Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Modelización constitutiva y computacional del daño y la fractura de materiales compuestos

En el trabajo se definen modelos constitutivos que permiten reproducir el proceso de fallo de estructuras de materiales compuestos en distintas escalas bajo cargas estáticas. Se define un modelo constitutivo para determinar la respuesta de estructuras de materiales compuestos mediante la teoría de laminados. El modelo es validado mediante un programa de ensayos experimentales con probetas con un agujero central geométricamente similares. Se muestra la capacidad del modelo de detectar el efecto tamaño. Se define un modelo constitutivo para materiales transversalmente isótropos bajo estados tridimensionales de tensión. El modelo se valida analizando numéricamente el proceso de agrietamiento de la matriz. Finalmente se desarrolla un modelo analítico para determinar el agrietamiento de la matriz y la delaminación entre las capas.

Multi-objective optimization scheme for static and dynamic multicast flows

Muchas de las nuevas aplicaciones emergentes de Internet tales como TV sobre Internet, Radio sobre Internet,Video Streamming multi-punto, entre otras, necesitan los siguientes requerimientos de recursos: ancho de banda consumido, retardo extremo-a-extremo, tasa de paquetes perdidos, etc. Por lo anterior, es necesario formular una propuesta que especifique y provea para este tipo de aplicaciones los recursos necesarios para su buen funcionamiento. En esta tesis, proponemos un esquema de ingeniería de tráfico multi-objetivo a través del uso de diferentes árboles de distribución para muchos flujos multicast. En este caso, estamos usando la aproximación de múltiples caminos para cada nodo egreso y de esta forma obtener la aproximación de múltiples árboles y a través de esta forma crear diferentes árboles multicast. Sin embargo, nuestra propuesta resuelve la fracción de la división del tráfico a través de múltiples árboles. La propuesta puede ser aplicada en redes MPLS estableciendo rutas explícitas en eventos multicast. En primera instancia, el objetivo es combinar los siguientes objetivos ponderados dentro de una métrica agregada: máxima utilización de los enlaces, cantidad de saltos, el ancho de banda total consumido y el retardo total extremo-a-extremo. Nosotros hemos formulado esta función multi-objetivo (modelo MHDB-S) y los resultados obtenidos muestran que varios objetivos ponderados son reducidos y la máxima utilización de los enlaces es minimizada. El problema es NP-duro, por lo tanto, un algoritmo es propuesto para optimizar los diferentes objetivos. El comportamiento que obtuvimos usando este algoritmo es similar al que obtuvimos con el modelo. Normalmente, durante la transmisión multicast los nodos egresos pueden salir o entrar del árbol y por esta razón en esta tesis proponemos un esquema de ingeniería de tráfico multi-objetivo usando diferentes árboles para grupos multicast dinámicos. (en el cual los nodos egresos pueden cambiar durante el tiempo de vida de la conexión). Si un árbol multicast es recomputado desde el principio, esto podría consumir un tiempo considerable de CPU y además todas las comuicaciones que están usando el árbol multicast serán temporalmente interrumpida. Para aliviar estos inconvenientes, proponemos un modelo de optimización (modelo dinámico MHDB-D) que utilice los árboles multicast previamente computados (modelo estático MHDB-S) adicionando nuevos nodos egreso. Usando el método de la suma ponderada para resolver el modelo analítico, no necesariamente es correcto, porque es posible tener un espacio de solución no convexo y por esta razón algunas soluciones pueden no ser encontradas. Adicionalmente, otros tipos de objetivos fueron encontrados en diferentes trabajos de investigación. Por las razones mencionadas anteriormente, un nuevo modelo llamado GMM es propuesto y para dar solución a este problema un nuevo algoritmo usando Algoritmos Evolutivos Multi-Objetivos es propuesto. Este algoritmo esta inspirado por el algoritmo Strength Pareto Evolutionary Algorithm (SPEA). Para dar una solución al caso dinámico con este modelo generalizado, nosotros hemos propuesto un nuevo modelo dinámico y una solución computacional usando Breadth First Search (BFS) probabilístico. Finalmente, para evaluar nuestro esquema de optimización propuesto, ejecutamos diferentes pruebas y simulaciones. Las principales contribuciones de esta tesis son la taxonomía, los modelos de optimización multi-objetivo para los casos estático y dinámico en transmisiones multicast (MHDB-S y MHDB-D), los algoritmos para dar solución computacional a los modelos. Finalmente, los modelos generalizados también para los casos estático y dinámico (GMM y GMM Dinámico) y las propuestas computacionales para dar slución usando MOEA y BFS probabilístico.

Story telling in sustainable development projects

This paper constitutes an attempt to find a means to represent multiple stories in the strong narrative of conventional sustainable development (SD) projects. The authors' experience of such projects in various parts of the world indicates that they have a tendency to arise from and reflect a dominant mindset, placing the SD project in what can be a working environment that is inimical to the very ideals that SD is supposed to represent. Short-termism and value for money drive project formats and objectives, whilst counter-narratives and alternative stories arising from stakeholders in such projects are often ignored. Yet these alternative threads often contain strong SD messages of their own and could, if effectively utilized, enhance the SD project process. This paper sets out the case for a new field - 'project ethnography' - allied with the growing use of meta-analysis to compare project 'stories'. The analytical model applied to compare projects is based on the Kolb learning cycle and involves a (3 X 4)-fold questioning of project conceptual ization and roll-out. Copyright @ 2oo6 John Wiley & Sons, Ltd and ERP Environment.

The spacing of orographic rainbands triggered by small-scale topography

A combination of idealized numerical simulations and analytical theory is used to investigate the spacing between convective orographic rainbands over the Coastal Range of western Oregon. The simulations, which are idealized from an observed banded precipitation event over the Coastal Range, indicate that the atmospheric response to conditionally unstable flow over the mountain ridge depends strongly on the subridge-scale topographic forcing on the windward side of the ridge. When this small-scale terrain contains only a single scale (l) of terrain variability, the band spacing is identical to l, but when a spectrum of terrain scales are simultaneously present, the band spacing ranges between 5 and 10 km, a value that is consistent with observations. Based on the simulations, an inviscid linear model is developed to provide a physical basis for understanding the scale selection of the rainbands. This analytical model, which captures the transition from lee waves upstream of the orographic cloud to moist convection within it, reveals that the spacing of orographic rainbands depends on both the projection of lee-wave energy onto the unstable cap cloud and the growth rate of unstable perturbations within the cloud. The linear model is used in tandem with numerical simulations to determine the sensitivity of the band spacing to a number of environmental and terrain-related parameters.

On the initiation of surface waves by turbulent shear flow

An analytical model is developed for the initial stage of surface wave generation at an air-water interface by a turbulent shear flow in either the air or in the water. The model treats the problem of wave growth departing from a flat interface and is relevant for small waves whose forcing is dominated by turbulent pressure fluctuations. The wave growth is predicted using the linearised and inviscid equations of motion, essentially following Phillips [Phillips, O.M., 1957. On the generation of waves by turbulent wind. J. Fluid Mech. 2, 417-445], but the pressure fluctuations that generate the waves are treated as unsteady and related to the turbulent velocity field using the rapid-distortion treatment of Durbin [Durbin, P.A., 1978. Rapid distortion theory of turbulent flows. PhD thesis, University of Cambridge]. This model, which assumes a constant mean shear rate F, can be viewed as the simplest representation of an oceanic or atmospheric boundary layer. For turbulent flows in the air and in the water producing pressure fluctuations of similar magnitude, the waves generated by turbulence in the water are found to be considerably steeper than those generated by turbulence in the air. For resonant waves, this is shown to be due to the shorter decorrelation time of turbulent pressure in the air (estimated as proportional to 1/Gamma), because of the higher shear rate existing in the air flow, and due to the smaller length scale of the turbulence in the water. Non-resonant waves generated by turbulence in the water, although being somewhat gentler, are still steeper than resonant waves generated by turbulence in the air. Hence, it is suggested that turbulence in the water may have a more important role than previously thought in the initiation of the surface waves that are subsequently amplified by feedback instability mechanisms.

Modelling energy consumption of relay-enabled MAC protocols in ad hoc networks

To enhance the throughput of ad hoc networks, dual-hop relay-enabled transmission schemes have recently been proposed. Since in ad hoc networks throughput is normally related to their energy consumption, it is important to examine the impact of using relay-enabled transmissions on energy consumption. In this paper, we present an analytical energy consumption model for dual-hop relay-enabled medium access control (MAC) protocols. Based on the recently reported relay-enabled distributed coordination function (rDCF), we have shown the efficacy of the proposed analytical model. This is a generalized model and can be used to predict energy consumption in saturated relay-enabled ad hoc networks via energy decomposition. This is helpful in designing MAC protocols for cooperative communications and it is shown that using a relay results not only in a better throughput but also better energy efficiency.

Impact of interference on throughput in dense WLANs with multiple APs

The popularity of wireless local area networks (WLANs) has resulted in their dense deployments around the world. While this increases capacity and coverage, the problem of increased interference can severely degrade the performance of WLANs. However, the impact of interference on throughput in dense WLANs with multiple access points (APs) has had very limited prior research. This is believed to be due to 1) the inaccurate assumption that throughput is always a monotonically decreasing function of interference and 2) the prohibitively high complexity of an accurate analytical model. In this work, firstly we provide a useful classification of commonly found interference scenarios. Secondly, we investigate the impact of interference on throughput for each class based on an approach that determines the possibility of parallel transmissions. Extensive packet-level simulations using OPNET have been performed to support the observations made. Interestingly, results have shown that in some topologies, increased interference can lead to higher throughput and vice versa.

Modeling energy consumption of dual-hop relay based MAC protocols in ad hoc networks

Given that the next and current generation networks will coexist for a considerable period of time, it is important to improve the performance of existing networks. One such improvement recently proposed is to enhance the throughput of ad hoc networks by using dual-hop relay-based transmission schemes. Since in ad hoc networks throughput is normally related to their energy consumption, it is important to examine the impact of using relay-based transmissions on energy consumption. In this paper, we present an analytical energy consumption model for dual-hop relay-based medium access control (MAC) protocols. Based on the recently reported relay-enabled Distributed Coordination Function (rDCF), we have shown the efficacy of the proposed analytical model. This is a generalized model and can be used to predict energy consumption in saturated relay-based ad hoc networks. This model can predict energy consumption in ideal environment and with transmission errors. It is shown that using a relay results in not only better throughput but also better energy efficiency. Copyright (C) 2009 Rizwan Ahmad et al.

Multivariate analysis of the Fugl-Meyer outcome measures assessing the effectiveness of GENTLE/S robot-mediated stroke therapy

Background: Robot-mediated therapies offer entirely new approaches to neurorehabilitation. In this paper we present the results obtained from trialling the GENTLE/S neurorehabilitation system assessed using the upper limb section of the Fugl-Meyer ( FM) outcome measure. Methods: We demonstrate the design of our clinical trial and its results analysed using a novel statistical approach based on a multivariate analytical model. This paper provides the rational for using multivariate models in robot-mediated clinical trials and draws conclusions from the clinical data gathered during the GENTLE/S study. Results: The FM outcome measures recorded during the baseline ( 8 sessions), robot-mediated therapy ( 9 sessions) and sling-suspension ( 9 sessions) was analysed using a multiple regression model. The results indicate positive but modest recovery trends favouring both interventions used in GENTLE/S clinical trial. The modest recovery shown occurred at a time late after stroke when changes are not clinically anticipated. Conclusion: This study has applied a new method for analysing clinical data obtained from rehabilitation robotics studies. While the data obtained during the clinical trial is of multivariate nature, having multipoint and progressive nature, the multiple regression model used showed great potential for drawing conclusions from this study. An important conclusion to draw from this paper is that this study has shown that the intervention and control phase both caused changes over a period of 9 sessions in comparison to the baseline. This might indicate that use of new challenging and motivational therapies can influence the outcome of therapies at a point when clinical changes are not expected. Further work is required to investigate the effects arising from early intervention, longer exposure and intensity of the therapies. Finally, more function-oriented robot-mediated therapies or sling-suspension therapies are needed to clarify the effects resulting from each intervention for stroke recovery.

The temperature response to stratospheric water vapour changes

This study uses an analytical model, based on the cooling-to-space approximation, and a fixed dynamical heating model to investigate the structure of the stratospheric cooling that occurs in response to a uniform increase in stratospheric water vapour (SWV). At all latitudes, the largest cooling occurs in the lower stratosphere and decreases in magnitude with height. The cooling is strongly enhanced in the Extratropics compared to the Tropics. This is markedly different to the case of an increase in CO2, which causes maximum cooling near the stratopause and a small warming in the tropical lower stratosphere. The qualitative differences in the structure of the cooling can be explained by the smaller opacity of water vapour bands in the stratosphere compared to CO2. The small opacity means that the magnitude of the initial heating rate perturbation only decreases by a factor of four between the upper and lower stratosphere for a SWV perturbation. Therefore, to balance the heating rate perturbation, the largest temperature change is required in the lower stratosphere. Increasing the background concentration of SWV causes the water vapour bands to become more opaque. For a SWV perturbation applied to a background SWV concentration ≥30 ppmv, the heating rate perturbation and temperature change structurally resemble those from an increase in CO2. In the Extratropics, the lower height of the tropopause is found to cause the enhancement in the cooling at those latitudes. By controlling the depth of atmosphere which adjusts to the SWV perturbation, the tropopause height affects the net exchange of radiation between the layers in the stratosphere as they cool. The latitudinal gradient in upwelling infrared radiation at the tropopause and variations in the background temperature are found to have only a minor effect on the structure of the stratospheric temperature response to a change in SWV.

Ultra-distal tephra deposits from super-eruptions: examples from Toba, Indonesia and Taupo Volcanic Zone, New Zealand

Voluminous rhyolitic eruptions from Toba, Indonesia, and Taupo Volcanic Zone (TVZ), New Zealand, have dispersed volcanic ash over vast areas in the late Quaternary. The ~74 ka Youngest Toba Tuff (YTT) eruption deposited ash over the Bay of Bengal and the Indian subcontinent to the west. The ~340 ka Whakamaru eruption (TVZ) deposited the widespread Rangitawa Tephra, dominantly to the southeast (in addition to occurrences northwest of vent), extending across the landmass of New Zealand, and the South Pacific Ocean and Tasman Sea, with distal terrestrial exposures on the Chatham Islands. These super-eruptions involved ~2500 km^3 and ~1500 km3 of magma (dense-rock equivalent; DRE), respectively. Ultra-distal terrestrial exposures of YTT at two localities in India, Middle Son Valley, Madhya Pradesh, and Jurreru River Valley, Andhra Pradesh, at distances of >2000 km from the source caldera, show a basal ‘primary’ ashfall unit ~4 cm thick, although deposits containing reworked ash are up to ~3 m in total thickness. Exposures of Rangitawa Tephra on the Chatham Islands, >900 km from the source caldera, are ~15-30 cm thick. At more proximal localities (~200 km from source), Rangitawa Tephra is ~55-70 cm thick and characterized by a crystal-rich basal layer and normal grading. Both distal tephra deposits are characterized by very-fine ash (with high PM10 fractions) and are crystal-poor. Glass chemistry, stratigraphy and grain-size data for these distal tephra deposits are presented with comparisons of their correlation, dispersal and preservation. Using field observations, ash transport and deposition were modeled for both eruptions using a semi-analytical model (HAZMAP), with assumptions concerning average wind direction and strength during eruption, column shape and vent size. Model outputs provide new insights into eruption dynamics and better estimates of eruption volumes associ- ated with tephra fallout. Modeling based on observed YTT distal tephra thicknesses indicate a relatively low (<40 km high), very turbulent eruption column, consistent with deposition from a co-ignimbrite cloud extending over a broad region. Similarly, the Whakamaru eruption was modeled as producing a predominantly Plinian column (~45 km high), with dispersal to the southeast by strong prevailing winds. Significant ash fallout of the main dispersal direction, to the northwest of source, cannot be replicated in this modeling. The widespread dispersal of large volumes of fine ash from both eruptions may have had global environmental consequences, acutely affecting areas up to thousands of kilometers from vent.

The key role of the western boundary in linking the AMOC strength to the north-south pressure gradient

A key idea in the study of the Atlantic meridional overturning circulation (AMOC) is that its strength is proportional to the meridional density gradient, or more precisely, to the strength of the meridional pressure gradient. A physical basis that would tell us how to estimate the relevant meridional pressure gradient locally from the density distribution in numerical ocean models to test such an idea, has been lacking however. Recently, studies of ocean energetics have suggested that the AMOC is driven by the release of available potential energy (APE) into kinetic energy (KE), and that such a conversion takes place primarily in the deep western boundary currents. In this paper, we develop an analytical description linking the western boundary current circulation below the interface separating the North Atlantic Deep Water (NADW) and Antarctic Intermediate Water (AAIW) to the shape of this interface. The simple analytical model also shows how available potential energy is converted into kinetic energy at each location, and that the strength of the transport within the western boundary current is proportional to the local meridional pressure gradient at low latitudes. The present results suggest, therefore, that the conversion rate of potential energy may provide the necessary physical basis for linking the strength of the AMOC to the meridional pressure gradient, and that this could be achieved by a detailed study of the APE to KE conversion in the western boundary current.

Resonant gravity-wave drag enhancement in linear stratified flow over mountains

High-drag states produced in stratified flow over a 2D ridge and an axisymmetric mountain are investigated using a linear, hydrostatic, analytical model. A wind profile is assumed where the background velocity is constant up to a height z1 and then decreases linearly, and the internal gravity-wave solutions are calculated exactly. In flow over a 2D ridge, the normalized surface drag is given by a closed-form analytical expression, while in flow over an axisymmetric mountain it is given by an expression involving a simple 1D integral. The drag is found to depend on two dimensionless parameters: a dimensionless height formed with z_1, and the Richardson number, Ri, in the shear layer. The drag oscillates as z_1 increases, with a period of half the hydrostatic vertical wavelength of the gravity waves. The amplitude of this modulation increases as Ri decreases. This behaviour is due to wave reflection at z_1. Drag maxima correspond to constructive interference of the upward- and downward-propagating waves in the region z < z_1, while drag minima correspond to destructive interference. The reflection coefficient at the interface z = z_1 increases as Ri decreases. The critical level, z_c, plays no role in the drag amplification. A preliminary numerical treatment of nonlinear effects is presented, where z_c appears to become more relevant, and flow over a 2D ridge qualitatively changes its character. But these effects, and their connection with linear theory, still need to be better understood.

The effect of wind shear and curvature on the gravity wave drag produced by a ridge

The analytical model proposed by Teixeira, Miranda, and Valente is modified to calculate the gravity wave drag exerted by a stratified flow over a 2D mountain ridge. The drag is found to be more strongly affected by the vertical variation of the background velocity than for an axisymmetric mountain. In the hydrostatic approximation, the corrections to the drag due to this effect do not depend on the detailed shape of the ridge as long as this is exactly 2D. Besides the drag, all the perturbed quantities of the flow at the surface, including the pressure, may be calculated analytically.