Analysis of Charges and Complications of Permanent Pacemaker Implantation in the Cardiac Catheterization Laboratory Versus the Operating Room

During the last two decades, an increasing number of permanent pacemakers have been implanted outside of the operating room (OR) by nonsurgeons. Previous investigators have demonstrated that pacemakers can be safely implanted in the cardiac catheterization laboratory with no increase in complications or infections. This is the first study of its kind to simultaneously evaluate cost, length of hospitalization, and complications between pacemakers implanted in the OR by surgeons with those implanted in the catheterization laboratory by an electrophysiologist. A total of 254 consecutive pacemaker implants were analyzed over a 2‐year period. The OR group consisted of 122 patients with a mean age of 64 ± 21 years versus 132 patients in the catheterization laboratory group with a mean age of 65 ± 17 years. The indication and type of pacemaker implanted were similar among both groups with 78% of OR patients and 73% of catheterization laboratory patients receiving dual chamber devices. The average cost for pacemaker implantation in our study was significantly higher in the OR group $5,464 ±$1,670 versus $2,682 ±$8 for the catheterization laboratory group (P < 0.001). There was a reduction in preimplant days in the catheterization laboratory group 3.16 ± 12.40 days versus 5.65 ± 9.54 days in the OR group (P < 0.05). Complications were minimal and there were no significant differences between the two groups. This study confirms that pacemakers can be safely implanted in the catheterization laboratory by nonsurgeons with no increase in complications and a significant reduction in hospital costs

ARCSECOND RESOLUTION MAPPING OF SULFUR DIOXIDE EMISSION IN THE CIRCUMSTELLAR ENVELOPE OF VY CANIS MAJORIS

We report Submillimeter Array observations of SO2 emission in the circumstellar envelope of the red supergiant VY CMa, with an angular resolution of ~1". SO2 emission appears in three distinct outflow regions surrounding the central continuum peak emission that is spatially unresolved. No bipolar structure is noted in the sources. A fourth source of SO2 is identified as a spherical wind centered at the systemic velocity. We estimate the SO2 column density and rotational temperature assuming local thermal equilibrium (LTE) as well as perform non-LTE radiative transfer analysis using RADEX. Column densities of SO2 are found to be ~10^16 cm^-2 in the outflows and in the spherical wind. Comparison with existing maps of the two parent species OH and SO shows the SO2 distribution to be consistent with that of OH. The abundance ratio f_SO2/f_SO is greater than unity for all radii greater than at least 3x10^16 cm. SO2 is distributed in fragmented clumps compared to SO, PN, and SiS molecules. These observations lend support to specific models of circumstellar chemistry that predict f_SO2/f_SO>1 and may suggest the role of localized effects such as shocks in the production of SO2 in the circumstellar envelope.Comment: Accepted for publication in Ap

A Long, Contingent Path to Comparative Advantage: Industrial Policy and the Japanese Iron and Steel Industry, 1900-1973

From the 1890s to 1960, industrial policy provided vital aid to the development of the Japanese iron and steel industry. Japanese industrial policy proved successful in steel even though public support was much prolonged, subject to political influence, and based on limited forecasting power ex ante, particularly with regard to recurrent raw material problems. Policy success in steel suggests the importance of large and pervasive market failures within a national context of underdevelopment. Over the longer term, on the other hand, as the Japanese economy grew more mature and its markets less expansive, implicit public commitment of aid to troubled industries may have engendered moral hazard, over-investment, and excess capacity—a set of problems that significantly reduces the attractions of the Japanese model