A comparative analysis of outpatient costs in HIV treatment programs

OBJECTIVE: To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems. METHODS: A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars. RESULTS: Annual cost of HIV outpatient treatment for the Brazilian national public program was US$ 2,572.92 in 2006 in São Paulo, ranging from US$ 1,726.19 for patients with CD4 cell count > 500 to US$ 3,693.28 for patients with 51 < CD4 cell count < 200. Antiretrovirals (ARVs) represented approximately 62.0% of annual HIV outpatient costs. Comparing among different health systems during the same period, HIV outpatient treatment presented higher costs in countries where HIV treatment is provided by the private sector. CONCLUSION: The main cost drivers of HIV outpatient treatment in different health systems were: ARVs, other medications, health professional services, and diagnostic exams. Nevertheless, the magnitude of cost drivers varied among HIV outpatient treatment programs due to health system efficiency. The data presented may be a valuable tool for public policy evaluation of HIV treatment programs worldwide.

Contribution of graduate programs in plant breeding to the education of plant breeders in Brazil

The success of agribusiness in Brazil in recent decades is unquestionable. Although the country has always had favorable conditions for agriculture (land, water and climate), this success has only come about recently, due to scientific research, which has resulted in considerable increases in yield and in improvement of product quality, as well as making the occupation of new agricultural frontiers possible. A decisive factor for development of agriculture in the country was the creation of EMBRAPA in 1973, which, in a few years, led to considerable demand for researchers with training in graduate programs. Among them are plant breeders, who came to exercise their activity throughout the country and in all ecosystems. The training of plant breeders was only possible because, as from the middle of the 1960s, the country began a wide-ranging education program, with the creation of several graduate programs in genetics and plant breeding.

The implementation of effective dual-language programs

[EN]This research investigates the ways of implementing dual-language programs and the schools’ internal procedures of evaluating them. Previous studies have examined the effectiveness of bilingual programs (Genovesee et al. 2005; Howard et al. 2005; Krashen 2004). However, there is little still known about schools’ procedures that systematize the organizational aspect of such programs. The Mixed Methods Research (MMR) approach was applied in this study to analyze data collected through questionnaires, interviews, and case studies.

Automatic code generation: from process algebraic architectural descriptions to multithreaded java programs

Process algebraic architectural description languages provide a formal means for modeling software systems and assessing their properties. In order to bridge the gap between system modeling and system im- plementation, in this thesis an approach is proposed for automatically generating multithreaded object-oriented code from process algebraic architectural descriptions, in a way that preserves – under certain assumptions – the properties proved at the architectural level. The approach is divided into three phases, which are illustrated by means of a running example based on an audio processing system. First, we develop an architecture-driven technique for thread coordination management, which is completely automated through a suitable package. Second, we address the translation of the algebraically-specified behavior of the individual software units into thread templates, which will have to be filled in by the software developer according to certain guidelines. Third, we discuss performance issues related to the suitability of synthesizing monitors rather than threads from software unit descriptions that satisfy specific constraints. In addition to the running example, we present two case studies about a video animation repainting system and the implementation of a leader election algorithm, in order to summarize the whole approach. The outcome of this thesis is the implementation of the proposed approach in a translator called PADL2Java and its integration in the architecture-centric verification tool TwoTowers.

Type Systems for Distributed Programs: Components and Sessions

Modern software systems, in particular distributed ones, are everywhere around us and are at the basis of our everyday activities. Hence, guaranteeing their cor- rectness, consistency and safety is of paramount importance. Their complexity makes the verification of such properties a very challenging task. It is natural to expect that these systems are reliable and above all usable. i) In order to be reliable, compositional models of software systems need to account for consistent dynamic reconfiguration, i.e., changing at runtime the communication patterns of a program. ii) In order to be useful, compositional models of software systems need to account for interaction, which can be seen as communication patterns among components which collaborate together to achieve a common task. The aim of the Ph.D. was to develop powerful techniques based on formal methods for the verification of correctness, consistency and safety properties related to dynamic reconfiguration and communication in complex distributed systems. In particular, static analysis techniques based on types and type systems appeared to be an adequate methodology, considering their success in guaranteeing not only basic safety properties, but also more sophisticated ones like, deadlock or livelock freedom in a concurrent setting. The main contributions of this dissertation are twofold. i) On the components side: we design types and a type system for a concurrent object-oriented calculus to statically ensure consistency of dynamic reconfigurations related to modifications of communication patterns in a program during execution time. ii) On the communication side: we study advanced safety properties related to communication in complex distributed systems like deadlock-freedom, livelock- freedom and progress. Most importantly, we exploit an encoding of types and terms of a typical distributed language, session π-calculus, into the standard typed π- calculus, in order to understand their expressive power.

Efficient certification of feasibility and objective value of linear programs and its applications

The use of linear programming in various areas has increased with the significant improvement of specialized solvers. Linear programs are used as such to model practical problems, or as subroutines in algorithms such as formal proofs or branch-and-cut frameworks. In many situations a certified answer is needed, for example the guarantee that the linear program is feasible or infeasible, or a provably safe bound on its objective value. Most of the available solvers work with floating-point arithmetic and are thus subject to its shortcomings such as rounding errors or underflow, therefore they can deliver incorrect answers. While adequate for some applications, this is unacceptable for critical applications like flight controlling or nuclear plant management due to the potential catastrophic consequences. We propose a method that gives a certified answer whether a linear program is feasible or infeasible, or returns unknown'. The advantage of our method is that it is reasonably fast and rarely answers unknown'. It works by computing a safe solution that is in some way the best possible in the relative interior of the feasible set. To certify the relative interior, we employ exact arithmetic, whose use is nevertheless limited in general to critical places, allowing us to rnremain computationally efficient. Moreover, when certain conditions are fulfilled, our method is able to deliver a provable bound on the objective value of the linear program. We test our algorithm on typical benchmark sets and obtain higher rates of success compared to previous approaches for this problem, while keeping the running times acceptably small. The computed objective value bounds are in most of the cases very close to the known exact objective values. We prove the usability of the method we developed by additionally employing a variant of it in a different scenario, namely to improve the results of a Satisfiability Modulo Theories solver. Our method is used as a black box in the nodes of a branch-and-bound tree to implement conflict learning based on the certificate of infeasibility for linear programs consisting of subsets of linear constraints. The generated conflict clauses are in general small and give good rnprospects for reducing the search space. Compared to other methods we obtain significant improvements in the running time, especially on the large instances.

Complementary mass spectrometric techniques for the characterization of the organic fraction in atmospheric aerosols

Aerosol particles are strongly related to climate, air quality, visibility and human health issues. They contribute the largest uncertainty in the assessment of the Earth´s radiative budget, directly by scattering or absorbing solar radiation or indirectly by nucleating cloud droplets. The influence of aerosol particles on cloud related climatic effects essentially depends upon their number concentration, size and chemical composition. A major part of submicron aerosol consists of secondary organic aerosol (SOA) that is formed in the atmosphere by the oxidation of volatile organic compounds. SOA can comprise a highly diverse spectrum of compounds that undergo continuous chemical transformations in the atmosphere.rnThe aim of this work was to obtain insights into the complexity of ambient SOA by the application of advanced mass spectrometric techniques. Therefore, an atmospheric pressure chemical ionization ion trap mass spectrometer (APCI-IT-MS) was applied in the field, facilitating the measurement of ions of the intact molecular organic species. Furthermore, the high measurement frequency provided insights into SOA composition and chemical transformation processes on a high temporal resolution. Within different comprehensive field campaigns, online measurements of particular biogenic organic acids were achieved by combining an online aerosol concentrator with the APCI-IT-MS. A holistic picture of the ambient organic aerosol was obtained through the co-located application of other complementary MS techniques, such as aerosol mass spectrometry (AMS) or filter sampling for the analysis by liquid chromatography / ultrahigh resolution mass spectrometry (LC/UHRMS).rnIn particular, during a summertime field study at the pristine boreal forest station in Hyytiälä, Finland, the partitioning of organic acids between gas and particle phase was quantified, based on the online APCI-IT-MS and AMS measurements. It was found that low volatile compounds reside to a large extent in the gas phase. This observation can be interpreted as a consequence of large aerosol equilibration timescales, which build up due to the continuous production of low volatile compounds in the gas phase and/or a semi-solid phase state of the ambient aerosol. Furthermore, in-situ structural informations of particular compounds were achieved by using the MS/MS mode of the ion trap. The comparison to MS/MS spectra from laboratory generated SOA of specific monoterpene precursors indicated that laboratory SOA barely depicts the complexity of ambient SOA. Moreover, it was shown that the mass spectra of the laboratory SOA more closely resemble the ambient gas phase composition, indicating that the oxidation state of the ambient organic compounds in the particle phase is underestimated by the comparison to laboratory ozonolysis. These observations suggest that the micro-scale processes, such as the chemistry of aerosol aging or the gas-to-particle partitioning, need to be better understood in order to predict SOA concentrations more reliably.rnDuring a field study at the Mt. Kleiner Feldberg, Germany, a slightly different aerosol concentrator / APCI-IT-MS setup made the online analysis of new particle formation possible. During a particular nucleation event, the online mass spectra indicated that organic compounds of approximately 300 Da are main constituents of the bulk aerosol during ambient new particle formation. Co-located filter analysis by LC/UHRMS analysis supported these findings and furthermore allowed to determine the molecular formulas of the involved organic compounds. The unambiguous identification of several oxidized C 15 compounds indicated that oxidation products of sesquiterpenes can be important compounds for the initial formation and subsequent growth of atmospheric nanoparticles.rnThe LC/UHRMS analysis furthermore revealed that considerable amounts of organosulfates and nitrooxy organosulfates were detected on the filter samples. Indeed, it was found that several nitrooxy organosulfate related APCI-IT-MS mass traces were simultaneously enhanced. Concurrent particle phase ion chromatography and AMS measurements indicated a strong bias between inorganic sulfate and total sulfate concentrations, supporting the assumption that substantial amounts of sulfate was bonded to organic molecules.rnFinally, the comprehensive chemical analysis of the aerosol composition was compared to the hygroscopicity parameter kappa, which was derived from cloud condensation nuclei (CCN) measurements. Simultaneously, organic aerosol aging was observed by the evolution of a ratio between a second and a first generation biogenic oxidation product. It was found that this aging proxy positively correlates with increasing hygroscopicity. Moreover, it was observed that the bonding of sulfate to organic molecules leads to a significant reduction of kappa, compared to an internal mixture of the same mass fractions of purely inorganic sulfate and organic molecules. Concluding, it has been shown within this thesis that the application of modern mass spectrometric techniques allows for detailed insights into chemical and physico-chemical processes of atmospheric aerosols.rn

Theoretical analysis of hidden photon searches in high-precision experiments

Although the Standard Model of particle physics (SM) provides an extremely successful description of the ordinary matter, one knows from astronomical observations that it accounts only for around 5% of the total energy density of the Universe, whereas around 30% are contributed by the dark matter. Motivated by anomalies in cosmic ray observations and by attempts to solve questions of the SM like the (g-2)_mu discrepancy, proposed U(1) extensions of the SM gauge group have raised attention in recent years. In the considered U(1) extensions a new, light messenger particle, the hidden photon, couples to the hidden sector as well as to the electromagnetic current of the SM by kinetic mixing. This allows for a search for this particle in laboratory experiments exploring the electromagnetic interaction. Various experimental programs have been started to search for hidden photons, such as in electron-scattering experiments, which are a versatile tool to explore various physics phenomena. One approach is the dedicated search in fixed-target experiments at modest energies as performed at MAMI or at JLAB. In these experiments the scattering of an electron beam off a hadronic target e+(A,Z)->e+(A,Z)+l^+l^- is investigated and a search for a very narrow resonance in the invariant mass distribution of the lepton pair is performed. This requires an accurate understanding of the theoretical basis of the underlying processes. For this purpose it is demonstrated in the first part of this work, in which way the hidden photon can be motivated from existing puzzles encountered at the precision frontier of the SM. The main part of this thesis deals with the analysis of the theoretical framework for electron scattering fixed-target experiments searching for hidden photons. As a first step, the cross section for the bremsstrahlung emission of hidden photons in such experiments is studied. Based on these results, the applicability of the Weizsäcker-Williams approximation to calculate the signal cross section of the process, which is widely used to design such experimental setups, is investigated. In a next step, the reaction e+(A,Z)->e+(A,Z)+l^+l^- is analyzed as signal and background process in order to describe existing data obtained by the A1 experiment at MAMI with the aim to give accurate predictions of exclusion limits for the hidden photon parameter space. Finally, the derived methods are used to find predictions for future experiments, e.g., at MESA or at JLAB, allowing for a comprehensive study of the discovery potential of the complementary experiments. In the last part, a feasibility study for probing the hidden photon model by rare kaon decays is performed. For this purpose, invisible as well as visible decays of the hidden photon are considered within different classes of models. This allows one to find bounds for the parameter space from existing data and to estimate the reach of future experiments.

Content and English Language Integrated Learning: The use of Moodle in Aircraft Maintenance Training Programs

The aim of this work is to develop a prototype of an e-learning environment that can foster Content and Language Integrated Learning (CLIL) for students enrolled in an aircraft maintenance training program, which allows them to obtain a license valid in all EU member states. Background research is conducted to retrace the evolution of the field of educational technology, analyzing different learning theories – behaviorism, cognitivism, and (socio-)constructivism – and reflecting on how technology and its use in educational contexts has changed over time. Particular attention is given to technologies that have been used and proved effective in Computer Assisted Language Learning (CALL). Based on the background research and on students’ learning objectives, i.e. learning highly specialized contents and aeronautical technical English, a bilingual approach is chosen, three main tools are identified – a hypertextbook, an exercise creation activity, and a discussion forum – and the learning management system Moodle is chosen as delivery medium. The hypertextbook is based on the technical textbook written in English students already use. In order to foster text comprehension, the hypertextbook is enriched by hyperlinks and tooltips. Hyperlinks redirect students to webpages containing additional information both in English and in Italian, while tooltips show Italian equivalents of English technical terms. The exercise creation activity and the discussion forum foster interaction and collaboration among students, according to socio-constructivist principles. In the exercise creation activity, students collaboratively create a workbook, which allow them to deeply analyze and master the contents of the hypertextbook and at the same time create a learning tool that can help them, as well as future students, to enhance learning. In the discussion forum students can discuss their individual issues, content-related, English-related or e-learning environment-related, helping one other and offering instructors suggestions on how to improve both the hypertextbook and the workbook based on their needs.

User centered retrofit: The case of kadk campus, Copenhagen, (dk)

The following research thesis is about a retrofit project made in Denmark, Copenhagen, and carried out on one of the buildings belonging to the Royal Danish Academy. The key assumption and base of the entire research process is that, up to now, the standard procedure in retrofit cases like this provides as comparative method between de facto and design, the use of Energy Simulation software. These programs generally divide the space into different thermal zones, assigning to each of them different levels of employment, activities, set-point temperatures set for cooling and heating analysis and so on, but always providing average and constant values, usually taken in the middle point of the single thermal zone. Therefore, the project and its research path stems from the attempt to investigate the potentialities of this kind of designing for retrofit process, as previously anticipated not antithetical but complementary to that classic energy-based retrofit, thus passing from the building scale, and all its thermal zones, to the users' scale, related to humans and microclimates. The main software used in this process is Autodesk Simulation CFD. The idea behind the project is that in certain situations, for example, it will not be necessary to add throughout insulation layers (previously parameterized and optimized with Design Builder), and that even in Winter conditions, due maybe to the users' activities, the increased level of clothing (clo) and the heat produced by equipments, thermal comfort could be achieved also in areas characterized by considerably lower MRT. After the analysis of the State of Art and its simulations, the project has still been supported by the tool itself, the CFD Software, in an iterative process aimed at achieving visible improvements in terms of MRT, on spaces with different needs and characteristics, both in Winter and Summer regimes.

Internet based health promotion campaign against skin cancer - Results of www.skincheck.ch in Switzerland

Conventional skin cancer prevention programs appeal to limited populations, and the middle aged male population responds less frequently. Our objective was to establish a complementary health promotion campaign tool for skin cancer prevention. Internet-based education, instruction for self assessment and teledermatological evaluation of skin lesions by an expert commission of dermatologists was used. Compliance and clinical diagnosis was assessed in a subgroup. 12,000 users visited the educational website. There was strong interest among the middle aged male population (53% (N = 262): male; mean age: 42). 28.5% of examined lesions (N = 494) were considered suspicious. Email requests, sent to the group whose lesions where considered suspicious, were answered by 46.0% of females (N = 29) and 59.7% of males (N = 46) with a female distribution predominantly in younger ages (52.6% of females with known age: < 30 years). Males were predominantly represented over 30 years (86.2% of all males). According to user's declarations, at least 8 (8.5%) malignant lesions (1 melanoma in situ, 1 squamous cell carcinoma, 4 basal cell carcinomas, 2 malignant lesions without declared diagnosis) were finally diagnosed by physicians. We conclude that internet-based, interactive, educational programs, in addition to existing health promotion campaigns, can enhance public participation in the middle aged male population in skin cancer prevention.

Differences in the quality of interpersonal care in complementary and conventional medicine

The study was part of a nationwide evaluation of complementary and alternative medicine (CAM) in Swiss primary care. The aim of the study was to compare patient-physician relationships and the respective patient-reported relief of symptoms between CAM and conventional primary care (COM).

The role of reinfection and partner notification in the efficacy of Chlamydia screening programs

Repeated Chlamydia trachomatis infections after treatment are common. One reason is reinfection from untreated partners in ongoing sexual partnerships. Mathematical models that are used to predict the impact of screening on reducing chlamydia prevalence often do not incorporate reinfection and might overestimate the expected impact. We describe a pair compartmental model that explicitly incorporates sexual partnership duration and reinfection. The pair model predicts a weaker impact of screening when compared directly with a model that does not accommodate partnerships. Effective management of sex partners to prevent reinfection might need to be strengthened in chlamydia control programs.

Complementary medicine courses in Swiss medical schools: actual status and students' experience

In line with growing public popularity of complementary and alternative medicine (CAM), courses in CAM have been implemented in Medical Schools internationally, but as yet in an uncoordinated and heterogeneous way. In Switzerland, comprehensive data about CAM education at Medical Faculties are lacking.