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.

Intertidal transect studies of northern Monterey Bay

In accordance with a contract dated 10/22/71 between the Association of the Monterey Bay Area Governments (AMBAG) and the University of California, Santa Cruz, (UCSC), two permanent intertidal transects with 14 permanent meter-square quadrats were established on the north shore of Monterey Bay during November, 1971. One transect (6 quadrats) was placed on the shore near the Santa Cruz Sanitation outfall, while the second (8 quadrats) was placed near the Eastcliff Sanitation District outfall at Soquel Polnt (Pleasure Point). Animals and plants within the quadrats were listed, their abundance estimated, and representative specimens collected for a reference collection maintained at UCSC. Additional species of animals and plants in the areas of the transects were collected for the reference collection. These collections will serve as a base-line for comparative studies which can follow the magnitude and direction of future changes in these areas.

Report of the Socio-economic Monitoring (SocMon) Training Workshop for Mannar, Sri Lanka, 26 May-1 June, 2015

The Socio-economic Monitoring (SocMon) training workshop followed up from the capacity building workshop held in Mannar, 2015. It's aims were to validate information collected at the previous workshop, assist in filling in any gaps and develop a vision tree fro future actions. Planned outputs included: a detailed workplan; a workshop process report; and a final socioeconomic base line report for Vidathaltivu village.

Survey of reproductive physiology on Epinephelus coioides in Khozestan province, Persian Gulf

Epinephelus coioides (family serranidae) is protogynous. This species is one of the most important fishes in food chain of marine proteins of persian Gulf. Therefore knowing about the reproductive biology and physiology of this species is an important role on aquaculture procedures. Monthly samples of Epinephelus coioides were obtained in khozestan Bahrekan province from 2001 to 2002 for annual variation of base line of reproductive hormone. The hormones such as: 17-B estradiol, Testosteron, Progesterone, Gonadotropin I ,II GTHI, II) and cortisol have assayed and also different stages of gonads from the histological point of view were studied by light and electron microscope. Aditional to morphometric and fecundity measurements, the important factors such as : Gonadosomatic index (GSI) Hepatosomotic index (HSI) and Condition factor (KF) were also studied. Environmental factors such as temperature, salinity, photoperiod and pH were analyzed for the determination of effective factors responsible for the changes of reproductive cycles. The flactmation of estroid hormones and gonadotropines show a significant variation in different stages of maturation, e.g 17-B estradiol's concentration in the third stages, GTH II in fourth stages of sexual maturation or final oocyte maturation, plasma Testosteron in post ovulation and Progesterone during maturation indicates the highest levels of above mentioned hormones. The total calcium concentration was high in all year. calcium concentration was correlated with GTH II synthesis and increases with GTH II in June. 17-B estradiol concentration was also correlated with GSI. The high concentration of cortisol throughout the year was an index of stress and development of ovary maturational processes. This species was protogynous synchronous hermaphrodites , and belongs to annual spawning species, being monandric. The sexual transition was found to occure in individuals of 51.2- 105 cm in length. GSI and HSI level confirms the time of spawning period is in April- June. Electrone microscopic studies of gonad tissues showed some changes in mitochondria and endoplasmic reticulum in the post ovulation, maturation and post spawning periods. During the monthly sampling the biochemistry of tissues variations indicated decrease in protein and lipid content, but an increase in water content of spawning fishes which was correlated to the maturation of Epinephelus coioides . sex ratio indicative of higher frequences of females to males during monthly sampling periods. The females were smaller than males in sizes, therefore the females lived in 8-15m depth, but males were living in upper limits of depth. The results indicated that the temperature was the most effective parameter in reproductive cycle of Epinephelus coioides and the mean 24°c was a convenient temperature for spawning. Photoperiod was the second effective. factor on the reproductive cycle for this species. It seemed that the increase in the photoperiod between January to May caused a development of the oocyte. Regarding to the results of this research, it seems that the period of spawning in Epinephelus coioides is in May- June and the aquaculture procedure of Epinephelus coioides could be performed in the above mentioned periods.

Sensitivity analysis and optimization of the nuclear fuel cycle

A sensitivity study has been conducted to assess the robustness of the conclusions presented in the MIT Fuel Cycle Study. The Once Through Cycle (OTC) is considered as the base-line case, while advanced technologies with fuel recycling characterize the alternative fuel cycles. The options include limited recycling in LWRs and full recycling in fast reactors and in high conversion LWRs. Fast reactor technologies studied include both oxide and metal fueled reactors. The analysis allowed optimization of the fast reactor conversion ratio with respect to desired fuel cycle performance characteristics. The following parameters were found to significantly affect the performance of recycling technologies and their penetration over time: Capacity Factors of the fuel cycle facilities, Spent Fuel Cooling Time, Thermal Reprocessing Introduction Date, and incore and Out-of-core TRU Inventory Requirements for recycling technology. An optimization scheme of the nuclear fuel cycle is proposed. Optimization criteria and metrics of interest for different stakeholders in the fuel cycle (economics, waste management, environmental impact, etc.) are utilized for two different optimization techniques (linear and stochastic). Preliminary results covering single and multi-variable and single and multi-objective optimization demonstrate the viability of the optimization scheme.

基于LBL声信标的AUV快速精确定位

长基线声学定位系统是水下机器人广泛应用的外部导航设备。以对"CR-02"6000m自治水下机器人(简称AUV)技术的深入开发为背景,提出在原有长基线(LBL)定位系统的基础上增加导航功能的方案。由于海水介质非均匀性与复杂的时空变化特性,给基于测距的位置计算带来很大困难。采用平均声速法计算耗时小而误差大,波阵面定位法误差小而耗时大。为解决这个矛盾,根据AUV深度传感器给出的深度信息,采用本征声线快速计算方法解算AUV的水平面位置。与波阵面法、平均声速法进行了综合比较。仿真实验表明该方法具有优良的性能,满足AUV导航需要。

深水机器人低成本导航系统的位置估计方法研究

依据6000米自治水下机器人及其长基线声学定位系统现有的导航设备,将测距声信标和机器人载体携带的低成本导航传感器:涡轮式计程仪,压力传感器以及TCM2电子罗盘测量的导航数据相融合,分别提出两种基于EKF的导航数据融合算法,对机器人的位置以及水流参数进行估计,解决复杂环境下的深水机器人位置估计问题.蒙特卡洛仿真实验和湖上试验数据后处理表明,设计的位置估计算法收敛快,精度高,计算时间小,能够满足深水机器人的导航需要.

基于超短基线的缆控水下机器人动力定位

动力定位 (DynamicPositioning(DP) )技术是水下机器人的关键技术之一。因此针对当前动力定位主要在缆控水下机器人 (ROV)中应用的情况 ,给出了ROV动力定位技术的实施方法。通过声学定位技术确定ROV的坐标 ,计算出与期望位姿的差 ,将其作为神经网络控制器的输入量来控制ROV ,从而进行动力定位。同时还重点研究了ROV动力定位中的主要研究内容即水声定位技术和定位控制技术的构建。

Determination of dissociation constants of Strychnos alkaloids from Strychnos nux-vomica L. by capillary electrophoresis

An accurate capillary electrophoresis method was developed for the determination of dissociation constants of five Strychnos alkaloids from Strychnos nux-vomica L. The method relies on measuring the effective mobility of the solute as a function of the buffer pH. The mathematical relationship was strictly derived from the fundamental electrophoresis theory and the dissociation equilibrium of a weak base without any simplifications. Careful optimization of the running buffer permitted base-line resolution of the five structurally similar alkaloids.

A non-LTE analysis of the spectra of two narrow lined main sequence stars in the SMC

An analysis of high-resolution VLT/UVES spectra of two B-type main sequence stars, NGC 346-11 and AV 304, in the Small Magellanic Cloud (SMC), has been undertaken, using the non-LTE tlusty model atmospheres to derive the stellar parameters and chemical compositions of each star. The chemical compositions of the two stars are in reasonable agreement. Moreover, our stellar analysis agrees well with earlier analyses of H II regions. The results derived here should be representative of the current base-line chemical composition of the SMC interstellar medium as derived from B-type stars.

The present-day chemical composition of the SMC from UVES spectra of the sharp-lined, B-type dwarf AV 304

High-resolution spectroscopic VLT/UVES observations are presented for the B-type main-sequence star, AV 304, in the Small Magellanic Cloud (SMC). These spectra have been analysed using LTE model-atmosphere techniques, to derive stellar atmospheric parameters and chemical compositions. As AV 304 is located within the hydrogen burning main-sequence band, its chemical composition should reflect that of the SMC interstellar medium (ISM). A detailed line-by-line differential analysis has been undertaken relative to a Galactic comparison star. A general metal deficiency for the a-process elements O, Si & S of -0.43 +/- 0.05 dex is found for AV 304, with iron having a similar underabundance. Oxygen may be relatively over- abundant by similar to0.1 dex and carbon and aluminium underabundant by similar to0.2 dex. A large nitrogen underabundance (of -1.2 dex relative to hydrogen and -0.7 dex relative to iron) is found. This is interpreted in terms of the CNO bi-cycle having been suppressed in the SMC. Furthermore, the large nitrogen deficiency is in excellent agreement with that found for SMC H II regions. Indeed, this represents a first for stellar astrophysics - confirming the low base-line nitrogen composition of the SMC ISM (viz. 12+log(N/H) similar to 6.66 +/- 0.10 dex).

Remote Detection and Identification of Organic Remains: An Assessment of Archaeological Potential

This paper reviews the various methods of using natural or induced light spectra as analytical tools in forensic archaeology. Chemical identi?cation can be made at long range and wide scale (tens of metres) down to short range and very small scale (nanometres). The identi?cation of organic gases and materials has used either chemical capture and chromatography, induced (laser or ultraviolet) light sources or laser Raman microscope spectroscopy. The remote gas detection method relies on the identi?cation of atmospheric gases by their characteristic light spectra. Modern spectroscopes can detect gases down to a few parts per million of an atmosphere. When the light source (wavelength) and direction is controlled, so laser-induced spectroscopy may be used to monitor the emission of gases such methane from buried organic remains. In order to identify the location of buried organic remains, a grid of sample points must be established using a base line or global
positioning system. When matched to base line or ground-positioning systems, such data can be manipulated by geographical information system packages. This would enable pinpointing of anomalies for excavation or avoidance. Microscope-based laser Raman spectroscopy can be used to directly analyse captured gases, swabs and surfaces without the problems of long-path detection. Copyright ? 2002 John Wiley & Sons, Ltd.

An Integrated Toolkit for the Conservation of Stone-Built Heritage

Rapid in situ diagnosis of damage is a key issue in the preservation of stone-built cultural heritage. This is evident in the increasing number of congresses, workshops and publications dealing with this issue. With this increased activity has come, however, the realisation that for many culturally significant artefacts it is not possible either to remove samples for analysis or to affix surface markers for measurement. It is for this reason that there has been a growth of interest in non-destructive and minimally invasive techniques for characterising internal and external stone condition. With this interest has come the realisation that no single technique can adequately encompass the wide variety of parameters to be assessed or provide the range of information required to identify appropriate conservation. In this paper we describe a strategy to address these problems through the development of an integrated `tool kit' of measurement and analytical techniques aimed specifically at linking object-specific research to appropriate intervention. The strategy is based initially upon the acquisition of accurate three-dimensional models of stone-built heritage at different scales using a combination of millimetre accurate LiDAR and sub-millimetre accurate Object Scanning that can be exported into a GIS or directly into CAD. These are currently used to overlay information on stone characteristics obtained through a combination of Ground Penetrating Radar, Surface Permeametry, Colorimetry and X-ray Fluorescence, but the possibility exists for adding to this array of techniques as appropriate. In addition to the integrated three-dimensional data array provided by superimposition upon Digital Terrain Models, there is the capability of accurate re-measurement to show patterns of surface loss and changes in material condition over time. Thus it is possible to both record and base-line condition and to identify areas that require either preventive maintenance or more significant pre-emptive intervention. In pursuit of these goals the authors are developing, through a UK Government supported collaboration between University Researchers and Conservation Architects, commercially viable protocols for damage diagnosis, condition monitoring and eventually mechanisms for prioritizing repairs to stone-built heritage. The understanding is, however, that such strategies are not age-constrained and can ultimately be applied to structures of any age.

Specific role of neuronal nitric-oxide synthase when tethered to the plasma membrane calcium pump in regulating the beta-adrenergic signal in the myocardium

The cardiac neuronal nitric-oxide synthase (nNOS) has been described as a modulator of cardiac contractility. We have demonstrated previously that isoform 4b of the sarcolemmal calcium pump (PMCA4b) binds to nNOS in the heart and that this complex regulates beta-adrenergic signal transmission in vivo. Here, we investigated whether the nNOS-PMCA4b complex serves as a specific signaling modulator in the heart. PMCA4b transgenic mice (PMCA4b-TG) showed a significant reduction in nNOS and total NOS activities as well as in cGMP levels in the heart compared with their wild type (WT) littermates. In contrast, PMCA4b-TG hearts showed an elevation in cAMP levels compared with the WT. Adult cardiomyocytes isolated from PMCA4b-TG mice demonstrated a 3-fold increase in Ser(16) phospholamban (PLB) phosphorylation as well as Ser(22) and Ser(23) cardiac troponin I (cTnI) phosphorylation at base line compared with the WT. In addition, the relative induction of PLB phosphorylation and cTnI phosphorylation following isoproterenol treatment was severely reduced in PMCA4b-TG myocytes, explaining the blunted physiological response to the beta-adrenergic stimulation. In keeping with the data from the transgenic animals, neonatal rat cardiomyocytes overexpressing PMCA4b showed a significant reduction in nitric oxide and cGMP levels. This was accompanied by an increase in cAMP levels, which led to an increase in both PLB and cTnI phosphorylation at base line. Elevated cAMP levels were likely due to the modulation of cardiac phosphodiesterase, which determined the balance between cGMP and cAMP following PMCA4b overexpression. In conclusion, these results showed that the nNOS-PMCA4b complex regulates contractility via cAMP and phosphorylation of both PLB and cTnI.

TNF-α Sensitizes Mechanoreceptors in Human Odontoblasts

Background: Mechanotransduction in the dental pulp is mediated by mechano-sensitive trigeminal afferents but accumulating evidence suggests odontoblasts also contribute to mechano-sensory functions of the pulp as evidenced by expression of TRP channels, calcium-activated potassium channels and TREK-1 potassium channels. Activation of these mechano-sensitive channels is considered critical for the mechanotransduction of fluid movement within dentinal tubules into electrical signals transmitted by the pulpal afferents to elicit tooth sensitivity and pain. Since tooth pain and sensitivity are potentiated by inflammation we hypothesise that the inflammatory cytokine TNF-α sensitizes odontoblast responses to mechanical stimuli. Objective: To investigate the effect of TNF-α on the response of odontblast-like cells to mechanical stimuli. Method: Odontoblast-like cells were derived from dental pulp cells of immature third molars as previously described (El-karim et al 20112011 Pain, 152, 2211-2223). Odontoblast response to mechanical stimuli (application of hypotonic solution) was determined using ratiometric calcium imaging. Cells were treated with TNF-α for either 24hrs or short application for 10 mins prior to calcium imaging. Result: Odontoblast-like cells responded to hypotonic solution (230 mOSM) by increase in cytoplasmic Ca2+ concentration [Ca+2]i that was reduced to near base line in the presence of the TRPV4 antagonist RN-1734. Incubation of odontoblast -like cells with TNFα for 24 hrs resulted in a significant increase in cytoplasmic Ca2+ concentration in response to hypotonic stimuli compared to untreated cells. Similar results were obtained when cells were treated with TNF-α for 10 mins prior to imaging. Conclusion: Both short and long term treatment of odontoblasts-like cells with TNF-α resulted in enhanced responses to mechanical stimuli mediated via TRPV4 channel suggesting a role for this channel in inflammatory dental pain.