Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

Background:Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial.Objective:To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective.Methods:We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied.Results:Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios.Conclusions:Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

Can climate shape flight activity patterns of Plebeia remota Hymenoptera, Apidae)?

Flight activity of foragers of four colonies of Plebeia remota (Holmberg, 1903) was registered from December 1998 to December 1999, using an automated system (photocells and PLC system). The colonies originated from two different regions: Cunha, state of São Paulo, and Prudentópolis, state of Paraná, Brazil. Flight activity was influenced by different climatic factors in each season. In the summer, the intensity of the correlations between flight activity and climatic factors was smaller than in the other seasons. During the autumn and winter, solar radiation was the factor that most influenced flight activity, while in the spring, this activity was influenced mainly by temperature. Except in the summer, the various climatic factors similarly influenced flight activity of all of the colonies. Flight activity was not affected by geographic origin of the colonies. Information concerning seasonal differences in flight activity of P. remota will be useful for prediction of geographic distribution scenarios under climatic changes.

Climate and land-use changes effects on the distribution of a regional endemism: Melanophryniscus sanmartini (Amphibia, Bufonidae)

ABSTRACT Amphibians are the most threatened vertebrate group according to the IUCN. Land-use and land cover change (LULCC) and climate change (CC) are two of the main factors related to declining amphibian populations. Given the vulnerability of threatened and rare species, the study of their response to these impacts is a conservation priority. The aim of this work was to analyze the combined impact of LULCC and CC on the regionally endemic species Melanophryniscus sanmartini Klappenbach, 1968. This species is currently categorized as near threatened by the IUCN, and previous studies suggest negative effects of projected changes in climate. Using maximum entropy methods we modeled the effects of CC on the current and mid-century distribution of M. sanmartini under two IPCC scenarios - A2 (severe) and B2 (moderate). The effects of LULCC were studied by superimposing the potential distribution with current land use, while future distribution models were evaluated under the scenario of maximum expansion of soybean and afforestation in Uruguay. The results suggest that M. sanmartini is distributed in eastern Uruguay and the south of Brazil, mainly related to hilly and grasslands systems. Currently more than 10% of this species' distribution is superimposed by agricultural crops and exotic forest plantations. Contrasting with a recent modelling study our models suggest an expansion of the distribution of M. sanmartini by mid-century under both climate scenarios. However, despite the rise in climatically suitable areas for the species in the future, LULCC projections indicate that the proportion of modified habitats will occupy up to 25% of the distribution of M. sanmartini. Future change in climate conditions could represent an opportunity for M. sanmartini, but management measures are needed to mitigate the effects of habitat modification in order to ensure its survival and allow the eventual expansion of its distribution.

Implementing a double dividend: recycling ecotaxes towards lower labour taxes

In this paper we follow the tradition of applied general equilibrium modelling of the Walrasian static variety to study the empirical viability of a double dividend (green, welfare, and employment) in the Spanish economy. We consider a counterfactual scenario in which an ecotax is levied on the intermediate and final use of energy goods. Under a revenue neutral assumption, we evaluate the real income and employment impact of lowering payroll taxes. To appraise to what extent the model structure and behavioural assumptions may influence the results, we perform simulations under a range of alternative model and policy scenarios. We conclude that a double dividend –better environmental quality, as measured by reduced CO2 emissions, and improved levels of employment– may be an achievable goal of economic policy.

Bidding for the surplus: realizing efficient outcomes in general economic environments

In this paper, we consider two classes of economic environments. In the first type, agents are faced with the task of providing local public goods that will benefit some or all of them. In the second type, economic activity takes place via formation of links. Agents need both to both form a network and decide how to share the output generated. For both scenarios, we suggest a bidding mechanism whereby agents bid for the right to decide upon the organization of the economic activity. The subgame perfect equilibria of this game generate efficient outcomes.

In whose backyard? A generalized bidding approach

We analyze situations in which a group of agents (and possibly a designer) have to reach a decision that will affect all the agents. Examples of such scenarios are the location of a nuclear reactor or the siting of a major sport event. To address the problem of reaching a decision, we propose a one-stage multi-bidding mechanism where agents compete for the project by submitting bids. All Nash equilibria of this mechanism are efficient. Moreover, the payoffs attained in equilibrium by the agents satisfy intuitively appealing lower bounds..

Optimal monitoring to implement clean technologies when pollution is random

We analyze a model where firms chose a production technology which, together with some random event, determines the final emission level. We consider the coexistence of two alternative technologies: a "clean" technology, and a "dirty" technology. The environmental regulation is based on taxes over reported emissions, and on penalties over unreported emissions. We show that the optimal inspection policy is a cut-off strategy, for several scenarios concerning the observability of the adoption of the clean technology and the cost of adopting it. We also show that the optimal inspection policy induces the firm to adopt the clean technology if the adoption cost is not too high, but the cost levels for which the firm adopts it depend on the scenario.

Non-hyperbolic boundary equilibrium bifurcations in planar Filippov systems: a case study approach

Boundary equilibrium bifurcations in piecewise smooth discontinuous systems are characterized by the collision of an equilibrium point with the discontinuity surface. Generically, these bifurcations are of codimension one, but there are scenarios where the phenomenon can be of higher codimension. Here, the possible collision of a non-hyperbolic equilibrium with the boundary in a two-parameter framework and the nonlinear phenomena associated with such collision are considered. By dealing with planar discontinuous (Filippov) systems, some of such phenomena are pointed out through specific representative cases. A methodology for obtaining the corresponding bi-parametric bifurcation sets is developed.

Equity and CO2 emissions distribution in climate change integrated assessment

Emissions distribution is a focus variable for the design of future international agreements to tackle global warming. This paper specifically analyses the future path of emissions distribution and its determinants in different scenarios. Whereas our analysis is driven by tools which are typically applied in the income distribution literature and which have recently been applied to the analysis of CO2 emissions distribution, a new methodological approach is that our study is driven by simulations run with a popular regionalised optimal growth climate change model over the 1995-2105 period. We find that the architecture of environmental policies, the implementation of flexible mechanisms and income concentration are key determinants of emissions distribution over time. In particular we find a robust positive relationship between measures of inequalities.

An application of MSIASM to Chinese exosomatic energy metabolism

The methodology of Multi-Scale Integrated The methodology of Multi-Scale Integrated Analysis of Societal Metabolism (MSIASM) is applied to analyze the Chinese economy. This paper presents four tasks: (i) identifying a set of benchmarks that makes it possible to compare various characteristics of the Chinese economy with those of other country groups and the world (level) average; (ii) explaining the differences over the selected set of benchmarks, by looking at the characteristics of the various sub-sectors of the Chinese economy; (iii) understanding existing trends and future feasible future development paths for China by studying the existence of reciprocal constraints between the whole economy and its sub-sectors; and (iv) examining plausible future scenarios of development.

Preliminary study of cooperation in hybrid ad-hoc networks

In this paper, we present a first approach to evolve a cooperative behavior in ad hoc networks. Since wireless nodes are energy constrained, it may not be in the best interest of a node to always accept relay requests. On the other hand, if all nodes decide not to expend energy in relaying, then network throughput will drop dramatically. Both these extreme scenarios are unfavorable to the interests of a user. In this paper we deal with the issue of user cooperation in ad hoc networks by developing the algorithm called Generous Tit-For-Tat. We assume that nodes are rational, i.e., their actions are strictly determined by self-interest, and that each node is associated with a minimum lifetime constraint. Given these lifetime constraints and the assumption of rational behavior, we study the added behavior of the network.

Diseño del subsistema RF para el receptor SAR biestático en banda-C SABRINA

Este proyecto tiene como objetivo diseñar un nuevo receptor SAR biestático para el sistema SABRINA (SAR Bistatic fixed Receiver for INterferometric Applications) caracterizando el sistema que ya existía. El nuevo dispositivo deberá cumplir con las características y requisitos del escenario teniendo en cuenta la potencia recibida y el ruido de cuantificación de la tarjeta digitalizadora. Con este fin se introducen previamente conocimientos de teoría RADAR y SAR. Además, se deberá compactar al máximo el sistema para conseguir un receptor autocontenido que facilite su traslado. Para tal fin se ha incorporado a la caja del receptor un sintetizador programable que actúa de oscilador local de las cadenas de recepción y una fuente de alimentación que provee la tensión a todos los componentes activos del dispositivo. Por otra parte el proyecto ilustra las diferentes campañas de experimentos que se han realizado durante el periodo de trabajo.

Desenvolupament futur de les revistes electròniques: una enquesta Delphi

Aquest article presenta els resultats d'una enquesta Delphi internacional i interdisciplinària sobre el desenvolupament futur de les revistes electròniques. El quadre d'experts constà de 45 científics, editors, bibliotecaris, agents de revistes i consultors. L'enquesta cobria cinc àrees d'interès sobre revistes electròniques: el futur rol de la literatura erudita en suport revista, escenaris per a les revistes del futur; crisi en les publicacions en sèrie; arxiu de revistes electròniques i nous models en l'adquisició i l'accés. L'enquesta Delphi va estudiar els canvis esperats durant els propers cinc a deu anys. Els resultats són analitzats i indiquen que, durant els seus 300 anys d'història, les revistes mai no han afrontat tants de canvis com els que experimenten ara, o els que s'esperen durant els propers cinc a deu anys.

Scenario-based assessment of future land use change on butterfly species distributions

Species distribution models (SDMs) are increasingly used to predict environmentally induced range shifts of habitats of plant and animal species. Consequently SDMs are valuable tools for scientifically based conservation decisions. The aims of this paper are (1) to identify important drivers of butterfly species persistence or extinction, and (2) to analyse the responses of endangered butterfly species of dry grasslands and wetlands to likely future landscape changes in Switzerland. Future land use was represented by four scenarios describing: (1) ongoing land use changes as observed at the end of the last century; (2) a liberalisation of the agricultural markets; (3) a slightly lowered agricultural production; and (4) a strongly lowered agricultural production. Two model approaches have been applied. The first (logistic regression with principal components) explains what environmental variables have significant impact on species presence (and absence). The second (predictive SDM) is used to project species distribution under current and likely future land uses. The results of the explanatory analyses reveal that four principal components related to urbanisation, abandonment of open land and intensive agricultural practices as well as two climate parameters are primary drivers of species occurrence (decline). The scenario analyses show that lowered agricultural production is likely to favour dry grassland species due to an increase of non-intensively used land, open canopy forests, and overgrown areas. In the liberalisation scenario dry grassland species show a decrease in abundance due to a strong increase of forested patches. Wetland butterfly species would decrease under all four scenarios as their habitats become overgrown

Els agrocombustibles a Catalunya : proposta d'avaluació d'escenaris de futur

En els darrers temps el debat dels agrocombustibles s’ha caracteritzat per l’aparició d’incerteses científiques i la discussió dels impactes ambientals i socioeconòmics, sovint difícils de mesurar i quantificar, que es podrien derivar de la implementació de la política pública d’impuls d’aquesta nova font energètica. Els sistemes tradicionals d’avaluació experta i les eines de decisió polítiques es veuen limitats per trobar solucions als problemes ambientals complexes com és el dels agrocombustibles, ja que es basen en el coneixement disciplinari i la previsió, sense considerar de forma explícita les incerteses. En l’estudi del debat i del procés d’elaboració de la política pública s’ha percebut una manca d’espais de comunicació i presa de decisions estructurats i integradors. Davant d’aquest context, en aquest treball s’ha dissenyat un procés participatiu d’avaluació de la implementació de la política pública. La proposta elaborada consta d’uns escenaris de futur sobre l’aplicació dels agrocombustibles a Catalunya, que han de ser valorats de forma participativa en grups de discussió. La identificació de les variables determinants i els nous escenaris de futur que resulten del procés, esdevindrien la informació per a reiniciar un nou procés d’avaluació. L’aplicació de nous procediments i noves eines d’anàlisi pot ser útil per reestructurar el problema i fonamentar les decisions polítiques, per tal d’augmentar-ne l’eficàcia,la legitimitat, i assegurar-ne criteris social i ambientalment justos.