Endoscopic surveillance of Barrett's esophagus: a cost-effectiveness comparison with mammographic surveillance for breast cancer

OBJECTIVE: Endoscopic surveillance of Barrett's esophagus is commonly practiced to detect malignancy in an early and curable stage. However, the cost-effectiveness of this practice has been questioned. To clarify this issue, we undertook a cost analysis of endoscopic surveillance to detect adenocarcinoma in Barrett's esophagus compared with mammography used to detect occult carcinoma of the breast, a widely accepted cancer surveillance technique. METHODS: The rate of esophageal adenocarcinoma detected by endoscopic surveillance was calculated for Duluth Clinic patients with Barrett's esophagus seen from 1980 to 1995 and compared with published rates. The rate of occult breast cancer detection was calculated for all women undergoing surveillance mammography at the Duluth Clinic for the year 1994 and compared with published rates. Costs for screening studies and therapy for cancer treatment for both cancers were calculated based on clinical results and assumptions regarding outcomes derived from published reports, and the costs were compared. RESULTS: Endoscopic surveillance of 149 patients with benign Barrett's esophagus was performed for a total of 510 patient-yr, during which time seven patients developed adenocarcinoma, an incidence of one case per 73 patient-yr of follow-up. Occult breast cancer was detected in 50 of 12,537 mammograms, a detection rate of 0.4%. The incidences in both cases were comparable to published figures. The costs of detecting a case of adenocarcinoma in Barrett's esophagus and occult breast cancer were $37,928 and $54,513, respectively, and those for treatment resulting in cure were $83,340 and $83,292. Cost per life-yr saved was $4,151 for adenocarcinoma in Barrett's esophagus and $57,926 for breast cancer. CONCLUSION: Endoscopic surveillance of patients with Barrett's esophagus compares favorably with the common practice of surveillance mammography to detect early breast cancer, and should therefore be considered to be as cost-effective as surveillance mammography.     

Roles of word frequency and age of acquisition in word naming and lexical decision.

Six experiments are reported that contrasted the effects of frequency and age of acquisition on written word recognition. Age of acquisition affected word-naming speed when frequency was controlled (Experiment 1), but there was no effect of frequency when age of acquisition was controlled (Experiment 2). Experiments 3 and 4 found an effect of age of acquisition upon immediate but not delayed naming speed, but no frequency effect on either immediate or delayed naming once age of acquisition was controlled. Independent effects of frequency and age of acquisition were observed in the lexical decision task (Experiments 5 and 6). Implications for theoretical accounts of word recognition and the possible roles of age of acquisition and frequency in word recognition are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comments on Debra Hull's concept of rationality.

D. B. Hull (1988) misinterprets "rationality" as used in rational-emotive therapy (RET) in her critique of the present author's (1987) article. As used in RET, rational not only means derived from reason, but also means efficiently aiding human happiness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do the Kallikaks look "menacing" or "retarded?"

To extend R. E. Fancher's (see record 1987-31600-001) review of claims that photographs of the Kallikak family in H. H. Goddard's (1912) study had been retouched to make them look more menacing and retarded, 29 Ss (aged 18–69 yrs) were surveyed for their impressions of the photographs. Overall, Ss were strongly inclined to view the photographed individuals as "kind" and "very bright." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Melanin Distribution in Human Skin: Influence of Cytoskeletal,Polarity, and Centrosome-Related Machinery of Stratum basale Keratinocytes

Melanin granules cluster within supra-nuclear caps in basal keratinocytes (KCs) of the human epidermis, where they protect KC genomic DNA against ultraviolet radiation (UVR) damage. While much is known about melanogenesis in melanocytes (MCs) and a moderate amount about melanin transfer from MC to KC, we know little about the fate of melanin once inside KCs. We recently reported that melanin fate in progenitor KCs is regulated by rare asymmetric organelle movement during mitosis. Here, we explore the role of actin, microtubules, and centrosome-associated machinery in distributing melanin within KCs. Short-term cultures of human skin explants were treated with cytochalasin-B and nocodazole to target actin filaments and microtubules, respectively. Treatment effects on melanin distribution were assessed by the Warthin–Starry stain, on centrosome-associated proteins by immunofluorescence microscopy, and on co-localisation with melanin granules by brightfield microscopy. Cytochalasin-B treatment disassembled supra-nuclear melanin caps, while nocodazole treatment moved melanin from the apical to basal KC domain. Centrosome and centriolar satellite-associated proteins showed a high degree of co-localisation with melanin. Thus, once melanin granules are transferred to KCs, their preferred apical distribution appears to be facilitated by coordinated movement of centrosomes and centriolar satellites. This mechanism may control melanin’s strategic position within UVR-exposed KCs.     

In Vivo Analysis of the Biocompatibility and Bone Healing Capacity of a Novel Bone Grafting Material Combined with Hyaluronic Acid

The present in vivo study analyses both the inflammatory tissue reactions and the bone healing capacity of a newly developed bone substitute material (BSM) based on xenogeneic bone substitute granules combined with hyaluronate (HY) as a water-binding molecule. The results of the hyaluronate containing bone substitute material (BSM) were compared to a control xenogeneic BSM of the same chemical composition and a sham operation group up to 16 weeks post implantationem. A major focus of the study was to analyze the residual hyaluronate and its effects on the material-dependent healing behavior and the inflammatory tissue responses. The study included 63 male Wistar rats using the calvaria implantation model for 2, 8, and 16 weeks post implantationem. Established and Good Laboratory Practice (GLP)-conforming histological, histopathological, and histomorphometrical analysis methods were conducted. The results showed that the new hyaluronate containing BSM was gradually integrated within newly formed bone up to the end of the study that ended in a condition of complete bone defect healing. Thereby, no differences to the healing capacity of the control BSM were found. However, the bone formation in both groups was continuously significantly higher compared to the sham operation group. Additionally, no differences in the (inflammatory) tissue response that was analyzed via qualitative and (semi-) quantitative methods were found. Interestingly, no differences were found between the numbers of pro- and anti-inflammatory macrophages between the three study groups over the entire course of the study. No signs of the HY as a water-binding part of the BSM were histologically detectable at any of the study time points, altogether the results of the present study show that HY allows for an optimal material-associated bone tissue healing comparable to the control xenogeneic BSM. The added HY seems to be degraded within a very short time period of less than 2 weeks so that the remaining BSM granules allow for a gradual osteoconductive bone regeneration. Additionally, no differences between the inflammatory tissue reactions in both material groups and the sham operation group were found. Thus, the new hyaluronate containing xenogeneic BSM and also the control BSM have been shown to be fully biocompatible without any differences regarding bone regeneration.     

The Structure of the Irreversibly Bound Adhesion Promoter-Substrate Interfacial Layer of γ-Aminopropylsilanetriol on Crystalline Si, as Measured by XPS and FTIR

The irreversibly bound interfacial layer deposited by the γ-aminopropysilanetriol adhesion promoter onto a crystalline silicon substrate, which remains even after profuse washing, was found by XPS to have resulted from the fragmentation and rearrangement of the original γ-aminopropylsilanetriol molecule. A mechanism is proposed, involving the homolytic scission of the terminal N-C bond. One of the subsequent reactions is believed to involve hydrogen loss by abstraction and the formation of a terminal vinyl group, which bonds to the substrate. Support for this mechanism is found in IR spectroscopy of this layer.     

Interstitial Oxygen in Tin-Doped Indium Oxide Transparent Conductors

We report first-principles density functional theory calculations of interstitial oxygen in tin-doped indium oxide (ITO), a transparent conducting oxide. Interstitial oxygen plays a critical role in the defect of ITO because it is by removal of interstitial oxygen that n -type charge carriers are produced. The Frank and Köstlin defect model successfully rationalizes the observed conductivity, Sn-doping, and oxygen partial pressure dependencies of ITO by postulating that tin atoms, which substitute for indium, are clustered with interstitial oxygen. Structural evidence for such a clustering, however, remains ambiguous. Recently published Rietveld refinement results of X-ray and neutron diffraction data found interstitial oxygen to be significantly displaced (0.4 Å) from the ideal fourfold position. Our calculations show that the experimental position is plausible only if interstitial oxygen is clustered with Sn_In defects at any of the three d -type cation sites nearest to the interstitial, thereby providing direct structural confirmation of the Frank and Köstlin defect model.     

Experimental and computational study of gas–solid fluidized bed hydrodynamics

The hydrodynamics of a two-dimensional gas–solid fluidized bed reactor were studied experimentally and computationally. Computational fluid dynamics (CFD) simulation results from a commercial CFD software package, Fluent, were compared to those obtained by experiments conducted in a fluidized bed containing spherical glass beads of 250– in diameter. A multifluid Eulerian model incorporating the kinetic theory for solid particles was applied in order to simulate the gas–solid flow. Momentum exchange coefficients were calculated using the Syamlal–O’Brien, Gidaspow, and Wen–Yu drag functions. The solid-phase kinetic energy fluctuation was characterized by varying the restitution coefficient values from 0.9 to 0.99. The modeling predictions compared reasonably well with experimental bed expansion ratio measurements and qualitative gas–solid flow patterns. Pressure drops predicted by the simulations were in relatively close agreement with experimental measurements at superficial gas velocities higher than the minimum fluidization velocity, U_mf. Furthermore, the predicted instantaneous and time-average local voidage profiles showed similarities with the experimental results. Further experimental and modeling efforts are required in a comparable time and space resolutions for the validation of CFD models for fluidized bed reactors.