Gordon states, "At about $1,000 per procedure, theres clearly an economic incentive".The Hemoccult II FOBT (combined with follow-up colonoscopy if indicated by the test) is over 5 times as cost effective as other screening strategies, but is only about 85% as sensitive. Because of this relatively low sensitivity, US guidelines advocate the over 5 times more expensive procedures instead, because even the relatively small increase in lives saved and 5-fold cost increase is seen as worth choosing, given US living standards. History
In the 1960s, Dr. Niwa and Dr. Yamagata at Tokyo University developed the device. After 1968, Dr. William Wolff and Dr. Hiromi Shinya pioneered the development of the colonoscope. Their invention, in 1969 in Japan, was an advance over the barium enema and the flexible sigmoidoscope because it allowed for the visualization and removal of polyps from the entire large intestine. Wolff and Shinya advocated for their invention and published much of the early evidence needed to overcome skepticism about the devices safety and efficacy. Colonoscopy with CCD invention and market is led by Fuji film, Olympus and Hoya in Japan. In 1982, Dr. Lawrence Kaplan of Aspen Medical Group in St. Paul, MN reported a series of 100 consecutive colonoscopies and upper endoscopies performed in a free-standing clinic miles from the nearest hospital, demonstrating the safety and cost effectiveness of these outpatient procedures.
Perforation of steel strips is used in the manufacture of some zesters and rasps. Historically, perforation patterns other than linear were used to mark stamps. A series of patents had been issued in the late 19th century for perforation machines to be used on rail lines for ticketing. Libraries and private collections used similar perforating stamps to mark ownership of books. End sheets, title pages, and image plates were punched with the namesake of the collection. Today, similarly elaborate perforation patterns continue to be used in orienteering. Bread bags for some bread often have micro-perforations in the plastic, which is supposed to keep the bread fresh by releasing excess moisture. Similarly, bags of concrete use small perforations to allow air to escape while they are being filled. See also
Film perforations
Punched tape


== References ==