Factors associated with lesion detection in colonoscopy among different indications.

BACKGROUND AND OBJECTIVE: Different factors may influence colonoscopy performance measures. We aimed to analyze procedure- and endoscopist-related factors associated with detection of colorectal lesions and whether these factors have a similar influence in the context of different colonoscopy indications: positive fecal immunochemical test (+FIT) and post-polypectomy surveillance colonoscopies. METHODS: This multicenter cross-sectional study included adults aged 40-80 years. Endoscopists (N = 96) who had performed ≥50 examinations were assessed for physician-related factors. Adenoma detection rate (ADR), adenomas per colonoscopy rate (APCR), advanced ADR, serrated polyp detection (SDR), and serrated polyps per colonoscopy rate (SPPCR) were calculated. RESULTS: We included 12,932 procedures, with 4810 carried out after a positive FIT and 1967 for surveillance. Of the 96 endoscopists evaluated, 43.8% were women, and the mean age was 41.9 years. The ADR, advanced ADR, and SDR were 39.7%, 17.7%, and 12.8%, respectively. Adenoma detection rate was higher in colonoscopies after a +FIT (50.3%) with a more than doubled advanced ADR compared to non-FIT procedures (27.6% vs. 13.0%) and similar results in serrated lesions (14.7% vs. 13.5%). Among all the detection indicators analyzed, withdrawal time was the only factor independently related to improvement (p < 0.001). Regarding FIT-positive and surveillance procedures, for both indications, withdrawal time was also the only factor associated with a higher detection of adenomas and serrated polyps (p < 0.001). Endoscopist-related factors (i.e., weekly hours dedicated to endoscopy, annual colonoscopy volume and lifetime number of colonoscopies performed) had also impact on lesion detection (APCR, advanced ADR and SPPCR). CONCLUSIONS: Withdrawal time was the factor most commonly associated with improved detection of colonic lesions globally and in endoscopies for + FIT and post-polypectomy surveillance. Physician-related factors may help to address strategies to support training and service provision. Our results can be used for establishing future benchmarking and quality improvement in different colonoscopy indications.

Applying the perturbative integral in aeromaneuvers around Mars to calculate the cost.

The perturbative integral method was applied to quantify the contribution of external forces during a specific interval of time in trajectories of spacecraft around asteroids and under the Luni-solar influence. However, this method has not been used to quantify the contributions of drag in aerocapture and aerobraking. For this reason, the planet Mars is selected to apply this method during an aerogravity-assisted maneuver. Several trajectories are analyzed, making use of a drag device with area to mass ratios varying from 0.0 to 20.0 m2/kg, simulating solar sails or de-orbit devices. The mathematical model is based in the restricted three-body problem. The use of this maneuver makes it possible to obtain the variations of energy in the trajectory, replacing expensive maneuvers based on fuel consumption. To observe the effects of the maneuvers, different values of pericenter velocity and altitude were selected for prograde and retrograde orbits. The innovation of this research is the application of an integral method to quantify the delta-V of the aero gravity maneuver, comparing the cost of the maneuver with the traditional methods of space propulsion. The results allow the identification of orbits with conditions to capture, and the perturbative maps show the velocity variations.