Custo-efetividade da Terapia Tripla para pacientes adultos portadores do genótipo 1 da hepatite C crônica.

As ações de prevenção, diagnóstico e tratamento da hepatite C crônica integram as agendas das políticas de saúde do Brasil e do mundo, pois se trata de uma doença com grande número de acometidos, com alto custo tratamento e que ocasiona graves desfechos e incapacidade, o que acaba por onerar seu custo social. Os protocolos clínicos e diretrizes terapêuticas demonstram os esforços de inúmeras entidades no combate da hepatite C, pois informam aos profissionais de saúde, pacientes e familiares e cidadãos em geral, qual seria a melhor forma, comprovada cientificamente, de se proceder frente a uma infecção desta natureza. Realizouse uma análise de custoefetividade, sob a perspectiva do SUS, das estratégias: tratamento e retratamento com a terapia dupla, tratamento com a terapia dupla e retratamento com a terapia tripla e tratamento com a terapia tripla. Através de modelo de simulação baseado em cadeias Markov foi criada uma coorte hipotética de 1000 indivíduos adultos, acima de 40 anos, de ambos os sexos, sem distinção declasse socioeconômica, com diagnóstico confirmado para hepatite C crônica, monoinfectados pelo genótipo 1 do VHC e com ausência de comorbidades. A simulação foi iniciada com todos os indivíduos portando a forma mais branda da doença, tida como a classificação histológica F0 ou F1 segundo a escala Metavir. Os resultados demonstram que as duas opções, ou seja, a terapia dupla/tripla e a terapia tripla estão abaixo do limiar de aceitabilidade para incorporação de tecnologia proposto pela OMS (2012) que é de 72.195 (R$/QALY) (IBGE, 2013; WHO, 2012). Ambas são custoefetivas, visto que o ICER da terapia dupla/tripla em relação alinha de base foi de 7.186,3 (R$/QALY) e o da terapia tripla foi de 59.053,8 (R$/QALY). Entretanto o custo incremental de terapia tripla em relação à dupla/tripla foi de 31.029 e a efetividade incremental foi de 0,52. Em geral, quando as intervenções analisadas encontramse abaixo do limiar, sugerese a adoção do esquema de maior efetividade. A terapia tripla, apesar de ter apresentado uma efetividade um pouco acima da terapia dupla/tripla, apresentou custo muito superior. Assim, como seria coerente a adoção de uma ou da outra para utilização no SUS, visto que este sistema apresenta recursos limitados, indicase a realização de um estudo de impacto orçamentário para obterse mais um dado de embasamento da decisão e assim poder apoiar o protocolo brasileiro existente ou sugerir a confecção de novo documento.

Avaliação vestibular em indivíduos com cinetose

A cinetose tem elevada prevalência mundial, sendo mais frequente na infância e no sexo feminino, mas também pode acometer adultos. Resulta de um conflito vestíbulo-visual que incide durante a locomoção em diversos meios de transporte, como carro, ônibus, avião e barco. A forma mais dramática ocorre no transporte marítimo. Ocasiona náusea, vômito, sudorese, aumento da salivação, redução do apetite, hipotensão e mal-estar. Geralmente é produzida por estímulo vestibular, mas também pode ser induzida por estímulo visual. Tanto as acelerações lineares quanto angulares geram cinetose se persistirem por longo período em indivíduos susceptíveis. Recentemente ocorre maior interesse nessa afecção devido ao crescente uso de tecnologia de simulação de vôo e direção automobilística. O objetivo do estudo foi analisar as alterações vestibulares nos indivíduos adultos com cinetose. Trata-se de um estudo prospectivo, tipo série de casos. Os pacientes do ambulatório do Hospital Universitário Pedro Ernesto-UERJ foram avaliados através de anamnese geral e dirigida e exame fisico geral e otorrinolaringológico. Aqueles com histórico de doença otológica foram excluídos. Posteriormente realizaram audiometria e testes vestibulares com o registro gráfico dos nistagmos através da vectoeletronistagmografia. Nos resultados das provas calóricas encontramos 3,33% de pacientes com alteração de predomínio direcional, 6,67% com alteração de predomínio labiríntico, 3,33% com hiperreflexia esquerda, 3,33% com hiporreflexia direita e 3,33% com hiporreflexia esquerda. Encontrados algumas variações na análise dos movimentos sacádicos, nistagmo optocinético e rastreio pendular. Os resultados foram de encontro aos achados da literatura. Diante dos achados, foi observado que o exame otoneurológico com registro gráfico da cinetose mostrou-se muito importante para a avaliação dos pacientes com essa afecção. O estudo traz benefícios por contribuir para o melhor entendimento da cinetose e estimular novas pesquisas na área.

Active control of sound radiated by a submarine hull in bending vibration using inertial actuators

Submarines are efficient sources of low frequency radiated noise due to the vibrations induced by the rotation of the propeller in a non uniform wake. In this work the possibility of using inertial actuators to reduce the far field sound pressure is investigated. The submerged vessel is modelled as a cylindrical shell with two conical end caps. Complicating effects such as ring stiffeners, bulkheads and the fluid loading are taken into account. A harmonic radial force is transmitted from the propeller to the hull through the stern end cone and it is tonal at the blade passing frequency (rotational speed of the shaft multiplied by the number of blades). The actuators are attached at the inside of the prow end cone to form a circumferential array. Both Active Vibration Control (AVC) and Active Structural Acoustic Control (ASAC) are analysed and it is shown that the inertial actuators can significantly reduce the far field sound pressure.

Modern challenges facing turbomachinery aeroacoustics

In this review we describe current scientific and technological issues in the quest to reduce aeroengine noise, in the face of predicted rapid increases in the volume of air traffic, on the one hand, and increasingly strict environmental regulation, on the other. Alongside conventional ducted turbofan designs, new open-rotor contra-rotating power plants are currently under development, which present their own noise challenges. The key sources of tonal and broadband noise, and the way in which noise propagates away from the source, are surveyed in both cases. We also consider in detail two key aspects underpinning the flow physics that continue to receive considerable attention, namely the acoustics of swirling flow and unsteady flow-blade interactions. Finally, we describe possible innovations in open-rotor engine design for low noise.

Active control of sound radiated by a submarine hull in axisymmetric vibration using inertial actuators

This paper investigates the use of inertial actuators to reduce the sound radiated by a submarine hull under excitation from the propeller. The axial forces from the propeller are tonal at the blade passing frequency. The hull is modeled as a fluid-loaded cylindrical shell with ring stiffeners and equally spaced bulkheads. The cylinder is closed at each end by circular plates and conical end caps. The forces from the propeller are transmitted to the hull by a rigid foundation connected to the propeller shaft. Inertial actuators are used as the structural control inputs. The actuators are arranged in circumferential arrays and attached to the internal end plates of the hull. Two active control techniques corresponding to active vibration control and discrete structural acoustic sensing are implemented to attenuate the structural and acoustic responses of the submarine. In the latter technique, error information on the radiated sound fields is provided by a discrete structural acoustic sensor. An acoustic transfer function is defined to estimate the far field sound pressure from a single point measurement on the hull. The inertial actuators are shown to provide control forces with a magnitude large enough to reduce the sound due to hull vibration. © 2012 American Society of Mechanical Engineers.

Neural representations of courtship song in the Drosophila brain.

Acoustic communication in drosophilid flies is based on the production and perception of courtship songs, which facilitate mating. Despite decades of research on courtship songs and behavior in Drosophila, central auditory responses have remained uncharacterized. In this study, we report on intracellular recordings from central neurons that innervate the Drosophila antennal mechanosensory and motor center (AMMC), the first relay for auditory information in the fly brain. These neurons produce graded-potential (nonspiking) responses to sound; we compare recordings from AMMC neurons to extracellular recordings of the receptor neuron population [Johnston's organ neurons (JONs)]. We discover that, while steady-state response profiles for tonal and broadband stimuli are significantly transformed between the JON population in the antenna and AMMC neurons in the brain, transient responses to pulses present in natural stimuli (courtship song) are not. For pulse stimuli in particular, AMMC neurons simply low-pass filter the receptor population response, thus preserving low-frequency temporal features (such as the spacing of song pulses) for analysis by postsynaptic neurons. We also compare responses in two closely related Drosophila species, Drosophila melanogaster and Drosophila simulans, and find that pulse song responses are largely similar, despite differences in the spectral content of their songs. Our recordings inform how downstream circuits may read out behaviorally relevant information from central neurons in the AMMC.

Active control of the accordion modes of a submerged hull

Active vibration control of a submerged hull is presented. A submarine hull can be idealised as a ring stiffened finite cylinder with applied fluid loading. At low frequencies, rotation of the propeller results in discrete tones at the blade passing frequency and its harmonics. The low frequency axial and radial vibration modes of the submerged body can result in a high level of radiated noise. Global hull modes are difficult to attenuate since passive control techniques such as damping materials are not practical due to size and weight constraints. This work investigates active vibration control of a submarine hull for attenuation of the structural and acoustic responses. Based on a feedforward algorithm at tonal frequencies, active vibration suppression of the axial and radial hull displacements are investigated. The effect of the various control arrangements on the structure-borne radiated noise is examined. Numerical simulations of the control performance are presented.

Review of computational aeroacoustics for application in electronics cooler noise

A review of computational aeroacoustics (CCA) was made for application in electronics cooler noise. Computational aeroacoustics encompasses all numerical methods where the purposes is to predict the noise emissions from a simulated flow. Numerical simulation of the flow inside and around heat sinks and fans can lead to a prediction of the emitted noise while they are still in the design phase. Direct CCA is theoretically the best way to predict flow-based acoustic phenomena numerically. It is typically used only for low-frequency sound prediction. The boundary element method offers low computational cost and does not use a computational grid, but instead use vortex-surface calculations to determine tonal noise. Axial fans are commonly used to increase the airflow and thus the heat transfer over the heat sinks within the computer cases. Very detailed source simulations in the fan and heat sink region coupled with the use of analogy methods could result in excellent simulation results with a reasonable computational effort.

Acoustic analogy in swirling mean flow applied to predict rotor trailing-edge noise

The present study aims at accounting for swirling mean flow effects on rotor trailing-edge noise. Indeed, the mean flow in between the rotor and the stator of the fan or of a compressor stage is highly swirling. The extension of Ffowcs-Williams & Hawkings' acoustic analogy in a medium at rest with moving surfaces and of Goldstein's acoustic analogy in a circular duct with uniform mean flow to a swirling mean flow in an annular duct is introduced. It is first applied to tonal noise. In most cases, the swirl modifies the pressure distribution downstream of the fan. In several configurations, when the swirl is rather close to a solid body swirl, it is often sufficient to apply a simple Doppler effect correction when predicting the duct modes in uniform mean flow in order to predict accurately the noise radiated with swirl. However, in other realistic configurations, the swirling mean-flow effect cannot be addressed using this simple Doppler effect correction. Second, a rotor trailing-edge noise model accounting for both the effects of the annular duct and the swirling mean flow is developed and applied to a realistic fan rotor with different swirling and sheared mean flows (and as a result different associated blade stagger angles). The benchmark cases are built from the Boeing 18-inch Fan Rig Broadband Noise Test. In all cases the swirling mean flow has an effect. In some cases the a simple Doppler effect may address it, but, in other realistic configurations our acoustic analogy with swirl is needed. © 2012 by the authors. Published by the American Institute of Aeronautics and Astronautics, Inc.

Investigating landing gear noise using fly-over data: The case of a Boeing 747-400

Modeling the noise originating from a landing gear has proven to be a challenging task, because of its complicated structure. In full-scale, landing gear noise can only be investigated experimentally by source localization techniques and fly-over measurements with microphone arrays. In the present work, measurements of a Boeing B747-400 were used to determine the contribution of the landing gear to the overall noise emitted during a fly-over and how the broadband noise from the landing gear scales with the flight velocity. A tonal source from the nose landing gear was identified at 380 Hz with a harmonic at 760 Hz and it most likely originates from a cavity. It was also found that the Power Spectral Density (PSD) of the high frequency broadband component varies linearly with frequency and there is some scaling with the ow velocity. Finally, the nose landing gear was shown to be a significant contributor to the overall airframe noise as expected.

AMAR: A Computational Model of Autosegmental Phonology

This report describes a computational system with which phonologists may describe a natural language in terms of autosegmental phonology, currently the most advanced theory pertaining to the sound systems of human languages. This system allows linguists to easily test autosegmental hypotheses against a large corpus of data. The system was designed primarily with tonal systems in mind, but also provides support for tree or feature matrix representation of phonemes (as in The Sound Pattern of English), as well as syllable structures and other aspects of phonological theory. Underspecification is allowed, and trees may be specified before, during, and after rule application. The association convention is automatically applied, and other principles such as the conjunctivity condition are supported. The method of representation was designed such that rules are designated in as close a fashion as possible to the existing conventions of autosegmental theory while adhering to a textual constraint for maximum portability.

Form, fi gure, and the experience of time in seven southern composers of the 1950s-60s

After the 1980s it is diffi cult, following stylistic criteria, to draw a map of contemporary academic music. All styles are compossible, and all are practiced. In this context, the geographical entity “South of Italy” does not stand out for a musical identity with special technical-stylistic features. Rather, at a socio-cultural level, the South remains today – in music no less than in all areas where there is a gap between top development and stagnation – a land of emigrants: six out of the seven composers treated (Ivan Fedele, Giuseppe Colardo, Rosario Mirigliano, Giuseppe Soccio, Nicola Cisternino, Biagio Putignano, Paolo Aralla) live in the North of Italy. The positive aspect of this is the affi nity of the South with the transnational and superstructural community of contemporary music, which from European and Western has now become almost global. The composers under consideration belong to the generation of the ‘50s, rooted in the serial and post-serial movements (from which Franco Donatoni, Luciano Berio, Luigi Nono, Salvatore Sciarrino, Giacinto Scelsi, are the principals models, to mention only the Italians), dipped in the general phenomenon of timbrism (particularly spectralism), and acquainted with electronics. They draw from these sources various instruments of compositional technique and aspects of their poetics. In particular these composers, active from the ‘80s, develop new ways of construction of the temporal form of music. They share the goal to establish a new continuity, different from the tonal one but at the same time transcending the serial and post-serial disintegration and fragmentation. The primary means to this end is a new enhancement of the category of fi gure, as a clear and distinct, recognizable aggregate of pitches, intervals, register, durations, timbre, articulation, dynamics, and texture. Each composer elaborates the atonal fi gural material in different ways, emphasizing one aspect or another. For example, Fedele (1953) is a master in the management of form per se, Colardo (1953) in the activation of disturbed harmonic effects, Mirigliano (1950) in the creation of a slight tension from the smallest vibrations of sound, Soccio (1950) in the set up of movement by means of accumulations and discharges of energy, Cisternino (1957) in a Cagean-Scelsian emphasis on sound as such, Putignano (1960) in the suspension of time through the succession and transformation of images, Aralla (1960) in the foundation of form from below, from the concreteness of sound.

GABRIEL URBAIN FAURÉ, THE UNSUNG MODERNIST: A PERFORMANCE SURVEY OF SELECTED LATE WORKS WRITTEN AFTER 1892 FOR PIANO SOLO, AND PIANO IN COLLABORATION WITH VIOLIN, VIOLONCELLO, AND VOICE

Gabriel Urbain Fauré lived during one of the most exciting times in music history. Spanning a life of 79 years (1845-1924), he lived through the height of Romanticism and the experimental avant-garde techniques of the early 20th century. In Fauré's music, one can find traces of Chopin, Liszt, Mendelssohn, Debussy and Poulenc. One can even argue that Fauré presages Skryabin and Shostakovich. The late works of Gabriel Fauré, chiefly those composed after 1892, testify to the argument that Fauré holds an important position in the shift from tonal to atonal composition and should be counted among such transitional composers as Gustav Mahler, Claude Debussy, Erik Satie, Richard Strauss, and Ferruccio Busoni. Fauré's unique way of fashioning harmonic impetus of almost purely linear means, resulting in a synthesis of harmonic and melodic devices, led me to craft the term mélodoharmonique. This term refers to a contrapuntally motivated technique of composition, particularly in a secondary layer of musical texture, in which a component of harmonic progression (i.e. arpeggiation, broken chord, etc.) is fused with linear motivic or thematic development. This dissertation seeks to bring to public attention through exploration in lecture and recital format, certain works of Gabriel Fauré, written after 1892. The repertoire will be selected from works for solo piano and piano in collaboration with violin, violoncello, and voice, which support the notion of Fauré as a modernist deserving larger recognition for his influence in the transition to atonal music. The recital repertoire includes the following--Song Cycles: La bonne chanson, opus 61; La chanson d'Ève, opus 95; Le jardin clos, opus 106; Mirages, opus 113; L'horizon chimérique, opus 118; Piano Works: Prelude in G minor opus 103, No. 3; Prelude in E minor opus 103, No. 9; Eleventh Nocturne, opus 104, No.1; Thirteenth Nocturne, opus 119; Chamber Works: Second Violin Sonata, opus 108; First Violoncello Sonata, opus 109; Second Violoncello Sonata, opus 117.

THE EFFECT OF A PROGRAM OF PORTABLE ELECTRONIC PIANO KEYBOARD EXPERIENCE ON THE ACQUISITION OF SIGHT-SINGING SKILL IN THE NOVICE HIGH SCHOOL CHORUS

The problem was to determine whether a method of aural and visual vocal training that included a program of portable electronic piano keyboard experience would be more effective in teaching sight-singing skills to novice high school chorus students than a method that included only aural and visual vocal training. A sub-problem was to determine whether novice chorus students enjoyed playing electronic keyboards in chorus as a reinforcement experience in sight-singing training. Students were randomly assigned to two treatment groups, tested with the Musical Aptitude Profile, Tonal Imagery, part A, and then trained separately. The experimental group sang repetitions of melodic patterns and utilized techniques associated with the Kodály Method while simultaneously playing keyboard. The comparison group received a similar treatment without using keyboards. The students were pre- and post-tested in sight-singing using the Vocal Sight-Reading Inventory. Results of the Analysis of Covariance using MAP scores as the covariate revealed no significant difference (p<.05) between post-test scores of the two groups. Improvement was noted in 96% of students from pre-test to post-test regardless of grouping. The repeated measures ANOVA revealed a significant relationship (p<.006) between aptitude group and post-test score. High aptitude students in both groups were found to benefit more from the training than low aptitude students. High aptitude keyboard group students achieved an average gain score that was 8.67 points higher than the comparison group. Of the total experimental group, 92% enjoyed playing keyboards in chorus. It is recommended that future research be undertaken to study the use of keyboards with advanced high school choruses and with uncertain singers in the high school chorus. Research is also needed to develop graded, valid, and reliable sight-singing tests for use in high school chorus. Techniques of the Kodály Method should be further investigated for use in high school sight-singing training.

Major and minor music compared to excited and subdued speech.

The affective impact of music arises from a variety of factors, including intensity, tempo, rhythm, and tonal relationships. The emotional coloring evoked by intensity, tempo, and rhythm appears to arise from association with the characteristics of human behavior in the corresponding condition; however, how and why particular tonal relationships in music convey distinct emotional effects are not clear. The hypothesis examined here is that major and minor tone collections elicit different affective reactions because their spectra are similar to the spectra of voiced speech uttered in different emotional states. To evaluate this possibility the spectra of the intervals that distinguish major and minor music were compared to the spectra of voiced segments in excited and subdued speech using fundamental frequency and frequency ratios as measures. Consistent with the hypothesis, the spectra of major intervals are more similar to spectra found in excited speech, whereas the spectra of particular minor intervals are more similar to the spectra of subdued speech. These results suggest that the characteristic affective impact of major and minor tone collections arises from associations routinely made between particular musical intervals and voiced speech.