Cost-effectiveness of Tenofovir / Emtricitabine / Efavirenz versus Zidovudine / Lamivudine / Efavirenz as fist-line regimens for the treatment of HIV-infected patients in low-income settings

The Highly Active Antiretroviral Therapy (HAART) is the combination of at least three antiretroviral compounds. The combination purpose is to reduce the likelihood of drug resistance. However in the long-term the resistance to the first-line combination occurs and leads to treatment failure. Thus, a second-line and even a third-line regimen are recommended in the long run. [...] [P. 5] The two treatment alternatives under comparison: Tenofovir (300 mg) CO-formulated with Emtricitabine (200 mg) and Efavirenz (600 mg) currently known under the brand name Atripla (R) was introduced in July 2006 in the United States market. The excellent safety profile and ease of use make this combination a perfect first-line regimen in low-income settings. Therefore, this treatment option was recommended in WHO 2006 reviewed guidelines. Unfortunately, Tenofovir and Emtricitabine compounds are still costly and not yet widely available. For a matter of simplification this regimen is referred in this report as "the recent" therapy. Initially, we had in mind to consider the most frequently used first-line regimen in low-income countries (Stavudine / Larnivudme / Nevirapine) as a comparator for this economic evaluation. Unfortunately, according to the literature review results (see Annex 3); there was no data available comparing head to head the effectiveness of this regimen with the recent one. Instead, we selected a less frequently but commonly used first-line regimen in low-income countries as a comparator: Zidovudine, Lamivudine, Efavirenz. This combination has extensive experience in durability, safety and toxicity and seems to be an optimal choice for a first-line regimen according to the clinical trial group 384 team. Furthermore, Zidovudine, one of the compounds of this combination is now recommended as one of the preferred NNRTI [Non Nucleoside Reverse Transcriptase Inhibitors] options to be considered by countries instead of Stavudine (the most used NNRTI in limited-income countries). As this combination has been included in the WHO guidelines as a first-line therapy since 2003 when WHO launched the "3 by 5" scaling-up initiative, this combination of drugs is referred in this report as the "old" therapy. Objectives: The primary objective of this economic evaluation is to compare the two first-line HAARTs introduced above, in a low-income setting context. Both of these combinations are recommended by the 2006 WHO guidelines as potential first-line regimens. The secondary objective is to provide a simplified and comprehensible cost-effectiveness modeling tool in order to help policy makers, in resource-limited settings, make decisions about which first-line HAART to fund using the scarce resources available. [P. 6-7]

Optimization of OSEM parameters in myocardial perfusion imaging reconstruction as a function of body mass index: a clinical approach

AbstractObjective:The present study is aimed at contributing to identify the most appropriate OSEM parameters to generate myocardial perfusion imaging reconstructions with the best diagnostic quality, correlating them with patients' body mass index.Materials and Methods:The present study included 28 adult patients submitted to myocardial perfusion imaging in a public hospital. The OSEM method was utilized in the images reconstruction with six different combinations of iterations and subsets numbers. The images were analyzed by nuclear cardiology specialists taking their diagnostic value into consideration and indicating the most appropriate images in terms of diagnostic quality.Results:An overall scoring analysis demonstrated that the combination of four iterations and four subsets has generated the most appropriate images in terms of diagnostic quality for all the classes of body mass index; however, the role played by the combination of six iterations and four subsets is highlighted in relation to the higher body mass index classes.Conclusion:The use of optimized parameters seems to play a relevant role in the generation of images with better diagnostic quality, ensuring the diagnosis and consequential appropriate and effective treatment for the patient.

Timing of visual stimuli in V1 and V5/MT: fMRI and TMS

Time perception is used in our day-to-day activities. While we understand quite well how our brain processes vision, touch or taste, brain mechanisms subserving time perception remain largely understudied. In this study, we extended an experiment of previous master thesis run by Tatiana Kenel-Pierre. We focused on time perception in the range of milliseconds. Previous studies have demonstrated the involvement of visual areas V1 and V5/MT in the encoding of temporal information of visual stimuli. Based on these previous findings the aim of the present study was to understand if temporal information was encoded in V1 and extrastriate area V5/MT in different spatial frames i.e., head- centered versus eye-centered. To this purpose we asked eleven healthy volunteers to perform a temporal discrimination task of visual stimuli. Stimuli were presented at 4 different spatial positions (i.e., different combinations of retinotopic and spatiotopic position). While participants were engaged in this task we interfered with the activity of the right dorsal V1 and the right V5/MT with transcranial magnetic stimulation (TMS). Our preliminary results showed that TMS over both V1 and V5/MT impaired temporal discrimination of visual stimuli presented at specific spatial coordinates. But whereas TMS over V1 impaired temporal discrimination of stimuli presented in the lower left quadrant, TMS over V5/MT affected temporal discrimination of stimuli presented at the top left quadrant. Although it is always difficult to draw conclusions from preliminary results, we could tentatively say that our data seem to suggest that both V1 and V5/MT encode visual temporal information in specific spatial frames.

Measuring the effects through time of the influence of visuomotor and visuotactile synchronous stimulation on a virtual body ownership illusion

Previous studies have examined the experience of owning a virtual surrogate body or body part through specific combinations of cross-modal multisensory stimulation. Both visuomotor (VM) and visuotactile (VT) synchronous stimulation have been shown to be important for inducing a body ownership illusion, each tested separately or both in combination. In this study we compared the relative importance of these two cross-modal correlations, when both are provided in the same immersive virtual reality setup and the same experiment. We systematically manipulated VT and VM contingencies in order to assess their relative role and mutual interaction. Moreover, we present a new method for measuring the induced body ownership illusion through time, by recording reports of breaks in the illusion of ownership ("breaks") throughout the experimental phase. The balance of the evidence, from both questionnaires and analysis of the breaks, suggests that while VM synchronous stimulation contributes the greatest to the attainment of the illusion, a disruption of either (through asynchronous stimulation) contributes equally to the probability of a break in the illusion.

Determinação de fósforo orgânico em águas de produção petrolífera por ICP- AES e ICP- MS após pré-concentração em coluna de sílica-C18

Results on the optimization of analytical methods for the determination of phosphorus in phosphino-polycarboxylate (PPCA), used frequently as scale inhibitor during oil production, by ICP-AES and ICP-MS are presented. Due to the complex matrix of production waters (brines) and their high concentration in inorganic phosphorus, the separation of organic phosphorus prior to its determination is necessary. In this work, minicolumns of silica immobilized C18 were used. Optimization of the separation step resulted in the following working conditions: (1) prewashing of the column with methanol (80% v/v); (2) use of a flow rate of 5 mL/min and 10 mL/min, respectively, for the preconditioning step and for percolation of the water sample; (3) final elution of organic phosphorus with 7 mL of buffer of H3BO3/NaOH (0.05 M, pH 9) with a flow rate of 1 mL/min. Sample detection limits (3s) for different combinations of nebulizers and spectrometric methods, based on 10 mL water aliquots, are: ICP-AES -Cross flow (47 mg/L) and Ultrasonic (18 mug/L); ICP-MS -Cross flow (1.2 mug/L), Cyclonic (0.7 mug/L) and Ultrasonic (0.5 mug/L). Typical recoveries of organic phosphorus are between 90 and 95% and the repeatability of the whole procedure is better than 10%. The developed methodology was applied successfully to samples from the oil-well NA 46, platform PNA 2, Campos basin, Brazil. Assessment of the PPCA inhibitor was possible at lower concentrations than achieved by current analytical methods, resulting in benefits such as reduced cost of chemicals, postponed oil production and lower environmental impacts.

Strategiatyö pienissä ja keskisuurissa kasvuyrityksissä Kouvolan seudulla

Tutkimuksen tarkoituksena oli kuvata ja ymmärtää, millaista strategiatyö on pienissä ja keskisuurissa kasvuyrityksissä ja miten sitä voitaisiin kehittää. Strategiatyötä ovat ne toimet, joita yritysten strategit tekevät strategiaprosessissa. Kirjallisuuskatsauksessa määriteltiin käsitteet ja teoreettinen viitekehys. Empiriassa kerättiin Kouvolan seudun kasvuyritysten strategeilta aineistoa lomakekyselyllä. Kahdeksan yrityksen strategeja, yrittäjäomistajia, haastattelemalla syvennettiin aineistoa. Aineiston laadullisella analyysillä tuotettiin vastaukset tutkimuskysymyksiin. Kahdessa kolmesta kohdeyrityksestä strategiatyö oli melko vakiintunutta. Strategiatyön avulla yrittäjät pyrkivät löytämään keinot hyödyntää markkinoilla havaitut mahdollisuudet ja muodostamaan tarvittavat resurssiyhdistelmät. Strategiatyö ei noudattanut selkeää, määritettyä prosessia. Strategian muotoutuminen, jalkauttaminen ja arviointi olivat strategiatyön osat, jotka olivat vuorovaikutuksessa strategin strategiajärkeilyn kautta. Strategiaa pidettiin yrityksen menestymisessä ja kasvussa tärkeänä tekijänä. Pk-kasvuyritykset ovat seudun tulevaisuuden kannalta niin tärkeä yritysryhmä, että niiden strategiatyötä olisi perusteltua kehittää yrityspalvelun toimesta ja panostuksilla.

Seisokkien aiheuttamat kustannukset ja tulonmenetykset ongelma- ja yhdyskuntajätteen termisessä käsittelyssä

Tämän opinnäytetyön tarkoituksena oli selvittää seisokkitunnista aiheutuvat kustannukset ja tulonmenetykset eri polttolinjoille ja niiden kombinaatioille Ekokem Oy Ab:n jätteenpolttolaitoksessa. Työ suoritettiin tarkastelemalla prosessitietokantaan tallentunutta tietoa sekä keräämällä tietoa haastatteluilla. Jätetulon menetyksen määrittelytavalla oli keskeinen vaikutus tulonmenetysten muodostumiseen. Muita kustannuksiin ja tulonmenetyksiin vaikuttavia tekijöitä olivat vuodenaika, seisokin pituus ja energiantoimituksen sopimukset. Kaikissa seisokeissa ei välttämättä aiheudu välitöntä jätetulon menetystä, mutta käsittelemättä jäävän jätteen voidaan silti nähdä aiheuttavan tilapäisvarastoinnin tarvetta, josta aiheutuu kustannuksia. Tämän vuoksi eri polttolinjojen jätetulon menetys laskettiin kahdella tavalla olettaen ensin kaiken polttamatta jäävän jätteen aiheuttavan jätetulon menetystä sekä siten, että jätetulon menetys ja mahdollisesta varastoinnista aiheutuvat kustannukset arvioitiin kokemusperäisesti. Jätetulon todellisten menetysten määräytyminen voi tapahtua kummalla tavalla hyvänsä riippuen seisokkihetkellä vallitsevista olosuhteista. Kustannukset ja tulonmenetykset laskettiin kolmelle eripituiselle ajanjaksolle ja jaettiin tuntihinnoiksi. Työssä käsitellyille eri seisokkitilanteille saatiin 131 eri tuntihintaa kun muuttujia vaihdeltiin. Suurimmat kustannukset ja tulonmenetykset muodostuivat jätevoimalan seisokista lämmityskaudella. Tämä johtui siitä, että jätevoimalassa poltettavaa yhdyskuntajätettä ei pystytä varastoimaan toisin kuin ongelmajätteitä. Jätevoimalan seisokkitunti voi lämmityskaudella maksaa enimmillään 2600 €/h, josta menetetyn jätetulon osuus on liki puolet. Lisäksi jätevoimalan höyryntuotanto on yli puolet kokonaistuotannosta.

Seleção de variáveis em QSAR

The process of building mathematical models in quantitative structure-activity relationship (QSAR) studies is generally limited by the size of the dataset used to select variables from. For huge datasets, the task of selecting a given number of variables that produces the best linear model can be enormous, if not unfeasible. In this case, some methods can be used to separate good parameter combinations from the bad ones. In this paper three methodologies are analyzed: systematic search, genetic algorithm and chemometric methods. These methods have been exposed and discussed through practical examples.

Use of the Optical Cantilever Microphone in Photoacoustic Spectroscopy

A novel cantilever pressure sensor was developed in the Department of Physics at the University of Turku in order to solve the sensitivity problems which are encountered when condenser microphones are used in photoacoustic spectroscopy. The cantilever pressure sensor, combined with a laser interferometer for the measurement of the cantilever movements, proved to be highly sensitive. The original aim of this work was to integrate the sensor in a photoacoustic gas detector working in a differential measurement scheme. The integration was made successfully into three prototypes. In addition, the cantilever was also integrated in the photoacoustic FTIR measurement schemes of gas-, liquid-, and solid-phase samples. A theoretical model for the signal generation in each measurement scheme was created and the optimal celldesign discussed. The sensitivity and selectivity of the differential method were evaluated when a blackbody radiator and a mechanical chopper were used with CO₂, CH4, CO, and C2H4 gases. The detection limits were in the sub-ppm level for all four gases with only a 1.3 second integration time and the cross interference was well below one percent for all gas combinations other than those between hydrocarbons. Sensitivity with other infrared sources was compared using ethylene as an example gas. In the comparison of sensitivity with different infrared sources the electrically modulated blackbody radiator gave a 35 times higher and the CO2-laser a 100 times lower detection limit than the blackbody radiator with a mechanical chopper. As a conclusion, the differential system is well suited to rapid single gas measurements. Gas-phase photoacoustic FTIR spectroscopy gives the best performance, when several components have to be analyzed simultaneously from multicomponent samples. Multicomponent measurements were demonstrated with a sample that contained different concentrations of CO₂, H₂O, CO, and four different hydrocarbons. It required an approximately 10 times longer measurement time to achieve the same detection limit for a single gas as with the differential system. The properties of the photoacoustic FTIR spectroscopy were also compared to conventional transmission FTIR spectroscopy by simulations. Solid- and liquid-phase photoacoustic FTIR spectroscopy has several advantages compared to other techniques and therefore it also has a great variety of applications. A comparison of the signal-to-noise ratio between photoacoustic cells with a cantilever microphone and a condenser microphone was done with standard carbon black, polyethene, and sunflower oil samples. The cell with the cantilever microphone proved to have a 5-10 times higher signal-to-noise ratio than the reference detector, depending on the sample. Cantilever enhanced photoacoustics will be an effective tool for gas detection and analysis of solid- and liquid-phase samples. The preliminary prototypes gave good results in all three measurement schemes that were studied. According to simulations, there are possibilities for further enhancement of the sensitivity, as well as other properties, of each system.

Development of power flows around Baltic countries with new grid links

In the Thesis main focus is done on power flow development paths around the Baltic States as well as on market-based requirements for creation of the common Baltic electricity market. Current market regulations between the countries are presented; barriers for creating competitive common Baltic power market and for electricity trading with third countries are clarified; solutions are offered and corresponding road map is developed. Future power development paths around the Baltic States are analysed. For this purpose the 330 kV transmission grid of Estonia, Latvia and Lithuania is modelled in a power flow tool. Power flow calculations are carried out for winter and summer peak and off-peak load periods in 2020 with different combinations of interconnections. While carrying out power balance experiments several power flow patterns in the Baltic States are revealed. Conclusions are made about security of supply, grid congestion and transmission capacity availability for different scenarios.

On the effects of welding parameters on weld quality of plasma arc keyhole welding of structural steels

The possibility and the usefulness of applying plasma keyhole welding to structural steels with different compositions and material thicknesses, and in various welding positions has been examinated. Single pass butt welding with I groove in flat, horizontal vertical and vertical positions and root welding with V , Y and U grooves of thick plate material in flat position have been studied and the welds with high quality has been obtained. The technological conditions for successful welding are presented. The single and interactive effects of welding parameters on weld quality, especially on surface weld defects, geometrical form errors, internal defects and mechanical properties (strength, ductility, impact toughness, hardness and bendability) of weld joint, are presented. Welding parameter combinations providing the best quality welds are also presented.

Shout and Act: an Algorithm for Digital Objects Preservation Inspired from Rescue Robots

We adapt the Shout and Act algorithm to Digital Objects Preservation where agents explore file systems looking for digital objects to be preserved (victims). When they find something they “shout” so that agent mates can hear it. The louder the shout, the urgent or most important the finding is. Louder shouts can also refer to closeness. We perform several experiments to show that this system works very scalably, showing that heterogeneous teams of agents outperform homogeneous ones over a wide range of tasks complexity. The target at-risk documents are MS Office documents (including an RTF file) with Excel content or in Excel format. Thus, an interesting conclusion from the experiments is that fewer heterogeneous (varying skills) agents can equal the performance of many homogeneous (combined super-skilled) agents, implying significant performance increases with lower overall cost growth. Our results impact the design of Digital Objects Preservation teams: a properly designed combination of heterogeneous teams is cheaper and more scalable when confronted with uncertain maps of digital objects that need to be preserved. A cost pyramid is proposed for engineers to use for modeling the most effective agent combinations

Biodiesel de soja: taxa de conversão em ésteres etílicos, caracterização físico-química e consumo em gerador de energia

Biodiesel was produced by the transesterification of neutral soybean oil and anhydrous ethanol using NaOH as catalyst. Combinations of biodiesel and diesel in the proportions of 0, 5, 10, 20, 40, 60, 80 and 100% were tested, respectively, as fuel in an energy generator. The average consumption and mixture performance were analysed. The tests showed a reduction in Diesel oil consumption when mixed with up to 20% of biodiesel. The quality characteristics of these fuels were analyzed.

An analytic approach to distribution logistics strategic management

Logistics management is increasingly being recognised by many companies to be of critical concern. The logistics function includes directly or indirectly many of the new areas for achieving or maintaining competitive advantage that companies have been forced to develop due to increasing competitive pressures. The key to achieving a competitive advantage is to manage the logistics function strategically which involves determining the most cost effective method of providing the necessary customer service levels from the many combinations of operating procedures in the areas of transportation, warehousing, order processing and information systems, production, and inventory management. In this thesis, a comprehensive distribution logistics strategic management process is formed by integrating the periodic strategic planning process with a continuous strategic issues management process. Strategic planning is used for defining the basic objectives for a company and assuring co operation and synergy between the different functions of a company while strategic issues management is used on a continuous basis in order to deal with environmental and internal turbulence. The strategic planning subprocess consists of the following main phases: (1) situational analyses, (2) defining the vision and strategic goals for the logistics function, (3) determining objectives and strategies, (4) drawing up tactical action plans, and (5) evaluating the implementation of the plans and making the needed adjustments. The aim of the strategic issues management subprocess is to continuously scan the environment and the organisation for early identification of the issues having a significant impact on the logistics function using the following steps: (1) the identification of trends, (2) assessing the impact and urgency of the identified trends, (3) assigning priorities to the issues, and (4) planning responses to the, issues. The Analytic Hierarchy Process (AHP) is a systematic procedure for structuring any problem. AHP is based on the following three principles: decomposition, comparative judgements, and synthesis of priorities. AHP starts by decomposing a complex, multicriteria problem into a hierarchy where each level consists of a few manageable elements which are then decomposed into another set of elements. The second step is to use a measurement methodology to establish priorities among the elements within each level of the hierarchy. The third step in using AHP is to synthesise the priorities of the elements to establish the overall priorities for the decision alternatives. In this thesis, decision support systems are developed for different areas of distribution logistics strategic management by applying the Analytic Hierarchy Process. The areas covered are: (1) logistics strategic issues management, (2) planning of logistic structure, (3) warehouse site selection, (4) inventory forecasting, (5) defining logistic action and development plans, (6) choosing a distribution logistics strategy, (7) analysing and selecting transport service providers, (8) defining the logistic vision and strategic goals, (9) benchmarking logistic performance, and (10) logistic service management. The thesis demonstrates the potential of AHP as a systematic and analytic approach to distribution logistics strategic management.

Private micro-irrigation costs using reclaimed water

The cost of reusing water in micro-irrigation at the field level has not been studied in depth although the use of effluents in agriculture is a viable alternative in areas where water is scarce or there is intense competition for its use. The aim of the present study is to analyse the private costs of water reuse in micro-irrigation in an experimental plot. This analysis is intended to provide information about the decision a farmer would make when the choice to use conventional or reclaimed water is guided by cost criteria. The components of the total costs of different combinations of four types of filters and five emitters that can be installed in micro-irrigation systems using reclaimed water have been studied with the data obtained from an experimental plot in conditions similar to those of fruit orchards. Different scenarios that compared the costs of using conventional or reclaimed water in terms of water price and nutrient content were also studied. The results show that a proper combination of filters and emitters can save up to 33% in irrigation costs. Capital costs and maintenance costs were the most variable among the different combinations. Scenario analysis showed that the greater price of reclaimed water could be compensated by high nutrient contents, which would reduce fertilizer costs