Avaliação do custo-efetividade da incorporação do Espectômetro de Massa em Tandem no Programa Nacional de Triagem Neonatal no Brasil para diagnóstico da Fenilcetonúria e MCAD.

A Espectrometria de Massa em Tandem (MS/MS) é mundialmente considerada padrão ouro para a Triagem Neonatal (TN) de Erros Inatos do Metabolismo (IEM). Além de apresentar melhor sensibilidade e especificidade possibilita rastrear uma vasta gama de IEM usando um único teste. Atualmente o Programa Nacional de Triagem Neonatal (PNTN) rastreia cinco doenças (Fenilcetonúria, Hipotiroidismo Congênito, Fibrose Cística, Hemoglobinopatias e Deficiência da Biotinidase). Uma das metas do PNTN é o aprimoramento e a incorporação de novas doenças e/ou tecnologias. Com a recente recomendação da CONITEC (Comissão Nacional de Incorporação de Tecnologias) para aquisição do MS/MS para diagnóstico de doenças raras, vislumbra-se o incremento desta tecnologia para ampliação de doenças triadas, melhora da qualidade do teste diagnóstico, corroborando para melhorar qualidade de vida das crianças acometidas pelos EIM. Este trabalho teve como objetivo realizar uma análise de custo efetividade, para incorporação da tecnologia de tandem MS/MS na triagem neonatal, sob a perspectiva do SUS. Desta maneira buscou-se comparar diferentes cenários da TN com a tecnologia atualmente utilizada (Fluorimetria) somente para Fenilcetonúria (PKU), e com MS/MS para rastreio da PKU e da Deficiência de Cadeia Média Acyl-Coenzima Desidrogenase (MCAD). Para tanto construiu-se um modelo matemático de decisão baseados em cadeias de Markov que simulou a TN da PKU e da MCAD, bem como a história natural da MCAD. Foi acompanhada uma coorte hipotética de cem mil recém-nascidos. O horizonte temporal adotado foi a expectativa de vida da população brasileira de 78 anos de acordo com IBGE. Utilizou-se uma taxa de desconto de 5% para os custos e consequências clínicas para ambos os cenários propostos. Quando incorporado o MS/MS para triagem da PKU os ganhos em saúde continuaram os mesmos, pois o desempenho do MS/MS e da Fluorimetria foram praticamente iguais (efetividade), porém o custo incremental foi quatro vezes maior para a mesma efetividade, o que torna o MS/MS somente para PKU não custo efetiva (dominada). No entanto, quando analisado o cenário do MS/MS para triagem da PKU e da MCAD o custo incremental do MS/MS no PNTN foi menor por causa da economia feita uma vez que é possível realizar ambos os testes no mesmo o teste do pezinho atual.

Multiple object tracking using evolutionary MCMC-based particle algorithms

Algorithms are presented for detection and tracking of multiple clusters of co-ordinated targets. Based on a Markov chain Monte Carlo sampling mechanization, the new algorithms maintain a discrete approximation of the filtering density of the clusters' state. The filters' tracking efficiency is enhanced by incorporating various sampling improvement strategies into the basic Metropolis-Hastings scheme. Thus, an evolutionary stage consisting of two primary steps is introduced: 1) producing a population of different chain realizations, and 2) exchanging genetic material between samples in this population. The performance of the resulting evolutionary filtering algorithms is demonstrated in two different settings. In the first, both group and target properties are estimated whereas in the second, which consists of a very large number of targets, only the clustering structure is maintained. © 2009 IFAC.

Survey of exist specifications morphometric, meristic and inter species molecular genetic on Bream (Abramis brava orientalis) in Anzali wetland, southern coast of Caspian Sea, Aras Dam Lake and Azerbijan Republic

Bream (Abramis brava orientalis) is one of Cyprindae the Caspian Sea and its basin which has a special ecological, biological and economical role. Stock of this fish in the Caspian Sea has reduced during several years for different reason the over fishing, different industrial, agriculture, urban pollution and destroy of the spawning habitat. So that fishery company decided to recover the stock of this fish by the way of artificial reproduction of a Bream couple hunted from south coast of the Caspian Sea (Iran) and setting the fingerling to the rivers and inflow wetlands of the Caspian Sea.This activity has due to 20 tons Bream annual fishing in the Iranian South coast of the Caspian Sea (Gilan province coast and Anzali wetland), The artificial reproduction has decreased Bream population diversity of Caspian sea and Anzali wetland.So it has been declined to improve Braem population diversity by the entrance of Azerbijan republic Bream and encounter to the Caspian sea Bream. Meanwhile there is Bream in the Aras Dam Lake which had been forgotten by the Fishery Company of Iran .For this reason specifications morphometric, meristic and inter species Molecular Genetic have been surveyed in Anzali wetland,Southern coast of Caspian Sea ,Aras Darn Lake and Azerbijan republic during 2003-2005. According to the research on specifications of Morphometric and Meristic of Anzali wetland(120 species),Southern coast of Caspian Sea(90 species), Aras Dam Lake(110 species) and Azerbijan Republic(125 species)has Morphometric and Meristic differences. So that average weight and total length of Anzali wetland Bream respectively was 167 g and 23/76 cm, 102 g and 27/62 cm in Caspian Sea , 461 g and 3 5/38 cm in Aras Darn Lake and 3 4189 g and 15/21 cm in Azerbijan republic (We forced to use 1 year Bream of artificial reproduction in Iran). Also variation coefficient average Morphometric, Morphometric specification Ration and meristic in Anzali wetland Bream was 17/45, 21/56 and 4/63, in Caspian Sea bream 22/58, 15/27 and 3124, in Aras Dam lake Lake 17145. 1.5/27 and 3/57 and Azerbaijan republic Bream 22/29, 19/66 and 4/22. Also Bream of these four regions in general status had Morphometric significant differences based on One Way ANOVA Analysis. Meanwhile Anzali wetland Bream with Caspian Sea Bream from 41 Morphometric surveyed factors in 33 factors, with Aras Darn Lake Bream in 41 factors, with Azerbkjan republic Bream in 41 factors,Caspian Sea Bream with Aras Darn Lake Bream in 36 factors,with Azerbijan republic B ream in 40 factors and A ras Dam L ake Bream with Azerbijan republic Bream in 38 factors had significant statistical differences. These four regions Bream had differences according to the Morphomertric specification ration based on One Way ANOVA Analysis. Also Anzali wetland Bream was surveyed with Caspian Sea Bream from 37 factors i n 27 factors, Anzali wetland Bream with Aras Dam 1ake in 37 factors Anzali wetland Bream with Azerbijan republic Bream in 32 factors,Caspian sea bream with Arsa Dam Lake Bream in 26 factors, Caspian Sea Bream with Azerbijan republic Bream in 29 factors and Aras Dam Lake Bream with Azerbijan republic Bream in 34 factor had significant statistical differences. Based on Meristic factor of four regions bream in 16 surveyed factors in 10 factors had meaningful differences according to the One Way ANOVA Analysis. While Anzali wetland Bream was surveyed with Caspian Sea Bream from in 3 factors,Anzali wetland Bream with Aras Dam lake in 8 factors,Anzali wetland Bream with Azerbijan republic B ream in 6 factors,Caspian Sea bream with Arsa Dam Lake Bream in 6 factors,Caspian sea Bream with Azerbijan republic Bream in 3 factors and Aras Dam Lake Bream with Azerijan republic Bream in 8 factor had significant statistical differences.Meanwihle based on Factor Analysis and Discriminant Breams had differences. Also according to the resrarchs Anzali wetland Bream in 0+ age group till 5+ (6 age groups),Caspian Sea bream in 1+ - 5+(5 age groups),Aras Darn Lake Bream in 1+ - 7+ (7 age groups) and Azerbijan republic Bream for Morphometric and Meristic studies in 1+age group and for molecular Genetic reaserch were in 8+and 9+ age groups. According to the research 4 ecosystems Bream in status of same age, Aras lake Bream were bigger according to weight and length.Also in this research genetic diversity between four population was researched by PCR-RFLP technic on a piece of mitochondrion genome with the length of 3500bp contain of tRNA-leu,tRNA-glu,ND5/6,Cytb. Between 17 used enzyme. 4 enzyme, Dral, Bc11, Haefll and Banff showed diversity in totally 6 composite haplotype was detected. Maximum nucleotide diversity by the value% 0/58 in Azerbijan republic Bream by all haplotype. Aras darn Lake Bream had 2 haplotype and nucleotide diversity of %0/35.Anzali wetland and Caspian Sea Bream had no diversity. Statistical analysis by the usage of Monte Carlo with 1000 repeat showed significant differences between Azerbaijan Bream and other Bream(P<0/0001) but there was no significant difference between 3 regions Bream(P>0/5).

SMERED: A Bayesian Approach to Graphical Record Linkage and De-duplication

We propose a novel unsupervised approach for linking records across arbitrarily many files, while simultaneously detecting duplicate records within files. Our key innovation is to represent the pattern of links between records as a {\em bipartite} graph, in which records are directly linked to latent true individuals, and only indirectly linked to other records. This flexible new representation of the linkage structure naturally allows us to estimate the attributes of the unique observable people in the population, calculate $k$-way posterior probabilities of matches across records, and propagate the uncertainty of record linkage into later analyses. Our linkage structure lends itself to an efficient, linear-time, hybrid Markov chain Monte Carlo algorithm, which overcomes many obstacles encountered by previously proposed methods of record linkage, despite the high dimensional parameter space. We assess our results on real and simulated data.

Repeated measures screening for down's syndrome

Objective To demonstrate the potential value of screening for Down's Syndrome using highly correlated repeated measures of serum markers taken in the first and second trimesters of pregnancy. Design A Monte Carlo simulation study. Population Detection rates and false positive rates relating to the maternal age distribution of England and Wales for the period 1996 to 1998 were obtained using marker distributions from the SURUSS study. Results Screening using first trimester nuchal translucency and repeated measures of uE3 and PAPP-A in the first and second trimester has an estimated false positive rate of 0.3% for an 85% detection rate. This should be compared with the integrated test with an estimated false positive rate of 1.2% for the same detection rate. Conclusionsâ?? The performance of repeated measures screening tests, and their acceptability to women, should be assessed in further prospective studies.

Simple models of complex aggregation: Vesicle formation by soft repulsive spheres with dipolelike interactions

Structural and thermodynamic properties of spherical particles carrying classical spins are investigated by Monte Carlo simulations. The potential energy is the sum of short range, purely repulsive pair contributions, and spin-spin interactions. These last are of the dipole-dipole form, with however, a crucial change of sign. At low density and high temperature the system is a homogeneous fluid of weakly interacting particles and short range spin correlations. With decreasing temperature particles condense into an equilibrium population of free floating vesicles. The comparison with the electrostatic case, giving rise to predominantly one-dimensional aggregates under similar conditions, is discussed. In both cases condensation is a continuous transformation, provided the isotropic part of the interatomic potential is purely repulsive. At low temperature the model allows us to investigate thermal and mechanical properties of membranes. At intermediate temperatures it provides a simple model to investigate equilibrium polymerization in a system giving rise to predominantly two-dimensional aggregates.

The Effect of Volume Shape Factor on the Crystal Size Distribution of Fragments due to Attrition

The effect of volume shape factor on crystal size distribution (CSD) is usually ignored to simplify the analysis of population balance equation. In the present work, the CSD of fragments generated from a mechanically stirred crystallizer as the result of attrition mechanism has been reported when the volume shape factor conforms to normal distribution. The physical model of GAHN and MERSMANN which relates the attrition resistance of a crystalline substances to its mechanical properties has been employed. The simulation of fragment size distribution was performed by Monte Carlo (MC) technique. The results are compared with those reported by GAHN and MERSMANN.

Estimating the masses of extra-solar planets

All extra-solar planet masses that have been derived spectroscopically are lower limits since the inclination of the orbit to our line-of-sight is unknown except for transiting systems. In theory, however, it is possible to determine the inclination angle, i, between the rotation axis of a star and an observer's line-of-sight from measurements of the projected equatorial velocity (v sin i), the stellar rotation period (P(rot)) and the stellar radius (R(*)). For stars which host planetary systems this allows the removal of the sin i dependency of extra-solar planet masses derived from spectroscopic observations under the assumption that the planetary orbits lie perpendicular to the stellar rotation axis.
We have carried out an extensive literature search and present a catalogue of v sin i, P(rot) and R(*) estimates for stars hosting extra-solar planets. In addition, we have used Hipparcos parallaxes and the Barnes-Evans relationship to further supplement the R(*) estimates obtained from the literature. Using this catalogue, we have obtained sin i estimates using a Markov-chain Monte Carlo analysis. This technique allows proper 1 Sigma two-tailed confidence limits to be placed on the derived sin i's along with the transit probability for each planet to be determined.
While we find that a small proportion of systems yield sin i's significantly greater than 1, most likely due to poor P(rot) estimations, the large majority are acceptable. We are further encouraged by the cases where we have data on transiting systems, as the technique indicates inclinations of similar to 90 degrees and high transit probabilities. In total, we are able to estimate the true masses of 133 extra-solar planets. Of these 133 extra-solar planets, only six have revised masses that place them above the 13M(J) deuterium burning limit; four of those six extra-solar planet candidates were already suspected to lie above the deuterium burning limit before correcting their masses for the sin i dependency. Our work reveals a population of high-mass extra-solar planets with low eccentricities, and we speculate that these extra-solar planets may represent the signature of different planetary formation mechanisms at work. Finally, we discuss future observations that should improve the robustness of this technique.

High-contrast imaging search for planets and brown dwarfs around the most massive stars in the solar neighborhood

There has been a long-standing discussion in the literature as to whether core accretion or disk instability is the dominant mode of planet formation. Over the last decade, several lines of evidence have been presented showing that core accretion is most likely the dominant mechanism for the close-in population of planets probed by radial velocity and transits. However, this does not by itself prove that core accretion is the dominant mode for the total planet population, since disk instability might conceivably produce and retain large numbers of planets in the far-out regions of the disk. If this is a relevant scenario, then the outer massive disks of B-stars should be among the best places for massive planets and brown dwarfs to form and reside. In this study, we present high-contrast imaging of 18 nearby massive stars of which 15 are in the B2-A0 spectral-type range and provide excellent sensitivity to wide companions. By comparing our sensitivities to model predictions of disk instability based on physical criteria for fragmentation and cooling, and using Monte Carlo simulations for orbital distributions, we find that ~85% of such companions should have been detected in our images on average. Given this high degree of completeness, stringent statistical limits can be set from the null-detection result, even with the limited sample size. We find that

Three-dimensional pure deflagration models with nucleosynthesis and synthetic observables for type ia supernovae

We investigate whether pure deflagration models ofChandrasekhar-mass carbon-oxygen white dwarf stars can account for one or more subclass of the observed population of Type Ia supernova (SN Ia) explosions. We compute a set of 3D full-star hydrodynamic explosion models, in which the deflagration strength is parametrized using the multispot ignition approach. For each model, we calculate detailed nucleosynthesis yields in a post-processing step with a 384 nuclide nuclear network. We also compute synthetic observables with our 3D Monte Carlo radiative transfer code for comparison with observations. For weak and intermediate deflagration strengths (energy release E {less-than or approximate} 1.1 × 10 erg), we find that the explosion leaves behind a bound remnant enriched with 3 to 10 per cent (by mass) of deflagration ashes. However, we do not obtain the large kick velocities recently reported in the literature. We find that weak deflagrations with E ~ 0.5 × 10 erg fit well both the light curves and spectra of 2002cx-like SNe Ia, and models with even lower explosion energies could explain some of the fainter members of this subclass. By comparing our synthetic observables with the properties of SNe Ia, we can exclude the brightest, most vigorously ignited models as candidates for any observed class of SN Ia: their B-V colours deviate significantly from both normal and 2002cx-like SNe Ia and they are too bright to be candidates for other subclasses.

Design of a compact spectrometer for high-flux MeV gamma-ray beams

A novel design for a compact gamma-ray spectrometer is presented. The proposed system allows for spectroscopy of high-flux multi-MeV gamma-ray beams with MeV energy resolution in a compact design. In its basic configuration, the spectrometer exploits conversion of gamma-rays into electrons via Compton scattering in a low-Z material. The scattered electron population is then spectrally resolved using a magnetic spectrometer. The detector is shown to be effective for gamma-ray energies between 3 and 20 MeV. The main properties of the spectrometer are confirmed by Monte Carlo simulations.

IMRT for image-guided single vocal cord irradiation

PURPOSE: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques.

METHODS AND MATERIALS: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions.

RESULTS: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose ± standard deviation to the planning target volume was 67 ± 1 Gy. The contralateral vocal cord dose was reduced from 66 ± 1 Gy in the conventional plans to 39 ± 8 Gy and 36 ± 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk.

CONCLUSIONS: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

Aplicação de métodos de customer relationship management ao tratamento de dados para o desenvolvimento de negócios

Tese de Doutoramento, Gestão, na especialidade de Marketing, Faculdade de Economia, Universidade do Algarve, 2007

Comparing impact and cost-effectiveness of primary prevention strategies for lipid-lowering.

BACKGROUND: Lipid-lowering therapy is costly but effective at reducing coronary heart disease (CHD) risk. OBJECTIVE: To assess the cost-effectiveness and public health impact of Adult Treatment Panel III (ATP III) guidelines and compare with a range of risk- and age-based alternative strategies. DESIGN: The CHD Policy Model, a Markov-type cost-effectiveness model. DATA SOURCES: National surveys (1999 to 2004), vital statistics (2000), the Framingham Heart Study (1948 to 2000), other published data, and a direct survey of statin costs (2008). TARGET POPULATION: U.S. population age 35 to 85 years. Time Horizon: 2010 to 2040. PERSPECTIVE: Health care system. INTERVENTION: Lowering of low-density lipoprotein cholesterol with HMG-CoA reductase inhibitors (statins). OUTCOME MEASURE: Incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Full adherence to ATP III primary prevention guidelines would require starting (9.7 million) or intensifying (1.4 million) statin therapy for 11.1 million adults and would prevent 20,000 myocardial infarctions and 10,000 CHD deaths per year at an annual net cost of $3.6 billion ($42,000/QALY) if low-intensity statins cost $2.11 per pill. The ATP III guidelines would be preferred over alternative strategies if society is willing to pay $50,000/QALY and statins cost $1.54 to $2.21 per pill. At higher statin costs, ATP III is not cost-effective; at lower costs, more liberal statin-prescribing strategies would be preferred; and at costs less than $0.10 per pill, treating all persons with low-density lipoprotein cholesterol levels greater than 3.4 mmol/L (>130 mg/dL) would yield net cost savings. RESULTS OF SENSITIVITY ANALYSIS: Results are sensitive to the assumptions that LDL cholesterol becomes less important as a risk factor with increasing age and that little disutility results from taking a pill every day. LIMITATION: Randomized trial evidence for statin effectiveness is not available for all subgroups. CONCLUSION: The ATP III guidelines are relatively cost-effective and would have a large public health impact if implemented fully in the United States. Alternate strategies may be preferred, however, depending on the cost of statins and how much society is willing to pay for better health outcomes. FUNDING: Flight Attendants' Medical Research Institute and the Swanson Family Fund. The Framingham Heart Study and Framingham Offspring Study are conducted and supported by the National Heart, Lung, and Blood Institute.

Decision analysis of the effectiveness of lung cancer screening using autofluorescence bronchoscopy and computed tomography

Background: Lung cancer (LC) is the leading cause of cancer death in the developed world. Most cancers are associated with tobacco smoking. A primary hope for reducing lung cancer has been prevention of smoking and successful smoking cessation programs. To date, these programs have not been as successful as anticipated. Objective: The aim of the current study was to evaluate whether lung cancer screening combining low dose computed tomography with autofluorescence bronchoscopy (combined CT & AFB) is superior to CT or AFB screening alone in improving lung cancer specific survival. In addition, the extent of improvement and ideal conditions for combined CT & AFB screening were evaluated. Methods: We applied decision analysis and Monte Carlo simulation modeling using TreeAge Software to evaluate our study aims. Histology- and stage specific probabilities of lung cancer 5-year survival proportions were taken from Surveillance and Epidemiologic End Results (SEER) Registry data. Screeningassociated data was taken from the US NCI Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), National Lung Screening Trial (NLST), and US NCI Lung Screening Study (LSS), other relevant published data and expert opinion. Results: Decision Analysis - Combined CT and AFB was the best approach at Improving 5-year survival (Overall Expected Survival (OES) in the entire screened population was 0.9863) and in lung cancer patients only (Lung Cancer Specific Expected Survival (LOSES) was 0.3256). Combined screening was slightly better than CT screening alone (OES = 0.9859; LCSES = 0.2966), and substantially better than AFB screening alone (OES = 0.9842; LCSES = 0.2124), which was considerably better than no screening (OES = 0.9829; LCSES = 0.1445). Monte Carlo simulation modeling revealed that expected survival in the screened population and lung cancer patients is highest when screened using CT and combined CT and AFB. CT alone and combined screening was substantially better than AFB screening alone or no screening. For LCSES, combined CT and AFB screening is significantly better than CT alone (0.3126 vs. 0.2938, p< 0.0001). Conclusions: Overall, these analyses suggest that combined CT and AFB is slightly better than CT alone at improving lung cancer survival, and both approaches are substantially better than AFB screening alone or no screening.