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.     

Widely tunable bottom-emitting vertical-cavity SOAs

We present bottom-emitting tunable vertical-cavity semiconductor optical amplifiers (VCSOAs) with an effective wavelength tuning range of >20 nm. These devices utilize a high reflectivity micromechanically tunable Bragg mirror as the back reflector. Compared with our first generation tunable VCSOAs, the bottom-emitting devices exhibit a two-fold increase in the effective tuning range as well as a five-fold reduction in the required tuning voltage.     

New lamps for old: the story of electric lighting

Of all the products of electrical technology, none has made a more profound difference to our way of life than the humble light bulb. The author describes the history of the light bulb from the time it was introduced and started to replace gas lamps to the present day. In particular the author discusses the early developments in arc lighting and incandescent filament lamps. The author also discusses the introduction of mercury vapour lamps, fluorescent lamps, and evacuation of the lamps     

High-power 1320-nm wafer-bonded VCSELs with tunnel junctions

A new long-wavelength vertical-cavity surface-emitting laser structure is described that utilizes AlGaAs-GaAs mirrors bonded to AlInGaAs-InP quantum wells with an intracavity buried tunnel junction. This structure offers complete wavelength flexibility in the 1250-1650 nm fiber communication bands and reduces the high free-carrier losses and bonded junction voltage drops in previous devices. The intracavity contacts electrically bypass the bonded junctions to reduce threshold voltage. N-type current spreading layers and undoped AlGaAs mirrors minimize optical losses. This has enabled 134/spl deg/C maximum continuous-wave lasing temperature, 2-mW room-temperature continuous-wave single-mode power, and 1-mW single-mode power at 80/spl deg/C, in various devices in the 1310-1340 nm wavelength range.     

Protective effects of green tea extracts (polyphenon E and EGCG) on human cervical lesions

We investigated clinical efficacy of green tea extracts (polyphenon E; poly E and (-)-epigallocatechin-3-gallate [EGCG]) delivered in a form of ointment or capsule in patients with human papilloma virus (HPV) infected cervical lesions. Fifty-one patients with cervical lesions (chronic cervicitis, mild dysplasia, moderate dysplasia and severe dysplasia) were divided into four groups, as compared with 39 untreated patients as a control. Poly E ointment was applied locally to 27 patients twice a week. For oral delivery, a 200 mg of poly E or EGCG capsule was taken orally every day for eight to 12 weeks. In the study, 20 out of 27 patients (74%) under poly E ointment therapy showed a response. Six out of eight patients under poly E ointment plus poly E capsule therapy (75%) showed a response, and three out of six patients (50%) under poly E capsule therapy showed a response. Six out of 10 patients (60%) under EGCG capsule therapy showed a response. Overall, a 69% response rate (35/51) was noted for treatment with green tea extracts, as compared with a 10% response rate (4/39) in untreated controls (P<0.05). Thus, the data collected here demonstrated that green tea extracts in a form of ointment and capsule are effective for treating cervical lesions, suggesting that green tea extracts can be a potential therapy regimen for patients with HPV infected cervical lesions.     

Psychiatric medication: what the occupational health nurse should know

1. Occupational health nurses need a general knowledge of psychiatric medications to work effectively with clients and their off site health providers. 2. Acquiring an understanding of the major classes of medications--anti-psychotic, anti-anxiety, anti-depressant, and antimanic--is important. 3. It is helpful to understand under what conditions and with which conditions psychotropic medications are helpful.