Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system Objectives: To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). Methods: A discrete event simulation model seas built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY)) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. Results: The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years, were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. Conclusion: From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.

Modeling of active holonic control systems for intelligent buildings

Building facilities have become important infrastructures for modern productive plants dedicated to services. In this context, the control systems of intelligent buildings have evolved while their reliability has evidently improved. However, the occurrence of faults is inevitable in systems conceived, constructed and operated by humans. Thus, a practical alternative approach is found to be very useful to reduce the consequences of faults. Yet, only few publications address intelligent building modeling processes that take into consideration the occurrence of faults and how to manage their consequences. In the light of the foregoing, a procedure is proposed for the modeling of intelligent building control systems, considersing their functional specifications in normal operation and in the of the event of faults. The proposed procedure adopts the concepts of discrete event systems and holons, and explores Petri nets and their extensions so as to represent the structure and operation of control systems for intelligent buildings under normal and abnormal situations. (C) 2012 Elsevier B.V. All rights reserved.

Physical objects on navigation channal simulation models

This paper presents the results of a simulation using physical objects. This concept integrates the physical dimensions of an entity such as length, width, and weight, with the usual process flow paradigm, recurrent in the discrete event simulation models. Based on a naval logistics system, we applied this technique in an access channel of the largest port of Latin America. This system is composed by vessel movement constrained by the access channel dimensions. Vessel length and width dictates whether it is safe or not to have one or two ships simultaneously. The success delivered by the methodology proposed was an accurate validation of the model, approximately 0.45% of deviation, when compared to real data. Additionally, the model supported the design of new terminals operations for Santos, delivering KPIs such as: canal utilization, queue time, berth utilization, and throughput capability

Self-similarities of periodic structures for a discrete model of a two-gene system

We report self-similar properties of periodic structures remarkably organized in the two-parameter space for a two-gene system, described by two-dimensional symmetric map. The map consists of difference equations derived from the chemical reactions for gene expression and regulation. We characterize the system by using Lyapunov exponents and isoperiodic diagrams identifying periodic windows, denominated Arnold tongues and shrimp-shaped structures. Period-adding sequences are observed for both periodic windows. We also identify Fibonacci-type series and Golden ratio for Arnold tongues, and period multiple-of-three windows for shrimps. (C) 2012 Elsevier B.V. All rights reserved.

Vertical distribution of benthic invertebrate larvae during an upwelling event along a transect off the tropical Brazilian continental margin

Abundance and composition of marine benthic communities have been relatively well studied in the SE Brazilian coast, but little is known on patterns controlling the distribution of their planktonic larval stages. A survey of larval abundance in the continental margin, using a Multi-Plankton Sampler, was conducted in a cross-shelf transect off Cabo Frio (23 degrees S and 42 degrees W) during a costal upwelling event. Hydrographic conditions were monitored through discrete CDT casts. Chlorophyll-a in the top 100 m of the water column was determined and changes in surface chlorophyll-a was estimated using SeaWiFS images. Based on the larval abundances and the meso-scale hydrodynamics scenario, our results suggest two different processes affecting larval distributions. High larval densities were found nearshore due to the upwelling event associated with high chlorophyll a and strong along shore current. On the continental slope, high larval abundance was associated with a clockwise rotating meander, which may have entrapped larvae from a region located further north (Cabo de Sao Tome, 22 degrees S and 41 degrees W). In mid-shelf areas, our data suggests that vertical migration may likely occur as a response to avoid offshore transport by upwelling plumes and/or cyclonic meanders. The hydrodynamic scenario observed in the study area has two distinct yet extremely important consequences: larval retention on food-rich upwelling areas and the broadening of the tropical domain to southernmost subtropical areas. (C) 2009 Elsevier B.V. All rights reserved.

ANALYSIS OF MANGROVE FOREST SUCCESSION, USING SEDIMENT CORES: A CASE STUDY IN THE CANANEIA-IGUAPE COASTAL SYSTEM, SAO PAULO-BRAZIL

Sediment cores are an essential tool for the analysis of the dynamics of mangrove succession. Coring was used to correlate changes in depositional environments and lateral sedimentary facies with discrete stages of forest succession at the Cananeia-Iguape Coastal System in southeastern Brazil. A local level successional pattern was examined based on four core series T1) a sediment bank; T2) a smooth cordgrass Spartina alterniflora bank; T3) an active mangrove progradation fringe dominated by Laguncularia racemosa, and; T4) a mature mangrove forest dominated by Avicennia schaueriana. Cores were macroscopically described in terms of color, texture, sedimentary structure and organic components. The base of all cores exhibited a similar pattern suggesting common vertical progressive changes in depositional conditions and subsequent successional colonization pattern throughout the forest. The progradation zone is an exposed bank, colonized by S. alterniflora. L. racemosa, replaces S. alterniflora as progradation takes place. As the substrate consolidates A. schaueriana replaces L. racemosa and attains the greatest structural development in the mature forest. Cores collected within the A. schaueriana dominated stand contained S. alterniflora fragments near the base, confirming that a smooth cordgrass habitat characterized the establishment and early seral stages. Cores provide a reliable approach to describe local-level successional sequences in dynamic settings subject to drivers operating on multiple temporal and spatial scales where spatial heterogeneity can lead to multiple equilibria and where similar successional end-points may be reached through convergent paths.

Ordovician klippen structures of the Sierra de Umango: New insights on Tectonic evolution of the Western Sierras Pampeanas, Argentina

The basement rock of the Pampean flat-slab (Sierras Pampeanas) in the Central Andes was uplifted and rotated in the Cenozoic era. The Western Sierras Pampeanas are characterised by meta-igneous rocks of Grenvillian Mesoproterozoic age and metasedimentary units metamorphosed in the Ordovician period. These rocks, known as the northern Cuyania composite terrane, were derived from Laurentia and accreted toward Western Gondwana during the Early Paleozoic. The Sierra de Umango is the westernmost range of the Western Sierras Pampeanas.This range is bounded by the Devonian sedimentary rocks of the Precordillera on the western side and Tertiary rocks from the Sierra de Maz and Sierra del Espinal on the eastern side and contains igneous and sedimentary rocks outcroppings from the Famatina System on the far eastern side. The Sierra de Umango evolved during a period of polyphase tectonic activity, including an Ordovician collisional event, a Devonian compressional deformation, Late Paleozoic and Mesozoic extensional faulting and sedimentation (Paganzo and Ischigualasto basins) and compressional deformation of the Andean foreland during the Cenozoic. A Nappe System and an important shear zone, La Puntilla-La Falda Shear Zone (PFSZ), characterise the Ordovician collisional event, which was related to the accretion of Cuyania Terrane to the proto-Andean margin of Gondwana. Three continuous deformational phases are recognised for this event: the D1 phase is distinguished by relics of 51 preserved as internal foliation within interkinematic staurolite por-phyroblasts and likely represents the progressive metamorphic stage; the D2 phase exhibits P-T conditions close to the metamorphic peak that were recorded in an 52 transposition or a mylonitic foliation and determine the main structure of Umango; and the D3 phase is described as a set of tight to recumbent folds with S3 axial plane foliation, often related to thrust faults, indicating the retrogressive metamorphic stage. The Nappe System shows a top-to-the S/SW sense direction of movement, and the PFSZ served as a right lateral ramp in the exhumation process. This structural pattern is indicative of an oblique collision, with the Cuyania Terrane subducting under the proto-Andean margin of Gondwana in the NE direction. This continental subduction and exhumation lasted at least 30 million years, nearly the entire Ordovician period, and produced metamorphic conditions of upper amphibolite-to-granulite facies in medium- to high-pressure regimes. At least two later events deformed the earlier structures: D4 and D5 deformational phases. The D4 deformational phase corresponds to upright folding, with wavelengths of approximately 10 km and a general N-S orientation. These folds modified the S2 surface in an approximately cylindrical manner and are associated with exposed, discrete shear zones in the Silurian Guandacolinos Granite. The cylindrical pattern and subhorizontal axis of the D4 folds indicates that the S2 surface was originally flat-lying. The D4 folds are responsible for preserving the basement unit Juchi Orthogneiss synformal klippen. This deformation corresponds to the Chanica Tectonic during the interval between the Devonian and Carboniferous periods. The D5 deformational phase comprehends cuspate-lobate shaped open plunging folds with E W high-angle axes (D5 folds) and sub-vertical spaced cleavage. The D5 folds and related spaced cleavage deformed the previous structures and could be associated with uplifting during the Andean Cycle. (C) 2012 Elsevier Ltd. All rights reserved.

Mating system parameters at hierarchical levels of fruits, individuals and populations in the Brazilian insect-pollinated tropical tree, Tabebuia roseo-alba (Bignoniaceae)

For many tree species, mating system analyses have indicated potential variations in the selfing rate and paternity correlation among fruits within individuals, among individuals within populations, among populations, and from one flowering event to another. In this study, we used eight microsatellite markers to investigate mating systems at two hierarchical levels (fruits within individuals and individuals within populations) for the insect pollinated Neotropical tree Tabebuia roseo-alba. We found that T. roseo-alba has a mixed mating system with predominantly outcrossed mating. The outcrossing rates at the population level were similar across two T. roseo-alba populations; however, the rates varied considerably among individuals within populations. The correlated paternity results at different hierarchical levels showed that there is a high probability of shared paternal parentage when comparing seeds within fruits and among fruits within plants and full-sibs occur in much higher proportion within fruits than among fruits. Significant levels of fixation index were found in both populations and biparental inbreeding is believed to be the main cause of the observed inbreeding. The number of pollen donors contributing to mating was low. Furthermore, open-pollinated seeds varied according to relatedness, including half-sibs, full-sibs, self-sibs and self- half-sibs. In both populations, the effective population size within a family (seed-tree and its offspring) was lower than expected for panmictic populations. Thus, seeds for ex situ conservation genetics, progeny tests and reforestation must be collected from a large number of seed-trees to guarantee an adequate effective population in the sample.

The rapid atmospheric monitoring system of the Pierre Auger Observatory

The Pierre Auger Observatory is a facility built to detect air showers produced by cosmic rays above 10(17) eV. During clear nights with a low illuminated moon fraction, the UV fluorescence light produced by air showers is recorded by optical telescopes at the Observatory. To correct the observations for variations in atmospheric conditions, atmospheric monitoring is performed at regular intervals ranging from several minutes (for cloud identification) to several hours (for aerosol conditions) to several days (for vertical profiles of temperature, pressure, and humidity). In 2009, the monitoring program was upgraded to allow for additional targeted measurements of atmospheric conditions shortly after the detection of air showers of special interest, e. g., showers produced by very high-energy cosmic rays or showers with atypical longitudinal profiles. The former events are of particular importance for the determination of the energy scale of the Observatory, and the latter are characteristic of unusual air shower physics or exotic primary particle types. The purpose of targeted (or "rapid") monitoring is to improve the resolution of the atmospheric measurements for such events. In this paper, we report on the implementation of the rapid monitoring program and its current status. The rapid monitoring data have been analyzed and applied to the reconstruction of air showers of high interest, and indicate that the air fluorescence measurements affected by clouds and aerosols are effectively corrected using measurements from the regular atmospheric monitoring program. We find that the rapid monitoring program has potential for supporting dedicated physics analyses beyond the standard event reconstruction.

A modified Primal-Dual Logarithmic-Barrier Method for solving the Optimal Power Flow problem with discrete and continuous control variables

The aim of solving the Optimal Power Flow problem is to determine the optimal state of an electric power transmission system, that is, the voltage magnitude and phase angles and the tap ratios of the transformers that optimize the performance of a given system, while satisfying its physical and operating constraints. The Optimal Power Flow problem is modeled as a large-scale mixed-discrete nonlinear programming problem. This paper proposes a method for handling the discrete variables of the Optimal Power Flow problem. A penalty function is presented. Due to the inclusion of the penalty function into the objective function, a sequence of nonlinear programming problems with only continuous variables is obtained and the solutions of these problems converge to a solution of the mixed problem. The obtained nonlinear programming problems are solved by a Primal-Dual Logarithmic-Barrier Method. Numerical tests using the IEEE 14, 30, 118 and 300-Bus test systems indicate that the method is efficient. (C) 2012 Elsevier B.V. All rights reserved.

Anisotropic Flow in Event-by-Event Ideal Hydrodynamic Simulations of root s(NN) 200 GeV Au+Au Collisions

We simulate top-energy Au + Au collisions using ideal hydrodynamics in order to make the first comparison to the complete set of midrapidity flow measurements made by the PHENIX Collaboration. A simultaneous calculation of nu(2), nu(3), nu(4), and the first event-by-event calculation of quadrangular flow defined with respect to the nu(2) event plane (nu(4){Psi(2)}) gives good agreement with measured values, including the dependence on both transverse momentum and centrality. This provides confirmation that the collision system is indeed well described as a quark-gluon plasma with an extremely small viscosity and that correlations are dominantly generated from collective effects. In addition, we present a prediction for nu(5).

Factor Xa activation of factor V is of paramount importance in initiating the coagulation system: lessons from a tick salivary protein

BACKGROUND: Generation of active procoagulant cofactor factor Va (FVa) and its subsequent association with the enzyme activated factor X (FXa) to form the prothrombinase complex is a pivotal initial event in blood coagulation and has been the subject of investigative effort, speculation, and controversy. The current paradigm assumes that FV activation is initiated by limited proteolysis by traces of (meizo) thrombin. METHODS AND RESULTS: Recombinant tick salivary protein TIX-5 was produced and anticoagulant properties were studied with the use of plasma, whole blood, and purified systems. Here, we report that TIX-5 specifically inhibits FXa-mediated FV activation involving the B domain of FV and show that FXa activation of FV is pivotal for plasma and blood clotting. Accordingly, tick feeding is impaired on TIX-5 immune rabbits, displaying the in vivo importance of TIX-5. CONCLUSIONS: Our data elucidate a unique molecular mechanism by which ticks inhibit the host's coagulation system. From our data, we propose a revised blood coagulation scheme in which direct FXa-mediated FV activation occurs in the initiation phase during which thrombin-mediated FV activation is restrained by fibrinogen and inhibitors.