Therapeutic interchange of conjugated and esterified estrogens in a managed care organization.

A program designed to curb increases in drug costs in an HMO by substituting esterified for conjugated estrogens was developed and studied. Patients were voluntarily switched from conjugated to esterified estrogens at an HMO in Washington State. Women were informed about the conversion through newsletters and during clinic and pharmacy visits and received physician and pharmacist counseling. Cost savings were estimated, and patient acceptance was evaluated by interviewing women in four groups, including women who were switched from conjugated to esterified estrogens and then switched back (C-E-C group), women who were not switched (C-C group), and women who were switched to esterified estrogens and not switched back (C-E group). During the first six months, 14,601 (89.2%) of 16,364 women taking conjugated estrogens were switched to esterified estrogens; of these, 13,654 (93.5%) continued taking esterified estrogens for at least six months. The HMO avoided $653,119 of an expected $750,000 cost increase for oral estrogen therapy during the first year of the program. A total of 754 women were interviewed; 65.8% in the C-E-C group and 78.4% in the C-E group reported being satisfied with the information they received. The conversion experience was rated as positive by 28.3% of women in the C-E-C group and 41.5% of women in the C-E group, negative by 25.1%, and 8.9%, and neutral by 46.6% and 49.6%. An HMO avoided a large increase in drug costs by substituting esterified for conjugated estrogens; only 6.5% of patients were switched back to conjugated estrogens at their physicians' or their own request; most patients thought the conversion was a neutral or positive experience.

Comparison of three-day butoconazole treatment with seven-day miconazole treatment for vulvovaginal candidiasis.

In this multicenter, parallel, randomized, investigator-blind trial, we compared the safety and efficacy of a three-day regimen of 2% butoconazole vaginal cream with those of a seven-day regimen of 2% miconazole vaginal cream. Enrolled were 271 nonpregnant women with vulvovaginal candidiasis. Each patient administered her assigned study medication to the posterior vaginal fornix for three or seven consecutive nights. All 271 patients were included in the safety evaluation, and 225 (111 receiving butoconazole and 114 receiving miconazole) were included in the efficacy evaluation. Eight to ten days after treatment completion, 88% of the butoconazole-treated patients and 91% of the miconazole-treated patients were Candida negative; 80% of the butoconazole-treated patients and 82% of the miconazole-treated patients were considered clinically cured. Thirty days after treatment completion, 73% of the butoconazole-treated patients and 69% of the miconazole-treated patients remained Candida negative; 78% of the butoconazole-treated patients and 80% of the miconazole-treated patients remained free of clinical symptoms of vulvovaginitis. None of the differences between the two treatment groups was statistically significant. Six patients (four receiving butoconazole and two receiving miconazole) reported increased symptoms of vulvovaginal irritation, and three of them (two receiving butoconazole and one receiving miconazole) withdrew from the trial. Thus, the efficacy and safety of the three-day butoconazole treatment regimen were equivalent to those of the seven-day miconazole treatment regimen. The advantage of the shorter butoconazole treatment is increased patient compliance with maintenance of high efficacy.

Surface temperature-field imaging with laser-induced thermographic phosphorescence.

A technique to remotely image temperature distributions of heated metallic surfaces is extended to higher temperatures. It uses a Dy(+3):YAG thermographic phosphor (TP) bonded to the surface and excited by radiation at 355 nm. Digital images of the emission from two excited states were recorded and divided by each other to correct by normalization for illumination and coating nonuniformities. Results show that the TP can survive heating and cooling cycles to 1400 K and that emitting states achieve thermodynamic equilibrium before radiating. Temperatures in the range of 300-1300 K were determined by normalization of pairs of emission images with a single calibration constant. Uncertainties of +/-7-13% at a spatial resolution of 20 microm and +/-0.7-4% at a resolution of 500 microm were achieved.

Surface temperature imaging below 300 K using La(2)O(2)S:Eu.

Surface temperature images obtained by the ratioing of visible (5)D(2) and (5)D(1), emissions from a La(2)O(2)S:Eu phosphor coating are demonstrated. The visible phosphor emissions permit imaging with standard CCD cameras. Temperature resolution to 1 K is achieved over a temperature range of 193-293 K.

Multiphoton ionization of N(2) by the third harmonic of a Nd:YAG laser: a new avenue for air diagnostics.

Ionization of N(2) by the third harmonic of a Nd:YAG laser is demonstrated and confirmed experimentally from both spectral and ion-collection measurements. Six photons at 355 nm excite the ground-state neutral molecule to the B(2) summation operator(+)(u) (upsilon' = 8) ionized state. Intense radiation at 391.4 nm associated with the B(2) summation operator(+)(u) (upsilon = 0) ? X(2) summation operator(+)(g) (upsilon'' = 0) transition was detected. The intensity of this line scales quadratically with the laser power. An ion concentration of 3.25 x 10(13) ions/cm(3) was detected after irradiation by a 45-mJ laser pulse focused to a diameter of 17 microm. The potential application of this ionization scheme for air velocity and temperature measurements is presented.

Calibration source for OH laser-induced fluorescence-density measurements with thermally dissociated H2O in atmospheric air.

A calibration technique for OH laser-induced fluorescence (LIF) density measurements through the use of the thermal dissociation of ambient H(2)O in an atmospheric air furnace with a tunable KrF laser has been demonstrated. The stable and uniform concentration of OH produced in the furnace permits direct calibration of LIF signals without the uncertainties associated with reference flames. The presence of OH in atmospheric air that is heated to temperatures exceeding 1500 K is sufficient for LIF measurements with most OH LIF laser systems. The measured OH density is found to agree well with the computed OH chemical-equilibrium density over a temperature range of 1500-1850 K.