Optimizing cardiovascular and chemopreventive benefits of aspirin: what role for the proton-pump inhibitors?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75584/1/j.1365-2036.2004.02347.x.pd

The clinical and economic impact of alternative staging strategies for adenocarcinoma of the pancreas

Several innovative imaging modalities, including endoscopic ultrasound, have increased the number of available preoperative staging methods in patients with adenocarcinoma of the pancreas. Our goal was to estimate the clinical outcomes and cost-effectiveness of alternative staging strategies for pancreatic adenocarcinoma. METHODS : Decision analysis was used to simulate alternative staging strategies. Cost inputs were based on Medicare reimbursements; clinical inputs were obtained from the available literature. Model endpoints of interest were cost per curative resection and appropriateness of treatment allocation based on pathological stage. RESULTS : Endoscopic ultrasound followed by laparoscopy yielded the lowest cost per curative resection ($37,600) and minimized the number of unnecessary surgical explorations (5.4 per 100 patients staged). Requiring angiographic confirmation when endoscopic ultrasound demonstrated an unresectable tumor yielded an intermediate cost-effectiveness ratio and virtually eliminated the risk of overstaging. Laparoscopy alone maximized the resection rate, but each additional resection would cost approximately$2 million relative to a strategy employing both endoscopic ultrasound and angiography. CONCLUSIONS : Staging strategies incorporating endoscopic ultrasound may improve treatment allocation and are cost-effective relative to angiography-based strategies. A staging protocol that does not incorporate an imaging modality to detect vascular invasion dramatically increases the cost per additional curative resection compared with more comprehensive staging protocols.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74623/1/j.1572-0241.2000.02191.x.pd

Change in convergence and accommodation after two weeks of eye exercises in typical young adults

Abstract: Introduction Although eye exercises appear to help heterophoria, convergence insufficiency and intermittent strabismus, true treatment effects can be confounded by placebo, practice and encouragement factors. This study assessed objective changes in vergence and accommodation responses in typical naïve young adults after two weeks of exercises compared to control conditions to assess the extent of treatment effects occur above other factors. Methods 156 asymptomatic young adults were randomly assigned to 6 exercise groups or 2 no-treatment groups. Treatment targeted i) accommodation, ii)vergence, iii) both, iv) convergence>accommodation, v)accommodation>convergence, or vi) a placebo. All were re-tested under identical conditions, except for the second control group who were additionally encouraged during testing. Objective accommodation and vergence were assessed to a range of targets moving in depth containing combinations of blur, disparity and proximity/looming cues. Results Response gain improved more for less naturalistic targets where more improvement was possible. Convergence exercises improved vergence for near across all targets (P=.035). Mean accommodation changed similarly,but non-significantly. No other treatment group differed significantly from the non-encouraged control group, while encouraging effort produced significantly increased vergence (P=.004) and accommodation (P=.005) gains in the other control group. Conclusions True treatment effects were small, only significantly better after vergence exercises to a non-accommodative target, and were rarely related to response they were designed to improve. Exercising accommodation without convergence made no difference to accommodation to cues containing detail. Additional effort improved objective responses the most, so should be controlled carefully in research, and considered when auditing treatment

Effect of Naproxen on Gastroesophageal Reflux and Esophageal Function: A Randomized, Double-Blind, Placebo-Controlled Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75450/1/j.1572-0241.1995.tb09312.x.pd

Photodetector Development for the Wheel Abrasion Experiment on the Sojourner Microrover of the Mars Pathfinder Mission

On-board the Mars Pathfinder spacecraft, launched in December of 1996, is a small roving vehicle named Sojourner. On Sojourner is an experiment to determine the abrasive characteristics of the Martian surface, called the Wheel Abrasion Experiment (WAE). The experiment works as follows: one of the wheels of the rover has a strip of black anodized aluminum bonded to the tread. The aluminum strip has thin coatings of aluminum, nickel and platinum deposited in patches. There are five (5) patches or samples of each metal, and the patches range in thickness from 200 A to 1000 A. The different metals were chosen for their differing hardness and their environmental stability. As the wheel is spun in the Martian soil, the thin patches of metal are abraded away, exposing the black anodization. The abrasion is monitored by measuring the amount of light reflected off of the samples. A photodetector was developed for this purpose, and that is the subject of this paper

Changing perceptions and practices regarding aspirin, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs among US primary care providers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74775/1/j.1365-2036.2008.03836.x.pd

Performance of Ga(0.47)In(0.53)As cells over a range of proton energies

Ga(0.47)In(0.53)As solar cells were processed by OMVPE and their characteristics determined at proton energies of 0.2, 0.5, and 3 MeV. Emphasis was on characteristics applicable to use of this cell as the low bandgap member of a monolithic, two terminal high efficiency InP/GaInAs cell. It was found that the radiation induced degradation in efficiency, I(sub SC), V(sub OC) and diffusion length increased with decreasing proton energy. When efficiency degradations were compared with InP it was observed that the present cells showed considerably more degradation over the entire energy range. Similar to InP, R(sub C), the carrier removal rate, decreased with increasing proton energy. However, numerical values for R(sub C) differed from those observed with InP. The difference is attributed to differing defect behavior between the two cell types. It was concluded that particular attention should be paid to the effects of low energy protons especially when the particle's track ends in one cell of the multibandgap device

Endoscopic ultrasound—guided fine needle aspiration in the diagnosis of mediastinal masses of unknown origin

The ability of endosonography to diagnose a variety of gastrointestinal pathology has been significantly advanced with the introduction of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy. EUS-FNA technology can also be applied to the evaluation of non-GI disorders. The role of EUS-FNA to establish the diagnosis of unexplained mediastinal masses has not been previously described. The aim of this study was to determine the diagnostic accuracy, impact on subsequent workup, and role of EUS-FNA in treating mediastinal masses of unknown cause. METHODS : A total of 26 patients (15 men and 11 women, mean age 61 yr, range 39–77 yr) underwent EUS-FNA in patients presenting with unexplained mediastinal masses at four tertiary referral centers. Presenting symptoms included: chest pain (10 patients), dysphagia (eight), cough (seven), fever (six), night sweats (three), and no symptoms/abnormal x-ray (five patients). Five of 26 patients had prior history of cancer (three lung, one tracheal, and one esophageal). RESULTS : Final diagnosis using EUS-FNA, surgery, autopsy, other diagnostic study, or long-term follow-up was available in all patients. EUS-FNA results were classified under three disease categories: 1) infectious, 2) benign/inflammatory, and 3) malignant. Final diagnosis included infectious in five patents, benign/inflammatory in nine, and malignant in 12. EUS-FNA was successful in 21 of 26 patients (81%) for all disease categories (infectious 60%, benign/inflammatory 78%, and malignant 92%). EUS-FNA was successful in directing subsequent workup in 77% (20 of 26) and therapy in 73% (19 of 26). Mean EUS-FNA passes for adequate tissue sampling was lower of nonmalignant disease categories (3.0 and 3.4) versus malignant disease (4.4). No complications were seen during the course of this study. CONCLUSIONS : EUS-FNA in patients presenting with idiopathic mediastinal masses establishes the diagnosis in the vast majority of cases, particularly for those with malignant disease. The emergence of transesophageal EUS-FNA of the mediastinum provides the ability to alter subsequent workup and therapy, obviating the need for more invasive diagnostic studies such as thoracotomy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72588/1/j.1572-0241.2002.06023.x.pd