of meat in a cold storage locker. And then maybe in a million years or so some lousy insect man from Jupiter comes along and finds you and takes you away to a museum...." "Shut up!" Johnson yelled. Dunbar laughed. "Boys, boys, don't get panicky. Keep your heads. Just stick to old Dunbar and he'll see you through. I'm always lucky. Only one way to go ... an' that's straight ahead to the sun with the red-rim around it ... and then we tune in the gravity repellers, and coast down, floating and singing down through the clouds to paradise." After that they traveled on for what seemed months to Russell, but it couldn't have been over a day or two of the kind of time-sense he had inherited from Earth. Then he saw how the other two stars also were beginning to develop red rims. He yelled this fact out to the others. And Alvar said. "Russ's right. That sun to the right, and the one behind us ... now they ALL have red rims around them. Dunbar—" A pause and no awareness of motion. Dunbar laughed. "Sure, they all maybe have a touch of red, but it isn't the same, boys. I can tell the difference. Trust me—" Russell half choked on his words. "You old goat! With those old eyes of yours, you couldn't see your way into a fire!" "Don't get panicky now. Keep your heads. In another year, we'll be there—" "God, you gotta' be sure," Alvar said. "I don't mind dyin' out here. But after a year of this, and then to get to a world that was only ashes, and not able to go any further—" "I always come through, boys. I'm lucky. Angel women will take us to their houses on the edges of cool lakes, little houses that sit there in the sun like fancy jewels. And we'll walk under colored fountains, pretty colored fountains just splashing and splashing like pretty rain on our hungry hides. That's worth waiting for." Russell did it before he hardly realized he was killing the old man. It was something he had had to do for a long time and that made it easy. There was a flash of burning oxygen from inside the suit of Dunbar. If he'd aimed right, Russell knew the fire-bullet should have pierced Dunbar's back. Now the fire was gone, extinguished automatically by units inside the suit. The suit was still inflated, self-sealing. Nothing appeared to have changed. The four of them hurtling on together, but inside that first suit up there on the front of the gravity rope, Dunbar was dead. He was dead and his mouth was shut for good. Dunbar's last faint cry from inside his suit still rang in Russell's ears, and he knew Alvar and Johnson had heard it too. Alvar and Johnson both called Dunbar's name a few times. There was no answer. "Russ—you shouldn't have done that," Johnson whispered. "You shouldn't have done that to the old man!" "No," Alvar said, so low he could barely be heard. "You shouldn't have done it." "I did it for the three of us," Russell said. "It was either him or us. Lies ... lies that was all he had left in his crazy head. Paradise ... don't tell me you guys don't see the red rims around all four suns, all four suns all around us. Don't tell me you guys didn't know he was batty, that you really believed all that stuff he was spouting all the time!" "Maybe he was lying, maybe not," Johnson said. "Now he's dead anyway." "Maybe he was wrong, crazy, full of lies," Alvar said. "But now he's dead." "How could he see any difference in those four stars?" Russell said, louder. "He thought he was right," Alvar said. "He wanted to take us to paradise. He was happy, nothing could stop the old man—but he's dead now." He sighed. "He was taking us wrong ... wrong!" Russell screamed. "Angels—music all night—houses like jewels—and women like angels—" " Shhhh ," said Alvar. It was quiet. How could it be so quiet, Russell thought? And up ahead the old man's pressure suit with a corpse inside went on ahead, leading the other three at the front of the gravity-rope. "Maybe he was wrong," Alvar said. "But now do we know which way is right?" Sometime later, Johnson said, "We got to decide now. Let's forget the old man. Let's forget him and all that's gone and let's start now and decide what to do." And Alvar said, "Guess he was crazy all right, and I guess we trusted him because we didn't have the strength to make up our own minds. Why does a crazy man's laugh sound so good when you're desperate and don't know what to do?" "I always had a feeling we were going wrong," Johnson said. "Anyway, it's forgotten, Russ. It's swallowed up in the darkness all around. It's never been." Russell said, "I've had a hunch all along that maybe the old man was here before, and that he was right about there being a star here with a world we can live on. But I've known we was heading wrong. I've had a hunch all along that the right star was the one to the left." "I don't know," Johnson sighed. "I been feeling partial toward that one on the right. What about you, Alvar?" "I always thought we were going straight in the opposite direction from what we should, I guess. I always wanted to turn around and go back. It won't make over maybe a month's difference. And what does a month matter anyway out here—hell there never was any time out here until we came along. We make our own time here, and a month don't matter to me." Sweat ran down Russell's face. His voice trembled. "No—that's wrong. You're both wrong." He could see himself going it alone. Going crazy because he was alone. He'd have broken away, gone his own direction, long ago but for that fear. "How can we tell which of us is right?" Alvar said. "It's like everything was changing all the time out here. Sometimes I'd swear none of those suns had red rims, and at other times—like the old man said, they're all pretty and lying and saying nothing, just changing all the time. Jezebel stars, the old man said." "I know I'm right," Russell pleaded. "My hunches always been right. My hunch got us out of that prison didn't it? Listen—I tell you it's that star to the left—" "The one to the right," said Johnson. "We been going away from the right one all the time," said Alvar. "We got to stay together," said Russell. "Nobody could spend a year out here ... alone...." "Ah ... in another month or so we'd be lousy company anyway," Alvar said. "Maybe a guy could get to the point where he'd sleep most of the time ... just wake up enough times to give himself another boost with the old life-gun." "We got to face it," Johnson said finally. "We three don't go on together any more." "That's it," said Alvar. "There's three suns that look like they might be right seeing as how we all agree the old man was wrong. But we believe there is one we can live by, because we all seem to agree that the old man might have been right about that. If we stick together, the chance is three to one against us. But if each of us makes for one star, one of us has a chance to live. Maybe not in paradise like the old man said, but a place where we can live. And maybe there'll be intelligent life, maybe even a ship, and whoever gets the right star can come and help the other two...." "No ... God no...." Russell whispered over and over. "None of us can ever make it alone...." Alvar said, "We each take the star he likes best. I'll go back the other way. Russ, you take the left. And you, Johnson, go to the right." Johnson started to laugh. Russell was yelling wildly at them, and above his own yelling he could hear Johnson's rising laughter. "Every guy's got a star of his own," Johnson said when he stopped laughing. "And we got ours. A nice red-rimmed sun for each of us to call his very own." "Okay," Alvar said. "We cut off the gravity rope, and each to his own sun." Now Russell wasn't saying anything. "And the old man," Alvar said, "can keep right on going toward what he thought was right. And he'll keep on going. Course he won't be able to give himself another boost with the life-gun, but he'll keep going. Someday he'll get to that red-rimmed star of his. Out here in space, once you're going, you never stop ... and I guess there isn't any other body to pull him off his course. And what will time matter to old Dunbar? Even less than to us, I guess. He's dead and he won't care." "Ready," Johnson said. "I'll cut off the gravity rope." "I'm ready," Alvar said. "To go back toward whatever it was I started from." "Ready, Russ?" Russell couldn't say anything. He stared at the endless void which now he would share with no one. Not even crazy old Dunbar. "All right," Johnson said. "Good-bye." Russell felt the release, felt the sudden inexplicable isolation and aloneness even before Alvar and Johnson used their life-guns and shot out of sight, Johnson toward the left and Alvar back toward that other red-rimmed sun behind them. And old Dunbar shooting right on ahead. And all three of them dwindling and dwindling and blinking out like little lights. Fading, he could hear their voices. "Each to his own star," Johnson said. "On a bee line." "On a bee line," Alvar said. Russell used his own life-gun and in a little while he didn't hear Alvar or Johnson's voices, nor could he see them. They were thousands of miles away, and going further all the time. Russell's head fell forward against the front of his helmet, and he closed his eyes. "Maybe," he thought, "I shouldn't have killed the old man. Maybe one sun's as good as another...." Then he raised his body and looked out into the year of blackness that waited for him, stretching away to the red-rimmed sun. Even if he were right—he was sure now he'd never make it alone. The body inside the pressure suit drifted into a low-level orbit around the second planet from the sun of its choice, and drifted there a long time. A strato-cruiser detected it by chance because of the strong concentration of radio-activity that came from it. They took the body down to one of the small, quiet towns on the edge of one of the many blue lakes where the domed houses were like bright joyful jewels. They got the leathery, well-preserved body from the pressure suit. "An old man," one of them mused. "A very old man. From one of the lost sectors. I wonder how and why he came so very far from his home?" "Wrecked a ship out there, probably," one of the others said. "But he managed to get this far. It looks as though a small meteor fragment pierced his body. Here. You see?" "Yes," another of them said. "But what amazes me is that this old man picked this planet out of all the others. The only one in this entire sector that would sustain life." "Maybe he was just a very lucky old man. Yes ... a man who attains such an age was usually lucky. Or at least that is what they say about the lost sectors." "Maybe he knew the way here. Maybe he was here before—sometime." The other shook his head. "I don't think so. They say some humans from that far sector did land here—but that's probably only a myth. And if they did, it was well over a thousand years ago." Another said. "He has a fine face, this old man. A noble face. Whoever he is ... wherever he came from, he died bravely and he knew the way, though he never reached this haven of the lost alive." "Nor is it irony that he reached here dead," said the Lake Chieftain. He had been listening and he stepped forward and raised his arm. "He was old. It is obvious that he fought bravely, that he had great courage, and that he knew the way. He will be given a burial suitable to his stature, and he will rest here among the brave. "Let the women dance and the music play for this old man. Let the trumpets speak, and the rockets fly up. And let flowers be strewn over the path above which the women will carry him to rest."
|
D. It helps to clarify what is true for the reader when the aliens find his body
|
Regarding Mrs. Done, hat is the parameter mentioned that warrants immediate medical attention according to the treatment regimen?
Choose the correct answer from the following options:
A. Blood pressure exceeding 160/90 mmHg
B. Body temperature surpassing 38.3°C
C. Any elevated liver enzymes
D. Blood glucose levels above 200 mg/dL
E. Drop in white blood cell count below 3,000 cells/µL
|
### Patient Report 0
**Dear colleague, **
We wish to provide an update regarding Mrs. Jane Done, born on
01.01.1966. She was admitted to our clinic from 02/18/2018 to
03/01/2018.
**Diagnoses: **
- Malignant melanoma of the left scapula, TD 16 mm, exophytic
ulcerating, invasion stage - III, R0
- **Mutation analysis:** BRAF status: mutated. PD-L1 status: PD-L1
tumor proportion score (TPS): \<1%. Immune cell infiltrate (IC): 2%
of tumor area. PD-L1 combined-positive score (CPS): 2.
- **History:** Ms. Done was admitted to the hospital with high grade
suspicion of malignant melanoma of the back. The patient reported a
skin lesion that had been present for approximately 4 weeks. The
lesion had grown rapidly during this time and appeared to be oozing
and bleeding. She presented to our outpatient clinic, where she was
advised to undergo surgical excision in case of suspected
malignancy.
- Questions about B-symptoms, AP complaints, stool or urine
abnormalities were negated.
- System Therapy (Adjuvant Treatment for Stage III Melanoma): 1
02/22/18: 1st dose pembrolizumab 200mg
03/15/18: 2nd dose Pembrolizumab 200mg
04/05/18: 3rd dose Pembrolizumab 200mg
04/26/18: 4th dose Pembrolizumab 200mg
05/17/18: 5th dose Pembrolizumab 200mg
06/07/18: 6th dose Pembrolizumab 200mg
06/28/18: 7th dose Pembrolizumab 200mg
07/19/18: 8th dose Pembrolizumab 200mg
08/09/18: 9th dose Pembrolizumab 200mg i.v.
**Physical examination findings:** 52-year-old female patient in normal
general condition, nutritional status, consciousness unremarkable.
Cranial mobility free, eye movement normal. Pupils are equal and
reactive to light and accommodation. Regular, normocardial heart rate
during recording. Cor and pulmo auscultatory and percutaneously
unremarkable. No typical heart murmurs. Abdomen: Abdominal wall, liver
and spleen not enlarged, no pain to palpation, no resistance to
palpation, vivid bowel sounds. Renal bed and spine not palpable. No
enlarged cervical, submandibular, supra- and infraclavicular, axillary
and inguinal lymph nodes palpable. inguinal lymph nodes palpable.
Further internal and orienting neurological examination neurological
examination remained without pathological findings.
**Skin findings:** In the area of the left scapula, a table tennis-ball
sized area with a slightly fissured, oozing, pink-black pigmented
surface. On the cranial side an irregularly black-brown pigmented macula
of about 3.2x1.2 cm is visible.
**PET/CT with 203 MBq (F-18)-Fluorodeoxyglucose from 02/18/2018: **
Weight: 66 kg, blood glucose: 118 mg/dL. 20 mg furosemide; acquisition
start 91 min after tracer injection; 821 mm scan length á () mm/s in
flow technique (neck to proximal thigh); oral and i.v. contrast (1.5
mL/kg, i.v., max. 120 mL). Quantitative analysis of
attenuation-corrected image data using SUV calculation.
**Findings:**
CT: In case of known contrast agent allergy, premedication was performed
with one ampoule each of H1 and H2 antihistamine. The contrast-enhanced
examination proceeded without complications during the course.
Neck: Symmetrical visualization of the soft tissues of the neck. No
evidence of pathologically enlarged cervical lymph nodes. Struma nodosa
with several hypodense nodes on the right side up to max. approx. 1 cm.
Thorax: Cutaneous/subcutaneous irregular-shaped lesion caudal to the
right scapula. Limited assessability in the lung window with motion
artifacts and shallow inspiration depth. As far as assessable, no
evidence of larger suspicious intrapulmonary pulmonary round foci. No
infiltrate. No pleural effusion. No evidence of pathologically enlarged
lymph nodes mediastinal, hilar and axillary bilaterally.
Abdomen/pelvis: Normal contrast of liver parenchyma without evidence of
suspicious focal liver lesions. Portal vein and hepatic veins perfused
regularly. Gallbladder without irritation. Spleen with accessory spleen,
pancreas and adrenal glands bds. regular. Kidneys perfused at the same
side. No urinary retention. Nephrolithiasis on the right side.
Visualization of the parenchymatous upper abdominal organs. No evidence
of pathologically enlarged coeliacal, mesenteric, retroperitoneal,
iliac, and inguinal lymph nodes. Inhomogeneously contrasted enlarged
prostate. Urinary bladder wall, as far as assessable with low filling
circumferentially wall thickened.
Skeleton: no evidence of suspicious osteodestructive lesions. Osteopenia
with degenerative skeletal changes.
PET:
Increased tracer enhancement of the suspicious lesion caudal to left
scapula, indicative of a melanoma (SUVmax 67). Focal intense tracer
enhancement in the right thyroid lobe (SUVmax approximately 7.9).
Elongated intense tracer enhancement in the lower abdomen ventrally
median without clear correlate, most consistent with contamination.
Otherwise, unremarkable activity distribution in the study area.
Assessment:
No evidence of metabolically active metastases in the study area.
**Operation report from** **02/22/2018**:
Procedure: Excision of malignant melanoma on the left upper back.
Preoperative Diagnosis: Malignant melanoma, left upper back.
Postoperative Diagnosis: Malignant melanoma, left upper back.
Anesthesia: Local anesthesia using 70 mL tumescent solution comprising
0.21% Lidocaine/Ropivacaine with epinephrine.
Procedure Details: The surgical area was prepped using Betadine. The
area was draped in a sterile fashion. Excision of the exophytic tumor
was performed, measuring 51 x 20 x 15 mm. A safety margin of 10 mm was
maintained in depth, with the excision extending slightly into the
subcutaneous tissue but not beyond the fascia. This resulted in a total
defect size of 75 x 45 mm. The defect could not be closed with a simple
primary suture. Perforator vessels were coagulated, and the defect was
bridged using skin flaps. Additional resection of Burow triangles was
done according to aesthetic units. The wound was closed using an
intracutaneous suture technique. A continuous overhand blocked suture
was used with 3-0 Vicryl. The patient was advised that the visible
suture material could be removed between postoperative days 14 and 16. A
dressing was applied, followed by a pressure dressing to minimize
swelling and promote healing. Comments: The patient tolerated the
procedure well and was provided postoperative care instructions.
Plan: Follow up in clinic for suture removal and wound assessment
between postoperative days 14 and 16.
**Histology Dermatohistology:** **02/23/2018.**
**Gross Examination:** A roughly oval excision specimen measuring 48 x
36 x 14 mm. The specimen is serially sectioned into lamellar stages A
through H (8 cassettes).
**Microscopic Examination:**
Stage A: Displays a benign epidermis and dermis without evidence of
melanocytic tumor cells.
Stage B: Features an irregularly thickened epidermis. At the center of
the section, melanocytic tumor cells are observed at the dermoepidermal
junction (positive for MelanA stain). Additionally, abundant
melanophages and pigment deposits are noted. The lateral safety margin
measures at least 8 mm.
Stage C: Resembles stage B. Atypical melanocytic tumor cells are present
at the dermoepidermal junction. Upper dermis displays fibrosis,
inflammation, and numerous melanophages (confirmed by positive MelanA
staining). The lateral safety margin is at least 6 mm.
Stage D: Central region shows melanocytic tumor cells in both the
epidermis and upper dermis. There is significant inflammation,
melanophages, and pigment deposition (confirmed by MelanA staining).
The maximum lateral safety margin here is approximately 8 mm. A small
lymph node in the subcutaneous fat tissue is also seen, infiltrated by
melanocytic tumor cells.
The tumor shows stages E, F, G and H: Exophytic, bovist-like growing
ulcerated hemorrhagic tumor consisting of completely pleomorphic tumor
cells. These cells vary in morphology, appearing both nested and
spindle-shaped, with clear cytoplasm and conspicuous nucleoli. Notable
pigment production is observed, as are numerous atypical mitoses.
Control staining in stage F with MelanA is completely positive. The
sections are entirely excised.
**Diagnosis:** Exophytic, ulcerated malignant melanoma with a tumor
thickness of at least 15 mm. The tumor invasion is categorized as stage
III.
**Medication upon discharge: **
**Medication** **Dosage** **Route** **Frequency**
----------------------------------------- --------------- -------------- ------------------------------------------------------------------------
Clopidogrel (Plavix) 75 mg Oral Once daily in the morning
Enoxaparin (Lovenox) 0.2 mL Subcutaneous In the evening, only on days when not receiving dialysis
Dronabinol (Marinol) Drops 3 drops Oral Morning and evening
Leuprorelin (Lupron Depot) 3.75 mg Depot Subcutaneous Every 4 weeks
Fentanyl Transdermal System (Duragesic) 12 μg/hr Transdermal Changed every 3 days
Pantoprazole (Protonix) 40 mg Oral Once daily in the morning
Sevelamer (Renagel) 800 mg Oral Once daily in the morning
Multivitamin One tablet Oral Once daily in the morning
Torsemide (Demadex) 200 mg Oral Once daily in the morning
Cholecalciferol (Dekristol) 20,000 IU Oral Once weekly
Sodium Bicarbonate (Bicanorm) One tablet Oral Once daily in the morning
Calcitriol (Rocaltrol) 0.25 μg Oral Once daily in the morning
Valacyclovir (Valtrex) 500 mg Oral Half-tablet daily in the morning
Trimethoprim/Sulfamethoxazole (Bactrim) 480 mg Oral Mornings on Mondays, Wednesdays, and Fridays
Dexamethasone (Decadron) 4 mg Oral In the morning on day 1 and day 2 following daratumumab administration
### Patient Report 1
**Dear colleague, **
We wish to provide an update regarding Mrs. Jane Done, born on
01.01.1966. She was admitted to our clinic from 10/23/2020 to
11/01/2020.
- Metastatic malignant melanoma (presumed ID 2018); M1, stage IV
according to UICC.
- Therapies to date:
- Resection of primary tumor (malignant melanoma) on the left upper
back (02/2018)
- 01/20 Microsurgical resection right frontal tumor
- 02/20 Excision of empyema
- 02-03/20: Radiation therapy
- 05/02/20: Start of immunotherapy with Nivolumab & 05/26/20: Start of
combination immunotherapy 60 mg nivolumab, 200 mg ipilimumab (-\>
drug exanthema)
**Physical examination findings: **
On admission, the patient was awake and adequately oriented. Height:
166cm, weight: 56kg. Nutritional status, consciousness unremarkable.
Cranial mobility free, eye movement regular. Pupils equal, pupillary
reflex responsive to accommodation and light. Regular, normocardial
heart rate on admission. Heart and lung: auscultatory and percutaneous
unremarkable. No typical heart murmurs. Abdomen: Abdominal wall Liver
and spleen are not enlarged, no tenderness, no rebound palpable.
Resistences palpable, loud bowel sounds. No enlarged No enlarged
cervical, submandibular, supra- and infraclavicular lymph nodes
palpable. **Skin findings:** Pronounced xerosis cutis, raised skin
folds, some with erythema and fine lamellar scale and fine lamellar
scale, especially on the arms and face. **Microbiology:** Nasal swab:
normal flora, no MRSA. Throat swab: Normal flora, no MRSA Virology:
10/23/2020: No detection of SARS-CoV-2 by PCR in the submitted material.
**Therapy and Progression:**
**Summary:** The patient presented with exsiccation eczema on the arms,
legs, and face.
**Treatment Details:** Topical Treatment for Eczema: Applied Desonide
Cream once daily to the affected areas. For maintenance, applied Eucerin
Cream daily to the body and a moisturizing ointment like Cetaphil to the
face.
**Antipruritic Treatment:** Prescribed Benadryl tablets, to be taken as
needed.
**Oncology Consultation:** The patient was educated by our oncologist,
Dr. Ex, regarding adjuvant therapy options. The potential benefits and
risks of a combination immunotherapy with Nivolumab and Ipilimumab were
discussed. The patient had already started Nivolumab 200 mg therapy on
05/26/2020.
**Incident on 10/28/2020**: The patient had an unattended fall,
resulting in a hematoma on the left forehead. An emergency CT scan
showed no new fractures or acute hemorrhage but confirmed the presence
of previously known cystic metastasis.
**Operation report (01/02/2020): **
**Diagnosis:** Hemorrhaged right frontal metastasis from previously
diagnosed malignant melanoma (ID 2018)
**Procedure:** Microsurgical resection of right frontal mass with
intraoperative neuromonitoring (MEPs stable) and neuronavigation via a
left frontolateral craniotomy.
Time: 10:34 am Closure Time: 1:04 pm. Total Duration: 2 hours 30 minutes
**Preoperative Evaluation:** Imaging identified a hemorrhage in the
right frontal lobe. Given the patient\'s history of malignant melanoma,
a hemorrhagic melanoma metastasis was suspected. No other intracranial
metastases were detected. The patient and their family were informed of
the surgical benefits and risks. After ample time for consideration and
questions, written informed consent was obtained.
**Procedure Details:** The patient was positioned supine and intubated.
The head was secured in a Mayfield clamp and rotated 60° to the right.
The navigation dataset was reviewed. Using the navigation system, a left
frontotemporal craniotomy was planned. An arcuate incision line was
drawn. The surgical area was shaved, cleaned, and sterilized.
Prophylactic antibiotics and mannitol were administered. A time-out was
conducted preoperatively. The skin was incised, and Raney clips were
inserted. The left temporal muscle was split. Using the navigation
system for guidance, a left frontolateral craniotomy was performed. The
bone flap was carefully removed and preserved in an antibiotic solution
for later reimplantation. The dura mater was opened, and the operating
microscope was introduced. Upon inspection, the tumor was evident.
**MRI brain report (01/04/2020): **
**Clinical Information:** Postoperative assessment following
microsurgical resection of a left frontal hemorrhaged metastasis from
previously diagnosed malignant melanoma.
**Technique:** Multiplanar, multisequence MRI of the brain, including
T1-weighted, T2-weighted, FLAIR, diffusion-weighted imaging (DWI), and
post-contrast T1-weighted sequences.
**Findings:** There is evidence of a right frontotemporal craniotomy
with associated post-surgical changes in the right frontal region.
Titanium plates and screws are noted securing the bone flap, causing
minimal artifact. The previous tumor site in the right frontal lobe
shows post-surgical changes with a well-circumscribed cavity. There is
no evidence of residual enhancing tumor within this cavity on
post-contrast sequences, suggesting complete resection. Surrounding this
cavity, there\'s mild edema, consistent with expected post-operative
changes. No other intracranial metastases. The ventricles are of normal
size and symmetric. There is no evidence of hydrocephalus. No midline
shift or mass effect is observed. There are scattered foci of
susceptibility artifact in the surgical bed on gradient echo sequences,
consistent with expected postoperative blood products. Major
intracranial vessels appear patent with no evidence of vascular
occlusion or significant stenosis. The remaining brain parenchyma
appears normal in signal intensity and morphology on all sequences. No
other significant abnormalities are identified.
**Impression:** Post-surgical changes in the left frontal lobe
consistent with recent tumor resection. There is no evidence of residual
tumor in the surgical bed. Expected postoperative edema and blood
products adjacent to the resection site. No new metastatic foci
identified. No evidence of complications such as hydrocephalus, midline
shift, or vascular abnormalities.
**Operation report (02/04/2020): **
**Diagnosis:** Subfascial, epidural, and subdural empyema following
resection of right frontal metastasis for malignant melanoma.
**Procedure:** Empyema removal (subfascial, epidural, subdural) S
Incision Time: 15:23 Closure Time: 04:01 PM Total Duration: 2 hours 31
minutes
**Preoperative Evaluation:** The patient had a prior surgical resection
of a right frontal metastasis due to known malignant melanoma. On a
recent outpatient visit, a cerebrospinal fluid (CSF) cushion was
identified and punctured, revealing the presence of pathogens. Imaging
indicated deep and subcutaneous abscesses, necessitating revision
surgery. The patient was adequately informed about the procedure,
understood the associated risks, and provided written consent.
**Procedure Details:** The patient was positioned supine with the head
rotated approximately 60° in a Mayfield clamp. The surgical area was
washed and sterilized, focusing on the pre-existing access point. A team
time-out was conducted. Perioperative antibiotics were withheld until
all samples for microbiology were obtained. The skin was incised,
revealing multiple layers of muscle. These were carefully dissected,
leading to the identification and evacuation of the subcutaneous
epifascial abscess. Infected muscle tissue and abscess walls were
resected. The skull flap appeared loosened. A miniplate was removed, and
upon further inspection, the dura mater appeared strained. It was
incised and revealed turbid fluid, indicating a deep abscess. The dura
mater was mobilized, though adherence to the cortex was observed around
the resection cavity, suggesting possible tumor regrowth. Affected areas
were carefully resected. After thorough irrigation, a drainage system
was inserted into the resection cavity. A duraplasty was performed,
followed by the reimplantation of the bone flap using a miniplate. The
patient was also included in a bone flap study and was randomized for
flap reimplantation. After further irrigation, the wound was
meticulously closed, and a subfascial drain was inserted. The final
closure was completed with single button sutures. Under the guidance of
the operating microscope, the tumor was meticulously dissected from the
surrounding healthy tissue. Special care was taken to minimize damage to
the surrounding brain structures. The intraoperative neuromonitoring
indicated stable MEPs throughout, suggesting that motor pathways
remained undisturbed during the procedure. Throughout the resection,
periodic hemostasis was achieved using bipolar electrocautery to control
bleeding. Following the complete resection of the tumor, the surgical
cavity was irrigated with sterile saline to remove any residual debris.
The integrity of the surrounding brain tissue was assessed, and no
immediate complications were observed. The dura mater was sutured,
ensuring a watertight closure. A synthetic dural graft was used to
reinforce the suture line. The preserved bone flap was reimplanted and
secured in place using titanium plates and screws. The temporal muscle
and soft tissues were reapproximated and sutured in layers. The skin was
closed using a combination of absorbable sutures for the subcutaneous
layer and non-absorbable sutures for the skin. Sterile dressings were
applied to the incision site. Postoperative Assessment: The procedure
was completed without complications. Immediate postoperative
neurological examination revealed no new deficits. The patient was
transferred to the recovery room in stable condition, awaiting
extubation by the anesthesiology team.
**Recommendations:** Close monitoring in the neurological intensive care
unit (NICU) is advised for the first 24 hours. Postoperative imaging,
typically an MRI, should be scheduled within the next 48 hours to assess
the extent of tumor resection and to rule out any postoperative
complications.
**Summary:** Mrs. Done\'s recent hospital course was complicated by the
detection and subsequent excision of a hemorrhagic metastasis from a
known history of malignant melanoma. She continues to be on targeted
therapy with close monitoring. No new metastasis or recurrence has been
detected as of the last evaluation. The interdisciplinary approach
involving the neurosurgery and oncology teams has been pivotal in her
management. Given the aggressive nature of melanoma, regular
surveillance and immediate action upon detection of new
lesions/metastasis are paramount for her prognosis.
**02-03/20: Radiation therapy **
Diagnosis: Metastatic malignant melanoma with a focus on the right
frontal metastasis. Technique: Stereotactic radiosurgery (SRS) using a
linear accelerator (LINAC). Fractionation: Given the aggressive nature
of malignant melanoma, a hypofractionated regimen was adopted. The
patient underwent five sessions, each delivering a dose of 6 Gy for a
cumulative total dose of 30 Gy.
Treatment Planning: A simulation CT scan with a 1mm slice thickness was
performed in the treatment position, with a thermoplastic mask for
immobilization. The treatment planning system utilized the simulation
CT, along with MRI for better tumor delineation. The target volume and
critical structures like the eyes, optic nerves, chiasm, and brainstem
were contoured. The radiation plan was optimized to ensure maximal dose
to the target while sparing the critical structures.
Procedure: At each session, patient positioning was verified using
cone-beam CT (CBCT) to ensure precise targeting. Real-time monitoring
was employed to account for any intrafraction motion.
Side Effects: The patient tolerated the treatment well. She reported
transient fatigue and mild scalp irritation, which resolved with
conservative measures. No acute radiation-induced neurotoxicity was
observed.
**Patient History Update: Mrs. Jane Done (DOB: 01/01/1966)**
**General Status (10/03/2020):**
Mrs. Done presented in stable condition with stable vital signs.
Neurologically, she\'s intact with no new focal deficits. The surgical
scars in the frontal region from previous operations are not fully
healed and there is some dehiscence and swelling, indicative of
infection. This wound complication can be traced back to her previous
history of an empyema which required surgical intervention.
**Dermatological Assessment:**
The previous exsiccation eczema, prominent on her arms, legs, and face,
has improved markedly. The treatment regimen involving consistent
moisturization and targeted topical therapies seems effective.
Importantly, there were no new suspicious skin lesions or nodules noted
during her most recent full-body skin check.
**Oncology Status:**
Mrs. Done remains on her immunotherapy regimen, specifically the
combination of Nivolumab and Ipilimumab. Her response has been positive,
with no new metastatic sites identified in the latest assessments. She
has displayed commendable compliance with this regimen and regular
follow-up evaluations.
**Recent MRI Brain (09/30/2020):**
Her latest multiplanar, multisequence MRI revealed post-surgical
alterations in the right frontal lobe, consistent with previous
observations. Encouragingly, there was no sign of any residual or
recurrent tumor activity. Moreover, the MRI did not show any new
intracranial metastatic sites or other significant abnormalities.
**Thoracic CT Scan (10/01/2020): **
Technique: Post complication-free bolus i.v. administration of Imeron
400, a multiline spiral CT was performed through the thorax during the
venous contrast phase, supplemented with thin-section, coronary, and
sagittal secondary reconstructions.
Findings: Multiple roundish subsolid nodules found bipulmonary, notably
a 4mm nodule in the right upper lobe. Blurred subpleural condensations
in the left upper lobe. Another blurred bronchus-associated
consolidation was observed in the left upper lobe and pleurally in the
left dorsal lower lobe. No evidence of pathologically enlarged lymph
nodes in the hilar, mediastinal, or axillary regions. Unchanged
presentation of the left adrenal gland from the preliminary examination.
Thickened imprinting of the gastric wall noted. Ventrally emphasized
spondylophytic attachments observed in the thoracic spine. No
osteodestructive processes detected.
**Impression:** Presence of multiple subsolid pulmonary nodules;
recommended follow-up in 4-6 weeks for potential (post-) inflammatory or
malignant genesis. No evidence of pathologically enlarged lymph nodes.
**Abdomen/Pelvis CT Scan (10/01/2023): **
Technique: A low dose CT scan was taken of the abdomen and pelvis.
**Findings:** Regular visualization of the acquired basal lung sections.
Orthotopic kidneys without urinary stasis. No evidence of urinary
calculi. Suspected uterine fibroids attached to the uterus wall.
Enlarged right ovary with minor calcifications. Assessment: Absence of
urinary calculi. Possible uterine fibroids and an enlarged right ovary,
suggesting a specialized gynecological examination.
**PICC Line Installation (10/02/2020)**
**Diagnosis:**
Home antibiotics required for wound healing disorder following discharge
due to an empyema.
**Type of Surgery:**
Installation of a PICC line in the left basilic vein.
**Anesthesia:**
Local anesthesia
**Procedure Details:**
The patient was presented for long-term antibiotic treatment due to a
wound healing disturbance post the discharge of an epidural abscess. The
primary aim was to apply a PICC-line catheter for the antibiotic
regimen. A written informed consent was duly obtained prior to the
procedure.
The standard procedure began with the washing off and draping of the
patient. A preoperative sonography of the arm veins was conducted. Based
on the sonographic results, it was decided to insert the catheter via
the left basilica vein.
Under venous congestion and following local anesthesia with 2mL Mecain,
a 2mm skin incision was made. The sonographically guided puncture was
performed successfully. Post this, the peel-away sheath was inserted.
With the wire in place, the catheter was advanced with its tip
positioned approximately 2cm below the carina. The wire was subsequently
removed. Following this, the catheter was aspirated and flushed with
NaCl to ensure its patency. A sterile fixation was then applied, and the
wound was dressed.
**Notes:**
No complications were observed during the procedure. The patient was
advised on the care and maintenance of the PICC line. Regular follow-ups
are recommended to monitor the wound healing and the effectiveness of
the antibiotic treatment.
The patient was discharged with instructions and is scheduled for a
follow-up in two weeks.
**Additional Therapeutic Engagements:**
For her overall well-being and to counter the side effects of her
treatment journey, Mrs. Done has been actively involved in physical
therapy sessions. These sessions focus on enhancing her strength and
balance, especially given the previous incident of an unattended fall.
To address the inevitable psychological strains of her diagnosis, she
has also been attending counseling sessions.
**Current Recommendations:**
-Continue the ongoing immunotherapy without changes.
-Dermatological check-ups every month are advised for early detection of
any potential skin abnormalities.
-Regular neurological evaluations are crucial to ensure no emergence of
new deficits.
-Imaging should be scheduled every six months for proactive monitoring.
-Her physical therapy regimen should be ongoing to maintain and improve
mobility.
-Continue counseling to support her emotional and psychological
well-being.
**Summary and Notes:**
Mrs. Done\'s resilience and adherence to her treatments are commendable.
Her progress is a testament to the integrated care approach she has been
receiving. Maintaining a proactive surveillance stance will be essential
for her long-term prognosis and quality of life.
### Patient Report 2
**Dear colleague, **
We wish to provide an update regarding our mutual patient, Mrs. Jane
Done, born on 01.01.1966. She was admitted to our clinic from 11/23/2020
to 12/01/2020.
**Previous Diagnoses and Therapies:**
-Metastatic malignant melanoma (presumed ID 2018); M1, stage IV
according to UICC.
-Resection of primary tumor (malignant melanoma) on the left upper back
(02/2018)
-01/20 Microsurgical resection right frontal tumor
-02/20 Excision of empyema
-02-03/20: Radiation therapy
-05/02/20: Start of immunotherapy with Nivolumab
-05/26/20: Start of combination immunotherapy 60 mg nivolumab, 200 mg
ipilimumab (resulting in drug exanthema)
**Current Presentation:**
Mrs. Done presented for a follow-up visit on 11/23/2020. Over the past
few months, she reported fatigue and intermittent bouts of nausea. Of
significant concern were newly identified skin changes located on her
right arm.
**Clinical Findings:**
Skin: Multiple macules and patches on the right arm, the largest
measuring about 1.5cm in diameter, hyperpigmented with irregular
borders.
**US: **
Ultrasound imaging of the right arm revealed no deep extension or
invasion of underlying structures. This preliminary assessment was
crucial, suggesting that if malignancy is present, it might be in early
stages.
**Histology: **
Histological examination: Gross Description: The sample consists of
multiple tan-pink soft tissue fragments, aggregating to 1.8 cm in the
greatest dimension.
Microscopic description: Sections show a proliferation of atypical
melanocytes arranged in nests and as single units at the dermoepidermal
junction. Some of these cells infiltrate the papillary dermis.
Immunohistochemistry: The atypical cells are positive for HMB-45 and
S-100. Melan A is focally positive. Ki-67 proliferation index is about
10%.
Final Diagnosis: Dysplastic nevus with severe atypia; margins appear
clear. Further excision is recommended to ensure complete removal and to
rule out invasive melanoma.
**Lab results: **
Complete Blood Count (CBC):
Hemoglobin: 12.3 g/dL (Normal range: 12-16 g/dL)
White Blood Cell Count: 6,200 cells/µL (Normal range: 4,000-11,000
cells/µL)
Platelet Count: 290,000 cells/µL (Normal range: 150,000-450,000
cells/µL)
Differential:
Neutrophils 65%, Lymphocytes 25%, Monocytes 8%, Eosinophils 2%. B.
Liver Function Tests (LFTs):
ALT (Alanine Aminotransferase): 40 U/L (Normal range: 7-56 U/L)
AST (Aspartate Aminotransferase): 38 U/L (Normal range: 10-40 U/L)
ALP (Alkaline Phosphatase): 90 U/L (Normal range: 44-147 U/L)
Total Bilirubin: 1.0 mg/dL (Normal range: 0.1-1.2 mg/dL)
Albumin: 4.2 g/dL (Normal range: 3.4-5.4 g/dL)
Assessment/Recommendations:
Given her history and the suspicious nature of the new skin changes, we
have decided to send the biopsy for urgent histological assessment.
Furthermore, considering her reported symptoms, we have conducted a
thorough internal check-up, including blood tests and liver function
tests, to rule out any systemic side effects of the immunotherapy.
We recommend continuous monitoring of Mrs. Done's condition and kindly
request your valuable input in managing her case optimally. A
multidisciplinary approach, given her complicated medical history, will
be most beneficial for the patient.
Please find attached the detailed examination and investigative reports
for your reference.
With kind regards,
### Patient Report 3
**Dear colleague, **
We wish to provide a comprehensive update regarding our mutual patient,
Mrs. Jane Done, born on 01.01.1966. She has had a history of various
medical conditions and treatments, which we believe is essential to
discuss for her optimal management and was admitted to our clinical from
01/01/2021 to 01/28/2021.
**Previous Diagnoses and Therapies:**
Metastatic malignant melanoma (presumed ID 2018); M1, stage IV according
to UICC. Resection of primary tumor (malignant melanoma) on the left
upper back (02/2018)
01/20 Microsurgical resection right frontal tumor
02/20 Excision of empyema
02-03/20: Radiation therapy
05/02/20: Start of immunotherapy with Nivolumab
05/26/20: Start of combination immunotherapy 60 mg nivolumab, 200 mg
ipilimumab (resulting in drug exanthema)
Imaging 01/02/2021: PET/CT: Cervical lymph node metastasis;
cMRI: no evidence of metastases. Contrast-enhancing meninges.
**Virology: **
Upon Admission: SARS-CoV2 PCR (Nose/Throat): POSITIVE with a viral load
of 7,000 Geq/mL and a Ct value of 32.
At Discharge: SARS-CoV2 PCR (Nose/Throat): POSITIVE with a viral load of
2,350 Geq/mL and a Ct value of 32.
**Microbiology: **
MRSA Screening Upon Admission: Nasal Swab: Normal flora detected; MRSA
not present. Throat Swab: Normal flora detected; MRSA not present.
Procedures:
\- Presentation to neurology for CSF puncture (e.g., exclude
meningeosis)
\- Panel sequencing complement
\- Surgery/therapy: Neck dissection followed by adjuvant therapy with
pembrolizumab.
Clinical examination:
Examination findings: Patient in normal general and nutritional
condition, consciousness unremarkable. Cranial mobility free, ocular
mobility normal. Pupils are isocor, pupillary reflex prompt to
accommodation and light. Regular, normocardial heart rate on admission.
No typical heart murmurs. Abdomen: abdominal wall soft, liver and spleen
not enlarged, vivid bowel sounds. Renal bed and spine not palpable. No
enlarged in the axillary or inguinal region palpable.
PET-CT from 01/02/2021:
Intense metabolically active lymph node metastases, otherwise no
evidence of vital tumor tissue in the study area.
**PET CT report from 01/02/2021: **
Procedure: PET/CT with 246 MBq (F-18)-fluorodeoxyglucose and a 60-minute
uptake period.
Findings: CT Findings: Neck: Right Level II: Three lymph nodes, largest
measuring 2.1 x 1.8 cm with central necrosis. Right Level III: Two lymph
nodes, largest measuring 1.5 x 1.2 cm. Left Level II: One lymph node
measuring 1.3 x 1.1 cm. Left Level IV: Two lymph nodes, largest
measuring 1.7 x 1.4 cm. Retropharyngeal space: One lymph node measuring
1.0 x 0.9 cm.
PET Findings: Neck: Right Level II: Increased FDG uptake with SUVmax of
7.8, consistent with metastatic disease. Right Level III: Increased FDG
uptake with SUVmax of 6.5. Left Level II: Increased FDG uptake with
SUVmax of 6.0. Left Level IV: Increased FDG uptake with SUVmax of 7.2.
Retropharyngeal space: Increased FDG uptake with SUVmax of 6.1.
Impression: Cervical Lymph Nodes: Multiple pathologically enlarged
cervical lymph nodes in bilateral level II, right level III, left level
IV, and retropharyngeal space with increased FDG uptake, highly
suggestive of metastatic involvement from the known primary melanoma.
**Surgery report 01/05/2021: **
The surgery commenced with a collaborative discussion with the
anesthesia team and a standard team time-out was executed. The patient
was properly positioned, and the surgical site was aseptically draped.
The facial neuromonitoring system was set up and verified. Local
anesthesia was then administered at the site of the skin incision, which
was located near the previous scar. This incision followed the anterior
border of the sternocleidomastoid muscle in a curved pattern. Upon
incising the subcutaneous tissue, the external jugular vein became
visible and was selectively ligated. The encountered tissue appeared
notably fibrotic and scarred. A skin incision extended from the mastoid
region down nearly to the clavicle. The platysma muscle was subsequently
cut. Due to the presence of a lymph node mass, the auricularis magnus
nerve had to be severed. The sternocleidomastoid muscle and the
posterior belly of the digastric muscle were then exposed. Multiple
darkened lymph node metastases were identified, both beneath the skin
and within the sternocleidomastoid muscle. In subsequent steps, efforts
were made to distinguish the internal jugular vein from the surrounding
scarred tissue. A lymph node mass, which exhibited characteristics
highly suggestive of metastasis (given its darkened color), was removed.
The accessory nerve was identified and preserved. Further dissection was
done posteriorly to the sternocleidomastoid muscle, in the direction of
level V. An expansive mass of lymph nodes was excised in this region.
The trapezoid branch of the accessory nerve was visualized, and its
function was monitored and preserved with the aid of neuromonitoring.
The removed lymph node mass, some excised tissue, and portions of the
sternocleidomastoid muscle with embedded lymph nodes were sent for
histological analysis. During the procedure, care was taken to avoid
damaging major neck vessels and nerves. Concluding the procedure, 8 and
10 French Redon drains were placed, the wound was closed in layers, and
then covered with a spray-on bandage, steristrips, and a pressure
dressing. The surgical site appeared bloodless at the conclusion of the
surgery.
**Macroscopy:**
**Macroscopic Description:**
Dimensions: 6.8 x 0.7 x 0.4 cm spindle-shaped, non-oriented skin and
subcutaneous tissue resection. Central area shows an irritation-free,
fine scar measuring up to 6.3 x 4.8 cm. The cut surface appears
consistently off-white.
Ink markings: soft tissue margin of specimen = green. A: central
lamellae B: spindle tips perpendicular
Anterior Margin of Upper Third of Sternocleidomastoid Muscle:
Dimensions: Four combined tissue samples totaling 4.7 x 3.8 x 1.1 cm.
Appearance: Tan, fibrous soft tissues with multiple uniformly dark
nodules on the cut surface, each measuring up to 1.1 cm.
A, B: one nodule each halved C, D: other nodular sections E: remaining
tan fibrous sections Anterior Margin of Lower Third of
Sternocleidomastoid Muscle: Largest measurement: 3.4 cm.
Appearance: Grayish-brown with some fibrous regions and homogeneously
dark-brown nodes up to 1.5 cm in size on the cut surface. A, B: one node
each halved C: other nodes D: brown-fibrous sections Region V Occipital:
Largest measurement: Two samples, each up to 3.8 cm.
Appearance: Mixture of grayish-tan and light brown fibrous soft tissue
with nodes up to 2.2 cm, uniformly dark brown.
A, B: one node halved C, D: another node halved each Processing: 16
paraffin blocks, HE stained.
Microscopic Description: Dermis and subcutaneous resection shows
scarring with fibrosis. Epidermis is regular, without any atypical
cells. No evidence of melanoma or carcinoma. 2./3.
Multiple nodular tumor clusters present in the soft tissue and skeletal
muscles, lacking lymph node structure. Tumor cells are polygonal, with
some spindle-shaped cells having moderately large, irregular nuclei and
noticeable nucleoli. Cytoplasm appears slightly granular with a light
brownish pigment.
Seven lymph nodes (measuring up to 3.6 cm) indicate metastasis from the
previously mentioned tumor, with extracapsular spread. Four other lymph
nodes are free from the tumor.
**Critical Findings:** Multiple nodular soft tissue metastases, with the
largest measuring 1.3 cm, indicative of melanoma present in both soft
tissue and muscle. Resection margins are mostly free of tumor, with the
closest approach being less than 0.15 cm (points 2 and 3). Seven lymph
nodes (up to 3.6 cm in size) show metastasis from the melanoma, with
extracapsular spread. Four lymph nodes are tumor-free (7 out of 11
nodes, ECE positive) (point 4). Dermis and subcutaneous excision shows
scarring fibrosis (point 1).
For the optimal management of Mrs. Done, close monitoring and a
multidisciplinary approach will be essential. Thank you for your
continued collaboration in ensuring the best care for our mutual
patient.
**Lab values upon discharge: **
**Parameter** **Result** **Reference Range** **Interpretation**
-------------------------------- -------------- ---------------------------------------- ---------------------
**Complete Blood Count (CBC)**
Hemoglobin (Hb) 12.4 g/dL 12.0 - 16.0 g/dL Within normal range
White Blood Cell (WBC) 9.2 x10\^9/L 4.0 - 10.0 x10\^9/L Within normal range
Platelets 250 x10\^9/L 150 - 400 x10\^9/L Within normal range
**Liver Function Tests (LFT)**
AST 28 U/L 10 - 35 U/L Within normal range
ALT 32 U/L 10 - 40 U/L Within normal range
Total Bilirubin 0.8 mg/dL 0.2 - 1.2 mg/dL Within normal range
**Kidney Function Test**
Serum Creatinine 0.9 mg/dL 0.5 - 1.2 mg/dL Within normal range
Blood Urea Nitrogen (BUN) 15 mg/dL 7 - 20 mg/dL Within normal range
**Electrolytes**
Sodium 138 mEq/L 135 - 145 mEq/L Within normal range
Potassium 4.2 mEq/L 3.5 - 5.0 mEq/L Within normal range
Chloride 101 mEq/L 95 - 105 mEq/L Within normal range
**Thyroid Function Tests**
TSH 3.1 mU/L 0.5 - 5.0 mU/L Within normal range
Free T4 1.4 ng/dL 0.9 - 2.4 ng/dL Within normal range
**Lipid Profile**
Total Cholesterol 190 mg/dL \< 200 mg/dL Desirable
LDL Cholesterol 100 mg/dL \< 100 mg/dL Optimal
HDL Cholesterol 55 mg/dL \> 40 mg/dL (Men), \> 50 mg/dL (Women) Normal
Triglycerides 110 mg/dL \< 150 mg/dL Normal
**Medication: **
**Medication** **Dosage** **Route** **Frequency**
---------------- ------------ ----------- -----------------------------
Pembrolizumab 200mg IV Every 3 weeks
Nivolumab 60mg IV As per oncologist\'s advice
Ipilimumab 200mg IV As per oncologist\'s advice
Paracetamol 500mg Oral Every 4-6 hours as needed
Omeprazole 20mg Oral Once daily
### Patient Report 4
**Dear colleague, **
We wish to provide an update regarding Mrs. Jane Done, born on
01.01.1966. She was admitted to our clinic from 02/14/2022 to
03/01/2022.
**Previous Diagnoses and Therapies:**
-Metastatic malignant melanoma (presumed ID 2018); M1, stage IV
according to UICC.
-Resection of primary tumor (malignant melanoma) on the left upper back
(02/2018)
-01/20 Microsurgical resection right frontal tumor
-02/20 Excision of empyema
-02-03/20: Radiation therapy
-05/02/20: Start of immunotherapy with Nivolumab
-05/26/20: Start of combination immunotherapy 60 mg nivolumab, 200 mg
ipilimumab (resulting in drug exanthema)
**Current Presentation:**
Mrs. Done showed multiple metastases in her CT examination. On physical
examination, Mrs. Done appears well-nourished and in no acute distress.
Her vital signs are stable. Cardiovascular examination reveals regular
heart sounds with no murmurs. Respiratory examination shows clear breath
sounds bilaterally. Abdominal examination reveals no palpable masses or
organomegaly. Neurological examination is within normal limits.
**Radiology/Nuclear Medicine**
**CT thorax/abdomen/pelvis + Contrast from 02/10/2022**
**Technique:** Multi-phase, multi-slice computed tomography of the
thorax, abdomen, and pelvis was performed following the intravenous
administration of contrast material. Coronal and sagittal
reconstructions were obtained.
**Thorax:** In the thoracic region, the lungs are notable for multiple
nodular opacities across both lung fields, consistent with metastatic
deposits. The most sizable lesion is seen in the right upper lobe,
approximately 1.5 cm in diameter. No associated cavitation or pleural
effusion is detected. A concerning 2 cm mass abutting the lateral wall
of the left ventricle is noted, raising the suspicion for cardiac
metastasis. The mediastinum also exhibits lymphadenopathy with a
dominant node in the prevascular space, measuring 2.2 cm. Further, there
are lytic lesions involving the sternum and right 4th rib, consistent
with osseous metastatic disease.
**Abdomen/pelvis**: Liver shows multiple hypodense lesions throughout
both lobes, indicative of metastatic spread. The dominant lesion in the
right lobe measures 3 cm. The kidneys, however, are unremarkable without
discernible metastatic deposits. Retroperitoneal lymphadenopathy is also
present, highlighted by a node anterior to the aorta of 1.8 cm. In
addition, there is a 2.5 cm mass identified within the left psoas
muscle, consistent with muscular metastasis. Both the left acetabulum
and the right iliac wing manifest with lytic lesions, suggestive of
metastatic involvement. There is also enlargement of the bilateral
internal iliac lymph nodes, with the left side\'s node measuring up to
1.6 cm. Bladder, prostate, and rectum with no discernible pathology.
**Impression**: Multiple pulmonary nodules consistent with pulmonary
metastases. Cardiac lesion suggestive of metastatic involvement.
Evidence of skeletal metastases in the thorax and pelvis. Hepatic and
muscular metastases, indicative of disseminated disease. Lymphadenopathy
in the mediastinal, retroperitoneal, and pelvic regions.
**PET-CT scan from 02/11/2022**
**Clinical Indication:** Follow-up evaluation of a known case of
Metastatic Melanoma, Stage IV, M1c with notable findings from a CT scan
dated 12/01/2014.
**Technique:** Whole-body PET-CT scan was conducted after intravenous
administration of 18F-FDG. The patient fasted for 6 hours prior to the
scan, and blood glucose levels were confirmed to be within the
acceptable range. Both CT and PET images were acquired, and images were
co-registered for optimal evaluation. Standard uptake values (SUVs) were
calculated for areas of interest.
**Findings: **
**Thorax:** Both lungs depict several hypermetabolic foci, corroborating
the CT findings of multiple nodules. The largest lesion in the right
upper lobe demonstrates an SUVmax of 8.2, indicative of active metabolic
disease. The cardiac mass adjacent to the left ventricle, measuring
approximately 2 cm, also reveals increased 18F-FDG uptake with an SUVmax
of 9.5, strengthening the suspicion of cardiac metastasis. Enlarged
mediastinal lymph nodes, particularly the node in the prevascular space,
shows marked hypermetabolism with an SUVmax of 7.4. Notably, the lytic
skeletal lesions identified on the CT in the sternum and right 4th rib
also display increased metabolic activity, consistent with metastatic
bone disease.
**Abdomen/Pelvis:** Hepatic lesions are congruent with the findings of
the preceding CT, showing heightened metabolic activity. The most
prominent lesion in the right lobe exhibits an SUVmax of 8.8.
Retroperitoneal lymph nodes are metabolically active, with the anterior
aortic node demonstrating an SUVmax of 6.9. The 2.5 cm left psoas muscle
mass also reveals increased uptake with an SUVmax of 7.3, suggesting
active muscular metastasis. In the pelvic region, the lytic lesions
identified in the left acetabulum and right iliac wing on the CT confirm
their malignant nature with notable metabolic activity. Bilateral
internal iliac lymph nodes show hypermetabolism with the left node\'s
SUVmax reaching 7.1. Other pelvic organs, including the bladder,
prostate, and rectum, did not show any significant 18F-FDG uptake, in
line with the unremarkable CT findings.
**Impression:** The PET-CT findings are consistent with active
metastatic disease. There is evidence of hypermetabolic pulmonary
nodules, a likely cardiac metastasis, hepatic and muscular metastases,
and metabolically active skeletal lesions in both the thorax and pelvis.
Additionally, there is hypermetabolism in the lymph nodes across
multiple regions. These findings align closely with the previously
diagnosed metastatic melanoma, Stage IV, M1c**. **
**Discussion**
Mrs. Done has been diagnosed with recurrent metastatic melanoma with
lymph node involvement. This poses significant implications for her
prognosis, emphasizing the need for urgent and comprehensive
intervention.
Her molecular profile has revealed the presence of the BRAF V600E
mutation.
Our recommended therapeutic combination includes Vemurafenib and
Cobimetinib, both of which are aimed at disrupting the aberrant BRAF-MEK
signaling cascade. Complementing this, we suggest the administration of
Pembrolizumab.
Mrs. Done is scheduled for six cycles of this treatment regimen. We will
monitor her laboratory parameters, such as blood counts, electrolytes,
and hepatic and renal profiles, bi-weekly. It is imperative to note that
any fevers surpassing 38.3°C warrant immediate medical attention.
Comprehensive patient education module has been designed to enable Mrs.
Done to identify and manage any potential side effects efficiently.
We will ensure rigorous monitoring of her blood pressure and lipid
metrics, with the possibility of introducing alternative medications if
clinical scenarios demand.
We deeply value your collaboration in Mrs. Done\'s healthcare journey.
Our team remains at your disposal for any queries or clarifications.
|
Body temperature surpassing 38.3°C
|
Where was the Quest III coming home from?
A. A dying star
B. Procyon
C. Capella
D. An expedition
|
THE GIANTS RETURN By ROBERT ABERNATHY Earth set itself grimly to meet them with corrosive fire, determined to blast them back to the stars. But they erred in thinking the Old Ones were too big to be clever. [Transcriber's Note: This etext was produced from Planet Stories Fall 1949. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] In the last hours the star ahead had grown brighter by many magnitudes, and had changed its color from a dazzling blue through white to the normal yellow, of a GO sun. That was the Doppler effect as the star's radial velocity changed relative to the Quest III , as for forty hours the ship had decelerated. They had seen many such stars come near out of the galaxy's glittering backdrop, and had seen them dwindle, turn red and go out as the Quest III drove on its way once more, lashed by despair toward the speed of light, leaving behind the mockery of yet another solitary and lifeless luminary unaccompanied by worlds where men might dwell. They had grown sated with the sight of wonders—of multiple systems of giant stars, of nebulae that sprawled in empty flame across light years. But now unwonted excitement possessed the hundred-odd members of the Quest III's crew. It was a subdued excitement; men and women, they came and stood quietly gazing into the big vision screens that showed the oncoming star, and there were wide-eyed children who had been born in the ship and had never seen a planet. The grownups talked in low voices, in tones of mingled eagerness and apprehension, of what might lie at the long journey's end. For the Quest III was coming home; the sun ahead was the Sun, whose rays had warmed their lives' beginning. Knof Llud, the Quest III's captain, came slowly down the narrow stair from the observatory, into the big rotunda that was now the main recreation room, where most of the people gathered. The great chamber, a full cross-section of the vessel, had been at first a fuel hold. At the voyage's beginning eighty per cent of the fifteen-hundred-foot cylinder had been engines and fuel; but as the immense stores were spent and the holds became radioactively safe, the crew had spread out from its original cramped quarters. Now the interstellar ship was little more than a hollow shell. Eyes lifted from the vision screens to interrogate Knof Llud; he met them with an impassive countenance, and announced quietly, "We've sighted Earth." A feverish buzz arose; the captain gestured for silence and went on, "It is still only a featureless disk to the telescope. Zost Relyul has identified it—no more." But this time the clamor was not to be settled. People pressed round the screens, peering into them as if with the naked eye they could pick out the atom of reflected light that was Earth, home. They wrung each other's hands, kissed, shouted, wept. For the present their fears were forgotten and exaltation prevailed. Knof Llud smiled wryly. The rest of the little speech he had been about to make didn't matter anyway, and it might have spoiled this moment. He turned to go, and was halted by the sight of his wife, standing at his elbow. His wry smile took on warmth; he asked, "How do you feel, Lesra?" She drew an uncertain breath and released it in a faint sigh. "I don't know. It's good that Earth's still there." She was thinking, he judged shrewdly, of Knof Jr. and Delza, who save from pictures could not remember sunlit skies or grassy fields or woods in summer.... He said, with a touch of tolerant amusement, "What did you think might have happened to Earth? After all, it's only been nine hundred years." "That's just it," said Lesra shakily. "Nine hundred years have gone by— there —and nothing will be the same. It won't be the same world we left, the world we knew and fitted in...." The captain put an arm round her with comforting pressure. "Don't worry. Things may have changed—but we'll manage." But his face had hardened against registering the gnawing of that same doubtful fear within him. He let his arm fall. "I'd better get up to the bridge. There's a new course to be set now—for Earth." He left her and began to climb the stairway again. Someone switched off the lights, and a charmed whisper ran through the big room as the people saw each other's faces by the pale golden light of Earth's own Sun, mirrored and multiplied by the screens. In that light Lesra's eyes gleamed with unshed tears. Captain Llud found Navigator Gwar Den looking as smug as the cat that ate the canary. Gwar Den was finding that the actual observed positions of the planets thus far located agreed quite closely with his extrapolations from long unused charts of the Solar System. He had already set up on the calculator a course that would carry them to Earth. Llud nodded curt approval, remarking, "Probably we'll be intercepted before we get that far." Den was jolted out of his happy abstraction. "Uh, Captain," he said hesitantly. "What kind of a reception do you suppose we'll get?" Llud shook his head slowly. "Who knows? We don't know whether any of the other Quests returned successful, or if they returned at all. And we don't know what changes have taken place on Earth. It's possible—not likely, though—that something has happened to break civilization's continuity to the point where our expedition has been forgotten altogether." He turned away grim-lipped and left the bridge. From his private office-cabin, he sent a message to Chief Astronomer Zost Relyul to notify him as soon as Earth's surface features became clear; then he sat idle, alone with his thoughts. The ship's automatic mechanisms had scant need of tending; Knof Llud found himself wishing that he could find some back-breaking task for everyone on board, himself included, to fill up the hours that remained. There was an extensive and well-chosen film library in the cabin, but he couldn't persuade himself to kill time that way. He could go down and watch the screens, or to the family apartment where he might find Lesra and the children—but somehow he didn't want to do that either. He felt empty, drained—like his ship. As the Quest III's fuel stores and the hope of success in man's mightiest venture had dwindled, so the strength had gone out of him. Now the last fuel compartment was almost empty and Captain Knof Llud felt tired and old. Perhaps, he thought, he was feeling the weight of his nine hundred Earth years—though physically he was only forty now, ten years older than when the voyage had begun. That was the foreshortening along the time axis of a space ship approaching the speed of light. Weeks and months had passed for the Quest III in interstellar flight while years and decades had raced by on the home world. Bemusedly Llud got to his feet and stood surveying a cabinet with built-in voice recorder and pigeonholes for records. There were about three dozen film spools there—his personal memoirs of the great expedition, a segment of his life and of history. He might add that to the ship's official log and its collections of scientific data, as a report to whatever powers might be on Earth now—if such powers were still interested. Llud selected a spool from among the earliest. It was one he had made shortly after leaving Procyon, end of the first leg of the trip. He slid it onto the reproducer. His own voice came from the speaker, fresher, more vibrant and confident than he knew it was now. "One light-day out from Procyon, the thirty-third day by ship's time since leaving Earth. "Our visit to Procyon drew a blank. There is only one huge planet, twice the size of Jupiter, and like Jupiter utterly unfit to support a colony. "Our hopes were dashed—and I think all of us, even remembering the Centaurus Expedition's failure, hoped more than we cared to admit. If Procyon had possessed a habitable planet, we could have returned after an absence of not much over twenty years Earth time. "It is cheering to note that the crew seems only more resolute. We go on to Capella; its spectrum, so like our own Sun's, beckons. If success comes there, a century will have passed before we can return to Earth; friends, relatives, all the generation that launched the Quest ships will be long since dead. Nevertheless we go on. Our generation's dream, humanity's dream, lives in us and in the ship forever...." Presently Knof Llud switched off that younger voice of his and leaned back, an ironic smile touching his lips. That fervent idealism seemed remote and foreign to him now. The fanfares of departure must still have been ringing in his ears. He rose, slipped the record back in its niche and picked out another, later, one. "One week since we passed close enough to Aldebaran to ascertain that that system, too, is devoid of planets. "We face the unpleasant realization that what was feared is probably true—that worlds such as the Sun's are a rare accident, and that we may complete our search without finding even one new Earth. "It makes no difference, of course; we cannot betray the plan.... This may be man's last chance of escaping his pitiful limitation to one world in all the Universe. Certainly the building of this ship and its two sisters, the immense expenditure of time and labor and energy stores that went into them, left Earth's economy drained and exhausted. Only once in a long age does mankind rise to such a selfless and transcendent effort—the effort of Egypt that built the pyramids, or the war efforts of the nations in the last great conflicts of the twentieth century. "Looked at historically, such super-human outbursts of energy are the result of a population's outgrowing its room and resources, and therefore signalize the beginning of the end. Population can be limited, but the price is a deadly frustration, because growth alone is life.... In our day the end of man's room for growth on the Earth was in sight—so we launched the Quests . Perhaps our effort will prove as futile as pyramid-building, less practical than orgies of slaughter to reduce pressure.... In any case, it would be impossible to transport very many people to other stars; but Earth could at least go into its decline with the knowledge that its race went onward and upward, expanding limitlessly into the Universe.... "Hopeless, unless we find planets!" Knof Llud shook his head sorrowfully and took off the spool. That was from the time when he had grown philosophical after the first disappointments. He frowned thoughtfully, choosing one more spool that was only four years old. The recorded voice sounded weary, yet alive with a strange longing.... "We are in the heart of Pleiades; a hundred stars show brilliant on the screens, each star encircled by a misty halo like lights glowing through fog, for we are traversing a vast diffuse nebula. "According to plan, the Quest III has reached its furthest point from Earth. Now we turn back along a curve that will take us past many more stars and stellar systems—but hope is small that any of those will prove a home for man, as have none of the thousands of stars examined already. "But what are a few thousand stars in a galaxy of billions? We have only, as it were, visited a handful of the outlying villages of the Universe, while the lights of its great cities still blaze far ahead along the Milky Way. "On flimsy excuses I have had Zost Relyul make observations of the globular cluster Omega Centauri. There are a hundred thousand stars there in a volume of space where one finds a few dozen in the Sun's neighborhood; there if anywhere must circle the planets we seek! But Omega Centauri is twenty thousand light years away.... "Even so—by expending its remaining fuel freely, the Quest III could achieve a velocity that would take us there without dying of senility of aging too greatly. It would be a one-way journey—even if enough fuel remained, there would be little point in returning to Earth after more than forty thousand years. By then our civilization certainly, and perhaps the human race itself, would have perished from memory. "That was why the planners limited our voyage, and those of the other Quests , to less than a thousand years Earth time. Even now, according to the sociodynamic predictions made then, our civilization—if the other expeditions failed also—will have reached a dangerously unstable phase, and before we can get back it may have collapsed completely from overpopulation. "Why go back, then with the news of our failure? Why not forget about Earth and go on to Omega Centauri? What use is quixotic loyalty to a decree five thousand years old, whose makers are dead and which may be forgotten back there? "Would the crew be willing? I don't know—some of them still show signs of homesickness, though they know with their minds that everything that was once 'home' has probably been swept away.... "It doesn't matter. Today I gave orders to swing the ship." Savagely Knof Llud stabbed the button that shut off the speaker. Then he sat for a time with head resting in his hands, staring into nothing. The memory of that fierce impulse to go on still had power to shake him. A couple of lines of poetry came into his head, as he read them once in translation from the ancient English.... ... for my purpose holds To sail beyond the sunset, and the baths Of all the western stars, until I die. Llud sighed. He still couldn't say just why he had given the order to turn back. The stars had claimed his heart—but he was still a part of Earth, and not even nine hundred years of space and time had been able to alter that. He wondered if there would still be a quiet stream and a green shady place beside it where a death-weary man, relieved at last of responsibility, could rest and dream no more.... Those things went on, if men didn't change them. And a pine forest where he and young Knof could go camping, and lie on their backs at night and gaze at the glittering constellations, far away, out of reach.... He wasn't sure he would want to do that, though. Suddenly a faint cushioned jar went through the great ship; it seemed to falter one moment in flight. The captain was on his feet instantly, but then his movements became unhurried. Whatever it had been was past, and he had a good idea what it had been—a meteoroid, nothing unusual in the vicinity of the Sun, though in interstellar space and around planetless stars such collisions were rare to the vanishing point. No harm could have been done. The Quest III's collision armor was nonmaterial and for practical purposes invulnerable. Just as he took his finger off the button that opened the door, the intercommunication phone shrilled imperatively. Knof Llud wheeled, frowning—surely a meteoroid impact wasn't that serious. Coincidence, maybe—it might be Zost Relyul calling as instructed. He reached the phone at the moment when another, heavier jolt shook the vessel. Llud snatched up the receiver with the speed of a scalded cat. "Captain?" It was Gwar Den's voice, stammering a little. "Captain, we're being attacked!" "Sound the alarm. Emergency stations." He had said it automatically, then felt a curious detached relief at the knowledge that after all these years he could still respond quickly and smoothly to a crisis. There was a moment's silence, and he heard the alarm start—three short buzzes and repeat, ringing through all the great length of the interstellar ship. Knowing that Gwar Den was still there, he said, "Now—attacked by what?" "Ships," said Gwar Den helplessly. "Five of them so far. No, there's a sixth now." Repeated blows quivered the Quest III's framework. The navigator said, obviously striving for calm, "They're light craft, not fifty feet long, but they move fast. The detectors hardly had time to show them before they opened up. Can't get a telescope beam on them long enough to tell much." "If they're that small," said Knof Llud deliberately, "they can't carry anything heavy enough to hurt us. Hold to course. I'll be right up." In the open doorway he almost fell over his son. Young Knof's eyes were big; he had heard his father's words. "Something's happened," he judged with deadly twelve-year-old seriousness and, without wasting time on questions, "Can I go with you, huh, Dad?" Llud hesitated, said, "All right. Come along and keep out of the way." He headed for the bridge with strides that the boy could not match. There were people running in the corridors, heading for their posts. Their faces were set, scared, uncomprehending. The Quest III shuddered, again and again, under blows that must have had millions of horsepower behind them; but it plunged on toward Earth, its mighty engines still steadily braking its interstellar velocity. To a man, the ship's responsible officers were already on the bridge, most of them breathless. To a man they looked appeal at Captain Knof Llud. "Well?" he snapped. "What are they doing?" Gwar Den spoke. "There are thirteen of them out there now, sir, and they're all banging away at us." The captain stared into the black star-strewn depths of a vision screen where occasional blue points of light winked ominously, never twice from the same position. Knof Jr. flattened himself against the metal wall and watched silently. His young face was less anxious than his elders'; he had confidence in his father. "If they had anything heavier," surmised the captain, "they'd have unlimbered it by now. They're out to get us. But at this rate, they can't touch us as long as our power lasts—or until they bring up some bigger stuff." The mild shocks went on—whether from projectiles or energy-charges, would be hard to find out and it didn't matter; whatever was hitting the Quest III's shell was doing it at velocities where the distinction between matter and radiation practically ceases to exist. But that shell was tough. It was an extension of the gravitic drive field which transmitted the engines' power equally to every atom of the ship; forces impinging on the outside of the field were similarly transmitted and rendered harmless. The effect was as if the vessel and all space inside its field were a single perfectly elastic body. A meteoroid, for example, on striking it rebounded—usually vaporized by the impact—and the ship, in obedience to the law of equal and opposite forces, rebounded too, but since its mass was so much greater, its deflection was negligible. The people in the Quest III would have felt nothing at all of the vicious onslaught being hurled against them, save that their inertialess drive, at its normal thrust of two hundred gravities, was intentionally operated at one half of one per cent efficiency to provide the illusion of Earthly gravitation. One of the officers said shakily, "It's as if they've been lying in wait for us. But why on Earth—" "That," said the captain grimly, "is what we have to find out. Why—on Earth. At least, I suspect the answer's there." The Quest III bored steadily on through space, decelerating. Even if one were no fatalist, there seemed no reason to stop decelerating or change course. There was nowhere else to go and too little fuel left if there had been; come what might, this was journey's end—perhaps in a more violent and final way than had been anticipated. All around wheeled the pigmy enemies, circling, maneuvering, and attacking, always attacking, with the senseless fury of maddened hornets. The interstellar ship bore no offensive weapons—but suddenly on one of the vision screens a speck of light flared into nova-brilliance, dazzling the watchers for the brief moment in which its very atoms were torn apart. Knof Jr. whooped ecstatically and then subsided warily, but no one was paying attention to him. The men on the Quest III's bridge looked questions at each other, as the thought of help from outside flashed into many minds at once. But Captain Llud said soberly, "It must have caught one of their own shots, reflected. Maybe its own, if it scored too direct a hit." He studied the data so far gathered. A few blurred pictures had been got, which showed cylindrical space ships much like the Quest III , except that they were rocket-propelled and of far lesser size. Their size was hard to ascertain, because you needed to know their distance and speed—but detector-beam echoes gave the distance, and likewise, by the Doppler method, the velocity of directly receding or approaching ships. It was apparent that the enemy vessels were even smaller than Gwar Den had at first supposed—not large enough to hold even one man. Tiny, deadly hornets with a colossal sting. "Robot craft, no doubt," said Knof Llud, but a chill ran down his spine as it occurred to him that perhaps the attackers weren't of human origin. They had seen no recognizable life in the part of the galaxy they had explored, but one of the other Quests might have encountered and been traced home by some unhuman race that was greedy and able to conquer. It became evident, too, that the bombardment was being kept up by a constant arrival of fresh attackers, while others raced away into space, presumably returning to base to replenish their ammunition. That argued a planned and prepared interception with virulent hatred behind it. Elsuz Llug, the gravitic engineer, calculated dismally, "At the rate we're having to shed energy, the fuel will be gone in six or eight hours." "We'll have reached Earth before then," Gwar Den said hopefully. "If they don't bring out the heavy artillery first." "We're under the psychological disadvantage," said the captain, "of not knowing why we're being attacked." Knof Jr. burst out, spluttering slightly with the violence of a thought too important to suppress, "But we're under a ps-psychological advantage, too!" His father raised an eyebrow. "What's that? I don't seem to have noticed it." "They're mad and we aren't, yet," said the boy. Then, seeing that he hadn't made himself clear, "In a fight, if a guy gets mad he starts swinging wild and then you nail him." Smiles splintered the ice of tension. Captain Llud said, "Maybe you've got something there. They seem to be mad, all right. But we're not in a position to throw any punches." He turned back to the others. "As I was going to say—I think we'd better try to parley with the enemy. At least we may find out who he is and why he's determined to smash us." And now instead of tight-beam detectors the ship was broadcasting on an audio carrier wave that shifted through a wide range of frequencies, repeating on each the same brief recorded message: "Who are you? What do you want? We are the interstellar expedition Quest III ...." And so on, identifying themselves and protesting that they were unarmed and peaceful, that there must be some mistake, and querying again, "Who are you ?" There was no answer. The ship drove on, its fuel trickling away under multiplied demands. Those outside were squandering vastly greater amounts of energy in the effort to batter down its defenses, but converting that energy into harmless gravitic impulses was costing the Quest III too. Once more Knof Llud had the insidious sense of his own nerves and muscles and will weakening along with the power-sinews of his ship. Zost Relyul approached him apologetically. "If you have time, Captain—I've got some data on Earth now." Eagerly Llud took the sheaf of photographs made with the telescope. But they told him nothing; only the continental outlines were clear, and those were as they had been nine hundred years ago.... He looked up inquiringly at Zost Relyul. "There are some strange features," said the astronomer carefully. "First of all—there are no lights on the night side. And on the daylight face, our highest magnification should already reveal traces of cities, canals, and the like—but it does not. "The prevailing color of the land masses, you see, is the normal green vegetation. But the diffraction spectrum is queer. It indicates reflecting surfaces less than one-tenth millimeter wide—so the vegetation there can't be trees or grass, but must be more like a fine moss or even a coarse mold." "Is that all?" demanded Llud. "Isn't it enough?" said Zost Relyul blankly. "Well—we tried photography by invisible light, of course. The infra-red shows nothing and likewise the ultraviolet up to the point where the atmosphere is opaque to it." The captain sighed wearily. "Good work," he said. "Keep it up; perhaps you can answer some of these riddles before—" " We know who you are ," interrupted a harshly crackling voice with a strange accent, " and pleading will do you no good. " Knof Llud whirled to the radio apparatus, his weariness dropping from him once more. He snapped, "But who are you?" and the words blended absurdly with the same words in his own voice on the still repeating tape. He snapped off the record; as he did so the speaker, still crackling with space static, said, "It may interest you to know that you are the last. The two other interstellar expeditions that went out have already returned and been destroyed, as you will soon be—the sooner, if you continue toward Earth." Knof Llud's mind was clicking again. The voice—which must be coming from Earth, relayed by one of the midget ships—was not very smart; it had already involuntarily told him a couple of things—that it was not as sure of itself as it sounded he deduced from the fact it had deigned to speak at all, and from its last remark he gathered that the Quest III's ponderous and unswerving progress toward Earth had somehow frightened it. So it was trying to frighten them. He shoved those facts back for future use. Just now he had to know something, so vitally that he asked it as a bald question, " Are you human? " The voice chuckled sourly. "We are human," it answered, "but you are not." The captain was momentarily silent, groping for an adequate reply. Behind him somebody made a choked noise, the only sound in the stunned hush, and the ship jarred slightly as a thunderbolt slammed vengefully into its field. "Suppose we settle this argument about humanity," said Knof Llud woodenly. He named a vision frequency. "Very well." The tone was like a shrug. The voice went on in its language that was quite intelligible, but alien-sounding with the changes that nine hundred years had wrought. "Perhaps, if you realize your position, you will follow the intelligent example of the Quest I's commander." Knof Llud stiffened. The Quest I , launched toward Arcturus and the star cloud called Berenice's Hair, had been after the Quest III the most hopeful of the expeditions—and its captain had been a good friend of Llud's, nine hundred years ago.... He growled, "What happened to him?" "He fought off our interceptors, which are around you now, for some time," said the voice lightly. "When he saw that it was hopeless, he preferred suicide to defeat, and took his ship into the Sun." A short pause. "The vision connection is ready." Knof Llud switched on the screen at the named wavelength, and a picture formed there. The face and figure that appeared were ugly, but undeniably a man's. His features and his light-brown skin showed the same racial characteristics possessed by those aboard the Quest III , but he had an elusive look of deformity. Most obviously, his head seemed too big for his body, and his eyes in turn too big for his head. He grinned nastily at Knof Llud. "Have you any other last wishes?" "Yes," said Llud with icy control. "You haven't answered one question. Why do you want to kill us? You can see we're as human as you are." The big-headed man eyed him with a speculative look in his great eyes, behind which the captain glimpsed the flickering raw fire of a poisonous hatred. "It is enough for you to know that you must die."
|
D. An expedition
|
Mrs. Anderson's tumor marker Ca19-9 levels in September 2021 were:
Choose the correct answer from the following options:
A. 525 U/ml.
B. 575 U/ml.
C. 380 U/ml.
D. 425 U/ml.
E. 680 U/ml.
|
### Patient Report 0
**Dear colleague, **
We report about your outpatient treatment on 09/01/2010.
Diagnoses: extensor tendon rupture D3 right foot
Anamnesis: The patient comes with a cut wound in the area of the MTP of
the D3 of the right foot to our surgical outpatient clinic. A large
shard of a broken vase had fallen on her toe with great force.
Findings: Right foot, D3:
Approximately 1cm long laceration in the area of the MTP. Tenderness to
pressure. Flexion
unrestricted, extension not possible.
X-ray: X-ray of the D3 of the right foot from 09/01/2010:
No evidence of bony lesion, regular joint position.
Therapy: inspection, clinical examination, radiographic control, primary
tendon suture and fitting of a dorsal splint.
Tetanus booster.
Medication: Mono-Embolex 3000IE s.c. (Certoparin).
Procedure: We recommend the patient to wear a dorsal splint until the
suture removal in 12-14 days. Afterwards further treatment with a vacuum
orthosis for another 4 weeks.
We ask for presentation in our accident surgery consultation on
September 14^th^, 2010.
In case of persistence or progression of complaints, we ask for an
immediate
our surgical clinic. If you have any questions, please do not hesitate
to contact us.
Best regards
### Patient Report 1
**Dear colleague, **
We report to you about our common patient, Mrs. Jill Anderson, born on
06/07/1975, who was in our outpatient treatment on 07/08/2014.
Diagnoses: Fracture tuberculum majus humeri
Luxation of the shoulder joint
Anamnesis: Fell on the left arm while falling down a hill during a hike.
No fall on the head.
Tetanus vaccination coverage is present according to the patient.
Findings: multiple abrasions: Left forearm, left pelvis and left tibia.
Dislocation of the shoulder. Motor function of forearm and hand not
limited. Peripheral circulation, motor function, and sensitivity intact.
X-ray: Shoulder left in two planes from 07/08/2014.
Anteroinferior shoulder dislocation with dislocated tuberculum majus
fracture and possible subcapital fracture line.
X-ray: Shoulder in 2 planes after reduction
Reduction of the shoulder joint. Still more than 3 mm dislocated
tuberculum majus
**Therapy**:
Reduction with **Midazolam** and **Fentanyl**.
**Medication**:
**Lovenox 40mg s.c.** daily
**Ibuprofen 400mg** 1-1-1
Pain management as needed.
**Procedure**:
Due to sedation, the patient was not able to be educated for surgery.
Surgery is planned for either tomorrow or today using a proximal humerus
internal locking system (PHILOS) or screw osteosynthesis. The patient is
to remain fasting.
**Other Notes**:
Inpatient admission.
### Patient Report 2
**Dear colleague, **
We report to you about our common patient, Mrs. Jill Anderson, who was
in our outpatient treatment on 02/01/2015.
Diagnoses: Ankle sprain on the right side.
Case history: patient presents to the surgical emergency department with
right ankle sprain after tripping on the stairs. The fall occurred
yesterday evening. Immediately thereafter cooled and
immobilized.
Findings: Right foot: Swelling and pressure pain over the fibulotalar
anterior ligament. No pressure pain over syndesmosis, outer ankle+fibula
head, Inner ankle, Achilles tendon, tarsus, or with midfoot compression.
Limited mobility due to pain. Toe mobility free, no pain over base of
fifth toe.
X-ray: X-ray of the right ankle in two planes dated 02/01/2015.
No evidence of fresh fracture
Procedure: The following procedure was discussed with the patient:
-Cooling, resting, elevation and immobilization in the splint for a
total of 6 weeks.
-Pain medication: Ibuprofen 400mg 1-1-1-1 under stomach protection with
Nexium 20mg 1-0-0
In case of persistence of symptoms, magnetic resonance imaging is
recommended.
Presentation with the findings to a resident orthopedist.
### Patient Report 3
**Dear colleague, **
we report on Mrs. Anderson, Jill, born 06/07/1975, who was in our
inpatient treatment from 09/28/2021 to 10/03/2021
Diagnosis:
Suspected pancreatic carcinoma
Other diseases and previous operations:
Status post thyroidectomy 2008
Fracture tuberculum majus humeri 2014
Current complaints:
The patient presented as an elective admission for ERCP and EUS puncture
for pancreatic head space involvement. She reported stool irregularities
with steatorrhea and acholic stool beginning in July 2021. Weight loss
of approximately 3kg. No bleeding stigmata. Micturition complaints are
denied. Urine color: dark yellow. The patient first noticed scleral and
cutaneous icterus in August 2021. No other hepatic skin signs. Patient
reported mild pain 1/10 in right upper quadrant.
CT of the chest and abdomen on 09/28/2021 showed a mass in the
pancreatic head with contact with the SMV (approximately 90 degrees) and
suspicion of lymph node metastasis dorsal adherent to the SMA.
Pronounced intra or extrahepatic cholestasis. Congested pancreatic duct.
Also showed suspicious locoregional lymph nodes, especially in the
interaortocaval space. No evidence of distant metastases.
Alcohol
Average consumption: 0.20L/day (wine)
Smoking status: Some days
Consumption: 0.20 packs/day
Smoking Years: 30.00; Pack Years: 6.00
Laboratory tests:
Blood group & Rhesus factor
Rh factor +
AB0 blood group: B
Family history
Patient's mother died of breast cancer
Occupational history: Consultant
Physical examination:
Fully oriented, neurologically unaffected. Normal general condition and
nutritional status
Heart: rhythmic, normofrequency, no heart murmurs.
Lungs: vesicular breath sounds bilaterally.
Abdomen: soft, vivid bowel sounds over all four quadrants. Negative
Murphy\'s sign.
Liver and spleen not enlarged palpable.
Lymph nodes: unremarkable
Scleral and cutaneous icterus. Mild skin itching. No other hepatic skin
signs.
### Patient Report 4
**Dear colleague, **
We report on Mrs. Jill Anderson, born born 06/07/1975, who was in our
inpatient treatment from 10/09/2021 to 10/30/2021.
**Diagnosis:**
High-grade suspicious for locally advanced pancreatic cancer.
**-CT of chest/abdomen/pelvis**: Mass in the head of the pancreas with
involvement of the SMV (approx. 90 degrees) and suspicious for lymph
node metastasis adjacent to the SMA. Prominent intra- or extrahepatic
bile duct dilation. Dilated pancreatic duct. Suspicious regional lymph
nodes, notably in the interaortocaval region. No evidence of distant
metastasis.
**-Endoscopic ultrasound-guided FNA (Fine Needle Aspiration)** on
09/29/21.
**-ERCP (Endoscopic Retrograde Cholangiopancreatography)** and metal
stent placement, 10 mm x 60 mm, on 09/29/21.
-Tumor board discussion on 09/30/21: Port placement recommended,
neoadjuvant chemotherapy with FOLFIRINOX proposed.
Medical history:
Mrs. Anderson was admitted to the hospital on 09/29/21 for ERCP and
endoscopic ultrasound-guided biopsy due to an unclear mass in the head
of the pancreas. She reported changes in bowel habits with fatty stools
and pale stools starting in July 2021, and has lost approximately 3 kg
since then. She denied any signs of bleeding. She had no urinary
symptoms but did note that her urine had been darker than usual. In
August 2021, she first noticed yellowing of the eyes and skin.
The CT scan of the chest and abdomen performed on 09/28/21 revealed a
mass in the pancreatic head in contact with the SMV (approx. 90 degrees)
and suspected lymph node metastasis close to the SMA. Additionally,
there was significant intra- or extrahepatic bile duct dilation and a
dilated pancreatic duct. Suspicious regional lymph nodes were also
noted, particularly in the area between the aorta and vena cava. No
distant metastases were found.
She was admitted to our gastroenterology ward for further evaluation of
the pancreatic mass. Upon admission, she reported only mild pain in the
right upper abdomen (pain scale 2/10).
Family history:
Her mother passed away from breast cancer.
Physical examination on admission:
Appearance: Alert and oriented, neurologically intact.
Heart: Regular rhythm, normal rate, no murmurs.
Lungs: Clear breath sounds in both lungs.
Abdomen: Soft, active bowel sounds in all quadrants. No tenderness.
Liver and spleen not palpable.
Lymph nodes: Not enlarged.
Skin: Jaundice present in the eyes and skin, slight itching. No other
liver-related skin changes.
Radiology
**Findings:**
**CT Chest/Abdomen/Pelvis with contrast on 09/28/21:**
Technique: After uneventful IV contrast injection, multi-slice spiral CT
was performed through the upper abdomen during arterial and parenchymal
phases and through the chest, abdomen, and pelvis during venous phase.
Oral contrast was also administered. Thin-section, coronal, and sagittal
reconstructions were done.
Thorax: The soft tissues of the neck appear symmetric. Heart and
mediastinum in midline position. No enlarged lymph nodes in mediastinum
or axilla. A calcified granuloma is seen in the right lower lung lobe;
no suspicious nodules or signs of inflammation. No fluid or air in the
pleural space.
Abdomen: A low-density mass is seen in the pancreatic head, measuring
about 37 x 26 mm. The mass is in contact with the superior mesenteric
artery (\<180°) and could represent lymph node metastasis. It is also in
contact with the superior mesenteric vein (\<180°) and the venous
confluence. There are some larger but not abnormally large lymph nodes
between the aorta and vena cava, as well as other suspicious regional
lymph nodes. Significant dilation of both intra- and extrahepatic bile
ducts is noted. The pancreatic duct is dilated to about 5 mm. The liver
appears normal without any suspicious lesions and shows signs of fatty
infiltration. The hepatic and portal veins appear normal. Spleen appears
normal; its vein is not involved. The left adrenal gland is slightly
enlarged while the right is normal. Kidneys show uniform contrast
uptake. No urinary retention. The contrast passes normally through the
small intestine after oral administration. Uterus and its appendages
appear normal. No free air or fluid inside the abdomen.
Bones: No signs of destructive lesions. Mild degenerative changes are
seen in the lower lumbar spine.
Assessment:
-Mass in the pancreatic head with contact to the SMV (approximately 90
degrees) and suspected lymph node metastasis near the SMA. There is
significant dilation of the intra- or extrahepatic bile ducts and the
pancreatic duct.
-Suspicious regional lymph nodes, especially between the aorta and vena
cava.
-No distant metastases.
**Ultrasound/Endoscopy:**
Endoscopic Ultrasound (EUS) on 09/29/21:
Procedure: Biopsy with a 22G needle was performed on an approximately 3
cm x 3 cm mass in the pancreatic head. No obvious bleeding was seen
post-procedure. Histopathological examination is pending.
Assessment: Biopsy of pancreatic head, awaiting histology results.
**ERCP on 09/29/21:**
Procedure: Fluoroscopy time: 17.7 minutes.
Indication: ERCP/Stenting.
The papilla was initially difficult to visualize due to a long mucosal
impression/swelling (possible tumor). Initially, only the pancreatic
duct was visualized with contrast. Afterward, the bile duct was probed
and dark bile was extracted for microbial testing. The contrast image
revealed a significant distal bile duct narrowing of about 2.8 cm length
with extrahepatic bile duct dilation. After an endoscopic papillotomy
(EPT) of 5 mm, a plastic stent with an inner diameter of 8.5 mm was
placed through the narrow passage, and the bile duct was emptied.
Assessment: Successful ERCP with stenting of bile duct. Clear signs of
tumor growth/narrowing in the distal bile duct. Awaiting microbial
results and histopathology results from the extracted bile.
Treatment:
Based on the initial findings, Mrs. Anderson was started on pain
management with acetaminophen and was scheduled for an ERCP and
endoscopic ultrasound-guided biopsy. The ERCP and stenting of the bile
duct were successful, and she is currently awaiting histopathological
examination results from the biopsy and microbial testing results from
the bile.
Gastrointestinal Tumor Board of 09/30/2021.
Meeting Occasion:
Pancreatic head carcinoma under evaluation.
CT:
Defined mass in the pancreatic head with contact to the SMV (approx. 90
degrees) and under evaluation for lymph node metastasis dorsally
adherent to the SMA. Pronounced intra- or extrahepatic bile duct
dilation. Dilated pancreatic duct.
-Suspected locoregional lymph nodes especially between aorta and vena
cava.
-No evidence of distant metastases.
MR liver (external):
-No liver metastases.
Previous therapy:
-ERCP/Stenting.
Question:
-Neoadjuvant chemo with FOLFIRINOX?
Consensus decision:
-CT: Pancreatic head tumor with contact to SMA \<180° and SMV, contact
to abdominal aorta, bile duct dilation.
MR: No liver metastases.
Pancreatic histology: -pending-.
Consensus:
-Surgical port placement,
-wait for final histology,
-intended neoadjuvant chemotherapy with FOLFIRINOX,
-Follow-up after 4 cycles.
Pathology findings as of 09/30/2021
Internal Pathology Report:
Clinical information/question:
FNA biopsy for pancreatic head carcinoma.
Macroscopic Description:
FNA: Fixed. Multiple fibrous tissue particles up to 2.2 cm in size.
Entirely embedded.
Processing: One block, H&E staining, PAS staining, serial sections.
Microscopic Description:
Histologically, multiple particles of columnar epithelium are present,
some with notable cribriform architecture. The nuclei within are
irregularly enlarged without discernible polarity. In the attached
fibrin/blood, individual cells with enlarged, irregular nuclei are also
observed. No clear stromal relationship is identified.
Critical Findings Report:
FNA: Segments of atypical glandular cell clusters, at least pancreatic
intraepithelial neoplasia with low-grade dysplasia. Corresponding
invasive growth can neither be confirmed nor ruled out with the current
sample.
For quality assurance, the case was reviewed by a pathology specialist.
Expected follow-up:
Mrs. Anderson is expected to follow up with her gastroenterologist and
the multidisciplinary team for her biopsy results, and the potential
treatment plan will be discussed after the results are available.
Depending on the biopsy results, she may need further imaging, surgery,
radiation, chemotherapy, or targeted therapies. Continuous monitoring of
her jaundice, abdominal pain, and bile duct function will be critical.
Based on this information, Mrs. Anderson has a mass in the pancreatic
head with suspected metastatic regional lymph nodes. The management and
prognosis for Mrs. Anderson will largely depend on the results of the
histopathological examination and staging of the tumor. If it is
pancreatic cancer, early diagnosis and treatment are crucial for a
better outcome. The multidisciplinary team will discuss the best course
of action for her treatment after the results are obtained.
### Patient Report 5
**Dear colleague, **
We are updating you on Mrs. Jill Anderson, who was under our outpatient
care on October 4th, 2021.
**Outpatient Treatment:**
**Diagnoses:**
Recommendation for neoadjuvant chemotherapy with FOLFIRINOX for advanced
pancreatic cancer (Dated 10/21)
Exocrine pancreatic dysfunction since around 07/21.
Prior occurrences on 02/21 and 2020.
**CT Scan of the chest, abdomen, and pelvis** on September 28, 2021:
**Thorax:** Symmetrical imaging of neck soft tissues. Cardiomediastinum
is centralized. There is no sign of mediastinal, hilar, or axillary
lymphadenopathy. Calcified granuloma noted in the right lower lobe, and
no concerning rounded objects or inflammatory infiltrates. No fluid in
the pleural cavity or pneumothorax.
**Abdomen:** Hypodense mass in the head of the pancreas measuring
approximately 34 x 28 mm. A secondary finding touching the superior
mesenteric artery (\< 180°). Possible lymph node metastasis. Contact
with the superior mesenteric vein (\<180°) and venous confluence.
Noticeable, yet not pathologically enlarged lymph nodes in the
interaortocaval space and other regional suspicious lymph nodes.
Significant intra- and extrahepatic bile duct blockage. The pancreatic
duct is dilated up to around 5 mm. The liver is consistent with no signs
of suspicious lesions and shows fatty infiltration. Liver and portal
veins are well perfused. The spleen appears normal with its vein not
infiltrated. The left adrenal gland appears enlarged, while the right is
slim. Kidney tissue displays even contrast. No urinary retention
observed. Post oral contrast, the contrast agent passed regularly
through the small intestine. Both the uterus and adnexa appear normal.
No free air or fluid present in the abdomen.
**Skeleton:** No osteodestructive lesions. Mild degenerative changes
with arthrosis of the facet joints in the lower back.
**Assessment:**
-Mass in the head of the pancreas touching the superior mesenteric vein
(approx 90 degrees) and possible lymph node metastasis adhering dorsally
to the superior mesenteric artery. Significant bile duct blockage.
Dilated pancreatic duct.
-Suspicious regional lymph nodes, especially interaortocaval.
-No distant metastases found.
**GI Tumor Board** on September 30, 2021:
**CT:** Tumor in the pancreatic head with contacts noted.
**MR:** No liver metastases.
**Pancreatic histology:** Pending.
**Consensus:**
Await final pathology.
Neoadjuvant-intended chemotherapy with FOLFIRINOX.
Review after 4 cycles.
**Summary:**
Mrs. Anderson was referred to us by her primary care physician following
the discovery of a tumor in the head of the pancreas through an
ultrasound. She has been experiencing unexplained diarrhea for
approximately 3 months, sometimes with an oily appearance. She exhibited
jaundice noticeable for about a week without any itching, and an MRI was
conducted.
Given the suspicion of a pancreatic head cancer, we proceeded with CT
staging. This identified an advanced pancreatic cancer with specific
contacts. MRI did not reveal liver metastases. The imaging did show bile
duct blockage consistent with her jaundice symptom.
She was admitted for an endosonographic biopsy of the pancreatic tumor
and ERCP/stenting. The biopsy identified dysplastic cells. No invasion
was observed due to the absence of a stromal component. A metal stent
was successfully inserted.
After reviewing the findings in our tumor board, we recommended
neoadjuvant chemotherapy with FOLFIRINOX. We scheduled her for a port
implant, and a DPD test is currently underway. Chemotherapy will begin
on October 14, with the first review scheduled after 4 cycles.
Please reach out if you have any questions. If her symptoms persist or
worsen, we advise an immediate revisit. For any emergencies outside
regular office hours, she can seek medical attention at our emergency
care unit.
Best regards,
### Patient Report 6
**Dear colleague, **
We are writing to update you on Ms. Jill Anderson, who visited our day
care center on December 22, 2021, for a partial inpatient treatment.
Diagnosis:
-Locally advanced pancreatic cancer recommended for neoadjuvant
chemotherapy with FOLFIRINOX.
-Exocrine pancreatic insufficiency since around July 2021.
-Previous incidents in February 2021 and 2020.
Past treatments:
-Diagnosis of locally advanced pancreatic head cancer in September 2021.
-4 cycles of FOLFIRINOX neoadjuvant were intended.
CT Scan:
GI Tumor Board Review:
Summary:
Mrs. Anderson had a CT follow-up while on FOLFIRINOX treatment. In case
her symptoms persist or worsen, we advise an immediate consultation. If
outside regular business hours, she can seek emergency care at our
emergency medical unit.
Best regards,
### Patient Report 7
**Dear colleague, **
Updating you about Mrs. Jill Anderson, who visited our surgical clinic
on December 25, 2021.
Diagnosis:
Potentially resectable pancreatic head cancer.
CT Scan:
-Progressive tumor growth with significant contact to the celiac trunk
and the superior mesenteric artery. Direct contact with the aorta
beneath.
-Progressive, suspicious lymph nodes around the aorta, but no clear
distant metastases.
-External MR for liver showed no liver metastases.
Medical History:
-ERCP/Stenting for bile duct blockage in 09/2021.
-4 cycles of FOLFIRINOX neoadjuvant from November to December 15, 2021.
-Encountered complications resulting in prolonged hospital stay.
-Received 3 Covid-19 vaccinations, last one in May 2021 and recovered
from the virus on August 14, 2021.
-Exocrine pancreatic insufficiency.
Physical stats: 65 kg (143 lbs), 176 cm (5\'9\").
CT consensus:
-Primary tumor has reduced in size with decreased contact with the
aorta. New tumor extension towards the celiac trunk. No distant
metastases found.
-MR showed no liver metastases.
-Tumor marker Ca19-9 levels: 525 U/mL (previously 575 U/mL in September
and 380 U/mL in November).
Recommendation:
Exploratory surgery and potential pancreatic head resection.
Procedure:
We discussed with the patient about undergoing an exploration with a
possible Whipple\'s procedure. The patient is scheduled to meet the
doctor today for lab work (Hemoglobin and white blood cell count). A
prescription for pantoprazole was provided.
Prehabilitation Recommendations:
-Individualized strength training and aerobic exercises.
-Lung function improvement exercises using Triflow, three times a day.
-Consider psycho-oncological support through primary care.
-Nutritional guidance, potential high-protein and calorie-dense diet,
supplemental nutrition through a port, and intake of creon and
pantoprazole.
The patient is scheduled for outpatient preoperative preparation on
January 13, 2022, at 10:00 AM. The surgical procedure is planned for
January 15th. Eliquis needs to be stopped 48 hours before the surgery.
Warm regards,
**Surgery Report:**
Diagnosis: Locally advanced pancreatic head cancer post 4 cycles of
FOLFIRINOX.
Procedure:
Exploratory laparotomy, adhesion removal, pancreatic head and vascular
visualization, biopsy of distal mesenteric root area, surgery halted due
to positive frozen section results, gallbladder removal, catheter
placement, and 2 drains.
Report:
Mrs. Anderson has a pancreatic head cancer and had received 4 cycles of
FOLFIRINOX neoadjuvant therapy. The surgery involved a detailed
abdominal exploration which did not reveal any liver metastases or
peritoneal cancer spread. However, a hard nodule was found away from the
head of the pancreas in the peripheral mesenteric root, from which a
biopsy was taken. Results showed adenocarcinoma infiltrates, leading to
the surgery\'s termination. An additional gallbladder removal was
performed due to its congested appearance. The surgical procedure
concluded with no complications.
**Histopathological Report:**
Further immunohistochemical tests were performed which indicate the
presence of a pancreatobiliary primary cancer. Other findings from the
gallbladder showed signs of chronic cholecystitis.
GI Tumor Board Review on January 9th, 2022:
Discussion focused on Mrs. Anderson's locally advanced pancreatic head
cancer, her exploratory laparotomy, and the halted surgery due to
positive frozen section results. The CT scan indicated the progression
of her tumor, but no distant metastases or liver metastases were found.
The question posed to the board concerns the best subsequent procedure
to follow.
### Patient Report 8
**Dear colleague, **
We are providing an update on Mrs. Jill Anderson, who was in our
outpatient care on 11/05/2022:
**Outpatient treatment**:
Diagnosis:
Progressive tumor disease under gemcitabine/nab-paclitaxel for
pancreatic head carcinoma (Date of onset 09/22).
01/17/22 Surgery: Exploratory laparotomy, adhesiolysis, visualization of
the pancreatic head and vascular structures, biopsy near the distal
mesenteric root. Surgery was stopped due to positive frozen section
results; gallbladder removal.
09/21 ERCP/Stenting: Metal stent insertion.
Diarrhea likely from exocrine pancreatic insufficiency since around
07/21.
Prior diagnosis: Locally advanced pancreatic head carcinoma as of 09/21.
Clinical presentation: Chronic diarrhea due to exocrine pancreatic
insufficiency.
CT: Pancreatic head carcinoma, borderline resectable.
MRI of liver: No liver metastases.
TM Ca19-9: 587 U/mL.
ERCP/Stenting: Metal stent in the bile duct.
EUS biopsy: PanIN with low-grade dysplasia.
GI tumor board: Proposed neoadjuvant chemotherapy.
From 10/21 to 12/21: 4 cycles of FOLFIRINOX (neoadjuvant).
Hospitalized for: Anemia, dehydration, and COVID.
12/21 CT: Mixed response, primary tumor site, lymph node metastasis.
GI tumor board: Recommendation for exploratory surgery/resection.
01/12/2021: Surgery: Evidence of adenocarcinoma near distal mesenteric
root. Surgery was discontinued.
GI tumor board: Chemotherapy change recommendation.
02/22 CT: Progression at the primary tumor site with increased contact
to the SMA; lymph node metastasis.
From 02/22 to 06/22: 4 cycles of gemcitabine/nab-paclitaxel.
05/22 TM Ca19-9: 224 U/mL.
1. Concomitant PRRT therapy:
02/22: 7.9 GBq Lutetium-177 FAP-3940.
04/22: 8.5 GBq Lutetium-177 FAP-3940.
06/22: 8.4 GBq Lutetium-177 FAP-3940.
07/22: CT: Progression of primary tumor with encasement of AMS;
suspected liver metastases.
TM: Ca19-9: 422 U/mL.
Recommendation: Switch to the NAPOLI regimen and perform diagnostic
panel sequencing.
**Summary**:
Mrs. Anderson visited with her sister and friend to discuss recent CT
results. With advanced pancreatic cancer and a prior surgery in 01/22,
she has been on gemcitabine/nab-paclitaxel and concurrent PRRT with
lutetium-177 FAP since 02/22. The latest CT indicates tumor progression
and potential liver metastases. We have recommended a change in
chemotherapy and continuation of PRRT. A follow-up CT in 3 months is
advised. Please contact us with any inquiries. If symptoms persist or
worsen, urgent consultation is advised. After hours, she can visit the
emergency room at our clinic.
**Operation report**:
Diagnosis: Infection of the right chest port.
Procedure: Removal of the port system and microbiological culture.
Anesthesia: Local.
**Procedure Details**:
Suspected infection of the right chest port. Elevated lab parameters
indicated a possible infection, prompting port removal. The patient was
informed and consented.
After local anesthesia, the previous incision site was reopened.
Yellowish discharge was observed. A sample was sent for microbiology.
The port was accessed, detached, and removed along with the associated
catheter. The vein was ligated. Infected tissue was excised and sent for
pathology. The site was cleaned with an antiseptic solution and sutured
closed. Sterile dressing applied.
Post-operative care followed standard protocols.
Warm regards,
### Patient Report 9
**Dear colleague, **
We report on Mrs. Jill Anderson, born 06/07/1975 who presented to our
outpatient clinic on12/01/2022.
Diagnosis:
Progressive tumor disease under gemcitabine/nab-paclitaxel for
pancreatic head carcinoma (Date of onset 09/22).
-low progressive lung lesions, possibly metastases
**CT pancreas, thorax, abdomen, pelvis dated 12/02/2022. **
**Findings:**
Chest:
Nodular goiter with low-density nodules in the left thyroid tissue. Port
placement in the right chest with the catheter tip located in the
superior vena cava. There are no suspicious pulmonary nodules. There is
also no increase in mediastinal or axillary lymph nodes. The dense
breast tissue on the right remains unchanged from the previous study.
Abdomen:
Fatty liver with uneven contrast in the liver tissue, possibly due to
uneven blood flow. As far as can be seen, no new liver lesions are
present. There is a small low-density area in the spleen, possibly a
splenic cyst. Two distinct low-density areas are noted in the right
kidney\'s tissue, likely cysts. Pancreatic tumor decreasing in site.
Local lymph nodes and nodules in the mesentery, with sizes up to about
9mm; some are near the intestines, also decreasing in size. There are
outpouchings (diverticula) in the left-sided colon. Hardening of the
abdominal vessels. An elongation of the right iliac artery is noted.
Spine:
There are degenerative changes, including a forward slip of the fifth
lumbar vertebra over the first sacral vertebra (grade 1-2
spondylolisthesis). There is also an indentation at the top of the tenth
thoracic vertebra.
Impression:
In the context of post-treatment chemotherapy following the surgical
removal of a pancreatic tumor, we note:
-Advanced pancreatic cancer, decreasing in size.
-Lymph nodes smaller than before.
-No other signs of metastatic spread.
**Summary:**
Mrs. Andersen completed neoadjuvant chemotherapy. Pancreatic head
resection can now be performed. For this we agreed on an appointment
next week. If you have any questions, please do not hesitate to contact
us. In case of persistence or worsening of the symptoms, we recommend an
immediate reappearance. Outside of regular office hours, this is also
possible in emergencies at our emergency unit.
Yours sincerely
### Patient Report 0
**Dear colleague, **
we report on Mrs. Jill Anderson, born 06/07/1975 who presented to our
outpatient clinic on 3/05/2023.
Diagnosis:
Progressive tumor disease under gemcitabine/nab-paclitaxel for
pancreatic head carcinoma after resection in 12/2022.
CT staging on 03/05/2023:
No local recurrence.
Intrapulmonary nodules of progressive size on both sides, suspicious for
pulmonary metastases.
Question:
Biopsy confirmation of suspicious lung foci?
Consensus decision:
VATS of a suspicious lung lesion (vs. CT-guided puncture).
### Patient Report 1
**Dear colleague, **
We report on your outpatient treatment on 04/01/2023.
Diagnoses:
Follow-up after completion of adjuvant chemotherapy with Gemcitabine
mono
to 03/23 (initial gemcitabine / 5-FU)
\- progressive lung lesions, possibly metastases -\> recommendation for
CT guided puncture
\- status post Whipple surgery for pancreatic cancer
CT staging: unexplained pulmonary lesions, possibly metastatic
**CT Chest/Abd./Pelvis with contrast dated 04/02/2023: **
Imaging method: Following complication-free bolus i.v. administration of
100 mL Ultravist 370, multi-detector spiral CT scan of the chest,
abdomen, and pelvis during arterial, late arterial, and venous phases of
contrast. Additionally, oral contrast was administered. Thin-slice
reconstructions, as well as coronal and sagittal secondary
reconstructions, were done.
Chest: Normal lung aeration, fully expanded to the chest wall. No
pneumothorax detected. Known metastatic lung nodules show increased size
in this study. For instance, the nodule in the apical segment of the
right lower lobe now measures 17 x 15 mm, previously around 8 x 10 mm.
Similarly, a solid nodule in the right posterior basal segment of the
lower lobe is now 12 mm (previously 8 mm) with adjacent atelectasis. No
signs of pneumonia. No pleural effusions. Homogeneous thyroid tissue
with a nodule on the left side. Solitary lymph nodes seen in the left
axillary region and previously smaller (now 9 mm, was 4mm) but with a
retained fatty hilum, suggesting an inflammatory origin. No other
evidence of abnormally enlarged or conspicuously shaped mediastinal or
hilar lymph nodes. A port catheter is inserted from the right, with its
tip in the superior vena cava; no signs of port tip thrombosis. Mild
coronary artery sclerosis.
Abdomen/Pelvis: Fatty liver changes visible with some areas of irregular
blood flow. No signs of lesions suspicious for cancer in the liver. A
small area of decreased density in segment II of the liver, seen
previously, hasn\'t grown in size. Portal and hepatic veins are patent.
History of pancreatic head resection with pancreatogastrostomy. The
remaining pancreas shows some dilated fluid-filled areas, consistent
with a prior scan from 06/26/20. No signs of cancer recurrence. Local
lymph nodes appear unchanged with no evidence of growth. More lymph
nodes than usual are seen in the mesentery and behind the peritoneum. No
signs of obstructions in the intestines. Mild abdominal artery
sclerosis, but no significant narrowing of major vessels. Both kidneys
appear normal with contrast, with some areas of dilated renal pelvis and
cortical cysts in both kidneys. Both adrenal glands are small. The rest
of the urinary system looks normal.
Skeleton: Known degenerative changes in the spine with calcification,
and a compression of the 10th thoracic vertebra, but no evidence of any
fractures. There are notable herniations between vertebral discs in the
lumbar spine and spondylolysis with spondylolisthesis at the L5/S1 level
(Meyerding grade I-II). No osteolytic or suspicious lesions found in the
skeleton.
Conclusion:
Oncologic follow-up post adjuvant chemotherapy and pancreatic cancer
resection:
-Lung nodules are increasing in size and number.
-No signs of local recurrence or regional lymph node spread.
-No new distant metastases detected
**Summary:**
Mrs. Anderson visited our outpatient department to discuss her CT scan
results, part of her ongoing pancreatic cancer follow-up. For a detailed
medical history, please refer to our previous notes. In brief, Mrs.
Anderson had advanced pancreatic head cancer for which she underwent a
pancreatic head resection after neoadjuvant therapy. She underwent three
cycles of adjuvant chemotherapy with gemcitabine/5-FU. The CT scan did
not show any local issues, and there was no evidence of local recurrence
or liver metastases. The previously known lung lesions have slightly
increased in size. We have considered a CT-guided biopsy. A follow-up
appointment has been set for 04/22/23. We are available for any
questions. If symptoms persist or worsen, we advise an immediate
revisit. Outside of regular hours, emergency care is available at our
clinic's department.
Dear Mrs. Anderson,
**Encounter Summary (05/01/2023):**
**Diagnosis:**
-Progressive lung metastasis during ongoing treatment break for
pancreatic adenocarcinoma
-CT scan 04/14-23: Uncertain progressive lung lesions -- differential
diagnoses include metastases and inflammation.
History of clot at the tip of the port.
**Previous Treatment:**
09/21: Diagnosed with pancreatic head cancer.
12/22: Surgery - pancreatic head removal-
3 months adjuvant chemo with gemcitabine/5-FU (outpatient).
**Summary:**
Recent CT results showed mainly progressive lung metastasis. Weight is
59 kg, slightly decreased over the past months, with ongoing diarrhea
(about 3 times daily). We have suggested adjusting the pancreatic enzyme
dose and if no improvement, trying loperamide. The CT indicated slight
size progression of individual lung metastases but no abdominal tumor
progression.
After discussing the potential for restarting treatment, considering her
diagnosis history and previous therapies, we believe there is a low
likelihood of a positive response to treatment, especially given
potential side effects. Given the minor tumor progression over the last
four months, we recommend continuing the treatment break. Mrs. Anderson
wants to discuss this with her partner. If she decides to continue the
break, we recommend another CT in 2-3 months.
**Upcoming Appointment:** Wednesday, 3/15/2023 at 11 a.m. (Arrive by
9:30 a.m. for the hospital\'s imaging center).
### Patient Report 2
**Dear colleague, **
we report on Mrs. Jill Anderson, who was in our inpatient treatment from
07/20/2023 to 09/12/2023.
**Diagnosis**
Seropneumothorax secondary to punction of a malignant pleural effusion
with progressive pulmonary metastasis of a pancreatic head carcinoma.
Previous therapy and course
-Status post Whipple surgery on 12/22
-3 months adjuvant CTx with gemcitabin/5-FU (out).
-\> discontinuation due to intolerance
1/23-3/23: 3 cycles gemcitabine mono
06/23 CT: progressive pulmonary lesions bipulmonary metastases.
06/23-07/23: 2 cycles gemcitabine / nab-paclitaxel
07/23 CT: progressive pulmonary metastases bilaterally, otherwise idem
Allergy: penicillin
**Medical History**
Mrs. Anderson came to our ER due to worsening shortness of breath. She
has a history of metastatic pancreatic cancer in her lungs. With
significant disease progression evident in the July 2023 CT scan and
worsening symptoms, she was advised to begin chemotherapy with 5-FU and
cisplatin (reduced dose) due to severe polyneuropathy in her lower
limbs. She has experienced worsening shortness of breath since July.
Three weeks ago, she developed a cough and consulted her primary care
physician, who prescribed cefuroxime for a suspected pneumonia. The
cough improved, but the shortness of breath worsened, leading her to
come to our ER with suspected pleural effusion. She denies fever and
systemic symptoms. Urinalysis was unremarkable, and stool is
well-regulated with Creon. She denies nausea and vomiting. For further
evaluation and treatment, she was admitted to our gastroenterology unit.
**Physical Examination at Admission**
48-year-old female, 176 cm, 59 kg. Alert and stable.
Skin: Warm, dry, no rashes.
Lungs: Diminished breath sounds on the right, normal on the left.
Cardiac: Regular rate and rhythm, no murmurs.
Abdomen: Soft, non-tender.
Extremities: Normal circulation, no edema.
Neuro: Alert, oriented x3. Neurological exam normal.
**Radiologic Findings**
07/20/2023 Chest X-ray: Evidence of right-sided pneumothorax with
pleural fluid, multiple lung metastases, port-a-cath in place with tip
at superior vena cava. Cardiomegaly observed.
08/02/2023 Chest X-ray: Pneumothorax on the right has increased. Fluid
still present.
08/06/2023 Chest X-ray after chest tube insertion: Improved lung
expansion, reduced fluid and pneumothorax.
08/17/2023 Chest X-ray: Chest tube on the right removed. Evidence of
right pleural effusion. No new pneumothorax.
07/12/2023 CT Chest/Abdomen/Pelvis with contrast: Progression of
pancreatic cancer with enlarged mediastinal and hilar lymph nodes
suggestive of metastasis. Increase in right pleural effusion. Right
adrenal mass noted, possibly adenoma.
**Consultations/Interventions**
06/07/2023 Surgery: Insertion of a 20Ch chest tube on the right side,
draining 500 mL of fluid immediately.
09/01/2023 Palliative Care: Discussed the progression of her disease,
current symptoms, and future care plans. Patient is waiting for the next
CT results but is leaning towards home care.
Patient advised about painkiller recall (burning in the upper abdomen,
central, radiating to the right; doctor\'s contact provided). Pain meds
distributed.
Patient reports increasing shortness of breath; according to on-call
physician, a consult for pleural condition is scheduled.
Patient denies pain and shortness of breath; overall, she is much
improved. Oxygen arranged by ward for home use.
-Home intake of pancreatic enzymes effective: 25,000 IU during main
meals and 10,000 IU for snacks.
-Patient notes constipation with excess pancreatic enzyme, insufficient
enzyme results in diarrhea/steatorrhea.
-Patient consumes Ensure Plus (400 kcal) once daily.
Assessment:
-Severe protein and calorie malnutrition with insufficient oral intake
-Current oral caloric intake: 700 kcal + 400 kcal drink supplement
-In the hospital, pancreatic enzyme intake is challenging because the
patient struggles to assess food fat content.
Recommendations:
Lab tests for malnutrition: Vitamin D, Vitamin B12, zinc, folic acid
Twice daily Ensure Plus or alternative product. Please record, possibly
order from pharmacy. After discharge, prescribe via primary care doctor.
-Pancreatic enzymes: 25,000 IU main meals, 10,000 IU snacks. Include in
the medical chart.
-Detailed discussion of pancreatic enzyme replacement (consumption of
enzymes with fatty meals, dosage based on fat content).
-Dietary guidelines for cancer patients (balanced nutrient-rich diet,
frequent small high-calorie, and protein-rich meals to maintain weight).
Psycho-oncology consult from 9/10/2023
Current status/medical history:
The patient is noticeably stressed due to her physical limitations in
the current scenario, leading to supply concerns. She is under added
strain because her insurance recently denied a care level. She dwells on
this and suffers from sleep disturbances. She also experiences pain but
is hesitant about \"imposing\" and requesting painkillers. The
palliative care service was consulted for both pain management and
exploration of potential additional outpatient support.
Mental assessment:
Alert, fully oriented. Engages openly and amicably. Thought processes
are orderly. Tends to ruminate. Worried about her care. No signs of
delusion or ego disorders. No anhedonia. Decreased drive and energy.
Appetite and sleep are significantly disrupted. No signs of suicidal
tendencies.
Coping with illness:
Patient\'s approach to illness appears passive. There is a notable
mental strain due to worries about living alone and managing daily life
independently.
Diagnosis: Adjustment disorder
Interventions:
A diagnostic and supportive discussion was held. We recommended
mirtazapine 7.5 mg at night, increasing to 15 mg after a week if
tolerated well. She was also encouraged to take pain medication with
Tylenol proactively or at fixed intervals if needed. A follow-up visit
at our outpatient clinic was scheduled for psycho-oncological care.
**Encounter Summary (07/24/2023):**
**Diagnosis:** Lung metastatic pancreatic cancer, seropneumothorax.
**Procedure:** Left-sided chest tube placement.
**Report: **
**INDICATION:**
Mrs. Anderson showed signs of a rapidly expanding seropneumothorax
following a procedure to drain a pleural effusion. Given the increase in
size and Mrs. Anderson\'s new requirement for supplemental oxygen, we
decided to place an emergency chest tube. After informing and obtaining
consent from Mrs. Anderson, the procedure was performed.
**PROCEDURE DETAILS:**
After pain management and patient positioning, a local anesthetic was
applied. An incision was made and the chest tube was inserted, which
immediately drained about 500 mL of fluid. The tube was then secured,
and the procedure was concluded. For the postoperative protocol, please
refer to the attached documentation.
**Pathology report (07/26/2023): **
Sample: Liquid material, 50 mL, yellow and cloudy.
Processing: Papanicolaou, Hemacolor, and HE staining.
Microscopic Findings:
Protein deposits, red blood cells, lymphocytes, many granulocytes,
eosinophils, histiocyte cell forms, mesothelium, and a lot of active
mesothelium. Granulocyte count is raised. There is a notable increase in
activated mesothelium. Additionally, atypical cells were found in
clusters with vacuolated cytoplasm and darkly stained nuclei.
Initial findings:
Presence of a malignant cell population in the samples, suggestive of
adenocarcinoma cells. A cell block was prepared from the residual liquid
for further categorization.
Follow-up findings from 8/04/2023:
Processing: Immunohistochemistry (BerEP4, CK7, CK20, CK19.9, CEA).
Microscopic Findings:
As mentioned, a cell block was created from the leftover liquid. HE
staining showed blood and clusters of plasma-rich cells, with contained
eosinophilia, mild to moderate vacuolization. Cell nuclei are darkly
stained, some are marginal. PAS test was negative. Immunohistochemical
reaction with antibodies against BerEP4, CK7, CK20, CK19.9, CEA were all
positive.
Final Findings:
After reviewing the leftover liquid in a cell block, the findings are:
Pleural puncture sample with evidence of atypical cells, both
cytopathologically and immunohistochemically, is consistent with cells
from a primary pancreatic-biliary cancer.
Diagnostic classification: Positive.
**Treatment and Progress:**
The patient was hospitalized with the mentioned medical history. Lab
results were inconclusive. During the physical exam, a notably weak
respiratory sound was noted on the right side; oxygen saturation was 97%
under 3L of O2. X-rays revealed a significant right-sided pleural
effusion, which was drained. After the procedure, the patient\'s
shortness of breath improved, with SpO2 at 95% under 2L of O2. However,
an x-ray follow-up displayed a seropneumothorax, which became more
evident over time, leading to the placement of a chest tube by the
thoracic surgery department. The pneumothorax decreased with suction and
remained stable without suction, allowing for tube removal. After the
pathological analysis of the fluid, atypical cells consistent with
pancreatic cancer were identified. A dietary consultation occurred; the
patient declined the recommended IV nutrition via port; proper
pancreatic enzyme intake was thoroughly explained. Given the cancer\'s
progression and the patient\'s deteriorating condition,
psycho-oncological care was initiated, and Mirtazapine 7.5 mg at night
was prescribed. An ultrasound follow-up at the bedside showed the
pleural effusion was slowly progressing (around 100-200mL/day), but no
draining was needed as vital signs were clinically stable. Our
palliative care colleagues arranged home care, including home oxygen
supply. The patient was discharged to her home on 9/28/2023 in stable
condition and without symptoms.
**Discharge Medications:**
Mirtazapine 7.5 mg at night
Paracetamol as required
Tylenol as required
Pancreatic enzymes: 25,000 IU main meals, 10,000 IU snacks.
Follow-up:
A follow-up visit was scheduled at our outpatient clinic for
psycho-oncological care. The patient is advised to get in touch
immediately if there are any concerns or if the pleural effusion
returns.
|
575 U/ml.
|
Could you please specify the chronological sequence of the radiological imaging procedures that Mrs. Mayer underwent?
Choose the correct answer from the following options:
A. Breast MRI < mammography < chest CT < digital mammography
B. Mammography and Tomosynthesis < Breast MRI < CT chest and abdomen < Digital Mammography
C. Mammography and Tomosynthesis < CT chest and abdomen < Breast MRI < Digital Mammography
D. Mammography and Tomosynthesis < Digital Mammography< CT chest and abdomen < Breast MRI
E. Mammography and Tomosynthesis < Digital Mammography < Breast MRI < CT chest and abdomen <
|
### Patient Report 0
**Dear colleague, **
We report to you about Mrs. Linda Mayer, born on 01/12/1948, who
presented to our outpatient clinic on 07/13/19.
**Diagnoses:**
- BIRADS IV, recommended biopsy during breast diagnostics.
- Left breast carcinoma: iT1b; iN0; MX; ER: 12/12; PR: 2/12; Her-2:
neg; Ki67: 15%.
**Other Diagnoses: **
- Status post apoplexy
- Status post cataract surgery
- Status post right hip total hip replacement (THR)
- Pemphigus vulgaris under azathioprine therapy
- Osteoporosis
- Obesity with a BMI of 35
- Undergoing immunosuppressive therapy with prednisolone
**Family History:**
- Sister deceased at age 39 from breast cancer.
- Mother and grandmother (maternal and paternal) were diagnosed with
breast cancer.
**Medical History:** The CT thorax report indicates the presence of
inflammatory foci, warranting further follow-up. The relevant data was
documented and presented during the tumor conference. Subsequently, a
telephone conversation was conducted with the patient to discuss the
next steps.
**Tumor board decision from 07/13/2019:**
**Imaging: **
1) MRI examination detected a unifocal lesion on the left external
aspect, measuring approximately 2.4 cm in size.
2) CT scan (thorax/abdomen 07/12/2019) revealed a previously known
liver lesion, likely a hemangioma. No evidence of metastases was
identified. Nonspecific, small foci were observed in the lungs,
likely indicative of post-inflammatory changes.
**Recommendations:**
1. If no metastasis (M0): Fast-track BRCA testing is recommended.
2. If BRCA testing returns negative: Proceed with a selective excision
of the left breast after ultrasound-guided fine needle marking and
sentinel lymph node biopsy on the left side. Additionally, perform
Endopredict analysis on the surgical specimen.
**Current Medication: **
**Medication** **Dosage** **Route** **Frequency**
------------------------------- ------------ ----------- ---------------
Aspirin 100mg Oral 1-0-0
Simvastatin (Zocor) 40mg Oral 0-1-0
Haloperidol (Haldol) 100mg Oral ½-0-½
Zopiclone (Imovane) 7.5mg Oral 0-0-1
Trazodone (Desyrel) 100mg Oral 0-0-½-
Calcium Supplement (Caltrate) 500mg Oral 1-0-1
Nystatin (Bio-Statin) As advised Oral 1-1-1-1
Pantoprazole (Protonix) 40mg Oral 1-0-0
Prednisolone (Prelone) 40mg Oral As advised
Tramadol/Naloxone (Ultram) 50/4mg Oral 1-0-1
Acyclovir (Zovirax) 800mg Oral 1-1-1
**Mammography and Tomosynthesis from 07/8/2019:**
[Findings]{.underline}**: **During the inspection and palpation, no
significant findings were noted on either side. Some areas with higher
mammographic density were observed, which slightly limited the
assessment. However, during the initial examination, a small
architectural irregularity was identified on the outer left side. This
irregularity appeared as a small, roundish compression measuring
approximately 6mm and was visible only in the medio-lateral oblique
image, with a nipple distance of 8cm. Apart from this discovery, there
were no other suspicious focal findings on either side. No clustered or
irregular microcalcifications were detected. Additionally, a long-term,
unchanged observation noted some asymmetry with denser breast tissue
present on both sides, particularly on the outer aspects. Sonographic
evaluation posed challenges due to the mixed echogenic glandular tissue.
As a possible corresponding feature to the questionable architectural
irregularity on the outer left side, a blurred, echo-poor area with a
vertical alignment measuring about 7x5mm was identified. Importantly, no
other suspicious focal findings were observed, and there was no evidence
of enlarged lymph nodes in the axilla on both sides.
[Assessment]{.underline}**:** The observed finding on the left side
presents an uncertain nature, categorized as BIRADS IVb. In contrast,
the finding on the right side appears benign, categorized as BIRADS II.
To gain a more conclusive understanding of the left-sided finding, we
recommend a histological assessment through a sonographically guided
high-speed punch biopsy. An appointment has been scheduled with the
patient to proceed with this biopsy and obtain a definitive
diagnosis.Formularbeginn
Formularende**Current Recommendations:**\
A fast-track decision will be made regarding tumor genetics, and the
patient will be notified of the appointment via telephone. The patient
should bring the pathology blocks from Fairview Clinic on the day of
blood collection for genetic testing, along with a referral for an
Endopredict test. A multidisciplinary team meeting will be convened
after the Endopredict test and genetic testing results are available. If
there is persistence or worsening of symptoms, we strongly advise the
patient to seek immediate re-evaluation. Additionally, outside of
regular office hours, the patient can seek assistance at the emergency
care unit in case of emergency.
**MRI from 07/11/2019:**
[Technique:]{.underline} Breast MRI (3T scanner) with dedicated mammary
surface coil:
[Findings:]{.underline} The overall contrast enhancement was observed
bilaterally to evaluate the Grade II findings. There was low to moderate
small-spotted contrast enhancement with slightly limited assessability.
The contrast dynamics revealed a patchy, confluent, blurred, and
elongated contrast enhancement, corresponding to the primary lesion,
which measured approximately 2.4 cm on the lower left exterior. Single
spicules were noted, and the lesion appeared hypointense in T1w imaging.
No suspicious focal findings with contrast enhancement were detected on
the right side. Small axillary lymph nodes were observed on the left
side, but they did not appear suspicious based on MR morphology.
Additionally, there were no suspicious lymph nodes on the right side.
[Assessment:]{.underline} An unifocal primary lesion measuring
approximately 2.4 cm in diameter was identified on the lower left
exterior. It exhibited patchy confluent enhancement and architectural
disturbance, with single spicules. No evidence of suspicious lymph nodes
was found. The left side is categorized as BIRADS 6, indicating a high
suspicion of malignancy, while the right side is categorized as BIRADS
2, indicating a benign finding.
### Patient Report 1
**Dear colleague, **
We are writing to provide you with an update on the medical condition of
Mrs. Linda Mayer, born on 01/12/1948, who attended our outpatient clinic
on 08/02/2019.
**Diagnoses:**
- Vacuum-assisted biopsy-confirmed ductal carcinoma in situ (DCIS) of
the right breast (17mm)
- Histological grade G3, estrogen receptor (ER) and progesterone
receptor (PR) negative.
- Postmenopausal for the past eight years.
- Previous surgical history includes an appendectomy.
- Allergies: Hay fever
**Current Presentation**: The patient sought consultation following a
confirmed diagnosis of DCIS (Ductal Carcinoma In Situ) in the right
breast, which was determined through a vacuum-assisted biopsy.
**Physical Examination**: Upon physical examination, there is evidence
of a post-intervention hematoma located in the upper right quadrant of
the right breast. However, the clip from the biopsy is not clearly
visible. A sonographic examination of the right axilla reveals no
abnormalities.
**Current Recommendations:**
- Imaging studies have been conducted.
- A case presentation is scheduled for our mammary conference
tomorrow.
- Subsequently, planning for surgery will commence, including the
evaluation of sentinel lymph nodes following a right mastectomy and
axillary lymph node dissection.
### Patient Report 2
**Dear colleague, **
We are writing to provide an update regarding Mrs. Linda Mayer, born on
01/12/1948, who received outpatient care at our facility on 08/29/2019.
**Diagnoses:**
- Vacuum-assisted biopsy-confirmed ductal carcinoma in situ (DCIS) of
the right breast, measuring 17mm in size, classified as Grade 3, and
testing negative for estrogen receptors (ER) and progesterone
receptors (PR).
- Mrs. Mayer has been postmenopausal for eight years.
- Notable allergy: Hay fever
**Tumor Board Decision:** Mammography imaging revealed a clip associated
with a focal finding in the right breast adjacent to calcifications.
[Recommendation]{.underline}: Proceed with sentinel lymph node
evaluation after right mastectomy, including clip localization on the
right side.
**Current Presentation**: During the patient\'s recent outpatient visit,
an extensive pre-operative consultation was conducted. This discussion
covered the indications for the surgery, details of the surgical
process, potential alternative options, as well as general and specific
risks associated with the procedure. These risks included the
possibility of an aesthetically suboptimal outcome and the chance of
encountering an R1 situation. The patient did not have any further
questions and provided written consent for the procedure.
**Physical Examination:** Both breasts appear normal upon inspection and
palpation. The right axilla shows no abnormalities.
**Medical History:** Mrs. Linda Mayer presented to our clinic with a
vacuum biopsy-confirmed DCIS of the right breast for therapeutic
intervention. The decision for surgery was reached following a
comprehensive review by our interdisciplinary breast board. After an
extensive discussion of the procedure\'s scope, associated risks, and
alternative options, the patient provided informed consent for the
proposed surgery.
**Preoperative Procedure:** Sonographic and mammographic fine needle
marking of the remaining findings and the clip in the right breast.
**Surgical Report:** Team time-out conducted with colleagues of
anesthesia. Patient positioned in the supine position. Surgical site
disinfection and sterile draping. Marking of the incision site.
A semicircular incision was made laterally on the right breast.
Visualization and dissection along the marking wire towards the marked
finding. Excision of the marked findings, with a safety margin of
approximately 1-2 cm. The excised specimen measured approximately 4 x 5
x 3 cm. Markings using standard protocol (green thread cranially, blue
thread ventrally). The excised specimen was sent for preparation
radiography. Hemostasis was meticulously ensured. Insertion of a 10Ch
Blake drain into the segmental cavity, followed by suturing.
Verification of a blood-dry wound cavity. Preparation radiography
included the marked area and the marking wires. The excised material was
transferred to our pathology colleagues for histological examination.
Subdermal and intracutaneous sutures with Monocryl 3/0 in a continuous
manner. Application of Steristrips and dressing. Instruments, swabs, and
cloths were accounted for per the nurse\'s checklist. The patient was
correctly positioned throughout the operation. The anesthesiologic
course was without significant problems. A thorax compression bandage
was applied in the operating room as a preventive measure against
bleeding.
**Postoperative Procedure:** Pain management, thrombosis prophylaxis,
application of a pressure dressing, drainage under suction.
**Examinations:** **Digital Mammography performed on 08/29/2019**
[Clinical indication]{.underline}: DCIS right
[Question]{.underline}: Please send specimen + Mx-FNM
**Findings**: Sonographically guided wire marking of the maximum
microcalcification group measuring about 12 mm. Local hematoma cavity
and inset clip marking directly cranial to the finding. Stitch direction
from lateral to medial. The wire is positioned with the tip caudal to
the clip in close proximity to the microcalcification. Additional
marking of the focal localization on the skin. Documentation of the wire
course in two planes.
- Telephone discussion of findings with the surgeon.
- Preparation radiography and preparation sonography are recommended.
- Marking wire and suspicious focal findings centrally included in the
preparation.
- Intraoperative report of findings has been conveyed to the surgeon.
**Current Recommendations:**
- Scheduled for inpatient admission on ward 22 tomorrow.
- Right breast mastectomy with sentinel lymph node evaluation.
### Patient Report 3
**Dear colleague, **
We are writing to update you on the clinical course of Mrs. Linda Mayer,
born on 01/12/1948, who was under our inpatient care from 08/30/2019 to
09/12/2019.
**Diagnosis:** Vacuum-assisted biopsy confirmed Ductal Carcinoma In Situ
(DCIS) in the right breast, measuring 17mm, Grade 3, ER/PR negative.
**Tumor Board Decision (07/13/2019):**
[Imaging:]{.underline} Clip identified in focal lesion in the right
breast, adjacent to calcifications.
[Recommendation]{.underline}**:** Spin Echo following fine-needle
localization with mammography-guided control of the clip in the right
breast.
[Subsequent Recommendation (08/27/2019):]{.underline} Radiation therapy
to the right breast. Regular follow-up is advised.
**Medical History:** Ms. Linda Mayer presented to our facility on
08/30/2019 for the aforementioned surgical procedure. After a
comprehensive discussion regarding the surgical plan, potential risks,
and possible complications, the patient consented to proceed. The
surgery was executed without complications on 09/01/2019. The
postoperative course was unremarkable, allowing for Ms. Mayer\'s
discharge on 09/12/2019 in stable condition and with no signs of wound
irritation.
**Histopathological Findings (09/01/2019):**
The resected segment from the right breast showed a maximum necrotic
zone of 1.6 cm with foreign body reaction, chronic resorptive
inflammation, fibrosis, and residual hemorrhage. These findings
primarily correspond to the pre-biopsy site. Surrounding this were areas
of DCIS with solid and cribriform growth patterns and comedonecrosis,
WHO Grade 3, Nuclear Grade 3, with a reconstructed extent of 3.5 cm.
Resection margins were as follows: ventral 0.15 cm, caudal 0.2 cm,
dorsal 0.4 cm, with remaining margins exceeding 0.5 cm. TNM
Classification (8th Edition, 2017): pTis (DCIS), R0, G3. Additional
immunohistochemical studies are underway to determine hormone receptor
status; a supplementary report will follow.
**Postoperative Plan:**
The patient was educated on standard postoperative care and the
importance of immediate re-evaluation for any persistent or worsening
symptoms. Radiation therapy to the right breast is planned, along with
regular follow-up appointments.
Should you have any questions or require further clarification, we are
readily available. For urgent concerns outside of regular office hours,
emergency care is available at the Emergency Department.
**Internal Histopathological Findings Report**
**Clinical Data:** DCIS in the right breast (17 mm), Grade 3, ER/PR
negative.
**Macroscopic Examination:**
The resected mammary segment from the right breast, marked with dual
threads and containing a fine-needle marker inserted ventro-laterally,
measures 4.5 x 5.5 x 3 cm (HxWxD) and weighs 35 grams. The specimen was
sectioned from medial to lateral into 14 lamellae. The cut surface
predominantly shows yellowish, lobulated mammary parenchyma with sparse
striated whitish glandular components. A DCIS-suspected area, up to 2.1
cm in size, is evident caudally and centro-ventrally (from lamellae
4-10), displaying both reddish-hemorrhagic and whitish-nodular
indurations. Minimal distances from the suspicious area to the resection
margins are as follows: cranial 2 cm, caudal 0.2 cm, dorsal 0.2 cm,
ventral 0.1 cm, medial 1.6 cm, lateral 2.5 cm. The suspect area was
completely embedded. Ink markings: green/cranial, yellow/caudal,
blue/ventral, black/dorsal.
**Microscopic Examination:**
Histological sections of the mammary parenchyma reveal fibro-lipomatous
stroma and glandular lobules with a two-layered epithelial lining. In
lamellae 3-6 and 11, solid and cribriform epithelial proliferations are
evident. Cells are cuboidal with variably enlarged, predominantly
moderately pleomorphic, round to oval nuclei. Comedo-like necroses are
occasionally observed in secondary lumina. Microscopic distances to the
deposition margins are consistent with the macroscopic findings. The
surrounding stroma in lamellae 6-9 shows extensive geographic adipose
tissue necrosis, multinucleated foreign body-type giant cells, foamy
cell macrophages, collagen fiber proliferation, and fresh hemorrhages.
**Supplemental Immunohistochemical Findings
(09/04/2019):** **Microscopy:** In the meantime, the material was
further processed as announced.
Here, the previously described intraductal epithelial growths, each with
negative staining reaction for the estrogen and progesterone receptor
(with regular external and internal control reaction).
**Critical Findings:**
Resected mammary segment with paracentral, max. 1.6 cm necrotic zone
with foreign body reaction, chronic resorptive. Chronic resorptive
inflammation, fibrosis, and hemorrhage remnants (primarily corresponding
to the pre-biopsy site), and surrounding portions of ductal carcinoma in
situ. Ductal carcinoma in situ, solid and rib-shaped growth type with
comedonecrosis, WHO grade 3, nuclear grade 3. The resection was locally
complete with the following Safety margins: ventral 0.15 cm, caudal 0.2
cm, dorsal 0.4 cm, and the remaining sedimentation margins more than 0.5
cm.
TNM classification (8th edition 2017): pTis (DCIS), R0, G3.
[Hormone receptor status:]{.underline}
- Estrogen receptor: negative (0%).
- Progesterone receptor: negative (0%).
### Patient Report 4
**Dear colleague, **
We are writing to provide an update regarding Mrs. Linda Mayer, born on
01/12/1948, who received outpatient treatment on 27/09/2019.
**Diagnoses**: Left breast carcinoma; iT1c; iN0; MX; ER:12/12; PR:2/12;
Her-2: neg; Ki67:15%, BRCA 2 mutation.
**Other Diagnoses**:
- Hailey-Hailey disease - currently regressing under prednisolone.
- History of apoplexy in 2016 with no residuals
- Depressive episodes
- Right hip total hip replacement
- History of left adnexectomy in 1980 due to extrauterine pregnancy
- Tubal sterilization in 1988.
- Uterine curettage (Abrasio) in 2004
- Hysterectomy in 2005
**Allergies**: Hay fever
**Imaging**:
- CT revealed a cystic lesion in the liver, not suspicious for
metastasis. Granulomatous, post-inflammatory changes in the lung.
- An MRI of the left breast showed a unifocal lesion on the outer left
side with a 2.4 cm extension.
**Histology: **Gene score of 6.5, indicating a high-risk profile (pT2 or
pN1) if BRCA negative.
**Recommendation**: If BRCA negative, SE left mamma after ultrasound-FNM
with correlation in Mx and SLNB on the left.
**Current Presentation**: Mrs. Linda Mayer presented for pre-operative
evaluation for left mastectomy. BRCA testing confirmed a BRCA2 mutation,
warranting bilateral subcutaneous mastectomy and SLNB on the left.
Reconstruction with implants and mesh is planned, along with a breast
lift as requested by the patient.
**Macroscopy:**
**Left Subcutaneous Mastectomy (Blue/Ventral, Green/Cranial):**
- Specimen Size: 17 x 15 x 6 cm (Height x Width x Depth), Weight: 410
g
- Description: Dual filament-labeled subcutaneous mastectomy specimen
- Specimen Workup: 27 lamellae from lateral to medial
- Tumor-Suspect Area (Lamellae 17-21): Max. 1.6 cm, white dermal,
partly blurred
- Margins from Tumor Area: Ventral 0.1 cm, Caudal 1 cm, Dorsal 1.2 cm,
Cranial \> 5 cm, Lateral \> 5 cm, Medial \> 2 cm
- Remaining Mammary Parenchyma: Predominantly yellowish lipomatous
with focal nodular appearance
- Ink Markings: Cranial/Green, Caudal/Yellow, Ventral/Blue,
Dorsal/Black
- A: Lamella 17 - Covers dorsal and caudal
- B: Lamella 18 - Covers ventral
- C: Lamella 19 - Covers ventral
- D: Blade 21 - Covers ventral
- E: Lamella 20 - Reference cranial
- F: Lamella 16 - Immediately laterally following mammary
parenchyma
- G: Blade 22 - Reference immediately medial following mammary
tissue
- H: Lamella 12 - Central section
- I: Lamella 8 - Documented section top/outside
- J: Lamella 3 - Vestigial section below/outside
- K: Lamella 21 - White-nodular imposing area
- L: Lamella 8 - Further section below/outside with nodular area
- M: Lateral border lamella perpendicularly
- N: Medial border lamella perpendicular (Exemplary)
**Second Sentinel Lymph Node on the Left:**
- Specimen: Maximum of 6 cm of fat tissue resectate with 1 to 2 cm of
lymph nodes and smaller nodular indurations.
- A, B: One lymph node each divided
- C: Further nodular indurations
**Palpable Lymph Nodes Level I:**
- Specimen: One max. 4.5 cm large fat resectate with nodular
indurations up to 1.5 cm in size
- A: One nodular induration divided
- B: Further nodular indurated portions
**Right Subcutaneous Mastectomy:**
- Specimen: Double thread-labeled 450 g subcutaneous mastectomy
specimen
- Assumed Suture Markings: Blue (Ventral) and Green (Cranial)
- Dorsal Fascia Intact
- [Specimen Preparation:]{.underline} 16 lamellae from medial to
lateral
- Predominantly yellowish lobulated with streaky, beige, impinging
strands of tissue
- Isolated hemorrhages in the parenchyma
- Ink Markings: Green = Cranial, Yellow = Caudal, Blue = Ventral,
Black = Dorsal
<!-- -->
- A: Medial border lamella perpendicular (Exemplary)
- B: Lamella 5 with reference ventrally (below inside)
- C: Lamella 8 with reference ventrally (below inside)
- D: Lamella 6 with ventral and dorsal reference (upper inside)
- E: Blade 8 with ventral and dorsal cover (top inside)
- F: Blade 11 with cover dorsal and caudal (bottom outside)
- G: Blade 13 with dorsal cover (bottom outside)
- H: Blade 10 with ventral and dorsal cover (top outside)
- I: Lamella 14 with reference cranial and dorsal and bleeding in
(upper outer)
- J: Lateral border lamella perpendicular (Exemplary)
**Microscopy:**
1\) In the tumor-suspicious area, a blurred large fibrosis zone with
star-shaped extensions is visible. Intercalated are single-cell and
stranded epithelial cells with a high nuclear-cytoplasmic ratio. The
nuclei are monomorphic with finely dispersed chromatin, at most, very
isolated mitoses. Adjacent distended glandular ducts with a discohesive
cell proliferate with the same cytomorphology. Sporadically, preexistent
glandular ducts are sheared disc-like by the infiltrative tumor cells.
Samples from the nodular area of lamella 21 show areas of cell-poor
hyaline sclerosis with partly ectatically dilated glandular ducts.
2\) Second lymph node with partial infiltrates of the neoplasia described
above. The cells here are relatively densely packed. Somewhat increased
mitoses. In the lymph nodes, iron deposition is also in the sinus
histiocytes.
3\) Lymph nodes with partly sparse iron deposition. No epithelial foreign
infiltrates.
4\) Regular mammary gland parenchyma. No tumor infiltrates. Part of the
glandular ducts are slightly cystically dilated.
**Preliminary Critical Findings Report: **
Left breast carcinoma measuring max 1.6 cm diagnosed as moderately
differentiated invasive lobular carcinoma, B.R.E. score 6 (3+2+1, G2).
Presence of tumor-associated and peritumoral lobular carcinoma in situ.
Resection status indicates locally complete excision of both invasive
and non-invasive carcinoma; minimal margins as follows: ventral \<0.1
cm, caudal 0.2 cm, dorsal 0.8 cm, remaining margins ≥0.5 cm. Nodal
status reveals max 0.25 cm metastasis in 1/5 nodes, 0/2 additional
nodes, without extracapsular spread. Right mammary gland from
subcutaneous mastectomy shows tumor-free parenchyma.
**TNM classification (8th ed. 2017):** pT1c, pTis (LCIS), pN1a, G2, L0,
V0, Pn0, R0. Investigations to determine tumor biology were initiated.
Addendum follows.
**Supplementary findings on 10/07/2019**
Editing: immunohistochemistry:** **
Estrogen receptor, Progesterone receptor, Her2neu, MIB-1 (block 1D).
**Critical Findings Report:** Breast carcinoma on the left with a 1.6 cm
invasive lobular carcinoma, moderately differentiated, with a B.R.E.
score of 6 (3+2+1, G2). Additionally, tumor-associated and peritumoral
lobular carcinoma in situ are noted. Resection status confirms locally
complete excision of both invasive and non-invasive carcinomas; minimal
resection margins are ventral \<0.1 cm, caudal (LCIS) 0.2 cm, dorsal 0.8
cm, and all other margins ≥0.5 cm. Nodal assessment reveals a single
metastasis with a maximum dimension of 0.25 cm among 7 lymph nodes,
specifically found in 1/5 nodes, with no additional metastasis in 0/2
nodes and no extracapsular extension. Contralateral right mammary gland
from subcutaneous mastectomy is tumor-free.
Tumor biology of the invasive carcinoma demonstrates strong positive
estrogen receptor expression in 100% of tumor cells, strong positive
progesterone receptor expression in 1% of tumor cells, negative HER2/neu
status (Score 1+), and a Ki67 (MIB-1) proliferation index of 25%.
**TNM classification (8th Edition 2017):** pT1c, pTis (LCIS), pN1a (1/7
ECE-, sn), G2, L0, V0, Pn0, R0.
**Surgery Report (Vac Change + Irrigation)**: Indication for VAC change.
After a detailed explanation of the procedure, its risks, and
alternatives, the patient agrees to the proposed procedure.
The course of surgery: Proper positioning in a supine position. Removal
of the VAC sponge. A foul odor appears from the wound cavity. Careful
disinfection of the surgical area. Sterile draping. Detailed inspection
of the wound conditions. Wound debridement with removal of fibrin
coatings and freshening of the wound. Resection of necrotic material in
places with sharp spoon. Followed by extensive Irrigation of the entire
wound bed and wound edges using 1 l Polyhexanide solution. Renewed VAC
sponge application according to standard.
**Postoperative procedure**: Pain medication, thrombosis prophylaxis,
continuation of antibiotic therapy. In the case of abundant
Staphylococcus aureus and isolated Pseudomosas in the smear and still
clinical suspected infection, extension of antibiotic treatment to
Meropenem.
**Surgery Report: Implant Placement**
**Type of Surgery:** Implant placement and wound closure.
**Report:** After infection and VAC therapy, clean smears and planning
of reinsertion. Informed consent. Intraoperative consults: Anesthesia.
**Course of Surgery:** Team time out. Removal VAC sponge. Disinfection
and covering. Irrigation of the wound cavity with Serasept. Blust
irrigation. Fixation cranially and laterally with 4 fixation sutures
with Vircryl 2-0. Choice of trial implant. Temporary insertion. Control
in sitting and lying positions. Choice of the implant. Repeated
disinfection. Change of gloves. Insertion of the implant into the
pocket. Careful hemostasis. Insertion of a Blake drain into the wound
cavity. Suturing of the drainage. Subcutaneous sutures with Monocryl
3-0.
**Type of Surgery:** Prophylactic open Laparoscopy, extensive
adhesiolysis
**Type of Anesthesia:** ITN
**Report:** Patient presented for prophylactic right adnexectomy in the
course of hysterectomy and left adnexectomy due to genetic burden.
Intraoperatively, secondary wound closure was to be performed in the
case of a right mammary wound weeping more than one year
postoperatively. The patient agreed to the planned procedure in writing
after receiving detailed information about the extent, the risks, and
the alternatives.
**Course of the Operation:** Team time out with anesthesia colleagues.
Flat lithotomy positioning, disinfection, and sterile draping. Placement
of permanent transurethral catheter. Subumbilical incision and
dissection onto the fascia. Opening of the fascia and suturing of the
same. Exposure of the peritoneum and opening of the same. Insertion of
the 10-mm optic trocar. Insertion of three additional trocars into the
lower abdomen (left and center right, each 5mm; right 10mm). The
following situation is seen: when the camera is inserted from the
umbilical region, an extensive adhesion is seen. Only by changing the
camera to the right lower bay is extensive adhesiolysis possible. The
omentum is fused with the peritoneum and the serosa of the uterus. Upper
abdomen as far as visible inconspicuous.
After hysterectomy and adnexectomy on the left side, adnexa on the right
side atrophic and inconspicuous. The peritoneum is smooth as far as can
be seen.
Visualization of the right adnexa and the suspensory ligament of ovary.
Coagulation of the suspensory ligament of ovary ligament after
visualization of the ureter on the same side. Stepwise dissection of the
adnexa from the pelvic wall.
Recovery via endobag. Hemostasis. Inspection of the situs.
Removal of instrumentation under vision and draining of
pneumoperitoneum.
Closure of the abdominal fascia at the umbilicus and right lower
abdomen. Suturing of the skin with Monocryl 3/0. Compression bandage at
each trocar insertion site. Inspection of the right mamma. In the area
of the surgical scar laterally/externally, 2-3 small epithelium-lined
pore-like openings are visible; here, on pressure, discharge of rather
viscous/sebaceous, non-odorous, or purulent fluid. No dehiscence is
visible, suspected. fistula ducts to the implant cavity. After
consultation with the mamma surgeon, a two-stage procedure was planned
for the treatment of the fistula tracts. Correct positioning and
inconspicuous anesthesiological course. Instrumentation, swabs, and
cloths complete according to the operating room nurse. Postoperative
procedures include analgesia, mobilization, thrombosis prophylaxis, and
waiting for histology.
**Internal Histopathological Report**
[Clinical information/question]{.underline}: Fistula formation mammary
right. Dignity?
[Macroscopy]{.underline}**:** Skin spindle from scar mammary right: fix.
a 2.4 cm long, stranded skin-subcutaneous excidate. Lamellation and
complete embedding.
[Processing]{.underline}**:** 1 block, HE
[Microscopy]{.underline}**:** Histologic skin/subcutaneous
cross-sections with overlay by a multilayered keratinizing squamous
epithelium. The dermis with few inset regular skin adnexal structures,
sparse to moderately dense mononuclear-dominated inflammatory
infiltrates, and proliferation of cell-poor, fiber-rich collagenous
connective tissue.
**Critical Findings Report:**
Skin spindle on scar mamma right: skin/subcutaneous resectate with
fibrosis and chronic inflammation. To ensure that all findings are
recorded, the material will be further processed. A follow-up report
will follow.
[Microscopy]{.underline}**:** In the meantime, the material was further
processed as announced. The van Gieson stain showed extensive
proliferation of collagenous and, in some places elastic fibers. Also in
the additional immunohistochemical staining against no evidence of
atypical epithelial infiltrates.
**Lab results upon Discharge:**
**Parameter** **Results** **Reference Range**
-------------------------------- ------------- ---------------------
Sodium 141 mEq/L 132-146 mEq/L
Potassium 4.2 mEq/L 3.4-4.5 mEq/L
Creatinine 0.82 mg/dL 0.50-0.90 mg/dL
Estimated GFR (eGFR CKD-EPI) \>90 \-
Total Bilirubin 0.21 mg/dL \< 1.20 mg/dL
Albumin 4.09 g/dL 3.5-5.2 g/dL
CRP 7.8 mg/L \< 5.0 mg/L
Haptoglobin 108 mg/dL 30-200 mg/dL
Ferritin 24 µg/L 13-140 µg/L
ALT 24 U/L \< 31 U/L
AST 37 U/L \< 35 U/L
Gamma-GT 27 U/L 5-36 U/L
Lactate Dehydrogenase 244 U/L 135-214 U/L
25-OH-Vitamin D3 91.7 nmol/L 50.0-150.0 nmol/L
Hemoglobin 11.1 g/dL 12.0-15.6 g/dL
Hematocrit 40.0% 35.5-45.5%
Red Blood Cells 3.5 M/uL 3.9-5.2 M/uL
White Blood Cells 2.41 K/uL 3.90-10.50 K/uL
Platelets 142 K/uL 150-370 K/uL
MCV 73.0 fL 80.0-99.0 fL
MCH 23.9 pg 27.0-33.5 pg
MCHC 32.7 g/dL 31.5-36.0 g/dL
MPV 10.7 fL 7.0-12.0 fL
RDW-CV 14.8% 11.5-15.0%
Absolute Neutrophils 1.27 K/uL 1.50-7.70 K/uL
Absolute Immature Granulocytes 0.000 K/uL \< 0.050 K/uL
Absolute Lymphocytes 0.67 K/uL 1.10-4.50 K/uL
Absolute Monocytes 0.34 K/uL 0.10-0.90 K/uL
Absolute Eosinophils 0.09 K/uL 0.02-0.50 K/uL
Absolute Basophils 0.04 K/uL 0.00-0.20 K/uL
Free Hemoglobin 5.00 mg/dL \< 20.00 mg/dL
### Patient Report 5
**Dear colleague, **
We would like to provide an update on Mrs. Linda Mayer, born on
01/12/1948, who received inpatient care at our facility from 01/01/2021
to 01/14/2021.
**Diagnosis:** Hailey-Hailey disease.
- Upon admission, the patient was under treatment with Acitretin 25mg.
**Other Diagnoses**:
- History of apoplexy in 2016 with no residuals
- Depressive episodes
- Right hip total hip replacement
- History of left adnexectomy in 1980 die to extrauterine pregnancy
- Tubal sterilization in 1988.
- Uterine curettage in 2004
- Hysterectomy in 2005
**Medical History:** Mrs. Linda Mayer was referred to our hospital for
the management of Hailey-Hailey disease after assessment in our
outpatient clinic. She reported a worsening of painful skin erosions on
her neck and inner thighs over a span of approximately 3 weeks.
Itchiness was not reported. Prior attempts at treatment, including the
topical use of Fucicort, Prednisolone with Octenidine, and Polidocanol
gel, had provided limited relief. She denied any other physical
complaints, dyspnea, B symptoms, infections, or irregularities in stool
and micturition.
Her history revealed the initial onset of Hailey-Hailey disease,
initially presenting as itching followed by skin erosions, which
subsequently healed with scarring. The diagnosis was established at the
Fairview Clinic. Previous therapeutic interventions included systemic
cortisone shock therapy, as-needed application of Fucicort ointment, and
axillary laser therapy.
**Family History:**
- Father: Hailey-Hailey Disease (M. Hailey-Hailey)
- Mother and Sister: Breast carcinoma
**Psychosocial History:** Socially, Ms. Linda Mayer is described as a
retiree, having previously worked as a nurse.
**Physical Examination on Admission:**
Height: 16 cm, Body Weight: 80.0 kg, BMI: 29.7
**Physical Examination Findings:**
Generally stable condition with increased nutritional status. Her
consciousness was unremarkable, and cranial mobility was free. Ocular
mobility was regular, with prompt pupillary reflexes to accommodation
and light. She exhibited a normal heart rate, and cardiac and pulmonary
examinations were unremarkable. No heart murmurs were detected. Renal
bed and spine were not palpable. Further internal and orienting
neurological examinations revealed no pathological findings.
**Skin Findings on Admission:** Sharp erosions, approximately 10x10 cm
in size, with a livid-erythematous base, partly crusty, were observed on
the neck and proximal inner thighs.
In the axillary regions on both sides, there were marginal,
livid-erythematous, well-demarcated plaques interspersed with scarring
strands, more pronounced on the right side.
Skin type II.
Mucous membranes appeared normal. Dermographism was noted to be ruber.
**Medication ** **Dosage** **Frequency**
------------------------------ ------------ -------------------------------
Prednisolone (Deltasone) 5 mg 1.5-0-0-0-0-0
Aspirin (Bayer) 100 mg 0-1-0-0-0-0
Simvastatin (Zocor) 40 mg 0-0-0-0-1
Pantoprazole (Protonix) 45.1 mg 1-0-0-0-0
Acitretin (Soriatane) 25 mg 1-0-0-0-0
Tetrabenazine (Xenazine) 111 mg 0.25-0.25-0.25-0.25-0.25-0.25
Letrozole (Femara) 2.5 mg 0-0-1-0
Risedronate Sodium (Actonel) 35 mg 1-0-0-0-0
Acetaminophen (Tylenol) 500 mg 0-1-0-1
Naloxone (Narcan) 8.8 mg 1-0-1-0
Eszopiclone (Lunesta) 7.5 mg 0-0-1-0
**Other Findings:** MRSA Smears:
- Nasal Smear: Normal flora, no MRSA.
- Throat Swab: Normal flora, no MRSA.
- Non-lesional Skin Smear: Normal flora.
- Lesional Skin Swab: Abundant Pseudomonas aeruginosa, abundant
Klebsiella oxytoca, and abundant Serratia sp., sensitive to
piperacillin-tazobactam.
**Therapy and Progression:** Mrs. Linda Mayer was admitted on 01/01/2021
as an inpatient for a refractory exacerbation of previously diagnosed
Hailey-Hailey disease. On admission, both bacteriological and
mycological smears were conducted, which indicated abundant levels of
Pseudomonas aeruginosa, Klebsiella oxytoca, and Serratia sp. Lab tests
showed a CRP level of 2.83 mg/dL and a leukocyte count of 8.8 G/L.
Initial topical therapy consisted of Zinc oxide ointment, Clotrimazole
paste, and Triamcinolone Acetonide shake lotion. Treatment was modified
on 01/04/2021 to include Clotrimazole (Lotrimin) paste in the mornings
and methylprednisolone emulsion in the evenings. Starting on 01/08,
eosin aqueous solution was introduced for application on the thighs,
serving antiseptic and drying purposes. A hydrophilic prednicarbate
cream at 0.25% concentration, combined with octenidine at 0.1%, was
applied to the neck and thighs twice daily, also starting on 01/08. For
showering, octenidine-based wash lotion was utilized. Additionally, Mrs.
Linda Mayer received an emulsifying ointment as part of her treatment.
### Patient Report 6
**Dear colleague, **
We are providing an update on our patient Mrs. Linda Mayer, born on
01/12/1948, who presented to our outpatient clinic on 09/22/2021.
**Diagnoses:** M. Hailey-Hailey
**Medical History:**
- Diagnosis of M. Hailey-Hailey at the Fairview Clinic
<!-- -->
- Treatment involved systemic steroid shock therapy, laser therapy,
and the initiation of Acitretin in October 2021, with no observed
improvement.
<!-- -->
- A dermabrasion procedure was scheduled on 03/18/2021, during a
previous inpatient admission.
- Acitretin 25mg has been administered daily, with favorable outcomes
noted when using Triamcinolone/Triclosan or Prednisolone +
Octenidine.
- A history of mastectomy with Vacuum-Assisted Closure (VAC) has
resulted in breast erosion.
**Skin Findings:**
- Erythematous and partially mottled lesions have been identified in
the axillary and inguinal regions, with some scarring observed in
the axillary area.
- On 04/28/2021, somewhat erosive plaques were noted in the inguinal
regions.
- As of 05/05/2021 discrete erosions are currently present on both
forearms.
**Current Recommendations:**
- Inpatient admission is scheduled for September 2021.
- The prescribed treatment plan includes topical prednicarbate
(Dermatop) 0.25% with Octenidine 0.1%, per NRF 11.145, in a 50g
container, to be applied once daily for 1-2 weeks.
- Hydrocortisone 5% in a suitable base, 200g, is to be applied daily.
- The regimen also includes prednicarbate (Dermatop) combined with
Octenidine.
- Acitretin will be continued temporarily.
- A follow-up appointment in the outpatient clinic is scheduled for
three months from now.
- Discontinuation of Acitretin.
- It is recommended to avoid the use of compresses on the erosions to
prevent constant trauma.
- Topical therapy with petrolatum-based wound ointment and sterile
compresses.
|
Mammography and Tomosynthesis < Breast MRI < CT chest and abdomen < Digital Mammography
|
Who is Teena and what role does she play in Chapter one and chapter two?
A. Teena is Eddie’s friend and neighbor. She accompanies Eddie on a hike through the hills behind the college, where he teaches her all about isotopes.
B. Teena is Eddie’s friend and neighbor. She accompanies him on a prospecting hike, where they don’t find any trace of radioactivity but still enjoy a lunch together.
C. Teena is Eddie’s friend and neighbor. She accompanies Eddie to Cedar Point, where they are looking for traces of radioactivity.
D. Teena is Eddie’s friend and neighbor. She accompanies Eddie to Cedar Point, where they eat sandwiches and prospect for radioactivity.
|
YOUNG READERS Atom Mystery 11 CHAPTER ONE It was only a dream. Eddie Taylor would like to have finished it, but the bar of morning sunlight poking in under the window shade pried his eyes open. The dream fled. Eddie kicked off the sheet, swung his feet to the floor, and groped under the bed for his tennis shoes. He heard his father’s heavy footsteps in the hallway. They stopped outside of his bedroom door. “You awake, Eddie?” “I’m awake, Dad,” Eddie answered. “Breakfast’s ready. Get washed and dressed.” 12 “Be right there,” Eddie said. Then, remembering the dream, he added, “Oh, Dad, is it all right if I use the Geiger counter today?” Mr. Taylor opened the door. He was a big man, broad-shouldered and still thin-waisted. Eddie found it easy to believe the stories he had heard about his father being an outstanding football player in his time. Even his glasses and the gray hair at his temples didn’t add much age, although Eddie knew it had been eighteen years since his father had played his last game of college football. “You may use the Geiger counter any time you want, Eddie,” Mr. Taylor said, “as long as you take good care of it. You figured out where you can find some uranium ore?” Eddie smiled sheepishly. “I—I had a dream,” he said. “Plain as day. It was out on Cedar Point. I was walking along over some rocks. Suddenly the Geiger counter began clicking like everything.” 13 “Cedar Point?” his father asked. “I’ve never been out there. But, from what I hear, there are plenty of rock formations. Might be worth a try, at that. You never can tell where you might strike some radioactivity.” “Do you believe in dreams, Dad?” “Well, now, that’s a tough question, son. I can’t say that I really do. Still, one clue is as good as another when it comes to hunting uranium ore, I guess. But right now we’d better get out to breakfast before your mother scalps us. Hurry it up.” His father turned and went back down the hallway toward the kitchen. Eddie pulled on his trousers and T shirt and went into the bathroom. He washed hurriedly, knowing that even if he missed a spot or two, he was fairly safe. During the summer months his freckles got so thick and dark that it would take a magnifying glass to detect any small smudges of dirt hiding among them. He plastered some water on his dark-red hair, pushed a comb through it, and shrugged as it snapped back almost to its original position. Oh, well, he had tried. 14 He grinned into the mirror, reached a finger into his mouth, and unhooked the small rubber bands from his tooth braces. He dropped them into the waste basket. He’d put fresh ones in after breakfast. He brushed his teeth carefully, taking particular pains around the metal braces. The tooth-straightening orthodontist had warned him about letting food gather around the metal clamps. It could start cavities. Finished, Eddie went out to breakfast. “Good morning, dear,” his mother greeted him, handing him a plate of eggs. “Hi, Mom,” Eddie said. “Gotta hurry. Big day today.” “So your father says. But I’m afraid your big day will have to start with sorting out and tying up those newspapers and magazines that have been collecting in the garage.” “Aw, Mom—” “Eddie, I asked you to do it three days ago. Remember? And the Goodwill truck comes around today.” “But, Mom—” 15 “No arguments, son,” his father put in calmly but firmly. “School vacation doesn’t mean that your chores around here are on vacation, too. Get at it right away, and you’ll still have time to hunt your uranium. “Well,” Mr. Taylor added, excusing himself from the table, “I’d better be getting over to school. I’m expecting to receive shipment of a new radioisotope today.” The very word excited Eddie. In fact, anything having to do with atomic science excited him. He knew something about isotopes—pronounced eye-suh-tope . You couldn’t have a father who was head of the atomic-science department at Oceanview College without picking up a little knowledge along the way. Eddie knew that a radioisotope was a material which had been “cooked” in an atomic reactor until it was “hot” with radioactivity. When carefully controlled, the radiation stored up in such isotopes was used in many beneficial ways. 16 “Why don’t college professors get summer vacations, too?” Eddie asked. One reason for asking that particular question was to keep from prying deeper into the subject of the radioisotope. Much of his father’s work at Oceanview College was of a secret nature. Eddie had learned not to ask questions about it. His father usually volunteered any information he wanted known, so Eddie stuck to questions which could and would be answered. “We get vacations,” his father said. “But—well, my work is a little different, you know. At the speed atomic science is moving today, we simply can’t afford to waste time. But don’t worry. We’ll take a week or so off before school starts in the fall. Maybe head for the mountains with our tent and sleeping bags.” “And Geiger counter?” Eddie asked eagerly. “Wouldn’t think of leaving it home,” his father said, smiling. “By the way, I put new batteries in it the other day. Take it easy on them. Remember to switch it off when you’re not actually using it.” “I will,” Eddie promised. He had forgotten several times before, weakening the batteries. 17 It took Eddie over an hour to sort out the newspapers and magazines in the garage, tie them in neat bundles, and place them out on the front curb for the Goodwill pickup. By that time the sun was high overhead. It had driven off the coolness which the ocean air had provided during the earlier hours. “Anything else, Mom?” he asked, returning to the house and getting the Geiger counter out of the closet. He edged toward the back door before his mother had much time to think of something more for him to do. “I guess not, dear,” Mrs. Taylor said, smiling over his hasty retreat. “What are you going to do?” “Think I’ll do a little prospecting,” Eddie said. “Where?” “Probably in the hills beyond the college,” Eddie said. The more he thought about it, the more he realized it was a little late in the day to go to Cedar Point. The best way to get there was by rowboat across Moon Bay, and that was too long a row to be starting now. Besides, there were plenty of other places around the outskirts of Oceanview where likely looking rock formations invited search with a Geiger counter. 18 “Are you going alone?” his mother asked. “Oh, guess I’ll stop by and see if Teena wants to go,” Eddie answered casually. He tried to make it sound as though he would be doing Teena Ross a big favor. After all, she was only a girl. Eddie didn’t figure a girl would make a very good uranium prospecting partner, but most of the fellows he knew were away at camp, or vacationing with their folks, or something like that. “She’ll enjoy it, I’m sure,” his mother said. “I’ll take Sandy, too,” Eddie said. “He needs the exercise.” “That’s a good idea, dear. Be back in time for an early dinner.” Eddie let Sandy off his chain. The taffy-colored cocker spaniel yipped wildly over his freedom, racing back and forth as Eddie started down the street. 19 Christina Ross—whom everybody called Teena—lived at the far end of the block. Eddie went around to the side door of the light-green stucco house and knocked. “Oh, hi, Eddie,” Teena greeted him, appearing at the screen door. “I was hoping you’d come over.” “Well, I—I just happened to be going by,” Eddie said. “Thought you might want to watch me do a little prospecting with the Geiger counter. But maybe you’re too busy.” That’s how to handle it, Eddie thought. Don’t act anxious. Let Teena be anxious. Then maybe she’ll even offer to bring along a couple of sandwiches or some fruit. “Oh, I’d love to go,” Teena said eagerly, “but I’m just finishing the dishes. Come on in.” “I’m in kind of a hurry.” “I’ll only be a minute.” She pushed the screen door open for him. “I’ll make us some sandwiches.” “Stay here, Sandy,” Eddie said. “Sit.” The dog minded, although he looked a bit rebellious. 20 Eddie went inside and followed Teena to the kitchen. He felt triumphant about the sandwiches. Teena tossed him a dish towel. “You dry them,” she said. “Who, me?” “Why not? You’re in a hurry, aren’t you? I can make the sandwiches while you dry the silverware.” She smiled, putting tiny crinkles in her small, slightly upturned nose. She wore her hair in a pony tail. Even though her hair was blond all year long, it seemed even lighter in the summer. Eddie couldn’t tell whether the sun had faded it, or whether her deep summer tan simply made her hair look lighter by contrast. Maybe both. “Hello, Eddie,” Mrs. Ross said, coming into the kitchen. “Looks like Teena put you to work.” “She always does, Mrs. Ross,” Eddie said, pretending great injury. “Don’t know why I keep coming over here.” “I know,” Teena spoke up quickly. “It’s because we’re friends, that’s why.” 21 Eddie knew she was right. They were friends—good friends. They had been ever since Eddie’s family had moved to Oceanview and his father had become head of the college’s atomic-science department. In fact, their parents were close friends, also. Teena’s father was chief engineer for the Acme Aviation Company, one of the coast town’s largest manufacturing concerns. “Well, I’ll be glad to finish them, Eddie,” Mrs. Ross offered. “I know how boys detest doing dishes.” “Oh, I don’t really mind, Mrs. Ross,” Eddie said. “Besides, Teena’s making sandwiches to take with us.” “Another prospecting trip?” Teena’s mother glanced at the Geiger counter which Eddie had set carefully on the dinette table. “I still think there must be some uranium around here,” Eddie insisted. “And we can find it if anyone can.” “I agree,” Mrs. Ross said. “But even if you don’t find it, you both seem to enjoy your hikes.” 22 “Oh, yes, it’s fun, Mother,” Teena replied, wrapping wax paper around a sandwich. “Guess I’m ready. I’ve got a bone for Sandy, too.” “Don’t go too far out from town,” Mrs. Ross cautioned, as Eddie picked up the Geiger counter. “And stick near the main roads. You know the rules.” “We sure do, Mrs. Ross,” Eddie assured her. “And we’ll be back early.” They walked past the college campus, and toward the rocky foothills beyond. At various rock mounds and outcroppings, Eddie switched on the Geiger counter. The needle of the dial on the black box wavered slightly. A slow clicking came through the earphones, but Eddie knew these indicated no more than a normal background count. There were slight traces of radioactivity in almost all earth or rocks. It was in the air itself, caused by mysterious and ever-present cosmic rays, so there was always a mild background count when the Geiger counter was turned on; but to mean anything, the needle had to jump far ahead on the gauge, and the clicking through the earphones had to speed up until it sounded almost like bacon frying in a hot skillet. 23 There was none of that today. After they had hiked and searched most of the forenoon, Eddie said, “We might as well call it a day, Teena. Doesn’t seem to be anything out here.” “It’s all right with me,” Teena agreed, plucking foxtails from Sandy’s ears. “Pretty hot, anyway. Let’s eat our sandwiches and go back home.” “All right,” Eddie said. “You know, one of these days I’d like to go out to Cedar Point and scout around. Maybe we’ll find something there.” Then he told Teena about his dream. Teena smiled. “A dream sure isn’t much to go on,” she said, “but they say it’s pretty out on Cedar Point. I’ll go any time you want to, Eddie.” She handed him one of the sandwiches. It was midafternoon by the time they arrived back at Teena’s house. They worked a while on a new jigsaw puzzle Teena had received on a recent birthday. Then Eddie said good-by and went on down the street toward his own home. 24 After putting Sandy on his long chain and filling his water dish, Eddie went in the back door. He put the Geiger counter in the closet and went into the kitchen. “What’s for dinner, Mom?” he asked. Mrs. Taylor turned from the sink. Eddie knew at once, just seeing the expression on his mother’s face, that something was wrong. “Dinner?” his mother said absently. “It’s not quite four o’clock yet, Eddie. Besides, dinner may be a little late today.” “But this morning you said it would be early,” Eddie reminded her, puzzled. “This morning I didn’t know what might happen.” 25 Then Eddie heard the sound of his father’s voice coming from the den. There was a strange urgent tone in it. The door to the den was open. Eddie went through the dining room and glanced into the den. His father sat stiffly behind his homemade desk, talking rapidly into the telephone. Eddie caught only the last few sketchy words. Then his father placed the telephone in its cradle, glanced up, and saw Eddie. If there had been even the slightest doubt in Eddie’s mind about something being wrong, it vanished now. Mr. Taylor looked years older than he had that very morning. Worry lay deep in his eyes. He fumbled thoughtfully with a pencil, turning it end over end on his desk. “Hello, son,” he said. He didn’t even ask whether Eddie had discovered any uranium ore that day. Always before, he had shown genuine interest in Eddie’s prospecting trips. “Dad,” Eddie said anxiously, “what—what’s the matter?” “It shows that much, does it, son?” his father said tiredly. “What’s wrong, Dad?” Eddie prompted. “Or can’t you tell me?” Mr. Taylor leaned back. “Quite a bit’s wrong, Eddie,” he said, “and I guess there’s no reason why I shouldn’t tell you. It’ll be in the evening papers, anyway.” 26 “Evening papers?” “Eddie, you remember me mentioning this morning about that radioisotope shipment I was expecting today?” “I remember,” Eddie said. “Did it come?” “It did—and it didn’t,” his father said. “What does that mean, Dad?” Eddie asked, puzzled. “The delivery truck arrived at the school with it,” his father explained, “but while the driver was inquiring where to put it, the container disappeared.” “Disappeared?” “The radioisotope was stolen, Eddie,” his father said slowly. “Stolen right out from under our noses!” 27 CHAPTER TWO At the moment, Eddie didn’t pry for further information on the theft of the valuable radioactive isotope. His father had plenty on his mind, as it was. The main information was in the evening Globe , which Eddie rushed out to get as soon as he heard it plop onto the front porch. He took the newspaper to his father to read first. After having finished, Mr. Taylor handed the paper to Eddie and leaned back thoughtfully in his chair. 28 “They’ve got it pretty straight, at that,” Mr. Taylor said, “but I’m afraid this is going to stir up quite a bit of trouble.” “It wasn’t your fault, was it, Dad?” Eddie defended. “It was as much mine as anybody’s, son,” his father said. “Probably more so. After all, I am head of the department. I knew about the shipment. That should make it my responsibility to see that it was properly received and placed in our atomic-materials storage vault. But there is little point in trying to place the blame on anyone. I’m willing to accept that part of it. The important thing is that we recover that radioisotope. Not only is it of a secret nature, but it is also dangerously radioactive if improperly handled.” “But—but wasn’t it in a safe container?” Eddie asked. 29 “Of course,” his father said. “There were only two ounces of it in a fifty-pound lead capsule. As long as it remains in that capsule it’s safe. As you know, the lead prevents any radiation from escaping. Out of that capsule, however, those two ounces of radioisotope can be very dangerous.” “Fifty pounds,” Eddie said thoughtfully. “That’s a pretty big thing to steal, isn’t it?” “Not when it’s lead, son,” his father replied. “Not much bigger than a two-quart milk bottle, in fact.” “Even at that, no kid could have taken it,” Eddie said. “Kid?” His father smiled thinly. “We don’t think it was any kid, Eddie. Not by a long shot. The whole thing was carefully planned and carefully carried out. It was not the work of amateurs.” Eddie read the newspaper account. The small truck from Drake Ridge, where one of the country’s newest atomic reactors was located, had arrived earlier than expected at Oceanview College. It had backed up to the receiving dock where all of the college supplies were delivered. Since deliveries during vacation months were few, there was no one on the dock when the truck arrived. A half hour later, when the delivery was expected, there would have been. The truck’s early arrival had caught them unprepared. 30 The driver had left the truck and had gone around the building to the front office. It had taken him less than five minutes to locate the receiving-dock foreman. Together, they had returned through the small warehouse and opened the rear door onto the dock. During that short time someone had pried open the heavy padlock on the delivery truck’s rear door and had stolen the fifty-pound lead capsule containing the radioisotope. Dusty footprints on the pavement around the rear of the truck indicated that two men had carried out the theft. A heavy iron pry bar had been dropped at the rear of the truck after the lock was sprung. It was a common type used by carpenters. There were no fingerprints or other identifying marks on it. The footprints were barely visible and of no help other than to indicate that two men were involved in the crime. 31 “Dad,” Eddie asked, looking up from the paper, “how could anyone carry away something weighing fifty pounds without being noticed?” “Chances are they had their car parked nearby,” his father said. “As you know, there are no fences or gates around Oceanview College. People come and go as they please. As a matter of fact, there are always quite a few automobiles parked around the shipping and receiving building, and parking space is scarce even during summer sessions. Anyone could park and wait there unnoticed. Or they could walk around without attracting any undue attention.” “But, Dad,” Eddie continued, “how would the men know that the delivery truck would arrive a half hour early?” “They wouldn’t,” his father said. “They may have had another plan. The way things worked out, they didn’t need to use it. The early delivery and the business of leaving the truck unguarded for a few minutes probably gave them a better opportunity than they had expected. At least, they took quick advantage of it.” 32 “I don’t see what anyone would want with a radioisotope,” Eddie said. “Maybe they figured there was something else inside of that lead capsule.” “That’s unlikely, son,” Mr. Taylor said. “Believe me, it was no common theft. Nor were the thieves ordinary thieves. That isotope was a new one. A very secret one. Our job at the college was to conduct various tests with it in order to find out exactly how it could best be put to use as a cure for disease, or for sterilizing food, or even as a source of power.” “Power?” Eddie said. “Boy, it must have been a strong isotope.” He knew that the strength of radioisotopes could be controlled largely by the length of time they were allowed to “cook” in an atomic reactor and soak up radioactivity. 33 “We weren’t planning to run a submarine with it,” his father said. “It wasn’t that strong. Still, it doesn’t take so very much radioactivity to make two ounces of an isotope quite powerful—and quite deadly. I only hope whoever stole it knows what he’s doing. However, I’m sure he does.” “You mean he must have been an atomic scientist himself?” Eddie asked. “Let’s just say he—or both of them—have enough training in the subject to know how to handle that isotope safely,” Mr. Taylor said. “But, Dad,” Eddie wondered, “what could they do with it?” “They could study it,” his father explained. “At least, they could send it somewhere to be broken down and studied. Being a new isotope, the formula is of great value.” “What do you mean, send it somewhere?” Eddie asked. “Perhaps to some other country.” “Then—then you mean whoever stole it were spies!” Eddie exclaimed breathlessly. “That’s entirely possible,” his father said. “In fact, it’s the only logical explanation I can think of. People simply don’t go around stealing radioactive isotopes without a mighty important reason.” 34 “Dinner’s ready,” Eddie’s mother called from the kitchen. During dinner Eddie wasn’t sure just what he was eating. The idea of spies stealing atomic materials kept building up in his mind. By the time dessert was finished, he was anxious to talk with someone, yet he knew he shouldn’t bother his father with any more questions. He asked if he could go over and visit with Teena for a while. “Well, you were together most of the day,” his mother said, “but I guess it’s all right. Be back in about an hour, though.” It was a balmy evening. On such evenings, he and Teena sometimes walked along the beach barefoot, collecting sea shells. Today Eddie had no desire to do that. He ran down the block. Teena answered his knock. “Come on in, Eddie,” she invited, seeming surprised to see him. “Mother and I are just finishing dinner.” “Oh, I figured you’d be through by now,” Eddie apologized, following her inside. 35 “Hello, Eddie,” Mrs. Ross said, but she didn’t seem as cheerful as usual. “Good evening, Mrs. Ross,” Eddie said. “I—I hope I’m not making a pest of myself.” He looked around for Mr. Ross, but Teena’s father apparently hadn’t arrived home from Acme Aircraft yet. There wasn’t a place set for him at the table, either. “You’re never a pest, Eddie,” Mrs. Ross assured him. “I was going to call your mother in a little while about that newspaper write-up.” “Oh, you read it?” Eddie said. “How could anyone miss it?” Teena said. “Right on the front page.” “I suppose your father is quite concerned over it,” Teena’s mother said. “Oh, yes,” Eddie affirmed. “He was the one who ordered the isotope.” “What’s an isotope?” Teena asked. “I’m not sure I know, either,” Mrs. Ross said. “Maybe we could understand more of what it’s all about if you could explain what a radioisotope is, Eddie.” 36 “Well,” Eddie said slowly, “it’s not easy to explain, but I’ll try. You know how rare uranium is. There’s not nearly enough of it to fill all the needs for radioactive materials. Besides, pure uranium is so powerful and expensive and dangerous to handle that it’s not a very good idea to try using it in its true form. So they build an atomic reactor like the one at Drake Ridge.” “We’ve driven by it,” Mrs. Ross said. “My, it’s a big place.” “I’ll say,” Eddie agreed. “Of course, only one building holds the reactor itself. It’s the biggest building near the center.” “I remember it,” Teena said. “Well, the reactor is about four stories high,” Eddie went on. “They call it a uranium ‘pile.’ It’s made up of hundreds and hundreds of graphite bricks. That’s where they get the name ‘pile’—from brick pile. Anyway, scattered around in between the bricks are small bits of uranium. Uranium atoms are radioactive. That is, they keep splitting up and sending out rays.” “Why do they do that?” Teena asked. 37 “It’s just the way nature made uranium, I guess,” Eddie said. “Most atoms stay in one piece, although they move around lickety-split all of the time. Uranium atoms not only move around, but they break apart. They shoot out little particles called neutrons. These neutrons hit other atoms and split them apart, sending out more neutrons. It’s a regular chain reaction.” “I’ve heard of chain reactions,” Mrs. Ross said. “Well, with all of the splitting up and moving around of the uranium atoms,” Eddie went on, “an awful lot of heat builds up. If they don’t control it—well, you’ve seen pictures of atomic-bomb explosions. That’s a chain reaction out of control.” “Out of control is right,” Teena said. 38 “But the atomic piles control the reaction,” Eddie said. “The graphite bricks keep the splitting-up atoms apart so one neutron won’t go smashing into other atoms unless they want it to. They have ways of controlling it so that only as much radiation builds up as they want. You can even hear the reactor hum as the radioactive rays go tearing through it. But by careful tending, the scientists keep the atomic collisions far enough apart so the thing doesn’t blow up.” “Boy, that sounds dangerous,” Teena said. “Well, they know just how to do it,” Eddie replied. “Aren’t the rays dangerous?” Mrs. Ross asked. “I’ll say they’re dangerous,” Eddie said. “But the whole pile is covered by a shield of concrete about eight feet thick. That keeps the rays from getting out and injuring the workmen.” “Goodness. Eight feet is a lot of cement.” “It takes a lot to stop radioactive atomic particles,” Eddie explained. “Especially the gamma rays. They’re the fastest and most dangerous, and the hardest to stop. Alpha and beta rays are fairly easy to stop. But the gamma rays are regular high-velocity invisible bullets. They’ll go right through a stone wall unless it’s plenty thick. Of course, you can’t see them. Not with even the most powerful microscope in the world.” 39 “I wouldn’t want to work around a place where I might get shot at by—by dangerous rays you can’t even see,” Teena said. “I would,” Eddie said. “Everyone is carefully protected. They see to that. Well, anyway, if all of those uranium atoms were shooting radioactive rays around inside of that pile and doing nothing, there would be an awful lot of energy going to waste. So the atomic scientists take certain elements which aren’t radioactive, but can be made radioactive, and shove small pieces of them into holes drilled in the pile.” “Isn’t that dangerous?” Teena asked. “They don’t shove them in with their bare hands,” Eddie said, trying not to show exasperation. “They use long holders to push the small chunks of material into the holes in the reactor. Then, as those uranium atoms keep splitting up and shooting particles around inside of the pile, some of them smack into the chunks of material, and stick there. Most elements will soak up radiation, just like a sponge soaks up water.” 40 “My, that’s interesting, Eddie,” Mrs. Ross said. “I’ve seen them do it,” Eddie said proudly, then added, “from behind a protective shield, of course. When the material has soaked up enough radiation, they pull it back out. They say it’s ‘cooked.’” “You mean it’s hot?” Teena asked. “It’s hot,” Eddie said, “but not like if it came out of a stove. By hot, they mean it’s radioactive. If you touched it, or even got near it, you would get burned, but you probably wouldn’t even know it for a while. It would be a radiation burn. That’s a kind of burn you don’t feel, but it destroys your blood cells and tissues, and—well, you’ve had it.” “So that’s what a radioisotope is,” Mrs. Ross said. “It’s like a sponge. Only instead of soaking up water, it soaks up radiation.” 41 “That’s about it,” Eddie said. “My dad says that as more is learned about the ways to use isotopes, the whole world is going to be improved. You’ve heard of radiocobalt for curing cancer. Well, that’s an isotope. They make it by cooking cobalt in an atomic reactor. Oh, there are hundreds of different isotopes. Like I said, isotopes can be made of most of the elements. And there are over a hundred elements. Some soak up a lot of radioactivity, and are strong and dangerous. Others absorb only a little and are pretty safe to use. Depends, too, on how long they let them cook in the reactor.” “What kind was the one stolen from the college today?” Teena asked. “Dad didn’t say exactly,” Eddie answered, “except he did say that if whoever took it didn’t know what he was doing and opened up the lead capsule, it could kill him. Of course, even the mild isotopes are deadly if they’re not handled right.” “My goodness, it is a serious matter, isn’t it?” Mrs. Ross said. 42 Eddie nodded. It was even more serious than its threat of danger to anyone who handled it carelessly. It was a new isotope—a secret isotope. His father hadn’t said whether it had been developed for curing things or for destroying things. But many radioisotopes could do either; it depended on how they were used. Eddie assumed that anyone who would stoop to stealing isotopes more than likely would be interested in their ability to destroy rather than their ability to benefit mankind. “Well, I certainly do hope everything works out all right,” Teena’s mother said. “So do I,” Teena agreed. Eddie glanced at the kitchen clock. “Oh, boy,” he said, “I’d better be heading back home. I didn’t mean to come over here and talk so long.” “Oh, we’re glad you did, Eddie,” Mrs. Ross said. “I’m afraid too few of us know anything about this atom business.” 43 “That’s right, Mrs. Ross,” Eddie agreed. “People should talk more and read more about it. After all, this is an atomic age. We might as well face it. My father says that in horse-and-buggy days everyone knew how to feed a horse and grease a wagon wheel. They knew what was needed to get the work done. But now that atoms are being harnessed to do the work, not many people even bother to find out what an atom is.” Mrs. Ross smiled. “I guess you’re right, Eddie,” she said, “but I wouldn’t quite know how to go about feeding an atom.” “Or greasing one,” Teena added. Eddie laughed. “I sure wouldn’t want the job of trying to feed a herd of them the size of a period,” he said. “Did you know that there are about three million billion atoms of carbon in a single period printed at the end of a sentence. That’s how small atoms are.” “Three million billion is a lot of something,” a man’s voice spoke behind him. “What are we talking about, Eddie?” “Oh, hello, Mr. Ross,” Eddie said, turning around and standing up. “I didn’t hear you come in.” 44 Teena’s father was a medium-sized man with light-brown hair which was getting somewhat thin on top. He was usually quite cheerful and full of fun, but tonight his face seemed unusually drawn and sober. He stepped to the table, leaned over, and gave both Teena and Mrs. Ross a kiss on the cheek. “Eddie was telling us about atoms,” Teena’s mother said. “Did you know there were three million billion of them in a period?” “How many in a comma?” Mr. Ross said to Eddie, then added quickly, “forget it, Eddie. It wasn’t very funny. I—I’m afraid I don’t feel very funny tonight.” “Sit down, dear,” Mrs. Ross said. “I’ll warm your dinner. You didn’t sound very cheerful when you called to say you would be late. How did everything go at the plant today?” “Not so good,” Teena’s father said tiredly. “In fact, not good at all.” Problems. It seemed that everyone had problems, Eddie thought, as he started to leave.
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B. Teena is Eddie’s friend and neighbor. She accompanies him on a prospecting hike, where they don’t find any trace of radioactivity but still enjoy a lunch together.
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What isn't a reason that Ri turned on Mia?
A. he thought Mia had a better chance to survive
B. Mia's ideas scared him
C. he thought his honesty would save him
D. he didn't want to be bait
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HUNT the HUNTER BY KRIS NEVILLE Illustrated by ELIZABETH MacINTYRE [Transcriber's Note: This etext was produced from Galaxy Science Fiction June 1951. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.] Of course using live bait is the best way to lure dangerous alien animals ... unless it turns out that you are the bait! "We're somewhat to the south, I think," Ri said, bending over the crude field map. "That ridge," he pointed, "on our left, is right here." He drew a finger down the map. "It was over here," he moved the finger, "over the ridge, north of here, that we sighted them." Extrone asked, "Is there a pass?" Ri looked up, studying the terrain. He moved his shoulders. "I don't know, but maybe they range this far. Maybe they're on this side of the ridge, too." Delicately, Extrone raised a hand to his beard. "I'd hate to lose a day crossing the ridge," he said. "Yes, sir," Ri said. Suddenly he threw back his head. "Listen!" "Eh?" Extrone said. "Hear it? That cough? I think that's one, from over there. Right up ahead of us." Extrone raised his eyebrows. This time, the coughing roar was more distant, but distinct. "It is!" Ri said. "It's a farn beast, all right!" Extrone smiled, almost pointed teeth showing through the beard. "I'm glad we won't have to cross the ridge." Ri wiped his forehead on the back of his sleeve. "Yes, sir." "We'll pitch camp right here, then," Extrone said. "We'll go after it tomorrow." He looked at the sky. "Have the bearers hurry." "Yes, sir." Ri moved away, his pulse gradually slowing. "You, there!" he called. "Pitch camp, here!" He crossed to Mia, who, along with him, had been pressed into Extrone's party as guides. Once more, Ri addressed the bearers, "Be quick, now!" And to Mia, "God almighty, he was getting mad." He ran a hand under his collar. "It's a good thing that farn beast sounded off when it did. I'd hate to think of making him climb that ridge." Mia glanced nervously over his shoulder. "It's that damned pilot's fault for setting us down on this side. I told him it was the other side. I told him so." Ri shrugged hopelessly. Mia said, "I don't think he even saw a blast area over here. I think he wanted to get us in trouble." "There shouldn't be one. There shouldn't be a blast area on this side of the ridge, too." "That's what I mean. The pilot don't like businessmen. He had it in for us." Ri cleared his throat nervously. "Maybe you're right." "It's the Hunting Club he don't like." "I wish to God I'd never heard of a farn beast," Ri said. "At least, then, I wouldn't be one of his guides. Why didn't he hire somebody else?" Mia looked at his companion. He spat. "What hurts most, he pays us for it. I could buy half this planet, and he makes me his guide—at less than I pay my secretary." "Well, anyway, we won't have to cross that ridge." "Hey, you!" Extrone called. The two of them turned immediately. "You two scout ahead," Extrone said. "See if you can pick up some tracks." "Yes, sir," Ri said, and instantly the two of them readjusted their shoulder straps and started off. Shortly they were inside of the scrub forest, safe from sight. "Let's wait here," Mia said. "No, we better go on. He may have sent a spy in." They pushed on, being careful to blaze the trees, because they were not professional guides. "We don't want to get too near," Ri said after toiling through the forest for many minutes. "Without guns, we don't want to get near enough for the farn beast to charge us." They stopped. The forest was dense, the vines clinging. "He'll want the bearers to hack a path for him," Mia said. "But we go it alone. Damn him." Ri twisted his mouth into a sour frown. He wiped at his forehead. "Hot. By God, it's hot. I didn't think it was this hot, the first time we were here." Mia said, "The first time, we weren't guides. We didn't notice it so much then." They fought a few yards more into the forest. Then it ended. Or, rather, there was a wide gap. Before them lay a blast area, unmistakable. The grass was beginning to grow again, but the tree stumps were roasted from the rocket breath. "This isn't ours!" Ri said. "This looks like it was made nearly a year ago!" Mia's eyes narrowed. "The military from Xnile?" "No," Ri said. "They don't have any rockets this small. And I don't think there's another cargo rocket on this planet outside of the one we leased from the Club. Except the one he brought." "The ones who discovered the farn beasts in the first place?" Mia asked. "You think it's their blast?" "So?" Ri said. "But who are they?" It was Mia's turn to shrug. "Whoever they were, they couldn't have been hunters. They'd have kept the secret better." "We didn't do so damned well." "We didn't have a chance," Mia objected. "Everybody and his brother had heard the rumor that farn beasts were somewhere around here. It wasn't our fault Extrone found out." "I wish we hadn't shot our guide, then. I wish he was here instead of us." Mia shook perspiration out of his eyes. "We should have shot our pilot, too. That was our mistake. The pilot must have been the one who told Extrone we'd hunted this area." "I didn't think a Club pilot would do that." "After Extrone said he'd hunt farn beasts, even if it meant going to the alien system? Listen, you don't know.... Wait a minute." There was perspiration on Ri's upper lip. " I didn't tell Extrone, if that's what you're thinking," Mia said. Ri's mouth twisted. "I didn't say you did." "Listen," Mia said in a hoarse whisper. "I just thought. Listen. To hell with how he found out. Here's the point. Maybe he'll shoot us, too, when the hunt's over." Ri licked his lips. "No. He wouldn't do that. We're not—not just anybody. He couldn't kill us like that. Not even him . And besides, why would he want to do that? It wouldn't do any good to shoot us. Too many people already know about the farn beasts. You said that yourself." Mia said, "I hope you're right." They stood side by side, studying the blast area in silence. Finally, Mia said, "We better be getting back." "What'll we tell him?" "That we saw tracks. What else can we tell him?" They turned back along their trail, stumbling over vines. "It gets hotter at sunset," Ri said nervously. "The breeze dies down." "It's screwy. I didn't think farn beasts had this wide a range. There must be a lot of them, to be on both sides of the ridge like this." "There may be a pass," Mia said, pushing a vine away. Ri wrinkled his brow, panting. "I guess that's it. If there were a lot of them, we'd have heard something before we did. But even so, it's damned funny, when you think about it." Mia looked up at the darkening sky. "We better hurry," he said. When it came over the hastily established camp, the rocket was low, obviously looking for a landing site. It was a military craft, from the outpost on the near moon, and forward, near the nose, there was the blazoned emblem of the Ninth Fleet. The rocket roared directly over Extrone's tent, turned slowly, spouting fuel expensively, and settled into the scrub forest, turning the vegetation beneath it sere by its blasts. Extrone sat on an upholstered stool before his tent and spat disgustedly and combed his beard with his blunt fingers. Shortly, from the direction of the rocket, a group of four high-ranking officers came out of the forest, heading toward him. They were spruce, the officers, with military discipline holding their waists in and knees almost stiff. "What in hell do you want?" Extrone asked. They stopped a respectful distance away. "Sir...." one began. "Haven't I told you gentlemen that rockets frighten the game?" Extrone demanded, ominously not raising his voice. "Sir," the lead officer said, "it's another alien ship. It was sighted a few hours ago, off this very planet, sir." Extrone's face looked much too innocent. "How did it get there, gentlemen? Why wasn't it destroyed?" "We lost it again, sir. Temporarily, sir." "So?" Extrone mocked. "We thought you ought to return to a safer planet, sir. Until we could locate and destroy it." Extrone stared at them for a space. Then, indifferently, he turned away, in the direction of a resting bearer. "You!" he said. "Hey! Bring me a drink!" He faced the officers again. He smiled maliciously. "I'm staying here." The lead officer licked his firm lower lip. "But, sir...." Extrone toyed with his beard. "About a year ago, gentlemen, there was an alien ship around here then, wasn't there? And you destroyed it, didn't you?" "Yes, sir. When we located it, sir." "You'll destroy this one, too," Extrone said. "We have a tight patrol, sir. It can't slip through. But it might try a long range bombardment, sir." Extrone said, "To begin with, they probably don't even know I'm here. And they probably couldn't hit this area if they did know. And you can't afford to let them get a shot at me, anyway." "That's why we'd like you to return to an inner planet, sir." Extrone plucked at his right ear lobe, half closing his eyes. "You'll lose a fleet before you'll dare let anything happen to me, gentlemen. I'm quite safe here, I think." The bearer brought Extrone his drink. "Get off," Extrone said quietly to the four officers. Again they turned reluctantly. This time, he did not call them back. Instead, with amusement, he watched until they disappeared into the tangle of forest. Dusk was falling. The takeoff blast of the rocket illuminated the area, casting weird shadows on the gently swaying grasses; there was a hot breath of dry air and the rocket dwindled toward the stars. Extrone stood up lazily, stretching. He tossed the empty glass away, listened for it to shatter. He reached out, parted the heavy flap to his tent. "Sir?" Ri said, hurrying toward him in the gathering darkness. "Eh?" Extrone said, turning, startled. "Oh, you. Well?" "We ... located signs of the farn beast, sir. To the east." Extrone nodded. After a moment he said, "You killed one, I believe, on your trip?" Ri shifted. "Yes, sir." Extrone held back the flap of the tent. "Won't you come in?" he asked without any politeness whatever. Ri obeyed the order. The inside of the tent was luxurious. The bed was of bulky feathers, costly of transport space, the sleep curtains of silken gauze. The floor, heavy, portable tile blocks, not the hollow kind, were neatly and smoothly inset into the ground. Hanging from the center, to the left of the slender, hand-carved center pole, was a chain of crystals. They tinkled lightly when Extrone dropped the flap. The light was electric from a portable dynamo. Extrone flipped it on. He crossed to the bed, sat down. "You were, I believe, the first ever to kill a farn beast?" he said. "I.... No, sir. There must have been previous hunters, sir." Extrone narrowed his eyes. "I see by your eyes that you are envious—that is the word, isn't it?—of my tent." Ri looked away from his face. "Perhaps I'm envious of your reputation as a hunter. You see, I have never killed a farn beast. In fact, I haven't seen a farn beast." Ri glanced nervously around the tent, his sharp eyes avoiding Extrone's glittering ones. "Few people have seen them, sir." "Oh?" Extrone questioned mildly. "I wouldn't say that. I understand that the aliens hunt them quite extensively ... on some of their planets." "I meant in our system, sir." "Of course you did," Extrone said, lazily tracing the crease of his sleeve with his forefinger. "I imagine these are the only farn beasts in our system." Ri waited uneasily, not answering. "Yes," Extrone said, "I imagine they are. It would have been a shame if you had killed the last one. Don't you think so?" Ri's hands worried the sides of his outer garment. "Yes, sir. It would have been." Extrone pursed his lips. "It wouldn't have been very considerate of you to—But, still, you gained valuable experience. I'm glad you agreed to come along as my guide." "It was an honor, sir." Extrone's lip twisted in wry amusement. "If I had waited until it was safe for me to hunt on an alien planet, I would not have been able to find such an illustrious guide." "... I'm flattered, sir." "Of course," Extrone said. "But you should have spoken to me about it, when you discovered the farn beast in our own system." "I realize that, sir. That is, I had intended at the first opportunity, sir...." "Of course," Extrone said dryly. "Like all of my subjects," he waved his hand in a broad gesture, "the highest as well as the lowest slave, know me and love me. I know your intentions were the best." Ri squirmed, his face pale. "We do indeed love you, sir." Extrone bent forward. " Know me and love me." "Yes, sir. Know you and love you, sir," Ri said. "Get out!" Extrone said. "It's frightening," Ri said, "to be that close to him." Mia nodded. The two of them, beneath the leaf-swollen branches of the gnarled tree, were seated on their sleeping bags. The moon was clear and cold and bright in a cloudless sky; a small moon, smooth-surfaced, except for a central mountain ridge that bisected it into almost twin hemispheres. "To think of him. As flesh and blood. Not like the—well; that—what we've read about." Mia glanced suspiciously around him at the shadows. "You begin to understand a lot of things, after seeing him." Ri picked nervously at the cover of his sleeping bag. "It makes you think," Mia added. He twitched. "I'm afraid. I'm afraid he'll.... Listen, we'll talk. When we get back to civilization. You, me, the bearers. About him. He can't let that happen. He'll kill us first." Ri looked up at the moon, shivering. "No. We have friends. We have influence. He couldn't just like that—" "He could say it was an accident." "No," Ri said stubbornly. "He can say anything," Mia insisted. "He can make people believe anything. Whatever he says. There's no way to check on it." "It's getting cold," Ri said. "Listen," Mia pleaded. "No," Ri said. "Even if we tried to tell them, they wouldn't listen. Everybody would know we were lying. Everything they've come to believe would tell them we were lying. Everything they've read, every picture they've seen. They wouldn't believe us. He knows that." "Listen," Mia repeated intently. "This is important. Right now he couldn't afford to let us talk. Not right now. Because the Army is not against him. Some officers were here, just before we came back. A bearer overheard them talking. They don't want to overthrow him!" Ri's teeth, suddenly, were chattering. "That's another lie," Mia continued. "That he protects the people from the Army. That's a lie. I don't believe they were ever plotting against him. Not even at first. I think they helped him, don't you see?" Ri whined nervously. "It's like this," Mia said. "I see it like this. The Army put him in power when the people were in rebellion against military rule." Ri swallowed. "We couldn't make the people believe that." "No?" Mia challenged. "Couldn't we? Not today, but what about tomorrow? You'll see. Because I think the Army is getting ready to invade the alien system!" "The people won't support them," Ri answered woodenly. " Think. If he tells them to, they will. They trust him." Ri looked around at the shadows. "That explains a lot of things," Mia said. "I think the Army's been preparing for this for a long time. From the first, maybe. That's why Extrone cut off our trade with the aliens. Partly to keep them from learning that he was getting ready to invade them, but more to keep them from exposing him to the people. The aliens wouldn't be fooled like we were, so easy." "No!" Ri snapped. "It was to keep the natural economic balance." "You know that's not right." Ri lay down on his bed roll. "Don't talk about it. It's not good to talk like this. I don't even want to listen." "When the invasion starts, he'll have to command all their loyalties. To keep them from revolt again. They'd be ready to believe us, then. He'll have a hard enough time without people running around trying to tell the truth." "You're wrong. He's not like that. I know you're wrong." Mia smiled twistedly. "How many has he already killed? How can we even guess?" Ri swallowed sickly. "Remember our guide? To keep our hunting territory a secret?" Ri shuddered. "That's different. Don't you see? This is not at all like that." With morning came birds' songs, came dew, came breakfast smells. The air was sweet with cooking and it was nostalgic, childhoodlike, uncontaminated. And Extrone stepped out of the tent, fully dressed, surly, letting the flap slap loudly behind him. He stretched hungrily and stared around the camp, his eyes still vacant-mean with sleep. "Breakfast!" he shouted, and two bearers came running with a folding table and chair. Behind them, a third bearer, carrying a tray of various foods; and yet behind him, a fourth, with a steaming pitcher and a drinking mug. Extrone ate hugely, with none of the delicacy sometimes affected in his conversational gestures. When he had finished, he washed his mouth with water and spat on the ground. "Lin!" he said. His personal bearer came loping toward him. "Have you read that manual I gave you?" Lin nodded. "Yes." Extrone pushed the table away. He smacked his lips wetly. "Very ludicrous, Lin. Have you noticed that I have two businessmen for guides? It occurred to me when I got up. They would have spat on me, twenty years ago, damn them." Lin waited. "Now I can spit on them, which pleases me." "The farn beasts are dangerous, sir," Lin said. "Eh? Oh, yes. Those. What did the manual say about them?" "I believe they're carnivorous, sir." "An alien manual. That's ludicrous, too. That we have the only information on our newly discovered fauna from an alien manual—and, of course, two businessmen." "They have very long, sharp fangs, and, when enraged, are capable of tearing a man—" "An alien?" Extrone corrected. "There's not enough difference between us to matter, sir. Of tearing an alien to pieces, sir." Extrone laughed harshly. "It's 'sir' whenever you contradict me?" Lin's face remained impassive. "I guess it seems that way. Sir." "Damned few people would dare go as far as you do," Extrone said. "But you're afraid of me, too, in your own way, aren't you?" Lin shrugged. "Maybe." "I can see you are. Even my wives are. I wonder if anyone can know how wonderful it feels to have people all afraid of you." "The farn beasts, according to the manual...." "You are very insistent on one subject." "... It's the only thing I know anything about. The farn beast, as I was saying, sir, is the particular enemy of men. Or if you like, of aliens. Sir." "All right," Extrone said, annoyed. "I'll be careful." In the distance, a farn beast coughed. Instantly alert, Extrone said, "Get the bearers! Have some of them cut a path through that damn thicket! And tell those two businessmen to get the hell over here!" Lin smiled, his eyes suddenly afire with the excitement of the hunt. Four hours later, they were well into the scrub forest. Extrone walked leisurely, well back of the cutters, who hacked away, methodically, at the vines and branches which might impede his forward progress. Their sharp, awkward knives snickered rhythmically to the rasp of their heavy breathing. Occasionally, Extrone halted, motioned for his water carrier, and drank deeply of the icy water to allay the heat of the forest, a heat made oppressive by the press of foliage against the outside air. Ranging out, on both sides of the central body, the two businessmen fought independently against the wild growth, each scouting the flanks for farn beasts, and ahead, beyond the cutters, Lin flittered among the tree trunks, sometimes far, sometimes near. Extrone carried the only weapon, slung easily over his shoulder, a powerful blast rifle, capable of piercing medium armor in sustained fire. To his rear, the water carrier was trailed by a man bearing a folding stool, and behind him, a man carrying the heavy, high-powered two-way communication set. Once Extrone unslung his blast rifle and triggered a burst at a tiny, arboreal mammal, which, upon the impact, shattered asunder, to Extrone's satisfied chuckle, in a burst of blood and fur. When the sun stood high and heat exhaustion made the near-naked bearers slump, Extrone permitted a rest. While waiting for the march to resume, he sat on the stool with his back against an ancient tree and patted, reflectively, the blast rifle, lying across his legs. "For you, sir," the communications man said, interrupting his reverie. "Damn," Extrone muttered. His face twisted in anger. "It better be important." He took the head-set and mike and nodded to the bearer. The bearer twiddled the dials. "Extrone. Eh?... Oh, you got their ship. Well, why in hell bother me?... All right, so they found out I was here. You got them, didn't you?" "Blasted them right out of space," the voice crackled excitedly. "Right in the middle of a radio broadcast, sir." "I don't want to listen to your gabbling when I'm hunting!" Extrone tore off the head-set and handed it to the bearer. "If they call back, find out what they want, first. I don't want to be bothered unless it's important." "Yes, sir." Extrone squinted up at the sun; his eyes crinkled under the glare, and perspiration stood in little droplets on the back of his hands. Lin, returning to the column, threaded his way among reclining bearers. He stopped before Extrone and tossed his hair out of his eyes. "I located a spoor," he said, suppressed eagerness in his voice. "About a quarter ahead. It looks fresh." Extrone's eyes lit with passion. Lin's face was red with heat and grimy with sweat. "There were two, I think." "Two?" Extrone grinned, petting the rifle. "You and I better go forward and look at the spoor." Lin said, "We ought to take protection, if you're going, too." Extrone laughed. "This is enough." He gestured with the rifle and stood up. "I wish you had let me bring a gun along, sir," Lin said. "One is enough in my camp." The two of them went forward, alone, into the forest. Extrone moved agilely through the tangle, following Lin closely. When they came to the tracks, heavily pressed into drying mud around a small watering hole, Extrone nodded his head in satisfaction. "This way," Lin said, pointing, and once more the two of them started off. They went a good distance through the forest, Extrone becoming more alert with each additional foot. Finally, Lin stopped him with a restraining hand. "They may be quite a way ahead. Hadn't we ought to bring up the column?" The farn beast, somewhere beyond a ragged clump of bushes, coughed. Extrone clenched the blast rifle convulsively. The farn beast coughed again, more distant this time. "They're moving away," Lin said. "Damn!" Extrone said. "It's a good thing the wind's right, or they'd be coming back, and fast, too." "Eh?" Extrone said. "They charge on scent, sight, or sound. I understand they will track down a man for as long as a day." "Wait," Extrone said, combing his beard. "Wait a minute." "Yes?" "Look," Extrone said. "If that's the case, why do we bother tracking them? Why not make them come to us?" "They're too unpredictable. It wouldn't be safe. I'd rather have surprise on our side." "You don't seem to see what I mean," Extrone said. " We won't be the—ah—the bait." "Oh?" "Let's get back to the column." "Extrone wants to see you," Lin said. Ri twisted at the grass shoot, broke it off, worried and unhappy. "What's he want to see me for?" "I don't know," Lin said curtly. Ri got to his feet. One of his hands reached out, plucked nervously at Lin's bare forearm. "Look," he whispered. "You know him. I have—a little money. If you were able to ... if he wants," Ri gulped, "to do anything to me—I'd pay you, if you could...." "You better come along," Lin said, turning. Ri rubbed his hands along his thighs; he sighed, a tiny sound, ineffectual. He followed Lin beyond an outcropping of shale to where Extrone was seated, petting his rifle. Extrone nodded genially. "The farn beast hunter, eh?" "Yes, sir." Extrone drummed his fingers on the stock of the blast rifle. "Tell me what they look like," he said suddenly. "Well, sir, they're ... uh...." "Pretty frightening?" "No, sir.... Well, in a way, sir." "But you weren't afraid of them, were you?" "No, sir. No, because...." Extrone was smiling innocently. "Good. I want you to do something for me." "I ... I...." Ri glanced nervously at Lin out of the tail of his eye. Lin's face was impassive. "Of course you will," Extrone said genially. "Get me a rope, Lin. A good, long, strong rope." "What are you going to do?" Ri asked, terrified. "Why, I'm going to tie the rope around your waist and stake you out as bait." "No!" "Oh, come now. When the farn beast hears you scream—you can scream, by the way?" Ri swallowed. "We could find a way to make you." There was perspiration trickling down Ri's forehead, a single drop, creeping toward his nose. "You'll be safe," Extrone said, studying his face with amusement. "I'll shoot the animal before it reaches you." Ri gulped for air. "But ... if there should be more than one?" Extrone shrugged. "I—Look, sir. Listen to me." Ri's lips were bloodless and his hands were trembling. "It's not me you want to do this to. It's Mia, sir. He killed a farn beast before I did, sir. And last night—last night, he—" "He what?" Extrone demanded, leaning forward intently. Ri breathed with a gurgling sound. "He said he ought to kill you, sir. That's what he said. I heard him, sir. He said he ought to kill you. He's the one you ought to use for bait. Then if there was an accident, sir, it wouldn't matter, because he said he ought to kill you. I wouldn't...." Extrone said, "Which one is he?" "That one. Right over there." "The one with his back to me?" "Yes, sir. That's him. That's him, sir." Extrone aimed carefully and fired, full charge, then lowered the rifle and said, "Here comes Lin with the rope, I see." Ri was greenish. "You ... you...." Extrone turned to Lin. "Tie one end around his waist." "Wait," Ri begged, fighting off the rope with his hands. "You don't want to use me, sir. Not after I told you.... Please, sir. If anything should happen to me.... Please, sir. Don't do it." "Tie it," Extrone ordered. "No, sir. Please. Oh, please don't, sir." "Tie it," Extrone said inexorably. Lin bent with the rope; his face was colorless. They were at the watering hole—Extrone, Lin, two bearers, and Ri. Since the hole was drying, the left, partially exposed bank was steep toward the muddy water. Upon it was green, new grass, tender-tuffed, half mashed in places by heavy animal treads. It was there that they staked him out, tying the free end of the rope tightly around the base of a scaling tree. "You will scream," Extrone instructed. With his rifle, he pointed across the water hole. "The farn beast will come from this direction, I imagine." Ri was almost slobbering in fear. "Let me hear you scream," Extrone said. Ri moaned weakly. "You'll have to do better than that." Extrone inclined his head toward a bearer, who used something Ri couldn't see. Ri screamed. "See that you keep it up that way," Extrone said. "That's the way I want you to sound." He turned toward Lin. "We can climb this tree, I think." Slowly, aided by the bearers, the two men climbed the tree, bark peeling away from under their rough boots. Ri watched them hopelessly. Once at the crotch, Extrone settled down, holding the rifle at alert. Lin moved to the left, out on the main branch, rested in a smaller crotch. Looking down, Extrone said, "Scream!" Then, to Lin, "You feel the excitement? It's always in the air like this at a hunt." "I feel it," Lin said. Extrone chuckled. "You were with me on Meizque?" "Yes." "That was something, that time." He ran his hand along the stock of the weapon. The sun headed west, veiling itself with trees; a large insect circled Extrone's head. He slapped at it, angry. The forest was quiet, underlined by an occasional piping call, something like a whistle. Ri's screams were shrill, echoing away, shiveringly. Lin sat quiet, hunched. Extrone's eyes narrowed, and he began to pet the gun stock with quick, jerky movements. Lin licked his lips, keeping his eyes on Extrone's face. The sun seemed stuck in the sky, and the heat squeezed against them, sucking at their breath like a vacuum. The insect went away. Still, endless, hopeless, monotonous, Ri screamed. A farn beast coughed, far in the matted forest. Extrone laughed nervously. "He must have heard." "We're lucky to rouse one so fast," Lin said. Extrone dug his boot cleats into the tree, braced himself. "I like this. There's more excitement in waiting like this than in anything I know." Lin nodded. "The waiting, itself, is a lot. The suspense. It's not only the killing that matters." "It's not only the killing," Lin echoed. "You understand?" Extrone said. "How it is to wait, knowing in just a minute something is going to come out of the forest, and you're going to kill it?" "I know," Lin said. "But it's not only the killing. It's the waiting, too." The farn beast coughed again; nearer. "It's a different one," Lin said. "How do you know?" "Hear the lower pitch, the more of a roar?" "Hey!" Extrone shouted. "You, down there. There are two coming. Now let's hear you really scream!" Ri, below, whimpered childishly and began to retreat toward the tether tree, his eyes wide. "There's a lot of satisfaction in fooling them, too," Extrone said. "Making them come to your bait, where you can get at them." He opened his right hand. "Choose your ground, set your trap. Bait it." He snapped his hand into a fist, held the fist up before his eyes, imprisoning the idea. "Spring the trap when the quarry is inside. Clever. That makes the waiting more interesting. Waiting to see if they really will come to your bait." Lin shifted, staring toward the forest. "I've always liked to hunt," Extrone said. "More than anything else, I think." Lin spat toward the ground. "People should hunt because they have to. For food. For safety." "No," Extrone argued. "People should hunt for the love of hunting." "Killing?" "Hunting," Extrone repeated harshly. The farn beast coughed. Another answered. They were very near, and there was a noise of crackling underbrush. "He's good bait," Extrone said. "He's fat enough and he knows how to scream good." Ri had stopped screaming; he was huddled against the tree, fearfully eying the forest across from the watering hole. Extrone began to tremble with excitement. "Here they come!" The forest sprang apart. Extrone bent forward, the gun still across his lap. The farn beast, its tiny eyes red with hate, stepped out on the bank, swinging its head wildly, its nostrils flaring in anger. It coughed. Its mate appeared beside it. Their tails thrashed against the scrubs behind them, rattling leaves. "Shoot!" Lin hissed. "For God's sake, shoot!" "Wait," Extrone said. "Let's see what they do." He had not moved the rifle. He was tense, bent forward, his eyes slitted, his breath beginning to sound like an asthmatic pump. The lead farn beast sighted Ri. It lowered its head. "Look!" Extrone cried excitedly. "Here it comes!" Ri began to scream again. Still Extrone did not lift his blast rifle. He was laughing. Lin waited, frozen, his eyes staring at the farn beast in fascination. The farn beast plunged into the water, which was shallow, and, throwing a sheet of it to either side, headed across toward Ri. "Watch! Watch!" Extrone cried gleefully. And then the aliens sprang their trap.
|
A. he thought Mia had a better chance to survive
|
Basing your judgments off of the cash flow statement and the income statement, what is American Water Works's FY2021 unadjusted operating income + depreciation and amortization from the cash flow statement (unadjusted EBITDA) in USD millions?
|
Evidence 0:
Table of Contents
American Water Works Company, Inc. and Subsidiary Companies
Consolidated Statements of Operations
(In millions, except per share data)
For the Years Ended December 31,
2021
2020
2019
Operating revenues
$
3,930
$
3,777
$
3,610
Operating expenses:
Operation and maintenance
1,777
1,622
1,544
Depreciation and amortization
636
604
582
General taxes
321
303
280
Other
(10)
Total operating expenses, net
2,734
2,529
2,396
Operating income
1,196
1,248
1,214
Other income (expense):
Interest expense
(403)
(397)
(386)
Interest income
4
2
4
Non-operating benefit costs, net
78
49
16
Gain or (loss) on sale of businesses
747
(44)
Other, net
18
22
29
Total other income (expense)
444
(324)
(381)
Income before income taxes
1,640
924
833
Provision for income taxes
377
215
212
Net income attributable to common shareholders
$
1,263
$
709
$
621
Basic earnings per share: (a)
Net income attributable to common shareholders
$
6.96
$
3.91
$
3.44
Diluted earnings per share: (a)
Net income attributable to common shareholders
$
6.95
$
3.91
$
3.43
Weighted average common shares outstanding:
Basic
182
181
181
Diluted
182
182
181
(a)
Amounts may not calculate due to rounding.
The accompanying notes are an integral part of these Consolidated Financial Statements.
84
Evidence 1:
Table of Contents
American Water Works Company, Inc. and Subsidiary Companies
Consolidated Statements of Cash Flows
(In millions)
For the Years Ended December 31,
2021
2020
2019
CASH FLOWS FROM OPERATING ACTIVITIES
Net income
$
1,263
$
709
$
621
Adjustments to reconcile to net cash flows provided by operating activities:
Depreciation and amortization
636
604
582
Deferred income taxes and amortization of investment tax credits
230
207
208
Provision for losses on accounts receivable
37
34
28
(Gain) or loss on sale of businesses
(747)
34
Pension and non-pension postretirement benefits
(41)
(14)
17
Other non-cash, net
(23)
(20)
(41)
Changes in assets and liabilities:
Receivables and unbilled revenues
(74)
(97)
(25)
Pension and non-pension postretirement benefit contributions
(40)
(39)
(31)
Accounts payable and accrued liabilities
66
(2)
66
Other assets and liabilities, net
134
44
(76)
Net cash provided by operating activities
1,441
1,426
1,383
CASH FLOWS FROM INVESTING ACTIVITIES
Capital expenditures
(1,764)
(1,822)
(1,654)
Acquisitions, net of cash acquired
(135)
(135)
(235)
Proceeds from sale of assets, net of cash on hand
472
2
48
Removal costs from property, plant and equipment retirements, net
(109)
(106)
(104)
Net cash used in investing activities
(1,536)
(2,061)
(1,945)
CASH FLOWS FROM FINANCING ACTIVITIES
Proceeds from long-term debt
1,118
1,334
1,530
Repayments of long-term debt
(372)
(342)
(495)
(Repayments of) proceeds from term loan
(500)
500
Net short-term borrowings with maturities less than three months
(198)
(5)
(178)
(Remittances) proceeds from issuances of employee stock plans and direct stock purchase plan, net of taxes paid of $18, $17 and $11 in
2021, 2020 and 2019, respectively
(1)
9
15
Advances and contributions in aid of construction, net of refunds of $25, $24 and $30 in 2021, 2020 and 2019, respectively
62
28
26
Debt issuance costs and make-whole premium on early debt redemption
(26)
(15)
(15)
Dividends paid
(428)
(389)
(353)
Anti-dilutive share repurchases
(36)
Net cash (used in) provided by financing activities
(345)
1,120
494
Net (decrease) increase in cash, cash equivalents and restricted funds
(440)
485
(68)
Cash, cash equivalents and restricted funds at beginning of period
576
91
159
Cash, cash equivalents and restricted funds at end of period
$
136
$
576
$
91
Cash paid during the year for:
Interest, net of capitalized amount
$
389
$
382
$
383
Income taxes, net of refunds of $6, $2 and $4 in 2021, 2020 and 2019, respectively
$
1
$
7
$
12
Non-cash investing activity:
Capital expenditures acquired on account but unpaid as of year end
$
292
$
221
$
235
Seller promissory note from the sale of the Homeowner Services Group
$
720
$
$
Contingent cash payment from the sale of the Homeowner Services Group
$
75
$
$
The accompanying notes are an integral part of these Consolidated Financial Statements.
86
|
$1832.00
|
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