A cost comparison of balloon angioplasty and stenting versus endarterectomy for the treatment of carotid artery stenosis

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.     

Presentation and treatment of spontaneous aortocaval fistula

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.     

Saccadic system functioning among schizophrenia patients and their first-degree biological relatives.

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)     

Duration of treatment with progesterone and regression of persistent ovarian follicles in cattle

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.     

Prejudicial Narratives: Building Tomorrow's World Today

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.     

Effects of constraints on lattice re-orientation and strain in polycrystal plasticity simulations

Employing a rate-dependent crystal plasticity model implemented in a novel and fast algorithm, two instantiations of an OFHC copper microstructure have been simulated by FE modelling to 11% tensile engineering strain with two different sets of boundary conditions. Analysis of lattice rotations, strain distributions and global stress–strain response show the effect of changing from free to periodic boundary conditions to be a perturbation of a response dictated by the microstructure. Average lattice rotation for each crystallographic grain has been found to be in fair agreement with Taylor-constraint simulations while fine scale element-resolved analysis shows large deviations from this prediction. Locally resolved analysis shows the existence of large domains dominated by slip on only a few slip systems. The modelling results are discussed in the light of recent experimental advances with respect to 2- and 3-dimensional characterization and analysis methods.     

Indicator to predict the movement of phosphorus from soil to subsurface flow

The movement of phosphorus (P) in subsurface flow can contribute to losses from agricultural land. This study aims to identify a soil P threshold above which P loss is likely to accelerate as a function of soil and management type. Lysimeters (25 cm i.d. by 30 cm deep) were taken of four soils from agricultural watersheds in Pennsylvania and New York. The soils had a range of Mehlich-3 extractable P (7-517 mg of P kg(-1)) in surface soil (0-7.5 cm for grassland and 0-23 cm for cultivated/arable) and reactive P, filtered <0.45 microm (RP(<0.45 microm) in subsurface flow (0.007-1.53 mg of P L(-1)). The loss of P from lysimeters increased greatly when Mehlich-3 extractable P was in excess of a mean concentration of 280 mg kg(-1), the degree of saturation of P sorption sites exceeded 38%, and the corrected P sorption strength (corrected for desorption) derived from the monolayer Langmuir equation was less than 0.07 L of P mg(-1). Of these variables, P sorption strength was most consistently related to RP(<0.45 microm) in subsurface flow across a range of soil managements. Use of the corrected Langmuir sorption strength parameter to estimate subsurface flow RP(<0.45 microm) derived from four U.S. soils was tested on four soils of different physiochemical characteristics (one calcareous) from the U.K. The U.K. soils showed similar concentration trends to the U.S. soils, with elevated RP(<0.45 microm) below a sorption strength of 0.07 L of P mg(-1). We propose that the P sorption strength derived from the monolayer Langmuir equation may be used to estimate the potential for P loss in subsurface flow, when simpler environmental tests such as P saturation derived from acid ammonium oxalate extraction are unclear or unsuitable.