Avaliação econômica do tratamento da esquizofrenia com antipsicóticos no Sistema Único de Saúde

OBJETIVO: Avaliar as relações de custo-utilidade entre medicamentos antipsicóticos de primeira e segunda gerações no tratamento da esquizofrenia. MÉTODOS: Foi construído um modelo de Markov de cinco anos, a partir de um levantamento em prontuários de pacientes atendidos em um centro de atenção psicossocial em Florianópolis (SC), 2006. Os custos foram avaliados sob a perspectiva o Sistema Único de Saúde. As utilidades foram medidas em anos de vida ajustados pela qualidade obtidas na literatura. RESULTADOS: No modelo de Markov, a alternativa mais custo-efetiva foi a utilização de risperidona e haloperidol antes de olanzapina. CONCLUSÕES: Os antipsicóticos haloperidol e risperidona apresentaram melhor relação de custo-efetividade quando comparados à olanzapina. Estratégias que priorizem a utilização de antipsicóticos com melhor relação de custo-efetividade podem otimizar recursos, sem necessariamente implicar prejuízos à saúde dos pacientes atendidos no Sistema Único de Saúde.

Demixing instability in coil-rod blends undergoing polycondensation reactions

The authors extend their earlier work on the stability of a reacting binary polymer blend with respect to demixing [D. J. Read, Macromolecules 31, 899 (1998); P. I. C. Teixeira , Macromolecules 33, 387 (2000)] to the case where one of the polymers is rod-like and may order nematically. As before, the authors combine the random phase approximation for the free energy with a Markov chain model for the chemistry to obtain the spinodal as a function of the relevant degrees of reaction. These are then calculated by assuming a simple second-order chemical kinetics. Results are presented, for linear systems, which illustrate the effects of varying the proportion of coils and rods, their relative sizes, and the strength of the nematic interaction between the rods. (c) 2007 American Institute of Physics.

Avaliação dos desvios no posicionamento da IMRT prostática com marcadores fiduciais versus estruturas anatómicas

Mestrado em Radioterapia

Helical tomotherapy versus 3D conformal radiotherapy in dosimetric planning for patients with localized prostate cancer

Radiotherapy is one of the therapeutics selected for localized prostate cancer, in cases where the tumour is confined to the prostate, penetrates the prostatic capsule or has reached the seminal vesicles (T1 to T3 stages). The radiation therapy can be administered through various modalities, being historically used the 3D conformal radiotherapy (3DCRT). Other modality of radiation administration is the intensity modulated radiotherapy (IMRT), that allows an increase of the total dose through modulation of the treatment beams, enabling a reduction in toxicity. One way to administer IMRT is through helical tomotherapy (TH). With this study we intent to analyze the advantages of helical tomotherapy when compared with 3DCRT, by evaluating the doses in the organs at risk (OAR) and planning target volumes (PTV).

Radioterapia adaptativa: utilização do cone-beam computed tomography para o cálculo de dose em radioterapia

Mestrado em Radiações Aplicadas às Tecnologias da Saúde - Ramo de especialização: Terapia com Radiações

Statistical analysis of quality control measurements in IMRT for head and neck and prostate cancer

Intensity Modulated Radiotherapy (IMRT) is a technique introduced to shape more precisely the dose distributions to the tumour, providing a higher dose escalation in the volume to irradiate and simultaneously decreasing the dose in the organs at risk which consequently reduces the treatment toxicity. This technique is widely used in prostate and head and neck (H&N) tumours. Given the complexity and the use of high doses in this technique it’s necessary to ensure as a safe and secure administration of the treatment, through the use of quality control programmes for IMRT. The purpose of this study was to evaluate statistically the quality control measurements that are made for the IMRT plans in prostate and H&N patients, before the beginning of the treatment, analysing their variations, the percentage of rejected and repeated measurements, the average, standard deviations and the proportion relations.

Capacity sharing and stealing in serverbased real-time systems

A dynamic scheduler that supports the coexistence of guaranteed and non-guaranteed bandwidth servers is proposed. Overloads are handled by an efficient reclaiming of residual capacities originated by early completions as well as by allowing reserved capacity stealing of non-guaranteed bandwidth servers. The proposed dynamic budget accounting mechanism ensures that at a particular time the currently executing server is using a residual capacity, its own capacity or is stealing some reserved capacity, eliminating the need of additional server states or unbounded queues. The server to which the budget accounting is going to be performed is dynamically determined at the time instant when a capacity is needed. This paper describes and evaluates the proposed scheduling algorithm, showing that it can efficiently reduce the mean tardiness of periodic jobs. The achieved results become even more significant when tasks’ computation times have a large variance.

Effects of emotional valence and three-dimensionality of visual stimuli on brain activation: an fMRI study

BACKGROUND: Examining changes in brain activation linked with emotion-inducing stimuli is essential to the study of emotions. Due to the ecological potential of techniques such as virtual reality (VR), inspection of whether brain activation in response to emotional stimuli can be modulated by the three-dimensional (3D) properties of the images is important. OBJECTIVE: The current study sought to test whether the activation of brain areas involved in the emotional processing of scenarios of different valences can be modulated by 3D. Therefore, the focus was made on the interaction effect between emotion-inducing stimuli of different emotional valences (pleasant, unpleasant and neutral valences) and visualization types (2D, 3D). However, main effects were also analyzed.METHODS: The effect of emotional valence and visualization types and their interaction were analyzed through a 3x2 repeated measures ANOVA. Post-hoc t-tests were performed under a ROI-analysis approach. RESULTS: The results show increased brain activation for the 3D affective-inducing stimuli in comparison with the same stimuli in 2D scenarios, mostly in cortical and subcortical regions that are related to emotional processing, in addition to visual processing regions. CONCLUSIONS: This study has the potential of clarify brain mechanisms involved in the processing of emotional stimuli (scenarios’ valence) and their interaction with three-dimensionality.

On the adaptation of broadcast transactions in token-passing fieldbus networks with heterogeneous transmission media

Broadcast networks that are characterised by having different physical layers (PhL) demand some kind of traffic adaptation between segments, in order to avoid traffic congestion in linking devices. In many LANs, this problem is solved by the actual linking devices, which use some kind of flow control mechanism that either tell transmitting stations to pause (the transmission) or just discard frames. In this paper, we address the case of token-passing fieldbus networks operating in a broadcast fashion and involving message transactions over heterogeneous (wired or wireless) physical layers. For the addressed case, real-time and reliability requirements demand a different solution to the traffic adaptation problem. Our approach relies on the insertion of an appropriate idle time before a station issuing a request frame. In this way, we guarantee that the linking devices’ queues do not increase in a way that the timeliness properties of the overall system turn out to be unsuitable for the targeted applications.

Custo-efetividade dos análogos de nucleosídeos/nucleotídeos para hepatite crônica B

OBJETIVO: Conduzir uma análise de custo-efetividade das alternativas medicamentosas com terapia de resgate na recaída por resistência viral para tratamento de pacientes com hepatite crônica B (HCB). MÉTODOS: Coorte hipotética de pacientes com HCB, HBeAg negativo, sem evidência clínica ou histológica de cirrose, DNA do VHB detectável, diagnóstico histológico da doença, HBsAg positivo no soro por mais de seis meses, elevados níveis de alanina transferase (ALT) (duas vezes maior que o limite superior da normalidade [LSN]) e média de idade de 40 anos. Modelo de Markov foi desenvolvido para a hepatite crônica B (antígeno HBeAg negativo) com horizonte temporal de 40 anos. Custos e benefícios foram descontados em 5%. As taxas anuais de progressão, custos devido a complicações e a eficácia dos medicamentos foram obtidos da literatura. As incertezas foram avaliadas por análises de sensibilidade unidirecional e probabilística. RESULTADOS: Iniciar o tratamento com entecavir resultou em 0,35 ano de vida ganho em relação à lamivudina. A razão de custo-efetividade incremental foi de R$ 16.416,08 por anos de vida ganhos. Na análise de sensibilidade a razão de custo-efetividade incremental foi mais sensível à variação na probabilidade de transição de hepatite crônica B para cirrose compensada, taxa de desconto e preço dos medicamentos (± 10%). Na análise de sensibilidade probabilística, a curva de aceitabilidade mostrou que iniciar com entecavir foi a alternativa mais custo-efetiva na comparação ao uso de lamivudina. CONCLUSÕES: A disponibilidade do entecavir é economicamente atrativa como parte do tratamento precoce para pacientes com hepatite crônica B sem coinfecção com o HIV.

Reconhecimento de língua gestual

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Informática e Computadores

Supporting real-time parallel task models with work-stealing

Dynamic parallel scheduling using work-stealing has gained popularity in academia and industry for its good performance, ease of implementation and theoretical bounds on space and time. Cores treat their own double-ended queues (deques) as a stack, pushing and popping threads from the bottom, but treat the deque of another randomly selected busy core as a queue, stealing threads only from the top, whenever they are idle. However, this standard approach cannot be directly applied to real-time systems, where the importance of parallelising tasks is increasing due to the limitations of multiprocessor scheduling theory regarding parallelism. Using one deque per core is obviously a source of priority inversion since high priority tasks may eventually be enqueued after lower priority tasks, possibly leading to deadline misses as in this case the lower priority tasks are the candidates when a stealing operation occurs. Our proposal is to replace the single non-priority deque of work-stealing with ordered per-processor priority deques of ready threads. The scheduling algorithm starts with a single deque per-core, but unlike traditional work-stealing, the total number of deques in the system may now exceed the number of processors. Instead of stealing randomly, cores steal from the highest priority deque.

Antivirais incorporados no Brasil para hepatite B cronica: analise de custo-efetividade

OBJETIVO Avaliar o custo-efetividade de diferentes tratamentos medicamentosos para hepatite B crônica entre pacientes adultos. MÉTODOS Utilizando modelo de Markov, construiu-se coorte hipotética de 40 anos para pacientes HBeAg-positivo ou HBeAg-negativo. Foram comparados os usos de adefovir, entecavir, tenofovir e lamivudina (com terapia de resgate em caso de resistência viral) para tratamento de pacientes adultos com hepatite B crônica, virgens de tratamento, com elevados níveis de alanina aminotransferase, sem evidência de cirrose e sem coinfecção por HIV. Valores para custo e efeito foram obtidos da literatura. A medida do efeito foi expressa em anos de vida ganhos (AVG). Taxa de desconto de 5% foi aplicada. Análise de sensibilidade univariada foi conduzida para avaliar incertezas do modelo. RESULTADOS O tratamento inicial com entecavir ou tenofovir apresentou melhores resultados clínicos. As menores razões custo-efetividade foram de entecavir para pacientes HBeAg-positivo (R$ 4.010,84/AVG) e lamivudina para pacientes HBeAg-negativo (R$ 6.205,08/AVG). Para pacientes HBeAg-negativo, a razão custo-efetividade incremental de entecavir (R$ 14.101,05/AVG) está abaixo do limiar recomendado pela Organização Mundial da Saúde. Análise de sensibilidade mostrou que variação nos custos dos medicamentos pode tornar tenofovir alternativa custo-efetiva tanto para pacientes HBeAg-positivo quanto para HBeAg-negativo. CONCLUSÕES Entecavir é alternativa recomendada para iniciar o tratamento de pacientes com hepatite B crônica no Brasil. Contudo, se houver redução no custo de tenofovir, esta pode se tornar alternativa mais custo-efetiva.

A fractional approach to the Fermi-Pasta-Ulam problem

This paper studies the Fermi-Pasta-Ulam problem having in mind the generalization provided by Fractional Calculus (FC). The study starts by addressing the classical formulation, based on the standard integer order differential calculus and evaluates the time and frequency responses. A first generalization to be investigated consists in the direct replacement of the springs by fractional elements of the dissipative type. It is observed that the responses settle rapidly and no relevant phenomena occur. A second approach consists of replacing the springs by a blend of energy extracting and energy inserting elements of symmetrical fractional order with amplitude modulated by quadratic terms. The numerical results reveal a response close to chaotic behaviour.

Schedulability analysis of generalized multiframe traffic on multihop-networks comprising software-implemented ethernet switches

Consider a multihop network comprising Ethernet switches. The traffic is described with flows and each flow is characterized by its source node, its destination node, its route and parameters in the generalized multiframe model. Output queues on Ethernet switches are scheduled by static-priority scheduling and tasks executing on the processor in an Ethernet switch are scheduled by stride scheduling. We present schedulability analysis for this setting.