Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial

Objective: To assess the cost effectiveness of laparoscopic hysterectomy compared with conventional hysterectomy (abdominal or vaginal). Design: Cost effectiveness analysis based on two parallel trials: laparoscopic (n = 324) compared with vaginal hysterectomy (n = 163); and laparoscopic (n = 573) compared with abdominal hysterectomy (n = 286). Participants: 1346 women requiring a hysterectomy for reasons other than malignancy. Main outcome measure: One year costs estimated from NHS perspective. Health outcomes expressed in terms of QALYs based on women's responses to the EQ-5D at baseline and at three points during up to 52 weeks' follow up. Results: Laparoscopic hysterectomy cost an average of pound401 ($708; C571) more (95$471789; E380 437). The, probability that laparoscopic hysterectomy is cost effective was below 50% for a large range of values of willingness to pay for an additional QALY. Laparoscopic hysterectomy cost an average of pound186 ($328; E265) more than abdominal hysterectomy, although 95$46 893; E37 813). If the NHS is willing to pay pound30 0 00 for an additional QALY, the probability that laparoscopic hysterectomy is cost effective is 56%. Conclusions: Laparoscopic hysterectomy is not cost effective relative to vaginal hysterectomy. Its cost effectiveness relative to the abdominal procedure is finely balanced

Critical chain length and superconductivity emergence in oxygen-equalized pairs of YBa2Cu3O6.30

The oxygen-order dependent emergence of superconductivity in YBa2Cu3O6+x is studied, for the first time in a comparative way, on pair samples having the same oxygen content and thermal history, but different Cu(1)Ox chain arrangements deriving from their intercalated and deintercalated nature. Structural and electronic non-equivalence of pairs samples is detected in the critical region and found to be related, on microscopic scale, to a different average chain length, which, on being experimentally determined by nuclear quadrupole resonance (NQR), sheds new light on the concept of critical chain length for hole doping efficiency.Comment: 7 RevTex pages, 2 Postscript figures. Submitted to Phys. Rev.

Macrostructural and Microstructural White Matter Alterations Are Associated with Apathy across the Clinical Alzheimer’s Disease Spectrum

Apathy is the commonest neuropsychiatric symptom in Alzheimer’s disease (AD). Previous findings suggest that apathy is caused by a communication breakdown between functional neural networks involved in motivational–affective processing. This study investigated the relationship between white matter (WM) damage and apathy in AD. Sixty-one patients with apathy (AP-PT) and 61 without apathy (NA-PT) were identified from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database and matched for cognitive status, age and education. Sixty-one cognitively unimpaired (CU) participants were also included as controls. Data on cognitive performance, cerebrospinal fluid biomarkers, brain/WM hyperintensity volumes and diffusion tensor imaging indices were compared across groups. No neurocognitive differences were found between patient groups, but the AP-PT group had more severe neuropsychiatric symptoms. Compared with CU participants, only apathetic patients had deficits on the Clock Drawing Test. AP-PT had increased WM damage, both macrostructurally, i.e., larger WM hyperintensity volume, and microstructurally, i.e., increased radial/axial diffusivity and reduced fractional anisotropy in the fornix, cingulum, anterior thalamic radiations and superior longitudinal and uncinate fasciculi. AP-PT showed signs of extensive WM damage, especially in associative tracts in the frontal lobes, fornix and cingulum. Disruption in structural connectivity might affect crucial functional inter-network communication, resulting in motivational deficits and worse cognitive decline

Hydrogeology of the Sabatini Volcanic District (Central Italy)

This paper supports the 'Hydrogeological map of the Sabatini Volcanic District'. The map provides an overview of the hydrogeological setting of the Sabatini Volcanic District, using experimental water level data integrated with former volcanological and hydrogeological studies. The 1:50,000 scale map was produced in order to provide support to local authorities and professionals working on groundwater management. Fifteen hydrogeological complexes were defined based on volcanological properties and hydrogeological conditions

STAR: Sum-Together/Apart Reconfigurable Multipliers for Precision-Scalable ML Workloads

To achieve an optimal balance between accuracy and latency in Deep Neural Networks (DNNs), precision-scalability has become a paramount feature for hardware specialized for Machine Learning (ML) workloads. Recently, many precision-scalable (PS) multipliers and multiply-and-accumulate (MAC) units have been proposed. They are mainly divided in two categories, Sum-Apart (SA) and Sum-Together (ST), and have been always presented as alternative implementations. Instead, in this paper, we introduce for the first time a new class of PS Sum-Together/Apart Reconfigurable multipliers, which we call STAR, designed to support both SA and ST modes with a single reconfigurable architecture. STAR multipliers could be useful in MAC units of CPU or hardware accelerators, for example, enabling them to handle both 2D Convolution (in ST mode) and Depth-wise Convolution (in SA mode) with a unique PS hardware design, thus saving hardware resources. We derive four distinct STAR multiplier architectures, including two derived from the well-known Divide-and-Conquer and Sub-word Parallel SA and ST families, which support 16, 8 and 4-bit precision. We perform an extensive exploration of these architectures in terms of power, performance, and area, across a wide range of clock frequency constraints, from 0.4 to 2.0 GHz, targeting a 28-nm CMOS technology. We identify the Pareto-optimal solutions with the lowest area and power in the low-frequency, mid-frequency, and high-frequency ranges. Our findings allow designers to select the best STAR solution depending on their design target, either low-power and low-area, high performance, or balanced

Divergent patterns of cognitive deficits and structural brain alterations between older adults in mixed-sex and same-sex relationships

Data availability statement: Publicly available datasets were analyzed in this study. These data can be found at: https://naccdata.org/.Copyright © 2022 Manca, Correro, Gauthreaux and Flatt. Background: Sexual minority (SM) older adults experience mental health disparities. Psychiatric disorders and neuropsychiatric symptoms (NPS) are risk factors for cognitive decline. Although older people in same-sex (SSR) compared to mixed-sex relationships (MSR) perform more poorly on cognitive screening tests, prior studies found no differences in rates of dementia diagnosis or neuropsychological profiles. We sought to explore the role of NPS on neurocognitive outcomes for SM populations. We compared cognitive performance and structural brain parameters of older adults in SSR and MSR. Methods: Data were originally collected at Alzheimer's Disease Research Centers (ADRCs). Inclusion criteria were: age of 55+ years, a study partner identified as a spouse/partner, and availability of T1-MRI brain volumes/thickness. Participants were labeled as either SSR or MSR based on their/their co-participant's reported sex. We identified 1,073 participants (1,037 MSR−555 cognitively unimpaired [CU]; 36 SSR−23 CU) with structural MRI data, Mini-Mental State Exam (MMSE), and Neuropsychiatric Inventory Questionnaire (NPI-Q) scores. A subset of the overall sample completed comprehensive neuropsychological assessment (n = 939; 908 MSR−494 CU; 31 SSR−22 CU). Covariates included in statistical models were age, sex, education, total intracranial volume, and apolipoprotein E genotype. Results: Multivariate general linear models showed significant diagnosis-by-relationship interaction effects on the left parahippocampal gyrus volume. After stratification by relationship group, only cognitively impaired (CI) MSR had significantly smaller left parahippocampal volumes than MSR-CU. The SSR group showed better episodic memory performance. Severity of neuropsychiatric symptoms was negatively associated with volume/thickness of bilateral fronto-temporal areas and with MMSE scores, predominantly in the MSR group. Conclusion: In our study, MSR participants presented with a more compromised cognitive profile than SSR participants. MSR-CI participants showed significantly smaller left medio-temporal volumes, a neural signature of AD. Neuropsychiatric symptoms predicted smaller fronto-temporal volumes in the MSR more consistently than in the SSR group. These findings may be due to unexplored protective factors against cognitive decline in SM elders. Indeed, social support has been proposed as a protective factor warranting future investigation.K01AG056669 and R24AG066599 (JF). The NACC database was funded by NIA/NIH Grant U24 AG072122. NACC data are contributed by the NIA-funded ADRCs: P30 AG019610 (PI Eric Reiman, MD), P30 AG013846 (PI Neil Kowall, MD), P50 AG008702 (PI Scott Small, MD), P50 AG025688 (PI Allan Levey, MD, PhD), P50 AG047266 (PI Todd Golde, MD, PhD), P30 AG010133 (PI Andrew Saykin, PsyD), P50 AG005146 (PI Marilyn Albert, PhD), P50 AG005134 (PI Bradley Hyman, MD, PhD), P50 AG016574 (PI Ronald Petersen, MD, PhD), P50 AG005138 (PI Mary Sano, PhD), P30 AG008051 (PI Thomas Wisniewski, MD), P30 AG013854 (PI Robert Vassar, PhD), P30 AG008017 (PI Jeffrey Kaye, MD), P30 AG010161 (PI David Bennett, MD), P50 AG047366 (PI Victor Henderson, MD, MS), P30 AG010129 (PI Charles DeCarli, MD), P50 AG016573 (PI Frank LaFerla, PhD), P50 AG005131 (PI James Brewer, MD, PhD), P50 AG023501 (PI Bruce Miller, MD), P30 AG035982 (PI Russell Swerdlow, MD), P30 AG028383 (PI Linda Van Eldik, PhD), P30 AG053760 (PI Henry Paulson, MD, PhD), P30 AG010124 (PI John Trojanowski, MD, PhD), P50 AG005133 (PI Oscar Lopez, MD), P50 AG005142 (PI Helena Chui, MD), P30 AG012300 (PI Roger Rosenberg, MD), P30 AG049638 (PI Suzanne Craft, PhD), P50 AG005136 (PI Thomas Grabowski, MD), P50 AG033514 (PI Sanjay Asthana, MD, FRCP), P50 AG005681 (PI John Morris, MD), and P50 AG047270 (PI Stephen Strittmatter, MD, PhD)

Bimodal Phase Diagram of the Superfluid Density in LaAlO3/SrTiO3 Revealed by an Interfacial Waveguide Resonator

We explore the superconducting phase diagram of the two-dimensional electron system at the LaAlO3/SrTiO3 interface by monitoring the frequencies of the cavity modes of a coplanar waveguide resonator fabricated in the interface itself. We determine the phase diagram of the superconducting transition as a function of temperature and electrostatic gating, finding that both the superfluid density and the transition temperature follow a dome shape, but that the two are not monotonically related. The ground state of this 2DES is interpreted as a Josephson junction array, where a transition from long- to short-range order occurs as a function of the electronic doping. The synergy between correlated oxides and superconducting circuits is revealed to be a promising route to investigate these exotic compounds, complementary to standard magneto-transport measurements.Comment: 5 pages, 4 figures and 10 pages of supplementary materia

Dynamical non-axisymmetric instabilities in rotating relativistic stars

We present new results on dynamical instabilities in rapidly rotating neutron-stars. In particular, using numerical simulations in full General Relativity, we analyse the effects that the stellar compactness has on the threshold for the onset of the dynamical bar-mode instability, as well as on the appearance of other dynamical instabilities. By using an extrapolation technique developed and tested in our previous study [1], we explicitly determine the threshold for a wide range of compactnesses using four sequences of models of constant baryonic mass comprising a total of 59 stellar models. Our calculation of the threshold is in good agreement with the Newtonian prediction and improves the previous post-Newtonian estimates. In addition, we find that for stars with sufficiently large mass and compactness, the m=3 deformation is the fastest growing one. For all of the models considered, the non-axisymmetric instability is suppressed on a dynamical timescale with an m=1 deformation dominating the final stages of the instability. These results, together with those presented in [1], suggest that an m=1 deformation represents a general and late-time feature of non-axisymmetric dynamical instabilities both in full General Relativity and in Newtonian gravity.Comment: To appear on CQG, NFNR special issue. 16 pages, 5 color figures, movies from http://www.fis.unipr.it/numrel/BarMode/ResearchBarMode.htm

Concentrations of free radicals and beta-endorphins in repeat breeder cows

Repeat breeding (RB) is one of the major problems that affect the reproductive efficiency and economy of milk production in dairy animals. So far, the etiopathogenesis of this pathology has not been defined completely. Stress has been hypothesized to be a cause of impaired reproductive efficiency. Stress may cause an overproduction of beta-endorphins and free radicals; in particular, reactive oxygen species (ROS). The aim of this work is to determine the concentrations of these substances in RB cows and to evaluate the correlation with the serum level of progesterone. The study was performed on 60 dairy cows: 26 RB and 34 control cows. Blood samples were collected on day 12 and day 16, after artificial insemination (AI) in all subjects, in order to assess the concentrations of progesterone, free radicals and beta-endorphins. The stressors, free radicals and beta-endorphins, that we considered, were higher in repeat breeders (day 12, 93.32(±1.91) UCarr and 0.50(±0.03) ng/ml; day 16, 94.42(±1.91) UCarr and 0.61(±0.03) ng/ml), with a lower level of progesterone, which probably is responsible for failure to conceive. The stress factors (free radicals and beta-endorphins) may actually enhance each other and induce an inhibition of progesterone synthesis in repeat breeders

Centre selection for clinical trials and the generalisability of results: a mixed methods study.

BACKGROUND: The rationale for centre selection in randomised controlled trials (RCTs) is often unclear but may have important implications for the generalisability of trial results. The aims of this study were to evaluate the factors which currently influence centre selection in RCTs and consider how generalisability considerations inform current and optimal practice. METHODS AND FINDINGS: Mixed methods approach consisting of a systematic review and meta-summary of centre selection criteria reported in RCT protocols funded by the UK National Institute of Health Research (NIHR) initiated between January 2005-January 2012; and an online survey on the topic of current and optimal centre selection, distributed to professionals in the 48 UK Clinical Trials Units and 10 NIHR Research Design Services. The survey design was informed by the systematic review and by two focus groups conducted with trialists at the Birmingham Centre for Clinical Trials. 129 trial protocols were included in the systematic review, with a total target sample size in excess of 317,000 participants. The meta-summary identified 53 unique centre selection criteria. 78 protocols (60%) provided at least one criterion for centre selection, but only 31 (24%) protocols explicitly acknowledged generalisability. This is consistent with the survey findings (n = 70), where less than a third of participants reported generalisability as a key driver of centre selection in current practice. This contrasts with trialists' views on optimal practice, where generalisability in terms of clinical practice, population characteristics and economic results were prime considerations for 60% (n = 42), 57% (n = 40) and 46% (n = 32) of respondents, respectively. CONCLUSIONS: Centres are rarely enrolled in RCTs with an explicit view to external validity, although trialists acknowledge that incorporating generalisability in centre selection should ideally be more prominent. There is a need to operationalize 'generalisability' and incorporate it at the design stage of RCTs so that results are readily transferable to 'real world' practice