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This PDF file contains the front matter associated with SPIE Proceedings Volume 8423, including the Title Page, Copyright information, Table of Contents, and the Conference Committee listing. © 2012 Copyright Society of Photo-Optical Instrumentation Engineers (SPIE).

We surveyed 178 orthopedic physicians in the Washington, DC, area to ascertain the effect on patient care of previous education in the area of drug and alcohol issues. The return rate was 75%. Of the respondents, 99% were male, average age was 46.7 years (+/- 9.3), and average number of years in practice was 15.2 (+/- 9.6). A majority of respondents indicated that they did not have training in the abuse potential of analgesics (92 [69%]), characteristics of benzodiazepine abuse (77 [58%]), or when to seek the assistance of an addiction medicine specialist for patients with chronic pain (106 [80%]). Only 41 (31%) of the orthopedists indicated that they inquire about alcohol and drug use before prescribing opiates for more than a week. We offer suggestions for self-education for interested physicians.

Background— Fractional flow reserve (FFR) measurement of intermediate coronary stenoses is recommended by guidelines when demonstration of ischemia by noninvasive testing is unavailable. The study aims to evaluate the penetration of this recommendation into current thinking about revascularization strategies for stable coronary artery disease. Methods and Results— International Survey on Interventional Strategy was conducted via a web-based platform. First, participants’ experiences in interventional cardiology were queried. Second, 5 complete angiograms were provided, presenting only focal intermediate stenoses. FFR and quantitative coronary angiography values were known; however, remained undisclosed. Determination of stenosis significance was asked for each lesion. In cases of uncertainty, the most appropriate adjunctive invasive diagnostic method among quantitative coronary angiography, intravascular ultrasound, optical coherence tomography, or FFR needed to be selected. International Survey on Interventional Strategy was taken by 495 participants who provided 4421 lesion evaluations. In 3158 (71%) decisions, participants relied solely on angiographic appearance that was discordant in 47% with the known FFR, using 0.80 as cutoff value. The use of FFR and imaging modalities was requested in 21% and 8%, respectively. Comparing 4 groups of participants according to the experience in FFR, angiogram-based decisions were less frequent with increasing experience (77% versus 72% versus 69% versus 67%, respectively; P P P Conclusions— The findings confirm that, even when all potential external constraints are virtually eliminated, visual estimation continues to dominate the treatment decisions for intermediate stenoses, indicative of a worrisome disconnect between recommendations and current practice.

BACKGROUND: Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear.OBJECTIVES: The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization.METHODS: Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold.RESULTS: A total of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief.CONCLUSIONS: FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy.

We study the sharp Fano-type resonance in a dimer metamaterial based on nanorods with different lengths. Breaking the length symmetry results in the excitation of a dark mode that weakly couples to the free space. Interference between the dark mode and the higher frequency bright mode gives rise to the peculiar asymmetric and sharp profile of the resonance. The steep dispersion and high sensitivity to slight variations of the dielectric environment of this resonance envisage the possible application of the asymmetric dimer metamaterial as an optical sensor for chemical or biological analysis.