Cost effectiveness of OptiMal (R) rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil

Background: In areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective. Method: The cost-effectiveness of the Optimal (R) and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U. S. dollars. Sensitivity analysis was performed considering key model parameters. Results: In the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to Plasmodium falciparum and Plasmodium vivax, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US$ 549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for P. vivax were 0.90 and 0.98, respectively, and when its sensitivity for P. falciparum was 0.83, the RDT was more cost-effective than microscopy. Conclusion: Microscopy is more cost-effective than OptiMal (R) in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.

An approach of optimal sensitivity applied in the tertiary loop of the automatic generation control

This paper proposes an approach of optimal sensitivity applied in the tertiary loop of the automatic generation control. The approach is based on the theorem of non-linear perturbation. From an optimal operation point obtained by an optimal power flow a new optimal operation point is directly determined after a perturbation, i.e., without the necessity of an iterative process. This new optimal operation point satisfies the constraints of the problem for small perturbation in the loads. The participation factors and the voltage set point of the automatic voltage regulators (AVR) of the generators are determined by the technique of optimal sensitivity, considering the effects of the active power losses minimization and the network constraints. The participation factors and voltage set point of the generators are supplied directly to a computational program of dynamic simulation of the automatic generation control, named by power sensitivity mode. Test results are presented to show the good performance of this approach. (C) 2008 Elsevier B.V. All rights reserved.

EXISTENCE OF S-ASYMPTOTICALLY omega-PERIODIC SOLUTIONS FOR ABSTRACT NEUTRAL EQUATIONS

A bounded continuous function it u : [0, infinity) -> X is said to be S-asymptotically omega-periodic if lim(t ->infinity)[u(t + omega) - u(t)] = 0. This paper is devoted to study the existence and qualitative properties of S-asymptotically omega-periodic mild solutions for some classes of abstract neutral functional differential equations with infinite delay, Furthermore, applications to partial differential equations are given.

The existence of solutions for impulsive neutral functional differential equations

This work deals with the existence of mild solutions for a class of impulsive functional differential equations of the neutral type associated with the family of linear closed (not necessarily bounded) operators {A(t) : t is an element of 1}. (C) 2009 Elsevier Ltd. All rights reserved.

Existence of asymptotically almost automorphic solutions to some abstract partial neutral integro-differential equations

The paper establishes the existence and uniqueness of asymptotically almost automorphic mild solution to an abstract partial neutral integro-differential equation with unbounded delay. An example is given to illustrate our results. (C) 2008 Elsevier Ltd. All rights reserved.

Existence of solutions for second order partial neutral functional differential equations

We establish existence of mild solutions for a class of abstract second-order partial neutral functional differential equations with unbounded delay in a Banach space.

Existence of solutions for a class of abstract differential equations with nonlocal conditions

We discuss the existence of mild, classical and strict solutions for a class of abstract differential equations with nonlocal conditions. Our technical approach allows the study of partial differential equations with nonlocal conditions involving partial derivatives or nonlinear expressions of the solution. Some concrete applications to partial differential equations are considered. (C) 2010 Elsevier Ltd. All rights reserved.

Effects of Optimal Medical Treatment With or Without Coronary Revascularization on Angina and Subsequent Revascularizations in Patients With Type 2 Diabetes Mellitus and Stable Ischemic Heart Disease

Background-In the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, an initial strategy of coronary revascularization and optimal medical treatment (REV) compared with an initial optimal medical treatment with the option of subsequent revascularization (MED) did not reduce all-cause mortality or the composite of cardiovascular death, myocardial infarction, and stroke in patients with type 2 diabetes mellitus and stable ischemic heart disease. In the same population, we tested whether the REV strategy was superior to the MED strategy in preventing worsening and new angina and subsequent coronary revascularizations. Methods and Results-Among the 2364 men and women (mean age, 62.4 years) with type 2 diabetes mellitus, documented coronary artery disease, and myocardial ischemia, 1191 were randomized to the MED and 1173 to the REV strategy preselected in the percutaneous coronary intervention (796) and coronary artery bypass graft (377) strata. Compared with the MED strategy, the REV strategy at the 3-year follow-up had a lower rate of worsening angina (8% versus 13%; P < 0.001), new angina (37% versus 51%; P = 0.001), and subsequent coronary revascularizations (18% versus 33%; P < 0.001) and a higher rate of angina-free status (66% versus 58%; P = 0.003). The coronary artery bypass graft stratum patients were at higher risk than those in the percutaneous coronary intervention stratum, and had the greatest benefits from REV. Conclusions-In these patients, the REV strategy reduced the occurrence of worsening angina, new angina, and subsequent coronary revascularizations more than the MED strategy. The symptomatic benefits were observed particularly for high-risk patients.

A Bayesian approach to fuzzy hypotheses testing for the estimation of optimal age for vaccination against measles

Fuzzy Bayesian tests were performed to evaluate whether the mother`s seroprevalence and children`s seroconversion to measles vaccine could be considered as ""high"" or ""low"". The results of the tests were aggregated into a fuzzy rule-based model structure, which would allow an expert to influence the model results. The linguistic model was developed considering four input variables. As the model output, we obtain the recommended age-specific vaccine coverage. The inputs of the fuzzy rules are fuzzy sets and the outputs are constant functions, performing the simplest Takagi-Sugeno-Kang model. This fuzzy approach is compared to a classical one, where the classical Bayes test was performed. Although the fuzzy and classical performances were similar, the fuzzy approach was more detailed and revealed important differences. In addition to taking into account subjective information in the form of fuzzy hypotheses it can be intuitively grasped by the decision maker. Finally, we show that the Bayesian test of fuzzy hypotheses is an interesting approach from the theoretical point of view, in the sense that it combines two complementary areas of investigation, normally seen as competitive. (C) 2007 IMACS. Published by Elsevier B.V. All rights reserved.

A new morphological variant of uterine PEComas with sex-cord-like pattern and WT1 expression: more doubts about the existence of uterine PEComas

PEComas are rare neoplasms that are sometimes associated with the tuberous sclerosis complex. They typically contain perivascular epithelioid cells that coexpress muscle and melanocytic markers. However, apart from these classical features, considerable clinical, pathologic, and immunohistochemical variation has been reported. WT1, the Wilms tumor gene product, can be expressed in various tumors from different anatomical sites, including sex-cord and other ovarian tumors with a sertoliform pattern. Neither a sex-cord like pattern nor WT1 expression has been described in PEComas. Here, we describe a case of uterine PEComa with a pattern of infiltration into the myometrium that is similar to stromal sarcomas, characterized by tongues and endovascular growing. The architecture and cellular morphology were similar to sex-cord tumors, and the PEComa was diffusely and strongly positive for WT1. We reviewed, from our files, an additional 9 cases of PEComa from different sites, and found WT1 expression in one more soft tissue tumor. We discuss the relationship between PEComas and other uterine sarcomas. (C) 2010 Elsevier Inc. All rights reserved.

Existence of pullback attractors for pullback asymptotically compact processes

This paper is concerned with the existence of pullback attractors for evolution processes. Our aim is to provide results that extend the following results for autonomous evolution processes (semigroups) (i) An autonomous evolution process which is bounded, dissipative and asymptotically compact has a global attractor. (ii) An autonomous evolution process which is bounded, point dissipative and asymptotically compact has a global attractor. The extension of such results requires the introduction of new concepts and brings up some important differences between the asymptotic properties of autonomous and non-autonomous evolution processes. An application to damped wave problem with non-autonomous damping is considered. (C) 2009 Elsevier Ltd. All rights reserved.

Existence of Solution for a Class of Quasilinear Systems

This paper proves the existence of nontrivial solution for a class of quasilinear systems oil bounded domains in R(N), N >= 2, whose nonlinearity has a double criticality. The proof is based oil a linking theorem without the Palais-Smale condition.

Existence of secondary bifurcations or isolas for PDEs

In this paper, we introduce a method to conclude about the existence of secondary bifurcations or isolas of steady state solutions for parameter dependent nonlinear partial differential equations. The technique combines the Global Bifurcation Theorem, knowledge about the non-existence of nontrivial steady state solutions at the zero parameter value and explicit information about the coexistence of multiple nontrivial steady states at a positive parameter value. We apply the method to the two-dimensional Swift-Hohenberg equation. (C) 2011 Elsevier Ltd. All rights reserved.

Existence of orthogonal geodesic chords on Riemannian manifolds with concave boundary and homeomorphic to the N-dimensional disk

In this paper we give a proof of the existence of an orthogonal geodesic chord on a Riemannian manifold homeomorphic to a closed disk and with concave boundary. This kind of study is motivated by the link (proved in Giambo et al. (2005) [8]) of the multiplicity problem with the famous Seifert conjecture (formulated in Seifert (1948) [1]) about multiple brake orbits for a class of Hamiltonian systems at a fixed energy level. (C) 2010 Elsevier Ltd. All rights reserved.

Discrete-time mean variance optimal control of linear systems with Markovian jumps and multiplicative noise

In this article, we consider the stochastic optimal control problem of discrete-time linear systems subject to Markov jumps and multiplicative noise under three kinds of performance criterions related to the final value of the expectation and variance of the output. In the first problem it is desired to minimise the final variance of the output subject to a restriction on its final expectation, in the second one it is desired to maximise the final expectation of the output subject to a restriction on its final variance, and in the third one it is considered a performance criterion composed by a linear combination of the final variance and expectation of the output of the system. We present explicit sufficient conditions for the existence of an optimal control strategy for these problems, generalising previous results in the literature. We conclude this article presenting a numerical example of an asset liabilities management model for pension funds with regime switching.