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1.
A cost comparison of balloon angioplasty and stenting versus endarterectomy for the treatment of carotid artery stenosis 总被引:1,自引:0,他引:1
WD Jordan GD Roye WS Fisher D Redden HA McDowell 《Canadian Metallurgical Quarterly》1998,27(1):16-22; discussion 22-4
PURPOSE: Percutaneous transluminal angioplasty with stenting (PTAS) of the carotid artery has been advocated as an alternative treatment for high-grade stenosis. Rationale for this approach includes less morbidity, shorter recovery, and lower cost when compared with carotid endarterectomy (CEA). METHODS: The clinical results and hospital charges of patients who underwent elective treatment for carotid stenosis were reviewed. During a concurrent 14-month period, 218 patients were admitted 229 times for 234 procedures for the treatment of 239 carotid bifurcation stenoses, 109 by PTAS and 130 by CEA. Hospital charges were reviewed for each hospitalization and were categorized according to radiology, operating room, cardiac catheterization laboratory, and all other hospital charges. RESULTS: The combined incidence of postprocedure strokes and deaths were: PTAS, eight strokes (7.7%) and one death (0.9%); CEA, two strokes (1.5%) and two deaths (1.5%). Total hospital charges per admission for the two groups were $30,140 for PTAS and $21,670 for CEA. The average postprocedure length of stay for PTAS was 2.9 days (median, 2 days) and for CEA was 3.1 days (median, 3 days). Cardiac catheterization laboratory charges for the PTAS group were $12,968, whereas the operating room charges for the CEA group were $4263. When hospitalizations that were extended by complications were excluded, the average total charges for the PTAS group (n = 84) dropped to $24,848 (mean length of stay, 1.9 days) and for the CEA group (n = 111) to $19,247 (mean length of stay, 2.6 days). CONCLUSIONS: After evaluating hospital charges, PTAS for the treatment of carotid stenosis cannot currently be justified on the basis of reduced costs alone. With future cost-containing measures, total hospital charges can be reduced in both groups. 相似文献
2.
JA Skinner G Prabhakar DG Genecov K Granke DE McDowell 《Canadian Metallurgical Quarterly》1997,90(10):993-996
BACKGROUND: Spontaneous rupture of abdominal aortic aneurysm into the inferior vena cava is rare. The clinical presentation is highly variable, and the diagnosis can be difficult, often being made only at operation. The aortocaval fistula results in a large left-to-right shunt, which can cause cardiac failure. Once the diagnosis is made, treatment is by surgical closure of the fistula and repair of the aneurysm with a graft. METHODS: This is a retrospective review of a single surgeon's experience with aortocaval fistula complicating abdominal aortic aneurysms. RESULTS: Over a 15-year period, we had five patients with spontaneous aortocaval fistula who were treated operatively. Preoperative diagnosis was made in two, suspected in one, and not made in two, one of whom died (the only perioperative death in the series). CONCLUSIONS: Spontaneous aortocaval fistulas are uncommon, and their preoperative recognition is difficult. Hematuria in association with an abdominal aortic aneurysm should raise the suspicion of an aortocaval fistula. Surgical correction is possible, with survival rates comparable to those associated with rupture of aneurysms into the retroperitoneum. Early operative control of the fistula is important to optimize the preload to the heart. 相似文献
3.
Clementz Brett A.; McDowell Jennifer E.; Zisook Sidney 《Canadian Metallurgical Quarterly》1994,103(2):277
In Study 1, 30 schizophrenia Ss and 27 nonpsychiatric comparison Ss were presented with a fixation task, a visually guided reflexive saccade (prosaccade) task, a predictive tracking task (0.4-Hz square wave), and an antisaccade task. The 2 groups did not differ on either the fixation or prosaccade tasks. Schizophrenia Ss had an increased number of errors on the antisaccade task and had decreased rightward visually guided saccade amplitudes during the predictive tracking task. In Study 2, 13 psychiatric comparison Ss and 32 1st-degree biological relatives of the schizophrenia Ss were compared with the schizophrenia Ss and a larger and older sample of nonpsychiatric Ss (n?=?33) on the predictive tracking and antisaccade tasks. The groups did not differ on predictive saccadic tracking. The schizophrenia Ss and their 1st-degree biological relatives made more errors on the antisaccade task than both the nonpsychiatric and psychiatric comparison groups (who did not significantly differ). Results are consistent with the notion that dysfunction of dorsolateral prefrontal cortex, caudate nucleus, or both is related to liability for schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved) 相似文献
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5.
The objective of the present study was to determine the duration of elevated concentrations of progesterone necessary to induce atresia of persistent ovarian follicles. Heifers were administered 25 mg of PGF2alpha on d 6 and 7 (d 0 = d of synchronized estrus) and a norgestomet implant from d 6 to 14. Ovaries were monitored by ultrasonography, and blood samples were collected on d 3, 5, 7, 9, 11, and 12 and daily from d 14 until ovulation. On d 12, heifers received either two progesterone-releasing intravaginal devices (PRID) for 6 h (6-h; n = 5), two PRID for 24 h (24-h; n = 5), or no treatment (CON; n = 5). Blood samples were collected at 15-min intervals from h -6 to 30 (PRID insertion = h 0) and analyzed for concentrations of LH. Characteristics of LH secretion were determined for consecutive 6-h periods (Period 0 to 5). Hourly blood samples, collected from h 0 to 29, were analyzed for concentrations of 17beta-estradiol (estradiol) and progesterone. The dominant ovarian follicles present on d 7 increased in size to 15.4+/-.3 mm on d 12 ("persistent follicle"). Following removal of the PRID and norgestomet implants, atresia of persistent follicles and ovulation of new follicles were induced in one of five and in four of five heifers in the 6-h and 24-h treatments, respectively. Persistent follicles ovulated after withdrawal of norgestomet in all other heifers. Concentrations of progesterone were increased from h 1 to 7 in the 6-h and h 1 to 26 in the 24-h treatment. Frequency of LH pulses was reduced (P < .05) during Periods 1 to 2 in the 6-h and Periods 1 to 5 in the 24-h treatment relative to the CON treatment. By h 10, concentrations of estradiol in the 6-h and 24-h treatments were lower (P < . 05) than in the CON treatment. This suppression continued through h 29 in the 24-h treatment (P < .05), whereas concentrations in the 6-h treatment were intermediate to those of the CON and 24-h treatments after h 14. Suppression of pulsatile LH release and estradiol secretion was evident with 6 and 24 h of treatment with progesterone, but only the 24-h treatment induced atresia of persistent follicles in a majority of the heifers. 相似文献
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7.
Porous polysulphone (PPSF) has recently been selected as a candidate material for use as a prosthetic surface coating in orthopaedic applications to acommodate ‘bone ingrowth’ for fixation to the skeletal system. The tension-loaded fatigue behaviour of PPSF was characterized based on the interpretation of stress/life (S/N) data. Results of this investigation indicate that the fatigue life of PPSF is governed by crack propagation across the sintered necks of the porous structure. In addition, experimental data revealed that the fatigue strength-reduction factor, Kf, remains equivalent to the tensile notch strength-reduction factor for a wide range of fatigue lives. However, analytical results indicate that the material has a low notch sensitivity and that a single application of a theoretical elastic stress-concentration factor in a fatigue analysis would be inappropriate. 相似文献
8.
Gifford L. Martin Jr Sabah U. Randhawa Edward D. McDowell 《Computers & Industrial Engineering》1988,14(4):429-440
A heuristic is developed to plan loads for containerized cargo ships. It is designed to serve a port which uses gantry cranes (transtainers) and trucks to handle containers. The model recognizes constraints on ship stability, placing containers in a bay with the proper length, limits on stack height in under-deck bays, limits on stack weight in on-deck bays, refrigerated containers, and the need for support under a container. Provisions are made for the operator to handle overstowage of cargo for different ports and placement of oversize cargo. The model uses minimization of transtainer movement time and minimization of rehandles in the yard as an objective. The heuristic uses strategies for container placement similar to those used in manual load planning. A test of two ships and four voyages at the Port of Portland produced feasible load plans for each voyage. Transtainer movement and rehandling time varied for the four voyages; but on the average, the heuristic reduced a composite material handling measure by 4.8%. 相似文献
9.
Alex McDowell 《Architectural Design》2015,85(4):26-33
Film production requires world building: the power to visualise and bring to life narrative through a film's total environment. This is often entirely speculative, imagining alternative or future worlds. Here, Alex McDowell , acclaimed British production designer, producer and Professor at the University of Southern California (USC) describes his world-building, narrative approach to production design, which he consolidated in the Steven Spielberg film Minority Report (2002) that envisioned Washington DC in the year 2050. The possibilities of this storytelling technique are demonstrated by its transference into real-life projects, such as the immersive model that his production company, 5D GlobalStudio, developed for Al Baydha, a Bedouin village in Saudi Arabia. 相似文献
10.
Integrating legacy soil phosphorus into sustainable nutrient management strategies for future food,bioenergy and water security 总被引:11,自引:0,他引:11