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

Climate Change, Habitat Loss, Protected Areas and the Climate Adaptation Potential of Species in Mediterranean Ecosystems Worldwide

Mediterranean climate is found on five continents and supports five global biodiversity hotspots. Based on combined downscaled results from 23 atmosphere-ocean general circulation models (AOGCMs) for three emissions scenarios, we determined the projected spatial shifts in the mediterranean climate extent (MCE) over the next century. Although most AOGCMs project a moderate expansion in the global MCE, regional impacts are large and uneven. The median AOGCM simulation output for the three emissions scenarios project the MCE at the end of the 21st century in Chile will range from 129–153% of its current size, while in Australia, it will contract to only 77–49% of its current size losing an area equivalent to over twice the size of Portugal. Only 4% of the land area within the current MCE worldwide is in protected status (compared to a global average of 12% for all biome types), and, depending on the emissions scenario, only 50–60% of these protected areas are likely to be in the future MCE. To exacerbate the climate impact, nearly one third (29–31%) of the land where the MCE is projected to remain stable has already been converted to human use, limiting the size of the potential climate refuges and diminishing the adaptation potential of native biota. High conversion and low protection in projected stable areas make Australia the highest priority region for investment in climate-adaptation strategies to reduce the threat of climate change to the rich biodiversity of the mediterranean biome

First measurement of neutrino oscillation parameters using neutrinos and antineutrinos by NOvA.

The NOvA experiment has seen a 4.4σ signal of ν[over ¯]_{e} appearance in a 2 GeV ν[over ¯]_{μ} beam at a distance of 810 km. Using 12.33×10^{20} protons on target delivered to the Fermilab NuMI neutrino beamline, the experiment recorded 27 ν[over ¯]_{μ}→ν[over ¯]_{e} candidates with a background of 10.3 and 102 ν[over ¯]_{μ}→ν[over ¯]_{μ} candidates. This new antineutrino data are combined with neutrino data to measure the parameters |Δm_{32}^{2}|=2.48_{-0.06}^{+0.11}×10^{-3}  eV^{2}/c^{4} and sin^{2}θ_{23} in the ranges from (0.53-0.60) and (0.45-0.48) in the normal neutrino mass hierarchy. The data exclude most values near δ_{CP}=π/2 for the inverted mass hierarchy by more than 3σ and favor the normal neutrino mass hierarchy by 1.9σ and θ_{23} values in the upper octant by 1.6σ

Observation of seasonal variation of atmospheric multiple-muon events in the NOvA Near Detector

Using two years of data from the NOvA Near Detector at Fermilab, we report a seasonal variation of cosmic ray induced multiple-muon (Nμ≥2) event rates which has an opposite phase to the seasonal variation in the atmospheric temperature. The strength of the seasonal multiple-muon variation is shown to increase as a function of the muon multiplicity. However, no significant dependence of the strength of the seasonal variation of the multiple-muon variation is seen as a function of the muon zenith angle, or the spatial or angular separation between the correlated muons

Plant growth enhancement by elevated CO2 eliminated by joint water and nitrogen limitation

http://www.nature.com/ngeo/Rising atmospheric CO2 concentrations can fertilize plant growth. The resulting increased plant uptake of CO2 could, in turn, slow increases in atmospheric CO2 levels and associated climate warming. CO2 fertilization e ects may be enhanced when water availability is low, because elevated CO2 also leads to improved plant water-use e ciency. However, CO2 fertilization e ects may be weaker when plant growth is limited by nutrient availability. How variation in soil nutrients and water may act together to influence CO2 fertilization is unresolved. Here we report plant biomass levels from a five-year, open-air experiment in a perennial grassland under two contrasting levels of atmospheric CO2, soil nitrogen and summer rainfall, respectively. We find that the presence of a CO2 fertilization e ect depends on the amount of available nitrogen and water. Specifically, elevated CO2 levels led to an increase in plant biomass of more than 33% when summer rainfall, nitrogen supply, or both were at the higher levels (ambient for rainfall and elevated for soil nitrogen). But elevated CO2 concentrations did not increase plant biomass when both rainfall and nitrogen were at their lower level. We conclude that given widespread, simultaneous limitation by water and nutrients, large stimulation of biomass by rising atmospheric CO2 concentrations may not be ubiquitous

Measurement of the νe -Nucleus Charged-Current Double-Differential Cross Section at «eν »=2.4 GeV Using NOvA

The inclusive electron neutrino charged-current cross section is measured in the NOvA near detector using 8.02×1020 protons-on-target in the NuMI beam. The sample of GeV electron neutrino interactions is the largest analyzed to date and is limited by ≃17% systematic rather than the ≃7.4% statistical uncertainties. The double-differential cross section in final-state electron energy and angle is presented for the first time, together with the single-differential dependence on Q2 (squared four-momentum transfer) and energy, in the range 1 GeV≤Eν<6 GeV. Detailed comparisons are made to the predictions of the GENIE, GiBUU, NEUT, and NuWro neutrino event generators. The data do not strongly favor a model over the others consistently across all three cross sections measured, though some models have especially good or poor agreement in the single differential cross section vs Q2

Search for slow magnetic monopoles with the NOvA detector on the surface

We report a search for a magnetic monopole component of the cosmic-ray flux in a 95-day exposure of the NOvA experiment’s Far Detector, a 14 kt segmented liquid scintillator detector designed primarily to observe GeV-scale electron neutrinos. No events consistent with monopoles were observed, setting an upper limit on the flux of 2 × 10−14 cm−2 s−1 sr−1 at 90% C.L. for monopole speed 6 × 10−4 < β < 5 × 10−3 and mass greater than 5 × 108 GeV. Because of NOvA’s small overburden of 3 meters-water equivalent, this constraint covers a previously unexplored low-mass region

Measurement of the double-differential muon-neutrino charged-current inclusive cross section in the NOvA near detector

We report cross-section measurements of the final-state muon kinematics for νμ charged-current interactions in the NOvA near detector using an accumulated 8.09×1020 protons on target in the NuMI beam. We present the results as a double-differential cross section in the observed outgoing muon energy and angle, as well as single-differential cross sections in the derived neutrino energy, Eν, and square of the four-momentum transfer, Q2. We compare the results to inclusive cross-section predictions from various neutrino event generators via χ2 calculations using a covariance matrix that accounts for bin-to-bin correlations of systematic uncertainties. These comparisons show a clear discrepancy between the data and each of the tested predictions at forward muon angle and low Q2, indicating a missing suppression of the cross section in current neutrino-nucleus scattering models

First measurement of neutrino oscillation parameters using neutrinos and antineutrinos by NOvA

The NOvA experiment has seen a 4.4σ signal of ν̄e appearance in a 2 GeV ν̄μ beam at a distance of 810 km. Using 12.33×1020 protons on target delivered to the Fermilab NuMI neutrino beamline, the experiment recorded 27 ν̄μ→ν̄e candidates with a background of 10.3 and 102 ν̄μ→ν̄μ candidates. This new antineutrino data are combined with neutrino data to measure the parameters |Δm322|=2.48-0.06+0.11×10-3 eV2/c4 and sin2θ23 in the ranges from (0.53-0.60) and (0.45-0.48) in the normal neutrino mass hierarchy. The data exclude most values near δCP=π/2 for the inverted mass hierarchy by more than 3σ and favor the normal neutrino mass hierarchy by 1.9σ and θ23 values in the upper octant by 1.6σ

First measurement of neutrino oscillation parameters using neutrinos and antineutrinos by NOvA

The NOvA experiment has seen a 4.4 σ signal of ¯ ν e appearance in a 2 GeV ¯ ν μ beam at a distance of 810 km. Using 12.33 × 10 20 protons on target delivered to the Fermilab NuMI neutrino beamline, the experiment recorded 27 ¯ ν μ → ¯ ν e candidates with a background of 10.3 and 102 ¯ ν μ → ¯ ν μ candidates. This new antineutrino data are combined with neutrino data to measure the parameters | Δ m 2 32 | = 2.4 8 + 0.11 − 0.06 × 10 − 3     eV 2 / c 4 and sin 2 θ 23 in the ranges from (0.53–0.60) and (0.45–0.48) in the normal neutrino mass hierarchy. The data exclude most values near δ C P = π / 2 for the inverted mass hierarchy by more than 3 σ and favor the normal neutrino mass hierarchy by 1.9 σ and θ 23 values in the upper octant by 1.6 σ