205 research outputs found
Barriers and opportunities for evidence-based health service planning: the example of developing a Decision Analytic Model to plan services for sexually transmitted infections in the UK
Decision Analytic Models (DAMs) are established means of evidence-synthesis to differentiate between health interventions. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet could also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models
A pragmatic, multicentre, randomised controlled trial comparing stapled haemorrhoidopexy to traditional excisional surgery for haemorrhoidal disease (eTHoS): study protocol for a randomised controlled trial
Background: Current interventions for haemorrhoidal disease include traditional haemorrhoidectomy (TH) and
stapled haemorrhoidopexy (SH) surgery. However, uncertainty remains as to how they compare from a clinical,
quality of life (QoL) and economic perspective. The study is therefore designed to determine whether SH is more
effective and more cost-effective, compared with TH.
Methods/Design: eTHoS (either Traditional Haemorrhoidectomy or Stapled Haemorrhoidopexy for Haemorrhoidal
Disease) is a pragmatic, multicentre, randomised controlled trial. Currently, 29 secondary care centres are open to
recruitment. Patients, aged 18 year or older, with circumferential haemorrhoids grade II to IV, are eligible to take part.
The primary clinical and economic outcomes are QoL profile (area under the curve derived from the EuroQol Group’s 5
Dimension Health Status Questionnaire (EQ-5D) at all assessment points) and incremental cost per quality adjusted life
year (QALY) based on the responses to the EQ-5D at 24 months. The secondary outcomes include a comparison of the
SF-36 scores, pain and symptoms sub-domains, disease recurrence, complication rates and direct and indirect costs
to the National Health Service (NHS). A sample size of n =338 per group has been calculated to provide 90% power
to detect a difference in the mean area under the curve (AUC) of 0.25 standard deviations derived from EQ-5D
score measurements, with a two-sided significance level of 5%. Allowing for non-response, 400 participants will
be randomised per group. Randomisation will utilise a minimisation algorithm that incorporates centre, grade of
haemorrhoidal disease, baseline EQ-5D score and gender. Blinding of participants and outcome assessors is not
attempted.
Discussion: This is one of the largest trials of its kind. In the United Kingdom alone, 29,000 operations for haemorrhoidal
disease are done annually. The trial is therefore designed to give robust evidence on which clinicians and health
service managers can base management decisions and, more importantly, patients can make informed choices.
Trial registration: Current Controlled Trials ISRCTN80061723 (assigned 8 March 2010
Observation of an Exotic Baryon in Exclusive Photoproduction from the Deuteron
In an exclusive measurement of the reaction , a
narrow peak that can be attributed to an exotic baryon with strangeness
is seen in the invariant mass spectrum. The peak is at
GeV/c with a measured width of 0.021 GeV/c FWHM, which is largely
determined by experimental mass resolution. The statistical significance of the
peak is . The mass and width of the observed peak are
consistent with recent reports of a narrow baryon by other experimental
groups.Comment: 5 pages, 5 figure
Measurement of the Polarized Structure Function for in the Resonance Region
The polarized longitudinal-transverse structure function
has been measured in the resonance region at and 0.65
GeV. Data for the reaction were taken at Jefferson Lab
with the CEBAF Large Acceptance Spectrometer (CLAS) using longitudinally
polarized electrons at an energy of 1.515 GeV. For the first time a complete
angular distribution was measured, permitting the separation of different
non-resonant amplitudes using a partial wave analysis. Comparison with previous
beam asymmetry measurements at MAMI indicate a deviation from the predicted
dependence of using recent phenomenological
models.Comment: 5 pages, LaTex, 4 eps figures: to be published in PRC/Rapid
Communications. Version 2 has revised Q^2 analysi
Survey of A_LT' asymmetries in semi-exclusive electron scattering on He4 and C12
Single spin azimuthal asymmetries A_LT' were measured at Jefferson Lab using
2.2 and 4.4 GeV longitudinally polarized electrons incident on He4 and C12
targets in the CLAS detector. A_LT' is related to the imaginary part of the
longitudinal-transverse interference and in quasifree nucleon knockout it
provides an unambiguous signature for final state interactions (FSI).
Experimental values of A_LT' were found to be below 5%, typically |A_LT'| < 3%
for data with good statistical precision. Optical Model in Eikonal
Approximation (OMEA) and Relativistic Multiple-Scattering Glauber Approximation
(RMSGA) calculations are shown to be consistent with the measured asymmetries.Comment: 9 pages, 5 figure
Onset of asymptotic scaling in deuteron photodisintegration
We investigate the transition from the nucleon-meson to quark-gluon
description of the strong interaction using the photon energy dependence of the
differential cross section for photon energies above 0.5 GeV and
center-of-mass proton angles between and . A possible
signature for this transition is the onset of cross section scaling
with the total energy squared, , at some proton transverse momentum, .
The results show that the scaling has been reached for proton transverse
momentum above about 1.1 GeV/c. This may indicate that the quark-gluon regime
is reached above this momentum.Comment: Accepted by PRL; 5 pages, 2 figure
Single pi+ Electroproduction on the Proton in the First and Second Resonance Regions at 0.25GeV^2 < Q^2 < 0.65GeV^2 Using CLAS
The ep -> e'pi^+n reaction was studied in the first and second nucleon
resonance regions in the 0.25 GeV^2 < Q^2 < 0.65 GeV^2 range using the CLAS
detector at Thomas Jefferson National Accelerator Facility. For the first time
the absolute cross sections were measured covering nearly the full angular
range in the hadronic center-of-mass frame. The structure functions sigma_TL,
sigma_TT and the linear combination sigma_T+epsilon*sigma_L were extracted by
fitting the phi-dependence of the measured cross sections, and were compared to
the MAID and Sato-Lee models.Comment: Accepted for publication in PR
Observation of an Exotic Baryon with S=+1 in Photoproduction from the Proton
The reaction was studied at Jefferson Lab using a
tagged photon beam with an energy range of 3-5.47 GeV. A narrow baryon state
with strangeness S=+1 and mass MeV/c was observed in the
invariant mass spectrum. The peak's width is consistent with the CLAS
resolution (FWHM=26 MeV/c), and its statistical significance is 7.8
1.0 ~. A baryon with positive strangeness has exotic structure and
cannot be described in the framework of the naive constituent quark model. The
mass of the observed state is consistent with the mass predicted by a chiral
soliton model for the baryon. In addition, the invariant mass
distribution was analyzed in the reaction with high
statistics in search of doubly-charged exotic baryon states. No resonance
structures were found in this spectrum.Comment: 5 pages, 5 figures, add reference
Observation of Nuclear Scaling in the Reaction at 1
The ratios of inclusive electron scattering cross sections of He,
C, and Fe to He have been measured for the first time. It is
shown that these ratios are independent of at Q1.4 (GeV/c) for
1.5 where the inclusive cross section depends primarily on the
high-momentum components of the nuclear wave function. The observed scaling
shows that the momentum distributions at high-momenta have the same shape for
all nuclei and differ only by a scale factor. The observed onset of the scaling
at Q1.4 and 1.5 is consistent with the kinematical expectation that
two nucleon short range correlations (SRC) are dominate the nuclear wave
function at 300 MeV/c. The values of these ratios in the scaling
region can be related to the relative probabilities of SRC in nuclei with
A3. Our data demonstrate that for nuclei with A12 these
probabilities are 5-5.5 times larger than in deuterium, while for He it is
larger by a factor of about 3.5.Comment: 11 pages, 10 figure
Photodisintegration of He into p+t
The two-body photodisintegration of He into a proton and a triton has
been studied using the CEBAF Large-Acceptance Spectrometer (CLAS) at Jefferson
Laboratory. Real photons produced with the Hall-B bremsstrahlung-tagging system
in the energy range from 0.35 to 1.55 GeV were incident on a liquid He
target. This is the first measurement of the photodisintegration of He
above 0.4 GeV. The differential cross sections for the He
reaction have been measured as a function of photon-beam energy and
proton-scattering angle, and are compared with the latest model calculations by
J.-M. Laget. At 0.6-1.2 GeV, our data are in good agreement only with the
calculations that include three-body mechanisms, thus confirming their
importance. These results reinforce the conclusion of our previous study of the
three-body breakup of He that demonstrated the great importance of
three-body mechanisms in the energy region 0.5-0.8 GeV .Comment: 13 pages submitted in one tgz file containing 2 tex file and 22
postscrip figure
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