Decision-analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer

Objective: To determine the cost-effectiveness of salvage cryotherapy (SC) in men with radiation recurrent prostate cancer (RRPC). Design: Cost-utility analysis using decision analytic modelling by a Markov model. Setting and methods: Compared SC and androgen deprivation therapy (ADT) in a cohort of patients with RRPC (biopsy proven local recurrence, no evidence of metastatic disease). A literature review captured published data to inform the decision model, and resource use data were from the Scottish Prostate Cryotherapy Service. The model was run in monthly cycles for RRPC men, mean age of 70 years. The model was run over the patient lifetime, to assess changes in patient health states and the associated quality of life, survival and cost impacts. Results are reported in terms of the discounted incremental costs and discounted incremental quality-adjusted life years (QALYs) gained between the 2 alternative interventions. Probabilistic sensitivity analysis used a 10 000 iteration Monte Carlo simulation. Results: SC has a high upfront treatment cost, but delays the ongoing monthly cost of ADT. SC is the dominant strategy over the patient lifetime; it is more effective with an incremental 0.56 QALY gain (95% CI 0.28 to 0.87), and less costly with a reduced lifetime cost of £29 719 (€37 619) (95% CI −51 985 to −9243). For a ceiling ratio of £30 000, SC has a 100% probability to be cost-effective. The cost neutral point was at 3.5 years, when the upfront cost of SC (plus any subsequent cumulative cost of side effects and ADT) equates the cumulative cost in the ADT arm. Limitations of our model may arise from its insensitivity to parameter or structural uncertainty. Conclusions: The platform for SC versus ADT cost-effective analysis can be employed to evaluate other treatment modalities or strategies in RRPC. SC is the dominant strategy, costing less over a patient's lifetime with improvements in QALYs

Quasinormal Modes of Dirty Black Holes

Quasinormal mode (QNM) gravitational radiation from black holes is expected to be observed in a few years. A perturbative formula is derived for the shifts in both the real and the imaginary part of the QNM frequencies away from those of an idealized isolated black hole. The formulation provides a tool for understanding how the astrophysical environment surrounding a black hole, e.g., a massive accretion disk, affects the QNM spectrum of gravitational waves. We show, in a simple model, that the perturbed QNM spectrum can have interesting features.Comment: 4 pages. Published in PR

Case Report: Spinal Anesthesia by Mini-laminotomy for a Patient with Ankylosing Spondylitis who was Difficult to Anesthetize

Case reportBackground: Orthopaedic surgeons frequently encounter patients with ankylosing spondylitis who would benefit from various types of lower limb operations; however, some of these patients present challenges for anesthesiologists. Case Description: We report the case of a 65-year-old patient with a fractured femoral component 30 years after a cemented THA. The patient had severe tracheal stenosis and ankylosing spondylitis making general endotracheal and conventional neuraxial anesthesia nearly impossible. Literature Review: Possible alternative anesthetic approaches described in the literature include awake fiberoptic bronchoscopic guided intubation, laryngeal mask airway, and caudal anesthesia. Purposes and Clinical Relevance: We achieved successful anesthesia using spinal laminotomy with the patient under local anesthesia followed by insertion of a spinal catheter and injection of an anesthetic agent. The loosened component was revised to a cementless THA. © 2010 The Author(s).published_or_final_versionSpringer Open Choice, 31 May 201

Multi-wavelength emissions from the millisecond pulsar binary PSR J1023+0038 during an accretion active state

Recent observations strongly suggest that the millisecond pulsar binary PSR J1023+0038 has developed an accretion disk since 2013 June. We present a multi-wavelength analysis of PSR J1023+0038, which reveals that 1) its gamma-rays suddenly brightened within a few days in June/July 2013 and has remained at a high gamma-ray state for several months; 2) both UV and X-ray fluxes have increased by roughly an order of magnitude, and 3) the spectral energy distribution has changed significantly after the gamma-ray sudden flux change. Time variabilities associated with UV and X-rays are on the order of 100-500 seconds and 50-100 seconds, respectively. Our model suggests that a newly formed accretion disk due to the sudden increase of the stellar wind could explain the changes of all these observed features. The increase of UV is emitted from the disk, and a new component in gamma-rays is produced by inverse Compton scattering between the new UV component and pulsar wind. The increase of X-rays results from the enhancement of injection pulsar wind energy into the intra-binary shock due to the increase of the stellar wind. We also predict that the radio pulses may be blocked by the evaporated winds from the disk and the pulsar is still powered by rotation.Comment: 8 pages, 3 figures; accepted for publication in Ap

Controlling for transactions bias in regional house price indices

Transactions bias arises when properties that trade are not a random sample of the total housing stock. Price indices are susceptible because they are typically based on transactions data. Existing approaches to this problem rely on Heckman-type correction methods, where a probit regression is used to capture the differences between properties that sell and those that do not sell in a given period. However, this approach can only be applied where there is reliable data on the whole housing stock. In many countries—the UK included—no such data exist and there is little prospect of correcting for transactions bias in any of the regularly updated mainstream house price indices. Thispaper suggests a possible alternative approach, using information at postcode sector level and Fractional Probit Regression to correct for transactions bias in hedonic price indices based on one and a half million house sales from 1996 to 2004, distributed across 1200 postcode sectors in the South East of England

Perturbative Approach to the Quasinormal Modes of Dirty Black Holes

Using a recently developed perturbation theory for uasinormal modes (QNM's), we evaluate the shifts in the real and imaginary parts of the QNM frequencies due to a quasi-static perturbation of the black hole spacetime. We show the perturbed QNM spectrum of a black hole can have interesting features using a simple model based on the scalar wave equation.Comment: Published in PR