Description: It is not known if there is a differential impact on Alzheimer’s disease (AD) diagnosis and outcomes if/when patients are diagnosed with cognitive decline by specialists versus non-specialists. This study exam...

Description: Background: Wireless capsule pH-metry (WC) is better tolerated than standard nasal pH catheter (SC), but endoscopic placement is expensive. Aims: to confirm that non-endoscopic peroral manometric placement of WC is as effective and better tolerated than SC and to perform a cost analysis of the available esophageal pH-metry methods. Methods: Randomized trial at 2 centers. Patients referred for esophageal pH testing were randomly assigned to WC with unsedated peroral placement or SC after esophageal manometry (ESM). Primary outcome was overall discomfort with pH-metry. Costs of 3 different pH-metry strategies were analyzed: 1) ESM + SC, 2) ESM + WC and 3) endoscopically placed WC (EGD + WC) using publicly funded health care system perspective. Results: 86 patients (mean age 51 +/- 2 years, 71% female) were enrolled. Overall discomfort score was less in WC than in SC patients (26 +/- 4 mm vs 39 +/- 4 mm VAS, respectively, p = 0.012) but there were no significant group differences in throat, chest, or overall discomfort during placement. Overall failure rate was 7% in the SC group vs 12% in the WC group (p = 0.71). Per patient costs ($Canadian) were $1475 for EGD + WC, $1014 for ESM + WC, and $906 for ESM + SC. Decreasing the failure rate of ESM + WC from 12% to 5% decreased the cost of ESM + WC to $991. The ESM + SC and ESM + WC strategies became equivalent when the cost of the WC device was dropped from $292 to $193. Conclusions: Unsedated peroral WC insertion is better tolerated than SC pH-metry both overall and during placement. Although WC is more costly, the extra expense is partially offset when the higher patient and caregiver time costs of SC are considered.Trial registrationClinicaltrials.gov Identifier NCT01364610

Description: A method was developed to measure porosity and dissolved interstitial silicate at millimeter intervals or less in a sediment core. In cores from Emerald Basin (Scotian Shelf), interstitial concentrations near the sediment surface did not drop rapidly to bottom-water concentrations as measured in bottle casts (28 µM) but remained as high as 166 µM in the upper 0.5 mm of sediment High rates of benthic silicate release were measured which could not be accounted for by interstitial concentration gradients or by ventilation of macro-invertebrate burrows. The silicate discontinuity observed between the sediments and water column suggests that a diffusive sublayer exists in a zone of viscous flow above the sediment surface. This is possible only if a surface reaction is primarily responsible for silicate release. By assuming a linear concentration gradient across this diffusive sublayer, the silicate release rates were used to estimate the thickness of the sublayer to be about 2 mm.