Estimates of avoided costs attributed to a short cervix screening program to prevent preterm birth from the perspective of the Unified Health System (SUS)

OBJECTIVE: To perform an economic cost analysis of the implementation of a short cervix screening program to reduce preterm birth in singleton pregnancies in a short-term time horizon. METHODS: We performed a cost-benefit economic analysis using the P5 trial database, a randomized multicenter clinical trial for prevention of preterm birth. Data collection was conducted from July 2015 to March 2019 in 17 different Brazilian hospitals. We conducted a cost analysis for universal cervical screening in singleton pregnancies between 18 weeks and 22 weeks plus 6 days. In subjects with a cervical length ≤ 25 mm, the analysis incorporated the costs of administering 200 mg/day of vaginal progesterone prophylactically until 36 weeks gestation. These findings were subsequently compared with the economic implications of forgoing cervical screening. The time horizon comprised from birth to 10 weeks postpartum. The outcome was measured monetarily in Brazilian real (R$) from the perspective of the Unified Health System. RESULTS: Among 7,844 women, 6.67$ 383,711.36, while non-screening generated an estimated additional cost of R$446,501.69 (related to the 29 non-screened preterm deliveries). Thus, screening and prophylaxis would generate a final cost reduction of R$ 62,790.33, constituting a possible cost-benefit strategy. CONCLUSION: Universal short cervix screening for preterm birth has lower costs compared to non-screening within a short-term time horizon, which suggests an interesting benefitcost ratio. Future studies should consider the cost-effectiveness of prophylactic treatment using sensitivity analyses in different scenarios within the Brazilian health system, as well as analyses that consider the long-term costs associated with preterm births, to robustly justify the implementation of a short cervix screening program.OBJETIVO: Realizar uma análise econômica de custo da implementação de um programa de rastreio de colo curto para redução da prematuridade em gestações únicas num horizonte temporal de curto prazo. MÉTODOS: Realizamos uma análise econômica do tipo custo-benefício utilizando o banco de dados do P5 trial, um ensaio clínico multicêntrico randomizado para prevenção da prematuridade. A coleta de dados ocorreu de julho de 2015 a março de 2019 em 17 diferentes hospitais do Brasil. Comparamos os custos do rastreamento universal em mulheres com gestação única de 18 a 22 semanas e 6 dias associado à progesterona vaginal profilática 200 mg/dia até 36 semanas naquelas com colo ≤ 25 mm com os do não rastreamento. O horizonte temporal foi do nascimento até 10 semanas após o parto. O desfecho foi medido monetariamente em real brasileiro (R$) na perspectiva do Sistema Único de Saúde. RESULTADOS: Entre 7.844 mulheres, 6,67$ 383.711,36, enquanto o não rastreamento gerou custo adicional estimado de R$446.501,69 (relacionado aos 29 partos prematuros não rastreados). Assim, o rastreamento mais a profilaxia geraria uma redução de custo final de R$ 62.790,33, apresentando-se como uma possível estratégia de custo-benefício. CONCLUSÃO: O rastreamento universal de colo curto para prematuridade apresenta menores custos em relação ao não rastreamento dentro de um horizonte temporal de curto prazo, o que sugere uma interessante relação de custo versus benefício. Novos estudos que considerem a custo-efetividade do tratamento profilático utilizando-se de análises de sensibilidade em diferentes cenários dentro do sistema de saúde brasileiro, assim como análises que considerem os custos de longo prazo atrelados ao nascimento prematuro, são necessários para justificar com robustez a implementação de um programa de rastreamento

A combined approach for comparative exoproteome analysis of Corynebacterium pseudotuberculosis

Background: Bacterial exported proteins represent key components of the host-pathogen interplay. Hence, we sought to implement a combined approach for characterizing the entire exoproteome of the pathogenic bacterium Corynebacterium pseudotuberculosis, the etiological agent of caseous lymphadenitis (CLA) in sheep and goats. Results: An optimized protocol of three-phase partitioning (TPP) was used to obtain the C. pseudotuberculosis exoproteins, and a newly introduced method of data-independent MS acquisition (LC-MSE) was employed for protein identification and label-free quantification. Additionally, the recently developed tool SurfG+ was used for in silico prediction of sub-cellular localization of the identified proteins. In total, 93 different extracellular proteins of C. pseudotuberculosis were identified with high confidence by this strategy; 44 proteins were commonly identified in two different strains, isolated from distinct hosts, then composing a core C. pseudotuberculosis exoproteome. Analysis with the SurfG+ tool showed that more than 75% (70/93) of the identified proteins could be predicted as containing signals for active exportation. Moreover, evidence could be found for probable non-classical export of most of the remaining proteins. Conclusions: Comparative analyses of the exoproteomes of two C. pseudotuberculosis strains, in addition to comparison with other experimentally determined corynebacterial exoproteomes, were helpful to gain novel insights into the contribution of the exported proteins in the virulence of this bacterium. The results presented here compose the most comprehensive coverage of the exoproteome of a corynebacterial species so far

Evidence for internal field in graphite: A conduction electron spin resonance study

We report conduction electron spin resonance measurements performed on highly oriented pyrolitic graphite samples between 10 K and 300 K using S (f = 4 GHz), X (f = 9.4 GHz), and Q (f = 34.4 GHz) microwave bands for the external dc-magnetic field applied parallel (H || c) and perpendicular (H perp c) to the sample hexagonal c-axis. The results obtained in the H || c geometry are interpreted in terms of the presence of an effective internal ferromagnetic-like field Heff-int(T,H) that increases as the temperature decreases and the applied dc-magnetic field increases. We associate the occurrence of the Heff-int(T,H) with the field-induced metal-insulator transition in graphite and discuss its origin in the light of relevant theoretical models.Comment: 10 pages (tex), 5 figures (ps

ESTIMATIVAS DE ÁREA BASAL E USO DO RELASCÓPIO DE BITTERLICH EM AMOSTRAGEM DE FLORESTA ESTACIONAL DECIDUAL

A Floresta Estacional Decidual da região nordeste de Goiás é um tipo de vegetação florestal do grande bioma Cerrado, que pode ocorrer em áreas de afloramento de calcário e, geralmente, apresenta maior biomassa de espécies arbóreas que a vegetação de cerrado adjacente. Este estudo foi desenvolvido em uma área de floresta intacta (Fazenda Flor Ermo) e em quatro áreas de floresta perturbada (Fazendas Formosa, Traçadal, Manguinha e Conçeição Mocambo). O objetivo foi estimar a área basal e a intensidade amostral utilizando o relascópio de Bitterlich em florestas deciduais. A área basal foi de 29,3 m²/ha na floresta intacta e de 23 a 24 m²/ha nas perturbadas. As florestas com perturbação acentuada apresentaram curvas de distribuição do desvio padrão dos pontos de amostragem com pequena variação comparada com a curvas das áreas com baixo nível de perturbação. Para um limite de confiança de 95 % de probabilidade de confiança para a estimativa da média, 20 unidades amostrais com o relascópio podem ser suficientes para amostrar satisfatoriamente a área basal nesse tipo de vegetação

Tunnel and thermal c-axis transport in BSCCO in the normal and pseudogap state

We consider the problem of c-axis transport in double-layered cuprates, in particular with reference to Bi$_{2}$Sr$_{2}$CaCu$_{2}$O$_{8+\delta}$ compounds. We exploit the effect of the two barriers on the thermal and tunnel transport. The resulting model is able to describe accurately the normal state c-axis resistivity in Bi$_{2}$Sr$_{2}$CaCu$_{2}$O$_{8+\delta}$, from the underdoped side up to the strongly overdoped. We extend the model, without introducing additional parameters, in order to allow for the decrease of the barrier when an external voltage bias is applied. The extended model is found to describe properly the c-axis resistivity for small voltage bias above the pseudogap temperature $T^{*}$, the c-axis resistivity for large voltage bias even below $T_c$, and the differential $dI/dV$ curves taken in mesa structures.Comment: 12 pages, 6 figures. Submitted to Superconductor Science and Technolog

Micro-costing analysis of guideline-based treatment by direct-acting agents: the real-life case of hepatitis C management in Brazil

Background Eradication of hepatitis C virus (HCV) using direct-acting agents (DAA) has been associated with a financial burden to health authorities worldwide. We aimed to evaluate the guideline-based treatment costs by DAAs from the perspective of the Brazilian Ministry of Health (BMoH). Methods The activity based costing method was used to estimate the cost for monitoring/treatment of genotype-1 (GT1) HCV patients by the following strategies: peg-interferon (PEG-IFN)/ribavirin (RBV) for 48 weeks, PEG-IFN/RBV plus boceprevir (BOC) or telaprevir (TEL) for 48 weeks, and sofosbuvir (SOF) plus daclastavir (DCV) or simeprevir (SIM) for 12 weeks. Costs were reported in United States Dollars without (US$) and with adjustment for purchasing power parity (PPP$). Drug costs were collected at the National Database of Health Prices and an overview of the literature was performed to assess effectiveness of SOF/DCV and SOF/SIM regimens in real-world cohorts. Results Treatment costs of GT1-HCV patients were PPP$43,176.28 (US$ 24,020.16) for PEG-IFN/RBV, PPP$71,196.03 (US$ 39,578.23) for PEG-IFN/RBV/BOC and PPP$86,250.33 (US$ 47,946.92) for PEG-IFN/RBV/TEL. Treatment by all-oral interferon-free regimens were the less expensive approach: PPP$19,761.72 (US$ 10,985.90) for SOF/DCV and PPP$21,590.91 (US$ 12,002.75) for SOF/SIM. The overview reported HCV eradication in up to 98% for SOF/DCV and 96% for SOF/SIM. Conclusion Strategies with all oral interferon-free might lead to lower costs for management of GT1-HCV patients compared to IFN-based regimens in Brazil. This occurred mainly because of high discounts over international DAA prices due to negotiation between BMoH and pharmaceutical industries

Plasmonic catalysis with designer nanoparticles

Catalysis is central to a more sustainable future and a circular economy. If the energy required to drive catalytic processes could be harvested directly from sunlight, the possibility of replacing contemporary processes based on terrestrial fuels by the conversion of light into chemical energy could become a step closer to reality. Plasmonic catalysis is currently at the forefront of photocatalysis, enabling one to overcome the limitations of "classical" wide bandgap semiconductors for solar-driven chemistry. Plasmonic catalysis enables the acceleration and control of a variety of molecular transformations due to the localized surface plasmon resonance (LSPR) excitation. Studies in this area have often focused on the fundamental understanding of plasmonic catalysis and the demonstration of plasmonic catalytic activities towards different reactions. In this feature article, we discuss recent contributions from our group in this field by employing plasmonic nanoparticles (NPs) with controllable features as model systems to gain insights into structure-performance relationships in plasmonic catalysis. We start by discussing the effect of size, shape, and composition in plasmonic NPs over their activities towards LSPR-mediated molecular transformations. Then, we focus on the effect of metal support interactions over activities, reaction selectivity, and reaction pathways. Next, we shift to the control over the structure in hollow NPs and nanorattles. Inspired by the findings from these model systems, we demonstrate a design-driven strategy for the development of plasmonic catalysts based on plasmonic-catalytic multicomponent NPs for two types of molecular transformations: the selective hydrogenation of phenylacetylene and the oxygen evolution reaction. Finally, future directions, challenges, and perspectives in the field of plasmonic catalysis with designer NPs are discussed. We believe that the examples and concepts presented herein may inspire work and progress in plasmonic catalysis encompassing the design of plasmonic multicomponent materials, new strategies to control reaction selectivity, and the unraveling of stability and reaction mechanisms.Peer reviewe

Currents and Superpotentials in classical gauge theories: II. Global aspects and the example of Affine gravity

The conserved charges associated to gauge symmetries are defined at a boundary component of space-time because the corresponding Noether current can be rewritten on-shell as the divergence of a superpotential. However, the latter is afflicted by ambiguities. Regge and Teitelboim found a procedure to lift the arbitrariness in the Hamiltonian framework. An alternative covariant formula was proposed by one of us for an arbitrary variation of the superpotential, it depends only on the equations of motion and on the gauge symmetry under consideration. Here we emphasize that in order to compute the charges, it is enough to stay at a boundary of spacetime, without requiring any hypothesis about the bulk or about other boundary components, so one may speak of holographic charges. It is well known that the asymptotic symmetries that lead to conserved charges are really defined at infinity, but the choice of boundary conditions and surface terms in the action and in the charges is usually determined through integration by parts whereas each component of the boundary should be considered separately. We treat the example of gravity (for any space-time dimension, with or without cosmological constant), formulated as an Affine theory which is a natural generalization of the Palatini and Cartan-Weyl (vielbein) first order formulations. We then show that the superpotential associated to a Dirichlet boundary condition on the metric (the one needed to treat asymptotically flat or AdS spacetimes) is the one proposed by Katz, Bi\u{c}{\'a}k and Lynden-Bell and not that of Komar. We finally discuss the KBL superpotential at null infinity.Comment: 16 pages, minor corrections and references added. Final version to appear in CQ