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9. An upper limit on the stochastic gravitational-wave background of cosmological origin

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Abbott, Bp, Abbott, R, Acernese, F, Adhikari, R, Ajith, P, Allen, B, Allen, G, Alshourbagy, M, Amin, Rs, Anderson, Sb, Anderson, Wg, Antonucci, F, Aoudia, S, Arain, Ma, Araya, M, Armandula, H, Armor, P, Arun, Kg, Aso, Y, Aston, S, Astone, P, Aufmuth, P, Aulbert, C, Babak, S, Baker, P, Ballardin, G, Ballmer, S, Barker, C, Barker, D, Barone, F, Barr, B, Barriga, P, Barsotti, L, Barsuglia, M, Barton, Ma, Bartos, I, Bassiri, R, Bastarrika, M, Bauer, Ts, Behnke, B, Beker, M, Benacquista, M, Betzwieser, J, Beyersdorf, Pt, Bigotta, S, Bilenko, Ia, Billingsley, G, Birindelli, S, Biswas, R, Bizouard, Ma, Black, E, Blackburn, Jk, Blackburn, L, Blair, D, Bland, B, Boccara, C, Bodiya, Tp, Bogue, L, Bondu, F, Bonelli, L, Bork, R, Boschi, V, Bose, S, Bosi, L, Braccini, S, Bradaschia, C, Brady, Pr, Braginsky, Vb, van den Brand JFJ, Brau, Je, Bridges, Do, Brillet, A, Brinkmann, M, Brisson, V, Van Den Broeck, C, Brooks, Af, Brown, Da, Brummit, A, Brunet, G, Bullington, A, Bulten, Hj, Buonanno, A, Burmeister, O, Buskulic, D, Byer, Rl, Cadonati, L, Cagnoli, G, Calloni, E, Camp, Jb, Campagna, E, Cannizzo, J, Cannon, Kc, Canuel, B, Cao, J, Carbognani, F, Cardenas, L, Caride, S, Castaldi, G, Caudill, S, Cavaglia, M, Cavalier, F, Cavalieri, R, Cella, G, Cepeda, C, Cesarini, E, Chalermsongsak, T, Chalkley, E, Charlton, P, Chassande Mottin, E, Chatterji, S, Chelkowski, S, Chen, Y, Christensen, N, Chung, Cty, Clark, D, Clark, J, Clayton, Jh, Cleva, F, Coccia, E, Cokelaer, T, Colacino, Cn, Colas, J, Colla, A, Colombini, M, Conte, R, Cook, D, Corbitt, Trc, Corda, C, Cornish, N, Corsi, A, Coulon, Jp, Coward, D, Coyne, Dc, Creighton, Jde, Creighton, Td, Cruise, Am, Culter, Rm, Cumming, A, Cunningham, L, Cuoco, E, Danilishin, Sl, D'Antonio, S, Danzmann, K, Dari, A, Dattilo, V, Daudert, B, Davier, M, Davies, G, Daw, Ej, Day, R, De Rosa, R, Debra, D, Degallaix, J, del Prete, M, Dergachev, V, Desai, S, Desalvo, R, Dhurandhar, S, Di Fiore, L, DI LIETO, Alberto, Emilio, Md, Di Virgilio, A, Diaz, M, Dietz, A, Donovan, F, Dooley, Kl, Doomes, Ee, Drago, M, Drever, Rwp, Dueck, J, Duke, I, Dumas, Jc, Dwyer, Jg, Echols, C, Edgar, M, Effler, A, Ehrens, P, Ely, G, Espinoza, E, Etzel, T, Evans, T, Fafone, V, Fairhurst, S, Faltas, Y, Fan, Y, Fazi, D, Fehrmann, H, Ferrante, Isidoro, Fidecaro, Francesco, Finn, Ls, Fiori, I, Flaminio, R, Flasch, K, Foley, S, Forrest, C, Fotopoulos, N, Fournier, Jd, Franc, J, Franzen, A, Frasca, S, Frasconi, F, Frede, M, Frei, M, Frei, Z, Freise, A, Frey, R, Fricke, T, Fritschel, P, Frolov, Vv, Fyffe, M, Galdi, V, Gammaitoni, L, Garofoli, Ja, Garufi, F, Genin, E, Gennai, A, Gholami, I, Giaime, Ja, Giampanis, S, Giardina, Kd, Giazotto, A, Goda, K, Goetz, E, Goggin, Lm, Gonzalez, G, Gorodetsky, Ml, Gosser, S, Gouaty, R, Granata, M, Granata, V, Grant, A, Gras, S, Gray, C, Gray, M, Greenhalgh, Rjs, Gretarsson, Am, Greverie, C, Grimaldi, F, Grosso, R, Grote, H, Grunewald, S, Guenther, M, Guidi, G, Gustafson, Ek, Gustafson, R, Hage, B, Hallam, Jm, Hammer, D, Hammond, Gd, Hanna, C, Hanson, J, Harms, J, Harry, Gm, Harry, Iw, Harstad, Ed, Haughian, K, Hayama, K, Heefner, J, Heitmann, H, Hello, P, Heng, Is, Heptonstall, A, Hewitson, M, Hild, S, Hirose, E, Hoak, D, Hodge, Ka, Holt, K, Hosken, Dj, Hough, J, Hoyland, D, Huet, D, Hughey, B, Huttner, Sh, Ingram, Dr, Isogai, T, Ito, M, Ivanov, A, Johnson, B, Johnson, Ww, Jones, Di, Jones, G, Jones, R, de la Jordana LS, Ju, L, Kalmus, P, Kalogera, V, Kandhasamy, S, Kanner, J, Kasprzyk, D, Katsavounidis, E, Kawabe, K, Kawamura, S, Kawazoe, F, Kells, W, Keppel, Dg, Khalaidovski, A, Khalili, Fy, Khan, R, Khazanov, E, King, P, Kissel, Js, Klimenko, S, Kokeyama, K, Kondrashov, V, Kopparapu, R, Koranda, S, Kozak, D, Krishnan, B, Kumar, R, Kwee, P, La Penna, P, Lam, Pk, Landry, M, Lantz, B, Laval, M, Lazzarini, A, Lei, H, Lei, M, Leindecker, N, Leonor, I, Leroy, N, Letendre, N, Li, C, Lin, H, Lindquist, Pe, Littenberg, B, Lockerbie, Na, Lodhia, D, Longo, M, Lorenzini, M, Loriette, V, Lormand, M, Losurdo, G, Lu, P, Lubinski, M, Lucianetti, A, Luck, H, Machenschalk, B, Macinnis, M, Mackowski, Jm, Mageswaran, M, Mailand, K, Majorana, E, Man, N, Mandel, I, Mandic, V, Mantovani, M, Marchesoni, F, Marion, F, Marka, S, Marka, Z, Markosyan, A, Markowitz, J, Maros, E, Marque, J, Martelli, F, Martin, Iw, Martin, Rm, Marx, Jn, Mason, K, Masserot, A, Matichard, F, Matone, L, Matzner, Ra, Mavalvala, N, Mccarthy, R, Mcclelland, De, Mcguire, Sc, Mchugh, M, Mcintyre, G, Mckechan, Dja, Mckenzie, K, Mehmet, M, Melatos, A, Melissinos, Ac, Mendell, G, Menendez, Df, Menzinger, F, Mercer, Ra, Meshkov, S, Messenger, C, Meyer, Ms, Michel, C, Milano, L, Miller, J, Minelli, J, Minenkov, Y, Mino, Y, Mitrofanov, Vp, Mitselmakher, G, Mittleman, R, Miyakawa, O, Moe, B, Mohan, M, Mohanty, Sd, Mohapatra, Srp, Moreau, J, Moreno, G, Morgado, N, Morgia, A, Morioka, T, Mors, K, Mosca, S, Mossavi, K, Mours, B, Mowlowry, C, Mueller, G, Muhammad, D, zur Muhlen, H, Mukherjee, S, Mukhopadhyay, H, Mullavey, A, Muller Ebhardt, H, Munch, J, Murray, Pg, Myers, E, Myers, J, Nash, T, Nelson, J, Neri, I, Newton, G, Nishizawa, A, Nocera, F, Numata, K, Ochsner, E, O'Dell, J, Ogin, Gh, O'Reilly, B, O'Shaughnessy, R, Ottaway, Dj, Ottens, Rs, Overmier, H, Owen, Bj, Pagliaroli, G, Palomba, C, Pan, Y, Pankow, C, Paoletti, F, Papa, Ma, Parameshwaraiah, V, Pardi, S, Pasqualetti, A, Passaquieti, Roberto, Passuello, D, Patel, P, Pedraza, M, Penn, S, Perreca, A, Persichetti, G, Pichot, M, Piergiovanni, F, Pierro, V, Pinard, L, Pinto, Im, Pitkin, M, Pletsch, Hj, Plissi, Mv, Poggiani, Rosa, Postiglione, F, Principe, M, Prix, R, Prodi, Ga, Prokhorov, L, Punken, O, Punturo, M, Puppo, P, Van der Putten, S, Quetschke, V, Raab, Fj, Rabaste, O, Rabeling, Ds, Radkins, H, Raffai, P, Raics, Z, Rainer, N, Rakhmanov, M, Rapagnani, P, Raymond, V, Re, V, Reed, Cm, Reed, T, Regimbau, T, Rehbein, H, Reid, S, Reitze, Dh, Ricci, F, Riesen, R, Riles, K, Rivera, B, Roberts, P, Robertson, Na, Robinet, F, Robinson, C, Robinson, El, Rocchi, A, Roddy, S, Rolland, L, Rollins, J, Romano, Jd, Romano, R, Romie, Jh, Rover, C, Rowan, S, Rudiger, A, Ruggi, P, Russell, P, Ryan, K, Sakata, S, Salemi, F, Sandberg, V, Sannibale, V, Santamaria, L, Saraf, S, Sarin, P, Sassolas, B, Sathyaprakash, Bs, Sato, S, Satterthwaite, M, Saulson, Pr, Savage, R, Savov, P, Scanlan, M, Schilling, R, Schnabel, R, Schofield, R, Schulz, B, Schutz, Bf, Schwinberg, P, Scott, J, Scott, Sm, Searle, Ac, Sears, B, Seifert, F, Sellers, D, Sengupta, As, Sentenac, D, Sergeev, A, Shapiro, B, Shawhan, P, Shoemaker, Dh, Sibley, A, Siemens, X, Sigg, D, Sinha, S, Sintes, Am, Slagmolen, Bjj, Slutsky, J, van der Sluys MV, Smith, Jr, Smith, Mr, Smith, Nd, Somiya, K, Sorazu, B, Stein, A, Stein, Lc, Steplewski, S, Stochino, A, Stone, R, Strain, Ka, Strigin, S, Stroeer, A, Sturani, R, Stuver, Al, Summerscales, Tz, Sun, Kx, Sung, M, Sutton, Pj, Swinkels, Bl, Szokoly, Gp, Talukder, D, Tang, L, Tanner, Db, Tarabrin, Sp, Taylor, Jr, Taylor, R, Terenzi, R, Thacker, J, Thorne, Ka, Thorne, Ks, Thuring, A, Tokmakov, Kv, Toncelli, Alessandra, Tonelli, Mauro, Torres, C, Torrie, C, Tournefier, E, Travasso, F, Traylor, G, Trias, M, Trummer, J, Ugolini, D, Ulmen, J, Urbanek, K, Vahlbruch, H, Vajente, G, Vallisneri, M, Vass, S, Vaulin, R, Vavoulidis, M, Vecchio, A, Vedovato, G, van Veggel AA, Veitch, J, Veitch, P, Veltkamp, C, Verkindt, D, Vetrano, F, Vicere, A, Villar, A, Vinet, Jy, Vocca, H, Vorvick, C, Vyachanin, Sp, Waldman, Sj, Wallace, L, Ward, H, Ward, Rl, Was, M, Weidner, A, Weinert, M, Weinstein, Aj, Weiss, R, Wen, L, Wen, S, Wette, K, Whelan, Jt, Whitcomb, Se, Whiting, Bf, Wilkinson, C, Willems, Pa, Williams, Hr, Williams, L, Willke, B, Wilmut, I, Winkelmann, L, Winkler, W, Wipf, Cc, Wiseman, Ag, Woan, G, Wooley, R, Worden, J, Wu, W, Yakushin, I, Yamamoto, H, Yan, Z, Yoshida, S, Yvert, M, Zanolin, M, Zhang, J, Zhang, L, Zhao, C, Zotov, N, Zucker, Me, Zweizig Jin, F., Xie, S., Yagil, A., Yamamoto, K., Yamaoka, J., Yang, U. K., Yang, Y. C., Yao, W. M., Yeh, G. P., Yi, K., Yoh, J., Yorita, K., Yoshida, T., G. B., Yu, Yu, I., S. S., Yu, Yun, J. C., Zanello, L., Zanetti, A., Zhang, X., Zheng, Y., Zucchelli, S., (Astro)-Particles Physics, The LIGO Scientific Collaboration, The Virgo Collaboration, Astrophysique Relativiste Théories Expériences Métrologie Instrumentation Signaux (ARTEMIS), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire de la Côte d'Azur, Université Côte d'Azur (UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de l'Accélérateur Linéaire (LAL), Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11), APC - Cosmologie, AstroParticule et Cosmologie (APC (UMR_7164)), Observatoire de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Observatoire de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3), Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL), Laboratoire d'Annecy de Physique des Particules (LAPP), Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), APC - Gravitation (APC-Gravitation), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Max-Planck-Institut für Gravitationsphysik ( Albert-Einstein-Institut ) (AEI), Max-Planck-Gesellschaft-Max-Planck-Gesellschaft, Laboratoire des matériaux avancés (LMA), Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Virgo, Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11), VIRGO, B. P., Abbott, R., Abbott, F., Acernese???, R., Adhikari, P., Ajith, B., Allen, G., Allen, M., Alshourbagy???§, R. S., Amin, S. B., Anderson, W. G., Anderson, F., Antonucci???, S., Aoudia, M. A., Arain, M., Araya, H., Armandula, P., Armor, K. G., Arun, Y., Aso, S., Aston, P., Astone???, P., Aufmuth, C., Aulbert, S., Babak, P., Baker, G., Ballardin, S., Ballmer, C., Barker, D., Barker, F., Barone???, B., Barr, P., Barriga, L., Barsotti, M., Barsuglia, M. A., Barton, I., Barto, R., Bassiri, M., Bastarrika, Bauer???, T. h. S., B., Behnke, M., Beker§, M., Benacquista, J., Betzwieser, P. T., Beyersdorf, S., Bigotta???§, I. A., Bilenko, G., Billingsley, S., Birindelli, R., Biswa, M. A., Bizouard, E., Black, J. K., Blackburn, L., Blackburn, D., Blair, B., Bland, C., Boccara, T. P., Bodiya, L., Bogue, F., Bondu, L., Bonelli???§, R., Bork, V., Boschi, S., Bose, L., Bosi???, S., Braccini???, C., Bradaschia???, P. R., Brady, V. B., Braginsky, J. F. J., van den Brand???§, J. E., Brau, D. O., Bridge, A., Brillet, M., Brinkmann, V., Brisson, C., Van Den Broeck, A. F., Brook, D. A., Brown, A., Brummit, G., Brunet, A., Bullington, H. J., Bulten???§, A., Buonanno, O., Burmeister, D., Buskulic, R. L., Byer, L., Cadonati, G., Cagnoli???, Calloni, Enrico, J. B., Camp, E., Campagna???, J., Cannizzo, K. C., Cannon, B., Canuel, J., Cao, F., Carbognani, L., Cardena, S., Caride, G., Castaldi, S., Caudill, M., Cavaglià, F., Cavalier, R., Cavalieri, G., Cella???, C., Cepeda, E., Cesarini???, T., Chalermsongsak, E., Chalkley, P., Charlton, E., Chassande Mottin, S., Chatterji???, S., Chelkowski, Y., Chen, N., Christensen, C. T. Y., Chung, D., Clark, J., Clark, J. H., Clayton, F., Cleva, E., Coccia???§, T., Cokelaer, C. N., Colacino, J., Cola, A., Colla§, M., Colombini§, R., Conte, D., Cook, T. R. C., Corbitt, C., Corda???§, N., Cornish, A., Corsi???, J. P., Coulon, D., Coward, D. C., Coyne, J. D. E., Creighton, T. D., Creighton, A. M., Cruise, R. M., Culter, A., Cumming, L., Cunningham, E., Cuoco, S. L., Danilishin, S., D'Antonio???, K., Danzmann, A., Dari???§, V., Dattilo, B., Daudert, M., Davier, G., Davie, E. J., Daw, R., Day, DE ROSA, Rosario, D., Debra, J., Degallaix, M., del Prete???, V., Dergachev, S., Desai, R., Desalvo, S., Dhurandhar, L., Di Fiore???, A., Di Lieto???§, M., Di Paolo Emilio???¶, A., Di Virgilio???, M., Díaz, A., Dietz, F., Donovan, K. L., Dooley, E. E., Doome, M., Drago||¶, R. W. P., Drever, J., Dueck, I., Duke, J. C., Duma, J. G., Dwyer, C., Echol, M., Edgar, A., Effler, P., Ehren, G., Ely, E., Espinoza, T., Etzel, M., Evan, T., Evan, V., Fafone???§, S., Fairhurst, Y., Falta, Y., Fan, D., Fazi, H., Fehrmann, I., Ferrante???§, F., Fidecaro???§, L. S., Finn, I., Fiori, R., Flaminio, K., Flasch, S., Foley, C., Forrest, N., Fotopoulo, J. D., Fournier, J., Franc, A., Franzen, S., Frasca???§, F., Frasconi???, M., Frede, M., Frei, Z., Frei, A., Freise, R., Frey, T., Fricke, P., Fritschel, V. V., Frolov, M., Fyffe, V., Galdi, L., Gammaitoni???§, J. A., Garofoli, Garufi, Fabio, E., Genin, A., Gennai???, I., Gholami, J. A., Giaime, S., Giampani, K. D., Giardina, A., Giazotto???, K., Goda, E., Goetz, L. M., Goggin, G., González, M. L., Gorodetsky, S., Goßler, R., Gouaty, M., Granata, V., Granata, A., Grant, S., Gra, C., Gray, M., Gray, R. J. S., Greenhalgh, A. M., Gretarsson, C., Greverie, F., Grimaldi, R., Grosso, H., Grote, S., Grunewald, M., Guenther, G., Guidi???, E. K., Gustafson, R., Gustafson, B., Hage, J. M., Hallam, D., Hammer, G. D., Hammond, C., Hanna, J., Hanson, J., Harm, G. M., Harry, I. W., Harry, E. D., Harstad, K., Haughian, K., Hayama, J., Heefner, H., Heitmann, P., Hello, I. S., Heng, A., Heptonstall, M., Hewitson, S., Hild, E., Hirose, D., Hoak, K. A., Hodge, K., Holt, D. J., Hosken, J., Hough, D., Hoyland, D., Huet, B., Hughey, S. H., Huttner, D. R., Ingram, T., Isogai, M., Ito, A., Ivanov, B., Johnson, W. W., Johnson, D. I., Jone, G., Jone, R., Jone, L., Sancho de la Jordana, L., Ju, P., Kalmu, V., Kalogera, S., Kandhasamy, J., Kanner, D., Kasprzyk, E., Katsavounidi, K., Kawabe, S., Kawamura, F., Kawazoe, W., Kell, D. G., Keppel, A., Khalaidovski, F. Y., Khalili, R., Khan, E., Khazanov, P., King, J. S., Kissel, S., Klimenko, K., Kokeyama, V., Kondrashov, R., Kopparapu, S., Koranda, D., Kozak, B., Krishnan, R., Kumar, P., Kwee, P., La Penna, P. K., Lam, M., Landry, B., Lantz, M., Laval, A., Lazzarini, H., Lei, M., Lei, N., Leindecker, I., Leonor, N., Leroy, N., Letendre, C., Li, H., Lin, P. E., Lindquist, T. B., Littenberg, N. A., Lockerbie, D., Lodhia, M., Longo, M., Lorenzini???, V., Loriette, M., Lormand, G., Losurdo???, P., Lu, M., Lubinski, A., Lucianetti, H., Lück, B., Machenschalk, M., Macinni, J. M., Mackowski, M., Mageswaran, K., Mailand, E., Majorana???, N., Man, I., Mandel, V., Mandic, M., Mantovani???, F., Marchesoni???, F., Marion, S., Márka, Z., Márka, A., Markosyan, J., Markowitz, E., Maro, J., Marque, F., Martelli???, I. W., Martin, R. M., Martin, J. N., Marx, K., Mason, A., Masserot, F., Matichard, L., Matone, R. A., Matzner, N., Mavalvala, R., Mccarthy, D. E., Mcclelland, S. C., Mcguire, M., Mchugh, G., Mcintyre, D. J. A., Mckechan, K., Mckenzie, M., Mehmet, A., Melato, A. C., Melissino, G., Mendell, D. F., Menéndez, F., Menzinger, R. A., Mercer, S., Meshkov, C., Messenger, M. S., Meyer, C., Michel, Milano, Leopoldo, J., Miller, J., Minelli, Y., Minenkov???, Y., Mino, V. P., Mitrofanov, G., Mitselmakher, R., Mittleman, O., Miyakawa, B., Moe, M., Mohan, S. D., Mohanty, S. R. P., Mohapatra, J., Moreau, G., Moreno, N., Morgado, A., Morgia???§, T., Morioka, K., Mor, Mosca, Simona, K., Mossavi, B., Mour, C., Mowlowry, G., Mueller, D., Muhammad, H., zur Mühlen, S., Mukherjee, H., Mukhopadhyay, A., Mullavey, H., Müller Ebhardt, J., Munch, P. G., Murray, E., Myer, J., Myer, T., Nash, J., Nelson, I., Neri???§, G., Newton, A., Nishizawa, F., Nocera, K., Numata, E., Ochsner, J., O'Dell, G. H., Ogin, B., O'Reilly, R., O'Shaughnessy, D. J., Ottaway, R. S., Otten, H., Overmier, B. J., Owen, G., Pagliaroli???§, C., Palomba???, Y., Pan, C., Pankow, F., Paoletti???, M. A., Papa, V., Parameshwaraiah, Pardi, Silvio, A., Pasqualetti, R., Passaquieti???§, D., Passuello???, P., Patel, M., Pedraza, S., Penn, A., Perreca, G., Persichetti???§, M., Pichot, F., Piergiovanni???, V., Pierro, L., Pinard, I. M., Pinto, M., Pitkin, H. J., Pletsch, M. V., Plissi, R., Poggiani???§, F., Postiglione, M., Principe, R., Prix, G. A., Prodi???§, L., Prokhorov, O., Punken, M., Punturo???, P., Puppo???, S., van der Putten???, V., Quetschke, F. J., Raab, O., Rabaste, D. S., Rabeling???§, H., Radkin, P., Raffai, Z., Raic, N., Rainer, M., Rakhmanov, P., Rapagnani???§, V., Raymond, V., Re???§, C. M., Reed, T., Reed, T., Regimbau, H., Rehbein, S., Reid, D. H., Reitze, F., Ricci???§, R., Riesen, K., Rile, B., Rivera, P., Robert, N. A., Robertson, F., Robinet, C., Robinson, E. L., Robinson, A., Rocchi???, S., Roddy, L., Rolland, J., Rollin, J. D., Romano, R., Romano???, J. H., Romie, C., Röver, S., Rowan, A., Rüdiger, P., Ruggi, P., Russell, K., Ryan, S., Sakata, F., Salemi???§, V., Sandberg, V., Sannibale, L., Santamaría, S., Saraf, P., Sarin, B., Sassola, B. S., Sathyaprakash, S., Sato, M., Satterthwaite, P. R., Saulson, R., Savage, P., Savov, M., Scanlan, R., Schilling, R., Schnabel, R., Schofield, B., Schulz, B. F., Schutz, P., Schwinberg, J., Scott, S. M., Scott, A. C., Searle, B., Sear, F., Seifert, D., Seller, A. S., Sengupta, D., Sentenac, A., Sergeev, B., Shapiro, P., Shawhan, D. H., Shoemaker, A., Sibley, X., Siemen, D., Sigg, S., Sinha, A. M., Sinte, B. J. J., Slagmolen, J., Slutsky, M. V., van der Sluy, J. R., Smith, M. R., Smith, N. D., Smith, K., Somiya, B., Sorazu, A., Stein, L. C., Stein, S., Steplewski, A., Stochino, R., Stone, K. A., Strain, S., Strigin, A., Stroeer, R., Sturani???, A. L., Stuver, T. Z., Summerscale, K. X., Sun, M., Sung, P. J., Sutton, B. L., Swinkel, G. P., Szokoly, D., Talukder, L., Tang, D. B., Tanner, S. P., Tarabrin, J. R., Taylor, R., Taylor, R., Terenzi???, J., Thacker, K. A., Thorne, K. S., Thorne, A., Thüring, K. V., Tokmakov, A., Toncelli???§, M., Tonelli???§, C., Torre, C., Torrie, E., Tournefier, F., Travasso???§, G., Traylor, M., Tria, J., Trummer, D., Ugolini, J., Ulmen, K., Urbanek, H., Vahlbruch, G., Vajente???§, M., Vallisneri, S., Va, R., Vaulin, M., Vavoulidi, A., Vecchio, G., Vedovato, A. A., van Veggel, J., Veitch, P., Veitch, C., Veltkamp, D., Verkindt, F., Vetrano???, A., Viceré???, A., Villar, J. Y., Vinet, H., Vocca???, C., Vorvick, S. P., Vyachanin, S. J., Waldman, L., Wallace, H., Ward, R. L., Ward, M., Wa, A., Weidner, M., Weinert, A. J., Weinstein, R., Wei, L., Wen, S., Wen, K., Wette, J. T., Whelan, S. E., Whitcomb, B. F., Whiting, C., Wilkinson, P. A., Willem, H. R., William, L., William, B., Willke, I., Wilmut, L., Winkelmann, W., Winkler, C. C., Wipf, A. G., Wiseman, G., Woan, R., Wooley, J., Worden, W., Wu, I., Yakushin, H., Yamamoto, Z., Yan, S., Yoshida, M., Yvert, M., Zanolin, J., Zhang, L., Zhang, C., Zhao, N., Zotov, M. E., Zucker, J., Zweizig, Pinto, Innocenzo, Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire de la Côte d'Azur, Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS), Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Physique Corpusculaire et Cosmologie - Collège de France (PCC), Collège de France (CdF)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Collège de France (CdF)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-AstroParticule et Cosmologie (APC (UMR_7164)), Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Observatoire de Paris, PSL Research University (PSL)-PSL Research University (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Observatoire de Paris, PSL Research University (PSL)-PSL Research University (PSL)-Université Paris Diderot - Paris 7 (UPD7), ESPCI ParisTech, Laboratoire d'Annecy de Physique des Particules (LAPP/Laboratoire d'Annecy-le-Vieux de Physique des Particules), PSL Research University (PSL)-PSL Research University (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Observatoire de Paris, PSL Research University (PSL)-PSL Research University (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Max-Planck-Institut für Gravitationsphysik ( Albert-Einstein-Institut ) (AEI), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Observatoire de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Observatoire de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Max-Planck-Institut für Gravitationsphysik ( Albert-Einstein-Institut ) (AEI), and Université de Lyon-Université de Lyon-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Big Bang, Cosmology and Nongalactic Astrophysics (astro-ph.CO), Age of the universe, Cosmic background radiation, FOS: Physical sciences, STRING COSMOLOGY, Astrophysics, 7. Clean energy, 01 natural sciences, Particle horizon, Gravitational wave background, De Sitter universe, 0103 physical sciences, 010306 general physics, Flatness problem, Physics, SPECTRUM, Multidisciplinary, 010308 nuclear & particles physics, GEO, Settore FIS/01 - Fisica Sperimentale, GRAVITATIONAL WAVES, Ekpyrotic universe, VIRGO, 13. Climate action, [PHYS.GRQC]Physics [physics]/General Relativity and Quantum Cosmology [gr-qc], Astrophysics - Cosmology and Nongalactic Astrophysics
Abstract

A stochastic background of gravitational waves is expected to arise from a superposition of a large number of unresolved gravitational-wave sources of astrophysical and cosmological origin. It is expected to carry unique signatures from the earliest epochs in the evolution of the universe, inaccessible to the standard astrophysical observations. Direct measurements of the amplitude of this background therefore are of fundamental importance for understanding the evolution of the universe when it was younger than one minute. Here we report direct limits on the amplitude of the stochastic gravitational-wave background using the data from a two-year science run of the Laser Interferometer Gravitational-wave Observatory (LIGO). Our result constrains the energy density of the stochastic gravitational-wave background normalized by the critical energy density of the universe, in the frequency band around 100 Hz, to be less than 6.9 x 10^{-6} at 95% confidence. The data rule out models of early universe evolution with relatively large equation-of-state parameter, as well as cosmic (super)string models with relatively small string tension that are favoured in some string theory models. This search for the stochastic background improves upon the indirect limits from the Big Bang Nucleosynthesis and cosmic microwave background at 100 Hz.

Published
2009

13. Which MR Imaging Sequences Are Necessary in Determining the Need for Radiation Therapy for Cord Compression? A Prospective Study

Author

Johnson, A.J., Ying, J., El Gammal, T., Timmerman, R.D., Kim, R.Y., and Littenberg, B.

Subjects
Adult, Aged, 80 and over, Male, Spinal Neoplasms, Contrast Media, Middle Aged, Radiation Dosage, Magnetic Resonance Imaging, Sensitivity and Specificity, Spine, Logistic Models, Humans, Female, Prospective Studies, Spinal Cord Compression, Aged
Abstract

Background and PURPOSE: To determine which MR imaging sequences are necessary to assess for spinal metastases. METHODS: Hypothetical MR imaging interpretations and management plans were made prospectively for consecutive adult cases acquired retrospectively. Standardized MR imaging protocols were independently interpreted by 2 neuroradiologists. MR imaging protocol types varied: 1) T1-weighted images only; 2) T1-weighted and T2-weighted images; 3) T1-weighted and postcontrast T1-weighted images; and 4) T1- and T2-weighted images and postcontrast T1-weighted images. Hypothetical management plans were created by 2 radiation oncologists. Logit model was used to investigate the effect of MR imaging protocol type on the probability of recommending radiation therapy (RT). Mixed effect models were used to investigate whether median spinal level or total number of spinal levels of planned RT was associated with MR imaging protocol type. RESULTS: Thirty-one subjects were evaluated, each with multiple scan interpretations. Logit model showed that neither MR imaging protocol type nor neuroradiologist reader affected the probability that the oncologist would recommend RT (all P > .50). Mixed models showed that neither ML nor NL was affected by MR imaging protocol type or by neuroradiologist reader (all P > .12). CONCLUSION: Although MR imaging is known to be the most useful diagnostic test in suspected spinal cord compression, which particular MR images are necessary remain unclear. Compared with T1-weighted images alone, the additional use of T2-weighted and/or postcontrast T1-weighted sequences did not significantly affect the probability that RT would be recommended or the levels that would be chosen for RT in our study. Our data suggest that unenhanced T1-weighted images may be sufficient for evaluation of possible cord compression.

Published
2007

35. The use of adherence aids by adults with diabetes: a cross-sectional survey.

Author

Littenberg B, MacLean CD, and Hurowitz L

Abstract

BACKGROUND: Adherence with medication taking is a major barrier to physiologic control in diabetes and many strategies for improving adherence are in use. We sought to describe the use of mnemonic devices and other adherence aids by adults with diabetes and to investigate their association with control of hyperglycemia, hyperlipidemia and hypertension. METHODS: Cross sectional survey of diabetic adults randomly selected from Primary Care practices in the Vermont Diabetes Information System. We used linear regression to examine the associations between the use of various aids and physiologic control among subjects who used oral agents for hyperglycemia, hypercholesterolemia, and hypertension. RESULTS: 289 subjects (mean age 65.4 years; 51% female) used medications for all three conditions. Adherence aids were reported by 80%. The most popular were day-of-the-week pill boxes (50%), putting the pills in a special place (41%), and associating pill taking with a daily event such as a meal, TV show, or bedtime (11%). After adjusting for age, sex, marital status, income, and education, those who used a special place had better glycemic control (A1C -0.36%; P = .04) and systolic blood pressure (-5.9 mm Hg; P = .05) than those who used no aids. Those who used a daily event had better A1C (-0.56%; P = .01) than patients who used no aids. CONCLUSION: Although adherence aids are in common use among adults with diabetes, there is little evidence that they are efficacious. In this study, we found a few statistically significant associations with adherence aids and better diabetes control. However, these findings could be attributed to multiple comparisons or unmeasured confounders. Until more rigorous evaluations are available, it seems reasonable to recommend keeping medicines in a special place for diabetic adults prescribed multiple medications. [ABSTRACT FROM AUTHOR]

Published
2006

37. The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability.

Author

Morris NS, MacLean CD, Chew LD, and Littenberg B

Abstract

BACKGROUND: Reading skills are important for accessing health information, using health care services, managing one's health and achieving desirable health outcomes. Our objective was to assess the diagnostic accuracy of the Single Item Literacy Screener (SILS) to identify limited reading ability, one component of health literacy, as measured by the S-TOFHLA. METHODS: Cross-sectional interview with 999 adults with diabetes residing in Vermont and bordering states. Participants were randomly recruited from Primary Care practices in the Vermont Diabetes Information System June 2003-December 2004. The main outcome was limited reading ability. The primary predictor was the SILS. RESULTS: Of the 999 persons screened, 169 (17%) had limited reading ability. The sensitivity of the SILS in detecting limited reading ability was 54% [95% CI: 47%, 61%] and the specificity was 83% [95% CI: 81%, 86%] with an area under the Receiver Operating Characteristics Curve (ROC) of 0.73 [95% CI: 0.69, 0.78]. Seven hundred seventy (77%) screened negative on the SILS and 692 of these subjects had adequate reading skills (negative predictive value = 0.90 [95% CI: 0.88, 0.92]). Of the 229 who scored positive on the SILS, 92 had limited reading ability (positive predictive value = 0.4 [95% CI: 0.34, 0.47]). CONCLUSION: The SILS is a simple instrument designed to identify patients with limited reading ability who need help reading health-related materials. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need. Further study of the use of the SILS in clinical settings and with more diverse populations is warranted. [ABSTRACT FROM AUTHOR]

Published
2006

39. Paper standard gamble: the reliability of a paper questionnaire to assess utility.

Author

Littenberg B, Partilo S, Licata A, and Kattan MW

Abstract

BACKGROUND: Quality of life is often best estimated by standard gamble techniques. However, these techniques usually require time-consuming and expensive interviews or computer-directed questionnaires. Paper Standard Gamble (PSG) is a paper questionnaire that has previously been shown to accurately represent standard gambles elicited by computer. The authors sought to demonstrate its test-retest reliability in comparison to other, paper-based measures of quality of life. METHODS: The authors used a longitudinal cohort design with duplicate assessments of quality of life by PSG, the Dermatology Life Quality Index, and the Mental and Physical Component Summary scores of the SF-12 in stable dermatology out-patients. Baseline measures were performed by mail 1 to 2 weeks before a scheduled dermatology clinic visit. Follow-up measures were performed in the waiting room before being seen by the dermatologist. The authors calculated the coefficient of variation and the Spearman rank correlation coefficient for each of the instruments. RESULTS: 74 patients with stable skin conditions participated. The coefficient of variation of PSG (0.47%) was smaller than the other instruments (4.26%-5.22%); PSG's correlation was higher (0.97 v. 0.65-0.80). CONCLUSION: PSG, a 1-page paper questionnaire, is a reliable measure of patient utility suitable for use in postal surveys. [ABSTRACT FROM AUTHOR]

Published
2003
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40. Using the free-to-total prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels.

Author

Hoffman, Richard M., Clanon, David L., Littenberg, Benjamin, Frank, Joseph J., Peirce, John C., Hoffman, R M, Clanon, D L, Littenberg, B, Frank, J J, and Peirce, J C

Subjects
PROSTATE cancer, DIAGNOSIS, ANTIGENS, CLINICAL chemistry, COMPARATIVE studies, RESEARCH methodology, MEDICAL cooperation, META-analysis, PROSTATE tumors, RESEARCH, STATISTICS, PROSTATE-specific antigen, DATA analysis, EVALUATION research, PREDICTIVE tests
Abstract

Background: Prostate-specific antigen (PSA) levels between 4.0 to 10.0 ng/ml have poor specificity in prostate cancer screening, leading to unnecessary biopsies.Objective: To determine whether the free-to-total PSA ratio (F/T PSA) improved the diagnostic accuracy of these nonspecific PSA levels.Measurements and Main Results: MEDLINE searchedwas from 1986 to 1997. Additional studies were identified from article bibliographies and by searching urology journals. Two investigators independently identified English-language studies providing F/T PSA ratio test-operating characteristics data on > or = 10 cancer patients with PSA values between 2.0 and 10.0 ng/ml. Twenty-one of 90 retrieved studies met selection criteria. Two investigators independently extracted data on methodology and diagnostic performance. Investigator-selected cut points for the optimal F/T PSA ratio had a median likelihood ratio of 1.76 (interquartile range, 1.40 to 2.11) for a positive test and 0.27 (0.20 to 0.40) for a negative test. Assuming a 25% pretest probability of cancer, the posttest probabilities were 37% following a positive test and 8% following a negative test. The summary receiver operating characteristic curve showed that maintaining test sensitivity above 90% was associated with false positive rates of 60% to 90%. Methodologic problems limited the validity and generalizability of the literature.Conclusions: A negative test reduced the posttest probability of cancer to approximately 10%. However, patients may find that this probability is not low enough to avoid undergoing prostate biopsy. The optimal F/T PSA ratio cut point and precise estimates for test specificity still need to be determined. [ABSTRACT FROM AUTHOR]

Published
2000
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42. The development and validation of an instrument to assess acute sinus disease in children.

Author

Garbutt, Jane M., Gellman, Elliot F., Littenberg, Benjamin, Garbutt, J M, Gellman, E F, and Littenberg, B

Subjects
QUESTIONNAIRES, QUALITY of life, SINUSITIS in children, LOGISTIC regression analysis
Abstract

Our goal was to produce a reliable, responsive instrument to quantify disease burden in children with acute sinusitis for use in clinical trials. In a cross sectional survey of 1611 community pediatric patients, parents rated the burden attributable to 13 sinus symptoms. Using logistic regression, we identified five symptoms that predicted the clinical diagnosis of sinusitis. The S5 is the average symptom score for nasal obstruction, daytime and nighttime coughing, headache and colored nasal discharge (range 0-3). The S5 was high in children with acute sinusitis (mean = 1.54, SD = 0.77, N = 93), and low in well children (mean = 0.42, SD = 0.56, N = 1019). We assessed reliability and responsiveness of S5 in a prospective cohort study of 41 children with sinusitis. Parents completed a questionnaire at the office visit, at 12 h and 3, 7, 10 and 14 days. Intra-subject reliability at 12 h was excellent (ICC = 0.94). The S5 score was responsive in 24 patients followed for 14 days who improved (mean change = 1.52, SD = 0.12, p = 0.0062). The S5 score is standardized, reliable, responsive, easily obtained, and can be used to determine study eligibility and assess treatment effects without a physician's evaluation. [ABSTRACT FROM AUTHOR]

Published
1999
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43. Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting.

Author

Katz, D A, Littenberg, B, and Cronenwett, J L

Subjects
*ABDOMINAL aortic aneurysms, *COMPARATIVE studies, *DECISION trees, *LONGITUDINAL method, *RESEARCH methodology, *MEDICAL cooperation, *PROBABILITY theory, *RESEARCH, *SYSTEMATIC reviews, *EVALUATION research, *RELATIVE medical risk, *AORTIC rupture
Abstract

Objective: To compare two clinical strategies for the management of small abdominal aortic aneurysms (AAAs) less than 5 cm in diameter: early surgery (repair small AAAs when diagnosed) and watchful waiting (measure AAA size every 6 months and repair when the diameter reaches 5 cm).Data Sources: We reviewed data from an earlier longitudinal study of patients with small AAAs to estimate incidence rates of rupture or acute expansion. Estimates for other parameters in the model were obtained by searching the medical literature (MEDLINE, 1966 to present).Data Synthesis: We constructed a Markov decision tree to compare early surgery with watchful waiting in patients with asymptomatic AAAs less than 5 cm in diameter, with respect to long-term survival in quality-adjusted life years. The average annual rates of rupture or acute expansion for AAAs with a maximal transverse diameter of less than 4.0, 4.0 to 4.9, and at least 5.0 cm, are 0, 3.3, and 14.4 events per 100 patient-years of observation, respectively. At an average rupture rate of 3.3 events per 100 patient-years and an average operative risk for elective surgery (4.6%, 30-day mortality), our model predicts that early surgery improves survival in patients who present with a 4-cm AAA. The benefit of early surgery decreases with increased age at presentation. If the average rupture rate for AAAs less than 5 cm is assumed to be low (eg, 0.4 event per 100 patient-years), watchful waiting if favored, particularly as operative risk increases. The decision in this subgroup, however, is sensitive to possible future increases in operative risk.Conclusions: In the majority of scenarios that we examined, early surgery is preferred to watchful waiting for patients with AAAs less than 5 cm in diameter. Watchful waiting is generally favored, however, for patients with a low risk of AAA rupture or acute expansion, including those patients who present with very small AAAs (eg, < 4 cm). More accurate data concerning the rupture risk of AAAs less than 5 cm would improve clinical decision making. [ABSTRACT FROM AUTHOR]

Published
1992
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44. The effect of an educational intervention on the perceived risk of breast cancer.

Author

Alexander, Nicole, Ross, Jonathan, Sumner, Walton, Nease, Robert, Littenberg, Benjamin, Alexander, N E, Ross, J, Sumner, W, Nease, R F Jr, and Littenberg, B

Subjects
BREAST tumors, COMMUNICATION, LONGITUDINAL method, PATIENT education, PHYSICIAN-patient relations, RISK assessment
Abstract

Objective: To appraise women's perceived risk of developing breast cancer and the effects of a physician's educational intervention on this perception.Design: Longitudinal before-and-after study involving four measures of participants risk of developing breast cancer. Eligible women provided the data needed to calculate an objective estimate of their individual risk of developing breast cancer before age 80 using the Gail formula. They also provided a subjective estimate of their individual perceived risk. Then, each participant met with a general internal medicine physician who provided personalized information and education. Immediately after education, and again several months later, we reassessed each woman's perceived risk.Setting: Physicians office.Participants: A convenience sample of 59 women participating in the Tamoxifen Breast Cancer Prevention Trial. Twenty-nine women returned for the follow-up risk assessment.Measurements and Main Results: The median calculated risk of breast cancer before age 80 (by the Gail formula) was 15%, but the median perceived risk before educational intervention was 50%. The perceived risk after educational intervention fell to 25%. At late follow-up, the median perceived risk remained at 25%. The difference between the preeducational perceptions and the calculated estimates was significant (1) < .0001). After educational intervention, perceived risk measures shifted closer to the calculated value, but still remained significantly higher (p <.0001).Conclusions: Women often substantially overestimate their chances of getting breast cancer. Educational intervention by a physician, including explanation of an individual's calculated risk, can reduce this error. The effect of education appears to persist at least for several months. [ABSTRACT FROM AUTHOR]

Published
1996
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45. Diagnosing pedal osteomyelitis: testing choices and their consequences.

Author

Mushlin, A I and Littenberg, B

Subjects
ANTIBIOTICS, OSTEOMYELITIS diagnosis, BIOPSY, BONES, CELLULITIS, COMPARATIVE studies, COST effectiveness, DECISION making, FOOT diseases, RESEARCH methodology, MEDICAL cooperation, OSTEOMYELITIS, HEALTH outcome assessment, PROBABILITY theory, RADIONUCLIDE imaging, RESEARCH, EVALUATION research, PREDICTIVE tests, DIAGNOSIS
Abstract

Objective: To compare the efficacies and cost-effectiveness of four strategies for the management of suspected pedal osteomyelitis in the setting of vascular impairment: 1) therapeutic trial of short-term antibiotics for presumed cellulitis without osteomyelitis (short); 2) technetium bone scanning followed by either short-term therapy if negative or either a biopsy or aggressive long-term intravenous therapy if positive (scan); 3) bone biopsy followed by long-term intravenous therapy if positive or short-term therapy if negative (biopsy); and 4) immediate long-term intravenous antibiotics for presumed osteomyelitis (long).Design: Decision analysis and cost-effectiveness analysis with sensitivity analyses. The main outcomes states are amputation and the resource expenditures associated with bone scans, biopsies, and therapies.Data Sources: The authors obtained estimates of test accuracy from literature review and summarized them using newly developed meta-analytic techniques.Main Results: The optimal decision depends heavily on the estimated probability of osteomyelitis at presentation. At very low probabilities, the short-term strategy is preferred. When the probability of osteomyelitis is from 2% to 8%, the lowest amputation rate occurs when one does a diagnostic scan. From 8% to 50%, the best outcomes follow biopsy. At probabilities higher than 50%, the preferred strategy is long-term antibiotics. However, the differences in outcomes are quite small even when osteomyelitis is a virtual certainty.Conclusions: Over the whole range of prior probabilities, the short-term strategy is the least expensive. At very low probabilities, it dominates the other strategies. When the likelihood of osteomyelitis is higher (10-20%), scanning results in outcomes and cost-effectiveness ratios comparable to those of immediate biopsy and is less invasive. When the probability of osteomyelitis is 50%, biopsy is quite cost-effective compared with all the other strategies (cost-effectiveness ratio = $15,502 per amputation averted) and is preferred to the scan strategy. When the confidence that a patient has osteomyelitis is very high (> 90% probability), the improved outcomes associated with long-term antibiotics are achieved with little additional expense and with favorable cost-effectiveness ratios compared with those of the other strategies. [ABSTRACT FROM AUTHOR]

Published
1994

46. Should adult tetanus immunization be given as a single vaccination at age 65? A cost-effectiveness analysis.

Author

Balestra, Dominic, Uttenberg, Benjamin, Balestra, D J, and Littenberg, B

Subjects
BACTERIAL vaccines, COMPARATIVE studies, COST effectiveness, IMMUNIZATION, LIFE expectancy, RESEARCH methodology, MEDICAL cooperation, RESEARCH, TETANUS, VALUE (Economics), EVALUATION research, STATISTICAL models, ECONOMICS, PREVENTION
Abstract

Objective: To compare three vaccination strategies for the prevention of adult tetanus. Each strategy includes childhood primary immunization and wound prophylaxis, and one of the following: 1) the currently recommended booster every ten years; 2) a single booster at 65 years of age; or 3) no intervention after age 6 except for wound prophylaxis.Methods: Cost-effectiveness analysis was used to compare the three different strategies. A Markov model, cycled annually from age 5 through age 85, was applied to each strategy to predict the incidence and costs of tetanus for the U.S. adult population.Results: The three strategies have very similar effects on life expectancy but different costs. Expressed incremental to no intervention after childhood primary immunization, the decennial booster strategy is least cost-effective, with a discounted incremental cost-effectiveness ratio of $143,138 per year of life saved compared with $4,527 for the single-booster strategy. Sensitivity analysis demonstrates that the decennial strategy is more effective but more costly over a wide range of model assumptions.Conclusions: The current policy of recommending tetanus booster vaccinations every ten years is effective but much more costly than a more easily implemented policy that also provides considerable protection against tetanus. The authors recommend forsaking decennial boosters in favor of a policy of including a single booster at age 65 along with other recommended health maintenance maneuvers reserved for that age. [ABSTRACT FROM AUTHOR]

Published
1993
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47. Technetium bone scanning in the diagnosis of osteomyelitis: a meta-analysis of test performance. Diagnostic Technology Assessment Consortium.

Author

Littenberg, B and Mushlin, A I

Subjects
COMPARATIVE studies, DIAGNOSTIC errors, RESEARCH methodology, MEDICAL cooperation, META-analysis, OSTEOMYELITIS, RADIONUCLIDE imaging, RESEARCH, TECHNETIUM, EVALUATION research, RECEIVER operating characteristic curves
Abstract

Purpose: To determine the diagnostic performance of technetium bone scanning in the setting of possible osteomyelitis in the foot of a patient who has diabetes or other vasculopathy.Design: Meta-analysis. Data identification and study selection: To be eligible for inclusion, a report must have used intravenous technetium-99m methylene diphosphonate or a similar agent in humans over the age of 16 years, must have addressed possible osteomyelitis of the lower extremity with ulcer or soft-tissue inflammation in the setting of diabetes, neuropathy, or vasculopathy, and must have allowed the generation of a two-by-two table. A structured search of the MEDLARS database found 296 possibly eligible reports; ten met all the inclusion criteria.Data Extraction and Synthesis: The reported sensitivity and specificity of each report were converted to their logistic transforms and a straight line was fitted by weighted least-squares regression. The line was then back-transformed to yield a summary receiver operating characteristic curve. The false-positive rate of the bone scan is at best in the range of 10 to 20%. This occurs at sensitivities between 70 and 80%. The studies with increased sensitivity also reported sizable increases in the false-positive rate ranging from 20 to over 90%. Even small increases in sensitivity have necessitated large sacrifices in specificity. Seven of the ten studies reported specificities under 70%.Conclusions: Published data defining the effectiveness of technetium bone scanning for the diagnosis of osteomyelitis in the impaired foot indicate relatively poor performance. In many clinical situations, the specificity of the bone scan will not be high enough to confirm the diagnosis of osteomyelitis. [ABSTRACT FROM AUTHOR]

Published
1992
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48. Gauze vs. plastic for peripheral intravenous dressings: testing a new technology.

Author

Littenberg, Benjamin, Thompson, Lynn, Littenberg, B, and Thompson, L

Subjects
CATHETERS, COMPARATIVE studies, LONGITUDINAL method, MATERIALS testing, RESEARCH methodology, MEDICAL cooperation, OCCLUSIVE surgical dressings, PLASTICS, RESEARCH, VEINS, EVALUATION research, RANDOMIZED controlled trials
Abstract

The authors conducted a randomized, prospective, controlled trial of three different dressings for peripheral intravenous catheters in 301 acutely ill medical inpatients. Catheters were dressed with dry clean gauze or one of two brands of transparent plastic. The gauze dressings remained in place significantly longer (47 hours median) than either Uniflex (39 hours) of Tegaderm (32 hours) transparent plastic dressings (p = 0.026). Catheters were removed for complications (inflammation, mechanical failure, or infiltration) in 35% of the gauze group, compared with 58% of the Uniflex group and 48% of the Tegaderm group (p = 0.015). Not only were inflamed venipuncture sites seen less often with gauze, inflammation occurred later (p = 0.002) and with lesser severity. Dry gauze dressings resulted in longer catheter life, lower complication rates, and less expense than transparent plastic dressings for peripheral intravenous catheters. [ABSTRACT FROM AUTHOR]

Published
1987
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50. Screening for hypertension.

Author

Littenberg, Benjamin, Garber, Alan M., Sox, Harold C., Littenberg, B, Garber, A M, and Sox, H C Jr

Subjects
CARDIOVASCULAR disease diagnosis, HYPERTENSION, MEDICAL screening
Abstract

Purpose: To review the evidence on four questions about screening asymptomatic adults for arterial hypertension: Is hypertension a significant health problem? Is it detectable at an early, presymptomatic stage? Is treatment available and effective? Do the benefits of screening outweigh the costs and risks?Data Identification and Selection: We did a computerized search of the MEDLARS data base to identify community-based trials of drug therapy for mild hypertension; other relevant citations are included when appropriate.Data Synthesis: We approached the preliminary questions in our analysis by narrative review and argument. The estimates of therapeutic efficacy are based on previously published meta-analyses. The cost-effectiveness of screening was addressed by formal mathematical modeling of the effect of screening on various U.S. populations. RESULTS OF ANALYSIS: Hypertension is clearly a significant health problem. It can be detected early, and effective treatment is available. Screening asymptomatic adults for hypertension has benefits that compare favorably to the risks and costs involved. According to our estimates, screening is most cost-effective for older adults compared with younger adults and for men compared with women and is highly sensitive to the cost of therapy for mild hypertension.Conclusions: We recommend hypertension screening for all adults. We also discuss the frequency and setting of screening activities. When a low-cost therapy is used, the cost-effectiveness of screening for hypertension compares favorably with other cardiovascular interventions. [ABSTRACT FROM AUTHOR]

Published
1990
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