Valuing innovative endoscopic techniques: prophylactic clip closure after endoscopic resection of large colon polyps

Background and Aims Clip closure of the mucosal defect after resecting large (≥20 mm) nonpedunculated colorectal polyps reduces postprocedure bleeding and is cost saving for payers. Clip costs are not reimbursed by payers, posing a major barrier to adoption of this technique in the community. We aimed to determine appropriate clip costs to support broader use of this procedure in practice. Methods We performed budget impact analysis using our recent decision analytic model, comparing prophylactic clip closure with no clip closure on national cost and outcomes data, to determine the maximum feasible clip price while maintaining cost savings in practice. Sensitivity analyses were performed on important clinical factors. Results In the original model, the baseline postprocedure bleeding risk was 6.8%, increasing cost of care by $614.11 averaged among all patients undergoing large polyp resection without clip closure. Prophylactic clip closure of only large right-sided polyps reduced postprocedure bleeding risk by 70.7$100 or less. Comparatively, prophylactic clip closure of large left-sided polyps had no clinical benefit and was not cost saving. Clip closure strategies focused only on extra-large polyps (≥40 mm), or patients taking antithrombotics regardless of polyp characteristics, were only minimally cost saving. Cost savings and maximum tolerated clip prices depended on medical comorbidity, which directly influences the costs of care to manage postprocedure bleeding. Conclusions Prophylactic clip closure after endoscopic resection of large colon polyps, particularly those in the right colon segment, is cost saving but requires clip costs less than $100. Translating these findings into practice requires gastroenterology practices to obtain reimbursement from payers for improved clinical outcomes and to align commercial clip prices with this clinical indication

Exo-zodi Modeling for the Large Binocular Telescope Interferometer

Habitable zone dust levels are a key unknown that must be understood to ensure the success of future space missions to image Earth analogs around nearby stars. Current detection limits are several orders of magnitude above the level of the solar system's zodiacal cloud, so characterization of the brightness distribution of exo-zodi down to much fainter levels is needed. To this end, the Large Binocular Telescope Interferometer (LBTI) will detect thermal emission from habitable zone exo-zodi a few times brighter than solar system levels. Here we present a modeling framework for interpreting LBTI observations, which yields dust levels from detections and upper limits that are then converted into predictions and upper limits for the scattered light surface brightness. We apply this model to the HOSTS survey sample of nearby stars; assuming a null depth uncertainty of 10^(–4) the LBTI will be sensitive to dust a few times above the solar system level around Sun-like stars, and to even lower dust levels for more massive stars

Web-based monitoring tools for Resistive Plate Chambers in the CMS experiment at CERN

The Resistive Plate Chambers (RPC) are used in the CMS experiment at the trigger level and also in the standard offline muon reconstruction. In order to guarantee the quality of the data collected and to monitor online the detector performance, a set of tools has been developed in CMS which is heavily used in the RPC system. The Web-based monitoring (WBM) is a set of java servlets that allows users to check the performance of the hardware during data taking, providing distributions and history plots of all the parameters. The functionalities of the RPC WBM monitoring tools are presented along with studies of the detector performance as a function of growing luminosity and environmental conditions that are tracked over time

Radiation background with the CMS RPCs at the LHC

The Resistive Plate Chambers (RPCs) are employed in the CMS Experiment at the LHC as dedicated trigger system both in the barrel and in the endcap. This article presents results of the radiation background measurements performed with the 2011 and 2012 proton-proton collision data collected by CMS. Emphasis is given to the measurements of the background distribution inside the RPCs. The expected background rates during the future running of the LHC are estimated both from extrapolated measurements and from simulation

Gastric Adenocarcinoma: A Multimodal Approach

Despite its declining incidence, gastric cancer (GC) remains a leading cause of cancer-related deaths worldwide. A multimodal approach to GC is critical to ensure optimal patient outcomes. Pretherapy fine resolution contrast-enhanced cross-sectional imaging, endoscopic ultrasound and staging laparoscopy play an important role in patients with newly diagnosed ostensibly operable GC to avoid unnecessary non-therapeutic laparotomies. Currently, margin negative gastrectomy and adequate lymphadenectomy performed at high volume hospitals remain the backbone of GC treatment. Importantly, adequate GC surgery should be integrated in the setting of a multimodal treatment approach. Treatment for advanced GC continues to expand with the emergence of additional lines of systemic and targeted therapies

Effect of germ cell depletion on levels of specific mRNA transcripts in mouse Sertoli cells and Leydig cells

It has been shown that testicular germ cell development is critically dependent upon somatic cell activity but, conversely, the extent to which germ cells normally regulate somatic cell function is less clear. This study was designed, therefore, to examine the effect of germ cell depletion on Sertoli cell and Leydig cell transcript levels. Mice were treated with busulphan to deplete the germ cell population and levels of mRNA transcripts encoding 26 Sertoli cell-specific proteins and 6 Leydig cell proteins were measured by real-time PCR up to 50 days after treatment. Spermatogonia were lost from the testis between 5 and 10 days after treatment, while spermatocytes were depleted after 10 days and spermatids after 20 days. By 30 days after treatment, most tubules were devoid of germ cells. Circulating FSH and intratesticular testosterone were not significantly affected by treatment. Of the 26 Sertoli cell markers tested, 13 showed no change in transcript levels after busulphan treatment, 2 showed decreased levels, 9 showed increased levels and 2 showed a biphasic response. In 60% of cases, changes in transcript levels occurred after the loss of the spermatids. Levels of mRNA transcripts encoding Leydig cell-specific products related to steroidogenesis were unaffected by treatment. Results indicate (1) that germ cells play a major and widespread role in the regulation of Sertoli cell activity, (2) most changes in transcript levels are associated with the loss of spermatids and (3) Leydig cell steroidogenesis is largely unaffected by germ cell ablation

Conductivity and redox stability of new double perovskite oxide Sr 1.6 K 0.4 Fe 1+ x Mo 1− x O 6− δ (x= 0.2, 0.4, 0.6)

A series of new perovskite oxides Sr1.6K0.4Fe1+xMo1−xO6−δ (x = 0.2, 0.4, 0.6) were synthesised by solid state reaction method. Synthesis of Sr1.6K0.4Fe1+xMo1−xO6−δ (x = 0.2, 0.4, 0.6) was achieved above 700 °C in 5 % H2/Ar, albeit with the formation of impurity phases. Phase stability upon redox cycling was only observed for sample Sr1.6K0.4Fe1.4Mo0.6O6−δ. Redox cycling of Sr1.6K0.4Fe1+xMo1−xO6−δ (x = 0.2, 0.4, 0.6) demonstrates a strong dependence on high temperature reduction to achieve high conductivities. After the initial reduction at 1200 °C in 5 %H2/Ar, then re-oxidation in air at 700 °C and further reduction at 700 °C in 5 %H2/Ar, the attained conductivities were between 0.1 and 58.4 % of the initial conductivity after reduction 1200 °C in 5 %H2/Ar depending on the composition. In the investigated new oxides, sample Sr1.6K0.4Fe1.4Mo0.6O6−δ is most redox stable also retains reasonably high electrical conductivity, ~70 S/cm after reduction at 1200 °C and 2–3 S/cm after redox cycling at 700 °C, indicating it is a potential anode for SOFCs

Pbca-Type In2O3: the high-pressure post-corundum phase at room temperature

This document is the Accepted Manuscript version of a Published Work that appeared in final form in Journal of Physical Chemistry C, copyright © American Chemical Society after peer review and technical editing by the publisher. To access the final edited and published work see http://dx.doi.org/10.1021/jp5061599High-pressure powder X-ray diffraction and Raman scattering measurements in cubic bixbyite-type indium oxide (c-In2O3) have been performed at room temperature. On increasing pressure c-In2O3 undergoes a transition to the Rh2O3-II structure but on decreasing pressure Rh2O3-II-type In2O3 undergoes a transition to a previously unknown phase with Pbca space group which is isostructural to Rh2O3-III. On further decrease of pressure, we observed a phase transition to the metastable corundum-type In2O3 near room conditions. Recompression of the metastable corundum-type In2O3 at room temperature leads to a transition to the Rh2O3-III phase, thus showing that the Rh2O3-III phase is the post-corundum phase at room temperature. Our results are supported by theoretical ab initio calculations. Furthermore, they show that the Rh2O3-III phase could be present in other sesquioxides, thus prompting to a revision of the pressure-temperature phase diagrams of sesquioxidesFinancial support by the Spanish MEC under Grant No. MAT2010-21270-C04-01/03/04, MAT2013-46649-C4-1/2/3-P, by MALTA Consolider Ingenio 2010 project (CSD2007-00045) and by Generalitat Valenciana (GVA-ACOMP-2013-012). Red Espanola de Supercomputacion (RES) and ALBA Synchrotron Light Source are also acknowledged. B.G.-D. and J.A.S. acknowledge financial support through the FPI program and Juan de la Cierva fellowship, respectively. We also thank J. L. Jorda for fruitful discussions. A.L.J.P. acknowledges financial support through Brazilian CNPq. A.S. expresses thanks to FEDER Grant UNLV10-3E-1253 for financial support.García-Domene, B.; Sans Tresserras, JÁ.; Gomis, O.; Manjón Herrera, FJ.; Ortiz, HM.; Errandonea, D.; Santamaría Pérez, D.... (2014). Pbca-Type In2O3: the high-pressure post-corundum phase at room temperature. Journal of Physical Chemistry C. 118(35):20545-20552. https://doi.org/10.1021/jp5061599S20545205521183