35 research outputs found
How to Detect an Astrophysical Nanohertz Gravitational-Wave Background
Analysis of pulsar timing data have provided evidence for a stochastic
gravitational wave background in the nHz frequency band. The most plausible
source of such a background is the superposition of signals from millions of
supermassive black hole binaries. The standard statistical techniques used to
search for such a background and assess its significance make several
simplifying assumptions, namely: i) Gaussianity; ii) isotropy; and most often
iii) a power-law spectrum. However, a stochastic background from a finite
collection of binaries does not exactly satisfy any of these assumptions. To
understand the effect of these assumptions, we test standard analysis
techniques on a large collection of realistic simulated datasets. The dataset
length, observing schedule, and noise levels were chosen to emulate the
NANOGrav 15-year dataset. Simulated signals from millions of binaries drawn
from models based on the Illustris cosmological hydrodynamical simulation were
added to the data. We find that the standard statistical methods perform
remarkably well on these simulated datasets, despite their fundamental
assumptions not being strictly met. They are able to achieve a confident
detection of the background. However, even for a fixed set of astrophysical
parameters, different realizations of the universe result in a large variance
in the significance and recovered parameters of the background. We also find
that the presence of loud individual binaries can bias the spectral recovery of
the background if we do not account for them.Comment: 14 pages, 8 figure
BHPR research: qualitative1.âComplex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis
Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 â, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duckâ). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?â). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has goneâ). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining aboutâ). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes
The NANOGrav 15-year Data Set: Evidence for a Gravitational-Wave Background
We report multiple lines of evidence for a stochastic signal that is
correlated among 67 pulsars from the 15-year pulsar-timing data set collected
by the North American Nanohertz Observatory for Gravitational Waves. The
correlations follow the Hellings-Downs pattern expected for a stochastic
gravitational-wave background. The presence of such a gravitational-wave
background with a power-law-spectrum is favored over a model with only
independent pulsar noises with a Bayes factor in excess of , and this
same model is favored over an uncorrelated common power-law-spectrum model with
Bayes factors of 200-1000, depending on spectral modeling choices. We have
built a statistical background distribution for these latter Bayes factors
using a method that removes inter-pulsar correlations from our data set,
finding (approx. ) for the observed Bayes factors in the
null no-correlation scenario. A frequentist test statistic built directly as a
weighted sum of inter-pulsar correlations yields (approx. ). Assuming a fiducial
characteristic-strain spectrum, as appropriate for an ensemble of binary
supermassive black-hole inspirals, the strain amplitude is (median + 90% credible interval) at a reference frequency of
1/(1 yr). The inferred gravitational-wave background amplitude and spectrum are
consistent with astrophysical expectations for a signal from a population of
supermassive black-hole binaries, although more exotic cosmological and
astrophysical sources cannot be excluded. The observation of Hellings-Downs
correlations points to the gravitational-wave origin of this signal.Comment: 30 pages, 18 figures. Published in Astrophysical Journal Letters as
part of Focus on NANOGrav's 15-year Data Set and the Gravitational Wave
Background. For questions or comments, please email [email protected]
Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial
Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96â1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme
Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial
BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22â754 patients were assessed for elegibility. Of 15â873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme
Modernization and democracy in China: Samuel P. Huntington and the âNeoâAuthoritarianâ debate
Transatlantic conflict management inside-out: the impact of domestic norms on regional security practices
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