Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling

BACKGROUND Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new interventions to enhance the outcomes of partner notification. OBJECTIVE To study the effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections (STIs). DESIGN Secondary data analysis of clinical audit data; systematic reviews of randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA)] published from 1 January 1980 to 31 December 2011; static models of clinical effectiveness and cost-effectiveness; and dynamic modelling studies to improve parameter estimation and examine effectiveness. SETTING General population and genitourinary medicine clinic attenders. PARTICIPANTS Heterosexual women and men. INTERVENTIONS Traditional partner notification by patient or provider referral, and new partner notification by expedited partner therapy (EPT) or its UK equivalent, accelerated partner therapy (APT). MAIN OUTCOME MEASURES Population prevalence; index case reinfection; and partners treated per index case. RESULTS Enhanced partner therapy reduced reinfection in index cases with curable STIs more than simple patient referral [risk ratio (RR) 0.71; 95% confidence interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The median number of partners treated for chlamydia per index case in UK clinics was 0.60. The number of partners needed to treat to interrupt transmission of chlamydia was lower for casual than for regular partners. In dynamic model simulations, > 10% of partners are chlamydia positive with look-back periods of up to 18 months. In the presence of a chlamydia screening programme that reduces population prevalence, treatment of current partners achieves most of the additional reduction in prevalence attributable to partner notification. Dynamic model simulations show that cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence of both STIs. APT has a limited additional effect on prevalence but reduces the rate of index case reinfection. Published quality-adjusted life-year (QALY) weights were of insufficient quality to be used in a cost-effectiveness study of partner notification in this project. Using an intermediate outcome of cost per infection diagnosed, doubling the efficacy of partner notification from 0.4 to 0.8 partners treated per index case was more cost-effective than increasing chlamydia screening coverage. CONCLUSIONS There is evidence to support the improved clinical effectiveness of EPT in reducing index case reinfection. In a general heterosexual population, partner notification identifies new infected cases but the impact on chlamydia prevalence is limited. Partner notification to notify casual partners might have a greater impact than for regular partners in genitourinary clinic populations. Recommendations for future research are (1) to conduct randomised controlled trials using biological outcomes of the effectiveness of APT and of methods to increase testing for human immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data should be a priority to determine QALYs associated with the sequelae of curable STIs; and (3) standardised parameter sets for curable STIs should be developed for mathematical models of STI transmission that are used for policy-making. FUNDING The National Institute for Health Research Health Technology Assessment programme.

Los paisajes del desecho: reactivación de los lugares del deterioro

Actualmente en nuestro planeta producimos 1.300 millones de toneladas de residuos urbanos al año. Si los extendemos sobre la superficie de un cuadrado de lado 100 m (una hectárea) alcanzarían una altura de 146 km. ¿Cuál es el origen de nuestros residuos? ¿A dónde va esta basura? ¿Cómo nos afecta? ¿Tiene alguna utilidad? Se trata de un problema antiguo que, en los últimos tiempos, ha adquirido una nueva dimensión por el tipo y la cantidad de residuos generados. Las primeras preocupaciones de la ciudad por ordenar estos problemas dieron lugar al establecimiento de espacios o lugares específicos para la acumulación de los residuos urbanos: los vertederos. Los desechos hoy se generan más rápidamente que los medios disponibles para reciclarlos o tratarlos. Los vertederos de residuos urbanos son y seguirán siendo, a corto y medio plazo, soluciones válidas por ser un método de gestión relativamente barato, sobre todo en los países en vías de desarrollo. Como consecuencia y necesidad de lo anterior, se plantea demostrar que la recuperación y la transformación de estos vertederos de residuos urbanos (lugares del deterioro), una vez abandonados, es posible y que además pueden dar lugar a nuevos espacios públicos estratégicos de la ciudad contemporánea. Son espacios de oportunidad, vacíos monumentales producto de una reactivación arquitectónica y paisajística realizada a partir de complejos procesos de ingeniería medioambiental. Pero las soluciones aplicadas a los vertederos de residuos urbanos desde mediados del siglo XX se han realizado exclusivamente desde la ingeniería para tratar de resolver cuestiones técnicas, un modelo agotado que ya no puede gestionar la magnitud que este problema ha alcanzado, haciéndose necesaria e inevitable la participación de la arquitectura para abrir nuevas líneas de investigación y de acción. En estos primeros compases del siglo XXI existe una “nueva” preocupación, un “nuevo” interés en los paradigmas de lo ecológico y de la sostenibilidad, también un interés filosófico (que igualmente otorga un nuevo valor al residuo como recurso), que dirigen su mirada hacia un concepto de paisaje abierto y diferente a modelos anteriores más estáticos, recuperando como punto de partida el ideal pintoresco. El landscape urbanism se consolida como una disciplina capaz de dar respuesta a lo natural y artificial simultáneamente, que sustituye a las herramientas tradicionales de la arquitectura para solucionar los problemas de la ciudad contemporánea, incorporando las infraestructuras de gran escala, como un vertedero de residuos urbanos, y los paisajes públicos que generan como el verdadero mecanismo de organización del urbanismo de hoy. No se trata solo de un modelo formal sino, lo que es más importante: de un modelo de procesos. Esta nueva preocupación permite abordar la cuestión del paisaje de manera amplia, sin restricciones, con un alto grado de flexibilidad en las nuevas propuestas que surgen como consecuencia de estos conceptos, si bien los esfuerzos, hasta la fecha, parecen haberse dirigido más hacia el fenómeno de lo estético, quedando todavía por explorar las consecuencias políticas, sociales, económicas y energéticas derivadas de los residuos. También las arquitectónicas. El proyecto del landscape urbanism se ocupa de la superficie horizontal, del plano del suelo. Desde siempre, la preparación de este plano para desarrollar cualquier actividad humana ha sido un gesto fundacional, un gesto propio necesario de toda arquitectura, que además ahora debe considerarlo como un medio o soporte biológicamente activo. En términos contemporáneos, el interés disciplinar radica en la continuidad y en la accesibilidad del suelo, diluyendo los límites; en que funcione a largo plazo, que se anticipe al cambio, a través de la flexibilidad y de la capacidad de negociación, y que sea público. La recuperación de un vertedero de residuos urbanos ofrece todas estas condiciones. Un breve recorrido por la historia revela los primeros ejemplos aislados de recuperación de estos lugares del deterioro, que han pasado por distintas fases en función de la cantidad y el tipo de los desechos producidos, evolucionando gracias a la tecnología y a una nueva mirada sobre el paisaje, hasta desarrollar una verdadera conciencia de lo ecológico (nacimiento de una ideología). El Monte Testaccio en Roma (siglos I-III d.C.) constituye un caso paradigmático y ejemplar de vertedero planificado a priori no solo como lugar en el que depositar los residuos, sino como lugar que será recuperado posteriormente y devuelto a la ciudad en forma de espacio público. Una topografía de desechos generada por acumulación, organizada y planificada durante tres siglos, que nos hace reflexionar sobre los temas de producción, consumo y proyecto arquitectónico. El Monte Testaccio revela una fuente de inspiración, un arquetipo de gestión sostenible de los recursos y del territorio. A través de la experiencia en la recuperación y transformación en espacios públicos de casos contemporáneos, como el antiguo vertedero de Valdemingómez en Madrid o el de El Garraf en Barcelona, se han analizado las técnicas y las soluciones empleadas para establecer nuevas herramientas de proyecto planteadas en clave de futuro, que revelan la importancia de los procesos frente a la forma, en los cuales intervienen muchos factores (tanto naturales como artificiales), entre ellos la vida y el tiempo de la materia viva acumulada. Son lugares para nuevas oportunidades y ejemplos de una nueva relación con la naturaleza. La reactivación de los vertederos de residuos, a través del proyecto, nos propone una nueva topografía construida en el tiempo, el suelo como soporte, como punto de encuentro de la naturaleza y los sistemas tecnológicos de la ciudad que posibilitan nuevos modos de vida y nuevas actividades. Los vertederos de residuos son inmensas topografías naturales surgidas de procesos artificiales, atalayas desde las que divisar un nuevo horizonte, un nuevo mundo, un nuevo futuro donde sea posible lograr la reversibilidad de nuestros actos del deterioro. Pero la voluntad de estas recuperaciones y transformaciones no consiste exclusivamente en su reintegración al paisaje, sino que han servido como muestra de las nuevas actitudes que la sociedad ha de emprender en relación a los temas medio ambientales. ABSTRACT Here on our planet we currently produce 1.3 billion tonnes of urban waste per year. If we were to spread this over a surface of 100m2 (one hectare), it would reach a height of 146km. What is the origin of this waste? Where does our refuse go? How does it affect us? Does it have any uses? We are dealing with an old problem which, in recent times, has taken on a new dimension due to the type of waste and the amount generated. Cities’ first concerns in resolving these problems gave rise to the establishment of areas or specific places for the accumulation of urban waste: landfills. These days, waste is generated more quickly than the available resources can recycle or process it. Urban waste landfills are and will continue to be, in the short and mid-term, valid solutions, given that they constitute a relatively cheap method for waste management, especially in developing countries. Consequently and necessarily, we plan to demonstrate that it is possible to recover and transform these urban waste landfills (areas of deterioration) once they have been abandoned and that they can give rise to new strategic public areas in contemporary cities. They are areas of opportunity, monumental vacancies produced by an architectural reactivation of the landscape, which is achieved using complex processes of environmental engineering. But the solutions applied to urban waste landfills throughout the 20th century have used engineering exclusively in the attempt to resolve the technical aspects. This is a worn-out model which can no longer handle the magnitude which the problem has attained and therefore, there is an inevitable need for the participation of architecture, which can open new lines of research and action. In these first steps into the 21st century, there is a “new” concern, a “new” interest in the paradigms of environmentalism and sustainability. There is also a philosophical interest (which assigns the new value of ‘resource’ to waste) and all is aimed towards the concept of an open landscape, unlike the previous, more static models, and the intention is to recover picturesque ideals as the starting point. Landscape urbanism has been established as a discipline capable of simultaneously responding to the natural and the artificial, replacing the traditional tools of architecture in order to resolve contemporary cities’ problems. It incorporates large scale infrastructures, such as urban waste landfills, and public landscapes which are generated as the true organisational mechanism of modern day urbanism. It is not merely a formal model, it is more important than that: it is a model of processes. This new concern allows us to address the matter of landscape in a broad way, without restrictions, and with a great degree of flexibility in the new proposals which come about as a consequence of these concepts. However, efforts to date seem to have been more directed at aesthetic aspects and we have yet to explore the political, social, economic and energetic consequences derived from waste – nor have we delved into the architectural consequences. The landscape urbanism project is involved with the horizontal surface, the ground plane. Traditionally, the preparation of this plane for the development of any human activity has been a foundational act, a necessary act of all architecture, but now this plane must be considered as a biologically active medium or support. In contemporary terms, the discipline’s interest lies in the continuity and accessibility of the land, diffusing the limits; in long term functionality; in the anticipation of change, via flexibility and the ability to negotiate; and in it being a public space. The recovery of an urban waste landfill offers all of these conditions. A brief look through history reveals the first isolated examples of recovery of these spaces of deterioration. They have gone through various phases based on the quantity and type of waste produced, they have evolved thanks to technology and a new outlook on the landscape, and a real environmental awareness has been developed (the birth of an ideology). Monte Testaccio in Rome (1st to 3rd Century AD) constitutes a paradigmatic and exemplary case of a landfill that was planned a priori not only as a place to deposit waste but also as a place that would be subsequently recovered and given back to the city in the form of a public space. This spoil mound, generated by organised and planned accumulation over three centuries, makes us reflect on the themes of production, consumption and architectural planning. Monte Testaccio reveals a source of inspiration, an archetype of the sustainable management of resources and land. Using our experience of contemporary cases of land recovery and its transformation into public spaces, such as the former Valdemingómez landfill in Madrid or the Garraf in Barcelona, we analysed the techniques and solutions used in order to establish new project tools. These are proposed with an eye on the future, seeing as they reveal the importance of the processes over the form and involve many factors (both natural and artificial), including the life and age of the accumulated living matter. They are places for new opportunities and examples of our new relationship with nature. The reactivation of landfills, via this project, is a proposal for a new topography built within time, using the ground as the support, as the meeting point between nature and the technological systems of the city which make it possible for new ways of life and new activities to come about. Landfills are immense natural topographical areas produced by artificial processes, watchtowers from which to discern a new horizon, a new world, a new future in which it will be possible to reverse our acts of deterioration. But the intention behind these recoveries and transformations does not only hope for landscape reintegration but it also hopes that they will also serve as a sign of the new attitudes that must be adopted by society with regard to environmental matters.

An alternative DEA measure:a case of OECD countries

Analysis of the production efficiency of industrialized countries, questioning whether certain countries perform better than others in producing more output with the same or less inputs, is an example of the importance of estimating production relationships. In order to estimate efficiency one needs an appropriate model for the two major inputs into production activity, namely labour and capital. A physical asset once installed is capable of contributing several years of output. This implies that investments made in previous years must be taken into account in order to produce a measure of the efficiency and productivity for any given year. The purpose of this article is to introduce a dynamic efficiency model and compare the results with previous work on the analysis of efficiency and productivity of OECD countries. The article proposes that dynamic models capture efficiency better than static models.

Aquisição e construção de modelos estáticos análogos a reservatórios petrolíferos com tecnologia lidar e georadar

The present work develops a methodology to establish a 3D digital static models petroleum reservoir analogue using LIDAR and GEORADAR technologies. Therefore, this work introduce The methodolgy as a new paradigm in the outcrop study, to purpose a consistent way to integrate plani-altimetric data, geophysics data, and remote sensing products, allowing 2D interpretation validation in contrast with 3D, complexes depositional geometry visualization, including in environmental immersive virtual reality. For that reason, it exposes the relevant questions of the theory of two technologies, and developed a case study using TerraSIRch SIR System-3000 made for Geophysical Survey Systems, and HDS3000 Leica Geosystems, using the two technologies, integrating them GOCAD software. The studied outcrop is plain to the view, and it s located at southeast Bacia do Parnaíba, in the Parque Nacional da Serra das Confusões. The methodology embraces every steps of the building process shows a 3D digital static models petroleum reservoir analogue, provide depositional geometry data, in several scales for Simulation petroleum reservoir

Static diffusion models of the upper atmosphere with empirical temperature profiles.

v. 8 no. 9

Simulation of delamination in composites under quasi-static and fatigue loading using cohesive zone models

Es desenvolupa una eina de disseny per l'anàlisi de la tolerància al dany en composites. L'eina pot predir el inici i la propagació de fisures interlaminars. També pot ser utilitzada per avaluar i planificar la necessitat de reparar o reemplaçar components durant la seva vida útil. El model desenvolupat pot ser utilitzat tan per simular càrregues estàtiques com de fatiga. El model proposat és un model de dany termodinàmicament consistent que permet simular la delaminació en composites sota càrregues variables. El model es formula dins el context de la Mecànica del Dany, fent ús dels models de zona cohesiva. Es presenta un metodologia per determinar els paràmetres del model constitutiu que permet utilitzar malles d'elements finits més bastes de les que es poden usar típicament. Finalment, el model és també capaç de simular la delaminació produïda per càrregues de fatiga.

Some numerical experiments on the effect of the variation of static stability in two-layer quasi-geostrophic models

A method to solve a quasi-geostrophic two-layer model including the variation of static stability is presented. The divergent part of the wind is incorporated by means of an iterative procedure. The procedure is rather fast and the time of computation is only 60–70% longer than for the usual two-layer model. The method of solution is justified by the conservation of the difference between the gross static stability and the kinetic energy. To eliminate the side-boundary conditions the experiments have been performed on a zonal channel model. The investigation falls mainly into three parts: The first part (section 5) contains a discussion of the significance of some physically inconsistent approximations. It is shown that physical inconsistencies are rather serious and for these inconsistent models which were studied the total kinetic energy increased faster than the gross static stability. In the next part (section 6) we are studying the effect of a Jacobian difference operator which conserves the total kinetic energy. The use of this operator in two-layer models will give a slight improvement but probably does not have any practical use in short periodic forecasts. It is also shown that the energy-conservative operator will change the wave-speed in an erroneous way if the wave-number or the grid-length is large in the meridional direction. In the final part (section 7) we investigate the behaviour of baroclinic waves for some different initial states and for two energy-consistent models, one with constant and one with variable static stability. According to the linear theory the waves adjust rather rapidly in such a way that the temperature wave will lag behind the pressure wave independent of the initial configuration. Thus, both models give rise to a baroclinic development even if the initial state is quasi-barotropic. The effect of the variation of static stability is very small, qualitative differences in the development are only observed during the first 12 hours. For an amplifying wave we will get a stabilization over the troughs and an instabilization over the ridges.

Evaluation of hybrid models for static and multistage transmission system planning

Neste trabalho é analisada a aplicação de algoritmos heurísticos para o Modelo Híbrido Linear - Hybrid Linear Model (HLM) - no problema de planejamento da expansão de sistemas de transmissão. O HLM é um modelo relaxado que ainda não foi suficientemente explorado. Assim, é realizada uma análise das características do modelo matemático e das técnicas de solução que podem ser usadas para resolver este tipo de modelo. O trabalho analisa em detalhes um algoritmo heurístico construtivo para o HLM e faz uma extensão da modelagem e da técnica de solução para o planejamento multi-estágio da expansão de sistemas de transmissão. Dentro deste contexto, também é realizada uma avaliação da qualidade das soluções encontradas pelo HLM e as possibilidades de aplicação deste modelo em planejamento de sistemas de transmissão. Finalmente, são apresentados testes com sistemas conhecidos na literatura especializada.

Distributed static linear Gaussian models using consensus

Algorithms for distributed agreement are a powerful means for formulating distributed versions of existing centralized algorithms. We present a toolkit for this task and show how it can be used systematically to design fully distributed algorithms for static linear Gaussian models, including principal component analysis, factor analysis, and probabilistic principal component analysis. These algorithms do not rely on a fusion center, require only low-volume local (1-hop neighborhood) communications, and are thus efficient, scalable, and robust. We show how they are also guaranteed to asymptotically converge to the same solution as the corresponding existing centralized algorithms. Finally, we illustrate the functioning of our algorithms on two examples, and examine the inherent cost-performance tradeoff.

Stochastic models for mainland-island metapopulations in static and dynamic landscapes

This paper has three primary aims: to establish an effective means for modelling mainland-island metapopulations inhabiting a dynamic landscape: to investigate the effect of immigration and dynamic changes in habitat on metapopulation patch occupancy dynamics; and to illustrate the implications of our results for decision-making and population management. We first extend the mainland-island metapopulation model of Alonso and McKane [Bull. Math. Biol. 64:913-958,2002] to incorporate a dynamic landscape. It is shown, for both the static and the dynamic landscape models, that a suitably scaled version of the process converges to a unique deterministic model as the size of the system becomes large. We also establish that. under quite general conditions, the density of occupied patches, and the densities of suitable and occupied patches, for the respective models, have approximate normal distributions. Our results not only provide us with estimates for the means and variances that are valid at all stages in the evolution of the population, but also provide a tool for fitting the models to real metapopulations. We discuss the effect of immigration and habitat dynamics on metapopulations, showing that mainland-like patches heavily influence metapopulation persistence, and we argue for adopting measures to increase connectivity between this large patch and the other island-like patches. We illustrate our results with specific reference to examples of populations of butterfly and the grasshopper Bryodema tuberculata.

Updating of Finite Element Models using static and dynamic optical strains with application to damage assessment

In the recent years, vibration-based structural damage identification has been subject of significant research in structural engineering. The basic idea of vibration-based methods is that damage induces mechanical properties changes that cause anomalies in the dynamic response of the structure, which measures allow to localize damage and its extension. Vibration measured data, such as frequencies and mode shapes, can be used in the Finite Element Model Updating in order to adjust structural parameters sensible at damage (e.g. Young’s Modulus). The novel aspect of this thesis is the introduction into the objective function of accurate measures of strains mode shapes, evaluated through FBG sensors. After a review of the relevant literature, the case of study, i.e. an irregular prestressed concrete beam destined for roofing of industrial structures, will be presented. The mathematical model was built through FE models, studying static and dynamic behaviour of the element. Another analytical model was developed, based on the ‘Ritz method’, in order to investigate the possible interaction between the RC beam and the steel supporting table used for testing. Experimental data, recorded through the contemporary use of different measurement techniques (optical fibers, accelerometers, LVDTs) were compared whit theoretical data, allowing to detect the best model, for which have been outlined the settings for the updating procedure.

Comparison of friction models applied to a control valve

Eight different models to represent the effect of friction in control valves are presented: four models based on physical principles and four empirical ones. The physical models, both static and dynamic, have the same structure. The models are implemented in Simulink/Matlab (R) and compared, using different friction coefficients and input signals. Three of the models were able to reproduce the stick-slip phenomenon and passed all the tests, which were applied following ISA standards. (C) 2008 Elsevier Ltd. All rights reserved.

Incorporating phase retardation effects into radiofrequency resonator models: application to magnetic resonance microscopy

A method is presented for including path propagation effects into models of radiofrequency resonators for use in magnetic resonance imaging. The method is based on the use of Helmholtz retarded potentials and extends our previous work on current density models of resonators based on novel inverse finite Hilbert transform solutions to the requisite integral equations. Radiofrequency phase retardation effects are most pronounced at high field strengths (frequencies) as are static field perturbations due to the magnetic materials in the resonators themselves. Both of these effects are investigated and a novel resonator structure presented for use in magnetic resonance microscopy.

Optimal design of piezolaminated structures using B-spline strip finite element models

A package of B-spline finite strip models is developed for the linear analysis of piezolaminated plates and shells. This package is associated to a global optimization technique in order to enhance the performance of these types of structures, subjected to various types of objective functions and/or constraints, with discrete and continuous design variables. The models considered are based on a higher-order displacement field and one can apply them to the static, free vibration and buckling analyses of laminated adaptive structures with arbitrary lay-ups, loading and boundary conditions. Genetic algorithms, with either binary or floating point encoding of design variables, were considered to find optimal locations of piezoelectric actuators as well as to determine the best voltages applied to them in order to obtain a desired structure shape. These models provide an overall economy of computing effort for static and vibration problems.