Cost-effectiveness analysis of 3-D computerized tomography colonography versus optical colonoscopy for imaging symptomatic gastroenterology patients.

BACKGROUND: When symptomatic gastroenterology patients have an indication for colonic imaging, clinicians have a choice between optical colonoscopy (OC) and computerized tomography colonography with three-dimensional reconstruction (3-D CTC). 3-D CTC provides a minimally invasive and rapid evaluation of the entire colon, and it can be an efficient modality for diagnosing symptoms. It allows for a more targeted use of OC, which is associated with a higher risk of major adverse events and higher procedural costs. A case can be made for 3-D CTC as a primary test for colonic imaging followed if necessary by targeted therapeutic OC; however, the relative long-term costs and benefits of introducing 3-D CTC as a first-line investigation are unknown. AIM: The aim of this study was to assess the cost effectiveness of 3-D CTC versus OC for colonic imaging of symptomatic gastroenterology patients in the UK NHS. METHODS: We used a Markov model to follow a cohort of 100,000 symptomatic gastroenterology patients, aged 50 years or older, and estimate the expected lifetime outcomes, life years (LYs) and quality-adjusted life years (QALYs), and costs (£, 2010-2011) associated with 3-D CTC and OC. Sensitivity analyses were performed to assess the robustness of the base-case cost-effectiveness results to variation in input parameters and methodological assumptions. RESULTS: 3D-CTC provided a similar number of LYs (7.737 vs 7.739) and QALYs (7.013 vs 7.018) per individual compared with OC, and it was associated with substantially lower mean costs per patient (£467 vs £583), leading to a positive incremental net benefit. After accounting for the overall uncertainty, the probability of 3-D CTC being cost effective was around 60 %, at typical willingness-to-pay values of £20,000-£30,000 per QALY gained. CONCLUSION: 3-D CTC is a cost-saving and cost-effective option for colonic imaging of symptomatic gastroenterology patients compared with OC

Ethnographic study of the use of interventions during the second stage of labor in Jeddah, Saudi Arabia

BACKGROUND: Routine use of medical interventions during labor has been identified as a clinical area for concern, since such routinized practice is not consistent with an evidence-based approach to care and continues to increase despite efforts to encourage normal childbirth. Therefore, the aim of our study was to explore maternity health professionals' use of interventions during the second stage of labor in two hospitals in Jeddah, Saudi Arabia, to understand what influences their decision-making and practices. METHODS: This was an exploratory study using an ethnographic approach. Data collection methods included participant observations of 19 labors and births (n = 8 at City Hospital and n = 11 at King's Hospital) and semi-structured interviews with 29 health care professionals. In addition, the hospital labor and delivery ward policies and guidelines from those hospitals were collected. Data were analyzed thematically. RESULTS: Medical interventions were used during the second stage of labor routinely, regardless of clinical indication. Three core influences that shaped the clinical decision-making were identified as follows: (a) organizational culture, (b) a medical concept of birth, and (c) a hierarchical system of control. We suggest that the clinical decision-making and routine practice in this setting arises out of the interface between these three core influences whereby hierarchical control and clinicians' exercise of power and feelings of powerlessness are fundamental drivers for an organizational culture of medicalized childbirth, despite the differing models of childbirth which professionals described. CONCLUSIONS: Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision-making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence-based practice and approaches to change need to take into account these different levels of influence

The European Society of Human Reproduction and Embryology guideline for the diagnosis and treatment of endometriosis: an electronic guideline implementability appraisal

<p>Abstract</p> <p>Background</p> <p>Clinical guidelines are intended to improve healthcare. However, even if guidelines are excellent, their implementation is not assured. In subfertility care, the European Society of Human Reproduction and Embryology (ESHRE) guidelines have been inventoried, and their methodological quality has been assessed. To improve the impact of the ESHRE guidelines and to improve European subfertility care, it is important to optimise the implementability of guidelines. We therefore investigated the implementation barriers of the ESHRE guideline with the best methodological quality and evaluated the used instrument for usability and feasibility.</p> <p>Methods</p> <p>We reviewed the ESHRE guideline for the diagnosis and treatment of endometriosis to assess its implementability. We used an electronic version of the guideline implementability appraisal (eGLIA) instrument. This eGLIA tool consists of 31 questions grouped into 10 dimensions. Seven items address the guideline as a whole, and 24 items assess the individual recommendations in the guideline. The eGLIA instrument identifies factors that influence the implementability of the guideline recommendations. These factors can be divided into facilitators that promote implementation and barriers that oppose implementation. A panel of 10 experts from three European countries appraised all 36 recommendations of the guideline. They discussed discrepancies in a teleconference and completed a questionnaire to evaluate the ease of use and overall utility of the eGLIA instrument.</p> <p>Results</p> <p>Two of the 36 guideline recommendations were straightforward to implement. Five recommendations were considered simply statements because they contained no actions. The remaining 29 recommendations were implementable with some adjustments. We found facilitators of the guideline implementability in the quality of decidability, presentation and formatting, apparent validity, and novelty or innovation of the recommendations. Vaguely defined actions, lack of facilities, immeasurable outcomes, and inflexibility within the recommendations formed barriers to implementation. The eGLIA instrument was generally useful and easy to use. However, assessment with the eGLIA instrument is very time-consuming.</p> <p>Conclusions</p> <p>The ESHRE guideline for the diagnosis and treatment of endometriosis could be improved to facilitate its implementation in daily practice. The eGLIA instrument is a helpful tool for identifying obstacles to implementation of a guideline. However, we recommend a concise version of this instrument.</p

Pulse Profile Variability of PSR J1022+1001 in NANOGrav Data

\ua9 2025. The Author(s). Published by the American Astronomical Society.Pulse profile stability is a central assumption of standard pulsar timing methods. Thus, it is important for pulsar timing array experiments such as the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) to account for any pulse profile variability present in their data sets. We show that in the NANOGrav 15 yr data set, the integrated pulse profile of PSR J1022+1001 as seen by the Arecibo radio telescope at 430, 1380, and 2030 MHz varies considerably in its shape from observation to observation. We investigate the possibility that this is due to the “ideal feed assumption” (IFA), on which NANOGrav’s routine polarization calibration procedure relies. PSR J1022+1001 is ∼90% polarized in one pulse profile component, and also has significant levels of circular polarization. Time-dependent deviations in the feed’s polarimetric response (PR) could cause mixing between the intensity I and the other Stokes parameters, leading to the observed variability. We calibrate the PR using a mixture of measurement equation modeling and measurement equation template matching techniques. The resulting profiles are no less variable than those calibrated using the IFA method, nor do they provide an improvement in the timing quality of this pulsar. We observe the pulse shape in 25 MHz bandwidths to vary consistently across the band, which cannot be explained by interstellar scintillation in combination with profile evolution with frequency. Instead, we favor phenomena intrinsic to the pulsar as the cause

The Anomalous Acceleration of PSR J2043+1711: Long-period Orbital Companion or Stellar Flyby?

\ua9 2025. The Author(s). Published by the American Astronomical Society.Based on the rate of change of its orbital period, PSR J2043+1711 has a substantial peculiar acceleration of 3.5 \ub1 0.8 mm s-1 yr-1, which deviates from the acceleration predicted by equilibrium Milky Way (MW) models at a 4σ level. The magnitude of the peculiar acceleration is too large to be explained by disequilibrium effects of the MW interacting with orbiting dwarf galaxies (∼1 mm s-1 yr-1), and too small to be caused by period variations due to the pulsar being a redback. We identify and examine two plausible causes for the anomalous acceleration: a stellar flyby, and a long-period orbital companion. We identify a main-sequence star in Gaia DR3 and Pan-STARRS DR2 with the correct mass, distance, and on-sky position to potentially explain the observed peculiar acceleration. However, the star and the pulsar system have substantially different proper motions, indicating that they are not gravitationally bound. However, it is possible that this is an unrelated star that just happens to be located near J2043+1711 along our line of sight (chance probability of 1.6%). Therefore, we also constrain possible orbital parameters for a circumbinary companion in a hierarchical triple system with J2043+1711; the changes in the spindown rate of the pulsar are consistent with an outer object that has an orbital period of 60 kyr, a companion mass of 0.3 M⊙ (indicative of a white dwarf or low-mass star), and a semimajor axis of 1900 au. Continued timing and/or future faint optical observations of J2043+1711 may eventually allow us to differentiate between these scenarios

The NANOGrav 15 yr Data Set: Chromatic Gaussian Process Noise Models for Six Pulsars

\ua9 2024. The Author(s). Published by the American Astronomical Society.Pulsar timing arrays (PTAs) are designed to detect low-frequency gravitational waves (GWs). GWs induce achromatic signals in PTA data, meaning that the timing delays do not depend on radio frequency. However, pulse arrival times are also affected by radio-frequency-dependent “chromatic” noise from sources such as dispersion measure (DM) and scattering delay variations. Furthermore, the characterization of GW signals may be influenced by the choice of chromatic noise model for each pulsar. To better understand this effect, we assess if and how different chromatic noise models affect the achromatic noise properties in each pulsar. The models we compare include existing DM models used by the North American Nanohertz Observatory for Gravitational waves (NANOGrav) and noise models used for the European PTA Data Release 2 (EPTA DR2). We perform this comparison using a subsample of six pulsars from the NANOGrav 15 yr data set, selecting the same six pulsars as from the EPTA DR2 six-pulsar data set. We find that the choice of chromatic noise model noticeably affects the achromatic noise properties of several pulsars. This is most dramatic for PSR J1713+0747, where the amplitude of its achromatic red noise lowers from log 10 A RN = − 14.1 − 0.1 + 0.1 to − 14.7 − 0.5 + 0.3 , and the spectral index broadens from γ RN = 2.6 − 0.4 + 0.5 to γ RN = 3.5 − 0.9 + 1.2 . We also compare each pulsar\u27s noise properties with those inferred from the EPTA DR2, using the same models. From the discrepancies, we identify potential areas where the noise models could be improved. These results highlight the potential for custom chromatic noise models to improve PTA sensitivity to GWs

The NANOGrav 15 yr Data Set: Search for Gravitational-wave Memory

\ua9 2025. The Author(s). Published by the American Astronomical Society.We present the results of a search for nonlinear gravitational-wave (GW) memory in the NANOGrav 15 yr data set. We find no significant evidence for memory signals in the data set, with a maximum Bayes factor of 3.1 in favor of a model including memory. We therefore place upper limits on the strain of potential GW memory events as a function of sky location and observing epoch. We find upper limits that are not always more constraining than previous NANOGrav results. We show that it is likely due to the increase in common red noise between the 12.5 and 15 yr NANOGrav data sets

The NANOGrav 15 Yr Data Set: Removing Pulsars One by One from the Pulsar Timing Array

\ua9 2025. The Author(s). Published by the American Astronomical Society. Evidence has emerged for a stochastic signal correlated among 67 pulsars within the 15 yr pulsar-timing data set compiled by the NANOGrav collaboration. Similar signals have been found in data from the European, Indian, Parkes, and Chinese pulsar timing arrays. This signal has been interpreted as indicative of the presence of a nanohertz stochastic gravitational-wave background (GWB). To explore the internal consistency of this result, we investigate how the recovered signal strength changes as we remove the pulsars one by one from the data set. We calculate the signal strength using the (noise-marginalized) optimal statistic, a frequentist metric designed to measure the correlated excess power in the residuals of the arrival times of the radio pulses. We identify several features emerging from this analysis that were initially unexpected. The significance of these features, however, can only be assessed by comparing the real data to synthetic data sets. After conducting identical analyses on simulated data sets, we do not find anything inconsistent with the presence of a stochastic GWB in the NANOGrav 15 yr data. The methodologies developed here can offer additional tools for application to future, more sensitive data sets. While this analysis provides an internal consistency check of the NANOGrav results, it does not eliminate the necessity for additional investigations that could identify potential systematics or uncover unmodeled physical phenomena in the data

The NANOGrav 15 yr Data Set: Running of the Spectral Index

\ua9 2025. The Author(s)The NANOGrav 15 yr data provide compelling evidence for a stochastic gravitational-wave (GW) background at nanohertz frequencies. The simplest model-independent approach to characterizing the frequency spectrum of this signal consists of a simple power-law fit involving two parameters: an amplitude A and a spectral index γ. In this Letter, we consider the next logical step beyond this minimal spectral model, allowing for a running (i.e., logarithmic frequency dependence) of the spectral index, grun (f ) = g + b ln (f /fref ). We fit this running-power-law (RPL) model to the NANOGrav 15 yr data and perform a Bayesian model comparison with the minimal constant-power-law (CPL) model, which results in a 95% credible interval for the parameter β consistent with no running, b \uce [-0.80, 2.96], and an inconclusive Bayes factor, B(RPL versus CPL) = 0.69 \ub1 0.01. We thus conclude that, at present, the minimal CPL model still suffices to adequately describe the NANOGrav signal; however, future data sets may well lead to a measurement of nonzero β. Finally, we interpret the RPL model as a description of primordial GWs generated during cosmic inflation, which allows us to combine our results with upper limits from Big Bang nucleosynthesis, the cosmic microwave background, and LIGO–Virgo–KAGRA