52 research outputs found
Plane curves with a big fundamental group of the complement
Let C \s \pr^2 be an irreducible plane curve whose dual C^* \s \pr^{2*}
is an immersed curve which is neither a conic nor a nodal cubic. The main
result states that the Poincar\'e group \pi_1(\pr^2 \se C) contains a free
group with two generators. If the geometric genus of is at least 2,
then a subgroup of can be mapped epimorphically onto the fundamental group
of the normalization of , and the result follows. To handle the cases
, we construct universal families of immersed plane curves and their
Picard bundles. This allows us to reduce the consideration to the case of
Pl\"ucker curves. Such a curve can be regarded as a plane section of the
corresponding discriminant hypersurface (cf. [Zar, DoLib]). Applying
Zariski--Lefschetz type arguments we deduce the result from `the bigness' of
the -th braid group of the Riemann surface of .Comment: 23 pages LaTeX. A revised version. The unnecessary restriction of the previous version has been removed, and the main result has
taken its final for
Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières
BACKGROUND: Chagas disease (American trypanosomiasis) is a zoonotic or anthropozoonotic disease caused by the parasite Trypanosoma cruzi. Predominantly affecting populations in poor areas of Latin America, medical care for this neglected disease is often lacking. Médecins Sans Frontières/Doctors Without Borders (MSF) has provided diagnostic and treatment services for Chagas disease since 1999. This report describes 10 years of field experience in four MSF programs in Honduras, Guatemala, and Bolivia, focusing on feasibility protocols, safety of drug therapy, and treatment effectiveness. METHODOLOGY: From 1999 to 2008, MSF provided free diagnosis, etiological treatment, and follow-up care for patients <18 years of age seropositive for T. cruzi in Yoro, Honduras (1999-2002); Olopa, Guatemala (2003-2006); Entre RÃos, Bolivia (2002-2006); and Sucre, Bolivia (2005-2008). Essential program components guaranteeing feasibility of implementation were information, education, and communication (IEC) at the community and family level; vector control; health staff training; screening and diagnosis; treatment and compliance, including family-based strategies for early detection of adverse events; and logistics. Chagas disease diagnosis was confirmed by testing blood samples using two different diagnostic tests. T. cruzi-positive patients were treated with benznidazole as first-line treatment, with appropriate counseling, consent, and active participation from parents or guardians for daily administration of the drug, early detection of adverse events, and treatment withdrawal, when necessary. Weekly follow-up was conducted, with adverse events recorded to assess drug safety. Evaluations of serological conversion were carried out to measure treatment effectiveness. Vector control, entomological surveillance, and health education activities were carried out in all projects with close interaction with national and regional programs. RESULTS: Total numbers of children and adolescents tested for T. cruzi in Yoro, Olopa, Entre RÃos, and Sucre were 24,471, 8,927, 7,613, and 19,400, respectively. Of these, 232 (0.9%), 124 (1.4%), 1,475 (19.4%), and 1,145 (5.9%) patients, respectively, were diagnosed as seropositive. Patients were treated with benznidazole, and early findings of seroconversion varied widely between the Central and South American programs: 87.1% and 58.1% at 18 months post-treatment in Yoro and Olopa, respectively; 5.4% by up to 60 months in Entre RÃos; and 0% at an average of 18 months in Sucre. Benznidazole-related adverse events were observed in 50.2% and 50.8% of all patients treated in Yoro and Olopa, respectively, and 25.6% and 37.9% of patients in Entre RÃos and Sucre, respectively. Most adverse events were mild and manageable. No deaths occurred in the treatment population. CONCLUSIONS: These results demonstrate the feasibility of implementing Chagas disease diagnosis and treatment programs in resource-limited settings, including remote rural areas, while addressing the limitations associated with drug-related adverse events. The variability in apparent treatment effectiveness may reflect differences in patient and parasite populations, and illustrates the limitations of current treatments and measures of efficacy. New treatments with improved safety profiles, pediatric formulations of existing and new drugs, and a faster, reliable test of cure are all urgently needed
The Index Bundle and Multiparameter Bifurcation for Discrete Dynamical Systems
We develop a K-theoretic approach to multiparameter bifurcation theory of homoclinic solutions of discrete non-autonomous dynamical systems from a branch of stationary solutions. As a byproduct we obtain a family index theorem for asymptotically hyperbolic linear dynamical systems which is of independent interest. In the special case of a single parameter, our bifurcation theorem weakens the assumptions in previous work by Pejsachowicz and the first author
Cost-Effectiveness of Chagas Disease Vector Control Strategies in Northwestern Argentina
Despite decreasing rates of prevalence and incidence, Chagas disease remains a serious problem in Latin America, especially for the rural poor. Without vaccines, control and prevention rely mostly on residual spraying of insecticides. Under the aegis of the Southern Cone Initiative, and in agreement with global trends in decentralization of the health systems, in 1992 the Argentinean vector control launched a new vector control program based on community participation. The present study represents the first thorough evaluation of the overall performance of such vector control program and the first comparative assessment of the cost-effectiveness of different vector control strategies in a highly endemic rural area of northwestern Argentina. Supported by results of independent studies, the present work shows that in rural, poor and dispersed areas of the Gran Chaco region, the implementation of a mixed (i.e., vertical attack phase followed by horizontal surveillance) strategy constantly supervised and supported by national or local vector control programs would be the most cost-effective option to interrupt vector-borne transmission of Chagas disease
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