To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p<.0001). ACEs’ exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.

Šiame tiriamajame darbe nagrinėjama bakterijos Salmonella enterica Serovar Typhimurium inkubacijos priklausomybė nuo inkubacinio periodo. Trumpai aptariami bakterijų inaktyvavimą aprašantys dažniausiai naudojami modeliai, skaitiškai išreiškiama lag fazė, randama jos ilgį aprašantį funkciją. Toliau vertinamos tiesinė ir liekamoji dalys bei išvedama inaktyvavimą aprašanti lygtis. Darbas baigiamas išvestinės formulės praktiniu panaudojimu ir rezultatų aptarimu. / Evaluation of Salmonella enterica Serovar Typhimurium inactivation by photosensitization and impact modeling The aim goal of this research is to evaluate the influence of irradiation of UV light and incubation period on Salmonella enterica Serovar Typhimurium bacteria. Shortly discussed most commonly used mathematical models of bacterial inactivation, expressed lag phase and its function. Next step is evaluation of line part and tail of inactivation (mortality) curve. At the end of the research the inactivation formula is deduced and the results are discussed.

Neurocysticercosis (NCC) is a parasitic disease caused by the larva of the zoonotic cestode Taenia solium. The objectives of this study were to evaluate the distribution of presenting clinical manifestations of NCC, to evaluate the socio-demographic characteristics of NCC patients, to compare quality of life of individuals diagnosed with NCC with an age and sex matched control population and to estimate the non-monetary burden of NCC in Mexico. In order to accomplish these objectives, a case series of NCC patients was conducted in two neurology referral hospitals in Mexico City, Mexico during 2007-2008. Information on clinical manifestations associated with NCC was obtained via medical chart reviews of NCC patients. Information on socio-demographic characteristics of NCC patients was obtained through the administration of questionnaires. In addition, a cross-sectional study was conducted to compare the quality of life of NCC patients to an age and sex matched control population using the short form 12 v2 (SF-12 v2) survey. Non-monetary burden of NCC in Mexico was estimated using disability adjusted life years (DALYs), incorporating morbidity due to both NCC-associated epilepsy and severe headache and mortality due to NCC-associated epilepsy. NCC patients presented to the neurology referral hospitals with numerous clinical manifestations, with severe headache and epilepsy being the most common. Lack of knowledge of T. solium transmission was common among NCC patients, with 25 percent of patients not knowledgeable about tapeworm infections in humans. Of those that were aware that tapeworm infections do occur, 57 percent were not aware of how the worms were transmitted to humans. The SF-12 v2 general health survey showed that individuals with NCC had a significantly lower score for all eight domains of health evaluated (physical functioning, role physical, bodily pain, vitality, general health, social functioning, role emotional and mental health) compared with the age and sex matched population from the same region (p< 0.05). The mean total number of DALYs lost due to NCC in Mexico was estimated to be 99,866 (95 percent CR: 43,187 –189,182), with a mean of 0.95 (95 percent CR: 0.4–1.8) DALYs lost per thousand persons per year.

Magistro darbe nagrinėjama romėnų, Lietuvos ir užsienio valstybių teisėje egzistuojanti daikto samprata, daiktų skirstymas į pagrindinius ir antraeilius apskritai bei konkrečios antraeilių daiktų rūšys: esminės pagrindinio daikto dalys, vaisiai, produkcija, pajamos ir priklausiniai. Magistro darbo tikslui pasiekti buvo išanalizuoti Lietuvos ir užsienio valstybių (Latvijos, Italijos, Kanados Kvebeko provincijos, Prancūzijos, Austrijos, Rusijos) teisinis reguliavimas, Lietuvos Aukščiausiojo Teismo praktika ir Lietuvos teisės mokslo darbai, susiję su daiktų skirstymu į pagrindinius ir antraeilius. Daugiausia praktinių Lietuvos teisės problemų yra susiję su priklausiniais ir esminėmis pagrindinio daikto dalimis, o su vaisiais, produkcija ir pajamomis siejama daugiau teorinio pobūdžio probleminiai klausimai. Magistro darbe šių problemų analizė atliekama įvertinant galimų sprendimų teigiamas ir neigiamas pasekmes, atitikimą įstatymų leidėjo tikslams ir atsižvelgiant į teisės doktrinoje pateikiamas nuomones bei jas palaikančius argumentus. / This paper analyses the conception of things, the classification of principal and auxiliary things generally and particular kinds of auxiliary things (essential parts of principal things, fruit, production, income and appurtenances) in Roman, Lithuanian and foreign countries’ law. Legal regulation of Lithuania and foreign countries (Latvia, Italy, Quebec province of Canada, France, Austria Russia), the practice of Lithuanian Supreme Court and Lithuanian legal doctrine, concerned with principal and auxiliary things, was analysed in order to achieve the purpose of this paper. The most part of practical problems of Lithuanian law are concerned with appurtenances and essential parts of principal things. Fruit, production and income usually are concerned with theoretical problems. Their analysis is based on evaluation of possible positive and negative effects, correspondence to purposes of legislator and correspondence to legal doctrine.

Darbe nagrinėjamos šių dienų techninių projektų aktualijos tokios, kaip struktūra, darbų atlikimo kokybė, sparta, naujų technologijų įvedimas, klaidų analizė. Pastaruosius penkiolika metų įvyko dideli pasikeitimai Lietuvos ūkio struktūrose. Pirmiausia sugriuvo senoji projektavimo tvarka vykdančios ir kontroliuojančios institucijos, po to vėl iš naujo buvo pradedamos kurti naujos. Pradėta kurti įstatymų bazė. Lietuvai įstojus į Europos sąjungą, šie procesai vyksta ir šiandien, įstatymai pritaikomi bendrai Europos sąjungos veiklai. Be įstatymų pasikeitimų į Lietuvą plūstelėjo techninių naujovių banga. Susivienijus Europai ir atsivėrus bendrai prekių rinkai, senąsias technologijas ir senuosius gamintojus išstūmė, deja ne visada geresniais, kokybiniais sprendimais pasižymintys nauji prekių tiekėjai. Lietuva, kartu su senąją infrastruktūra, prarado ir senuosius projektuotojus, darbų vadovus, kitus specialistus. Vieni persikvalifikavo, kiti tiesiog prarado kvalifikaciją. Taigi, pastebimai atgijus ekonomikai, statybai Lietuvoje, didelę kadrų dalį sudaro jauni, neretai su patirties trūkumu, specialistai. Šiame darbe ištirta Lietuvoje esama techninių projektų ir šia veiklą reglamentuojančių dokumentų bei naujovių situacija. Šis darbas skirtas pradedančiam jaunam specialistui padėti, rasti tiesesnį kelią brandesnių, profesionalesnių projektų link. / Such modern-day questions of technical projects as structure, the quality of work accomplishment, the speed of work, the establishment of new technologies, analysis of mistakes are being analysed in this work. Considerable changes within economy structures of Lithuania have been taking place during late 15 years. First of all, all the institutions, which had pursued and administrated the methods and order of the old planning style, collapsed, later the new ones have been undertaken. The basis of legislation was launched. Since Lithuania entered the European Union the mentioned process has been taking place and nowadays, and the legislation is being adapted to the common activities of European Union. Moreover, despite the changes in legislation, the new wave of technical innovations has sprung. After consolidation of Europe and when the common commodity market was opened the new commodity suppliers (unfortunately, not always having decisions of better quality) superseded the old technologies and the old manufacturers. Lithuania has been losing its old designers, executives, the other proficient workers together with its old facilities. Some specialists have retrained, the other simply have lost their qualification. Consequently, since the economy and construction have visibly revived in Lithuania, the young specialists, often with lack of experience, have made a big proportion of the personnel. The present situation in Lithuania, related with its technical projects and... [to full text]

Užsakovams pritaikytų gaminių projektavimo procesas šiuo metu yra paplitęs mašinų gamyboje ir kitose pramonės šakose. Šio proceso metu gaminio konstrukcija keičiama atsižvelgiant į užsakovo poreikius. Tokie gaminiai yra metalo ir medžio apdirbimo staklės, liftai, eskalatoriai, kranai, sunkvežimiai ir pan. Nors pritaikytas pagal poreikius gaminys yra brangesnis už serijiniu būdu padarytus gaminius, tačiau jis žymiai pigesnis už vienetinius gaminius. Mašinų ir įrenginių konstrukcijos projektams sudaryti iš sudedamųjų dalių yra naudojami gaminio konfigūravimo metodai. Šių metodų pagrindinis trūkumas yra tas, kad papildyti gaminio konfigūravimo modelį yra sudėtinga. Kuriant naujus gaminių konstrukcijų variantus yra naudojamos tik modelyje esančios sudedamosios dalys, bet nenumatomas būdas kurti naują konstrukcijos projektą iš labiausiai panašios modelyje esančios gaminio konstrukcijos. Nepakankamai įvertinama, kad gaminio konfigūravimo modelis dažnai keičiamas ir tobulinamas. Taip pat reikalinga galimybė gaminio konfigūravimo modelyje kurti naujas sudedamąsias dalis, plečiant gaminių pasiūlą ir atsiradus naujiems užsakovų poreikiams. Šio darbo tikslas – sukurti gaminio konstrukcijos variantų sudarymo ir parinkimo metodą, kurį taikant būtų greičiau ir lengviau kuriami nauji gaminio konstrukcijos modelio variantai naudojant sudedamąsias dalis, jų savybes ir galimų ryšių tarp sudedamųjų dalių ribojimus. Siekiant tikslo, buvo sprendžiami šie uždaviniai: ištirti esamus gaminio... [toliau žr. visą tekstą] / In modern business of machine manufacturing, there is a growing tendency towards design of custom tailored products. The construction of the product usually is changed during the customization according to the requirements of the customer. The examples of such products are refrigerators, metal and wood processing machines, elevators, escalators, hoisting cranes, trucks, etc. Customizable products of this type are more expensive than mass or batch produced ones, but they are much less expensive than one-off or small batch production. The product configuration methods are used for creating construction variants. These methods contain two main phases: initially a set of all available variants of product construction are modeled, later a specific product variant is selected with respect to the customer’s criteria. This set of all product variants is further called the product configuration model. If there is no such construction variant that meets customer’s requirements in the product configuration model created in advance, then the new variant has to be designed and included into the configuration model. The aim of this work is to develop the method for defining variants of product’s construction. Using this method, new variants of product construction model should be created faster and easier, being composed from the constituent parts, their properties, and constraints defining relations of the parts. Following tasks were accomplished in this work: to analyze the existing... [to full text]

In modern business of machine manufacturing, there is a growing tendency towards design of custom tailored products. The construction of the product usually is changed during the customization according to the requirements of the customer. The examples of such products are refrigerators, metal and wood processing machines, elevators, escalators, hoisting cranes, trucks, etc. Customizable products of this type are more expensive than mass or batch produced ones, but they are much less expensive than one-off or small batch production. The product configuration methods are used for creating construction variants. These methods contain two main phases: initially a set of all available variants of product construction are modeled, later a specific product variant is selected with respect to the customer’s criteria. This set of all product variants is further called the product configuration model. If there is no such construction variant that meets customer’s requirements in the product configuration model created in advance, then the new variant has to be designed and included into the configuration model. The aim of this work is to develop the method for defining variants of product’s construction. Using this method, new variants of product construction model should be created faster and easier, being composed from the constituent parts, their properties, and constraints defining relations of the parts. Following tasks were accomplished in this work: to analyze the existing... [to full text] / Užsakovams pritaikytų gaminių projektavimo procesas šiuo metu yra paplitęs mašinų gamyboje ir kitose pramonės šakose. Šio proceso metu gaminio konstrukcija keičiama atsižvelgiant į užsakovo poreikius. Tokie gaminiai yra metalo ir medžio apdirbimo staklės, liftai, eskalatoriai, kranai, sunkvežimiai ir pan. Nors pritaikytas pagal poreikius gaminys yra brangesnis už serijiniu būdu padarytus gaminius, tačiau jis žymiai pigesnis už vienetinius gaminius. Mašinų ir įrenginių konstrukcijos projektams sudaryti iš sudedamųjų dalių yra naudojami gaminio konfigūravimo metodai. Šių metodų pagrindinis trūkumas yra tas, kad papildyti gaminio konfigūravimo modelį yra sudėtinga. Kuriant naujus gaminių konstrukcijų variantus yra naudojamos tik modelyje esančios sudedamosios dalys, bet nenumatomas būdas kurti naują konstrukcijos projektą iš labiausiai panašios modelyje esančios gaminio konstrukcijos. Nepakankamai įvertinama, kad gaminio konfigūravimo modelis dažnai keičiamas ir tobulinamas. Taip pat reikalinga galimybė gaminio konfigūravimo modelyje kurti naujas sudedamąsias dalis, plečiant gaminių pasiūlą ir atsiradus naujiems užsakovų poreikiams. Šio darbo tikslas – sukurti gaminio konstrukcijos variantų sudarymo ir parinkimo metodą, kurį taikant būtų greičiau ir lengviau kuriami nauji gaminio konstrukcijos modelio variantai naudojant sudedamąsias dalis, jų savybes ir galimų ryšių tarp sudedamųjų dalių ribojimus. Siekiant tikslo, buvo sprendžiami šie uždaviniai: ištirti esamus gaminio... [toliau žr. visą tekstą]

Darbo tikslas – įvertinti jogurtų sudedamąsias dalis, mitybinę vertę ir vartotojų nuomonę apie jogurtus. Darbo uždaviniai: 1. Remiantis moksline literatūra, aptarti jogurto savybes, gaminimo metodikas, įvairovę; 2. Įvertinti apklaustųjų nuomonę pasirenkant pirkti ir vartoti jogurto produktus; 3. Atlikti jogurto sudedamųjų dalių analizę, pagal pakuočių ženklinime pateiktą informaciją; 4. Atlikti laktozės laboratorinius tyrimus atrinktuose jogurto pavyzdžiuose; 5. Parengti jogurtų vartojimo rekomendacijas. Darbo metodai – mokslinės literatūros analizė, kokybinis (jogurto sudėtis) ir kiekybiniai (anketinė apklausa, laktozės laboratorinis tyrimas) tyrimai, statistinė tyrimo rezultatų analizė. Siekiant įvertinti jogurtų sudedamąsias dalis, jų mitybinę vertę, bei apklaustųjų nuomonę pasirenkant pikti ir vartoti jogurtą, tyrimui buvo parinkti šie tyrimo instrumentai: vartotojų apklausos klausimynas (anketa), jogurtų pakuočių ženklinimo etiketės; jogurtų laboratorinių tyrimų protokolas. / The aim of the research – to evaluate the ingredients, the nutritive value of yoghurts and consumers‘opinion on yoghurts. Research tasks: 1. To discuss the characteristics of yoghurt in accordance with the scientific literature, its production techniques and its diversity; 2. To evaluate the opinion of respondents which determine their choice when buying and consuming yoghurt products; 3. To conduct the yoghurt ingredients’ analysis according to the package labelling information; 4. To perform lactose laboratory tests of selected samples of yoghurt; 5. To prepare yoghurt consumption recommendations. Methods of the Work – scientific literature analysis, qualitative (yoghurt composition) and quantitative (questionnaire, lactose laboratory test) research, statistical analysis of the survey results. In order to evaluate the yoghurt’s ingredients, its nutritional value and the respondents’ preferences of buying and consuming yoghurt the following tools for the conduction of research have been chosen: consumer survey questionnaire; yoghurt packaging labelling marking; the protocol of yoghurts’ laboratory testing.

Introduction: Adverse childhood experiences (ACEs) have been considered a significant risk factor for poorer adult outcomes. Considering the studies linking ACEs to chronic diseases in adulthood as well as the increasing prevalence for these chronic conditions, exposure to childhood traumas represents a significant economic burden in the United States which has not been explored. This study provides the first examination of the attributable burden and costs of conditions associated with exposure to ACEs in Tennessee (TN) and Virginia (VA) during 2017. Methods: This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data for TN and VA in 2017. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis ) and two risk factors (smoking and drinking ) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between individuals exposed to ACEs and the risk factors with the chronic diseases. The population attributable risk (PAR) were estimated for the ACEs related diseases and risk factors. These estimates were combined with published estimates of health care expenses and Disability Adjusted-Life-Years (DALYs). Results: Among those who had experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who had experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs exposure resulted in a burden of about 115,00 years and 125,000 years in terms of DALYs in TN and VA respectively. The total health spending associated with ACEs based on PARs was about $650 million ($158.15 per adult) and $942 million ($305.02 per adult) in TN and VA respectively. Depression accounted for the largest combined sum of health care spending (TN - $448,105,983, VA – $633,225,398). With DALYs valued at $235,855 in 2017 dollars, the monetized cost of DALYs attributable to ACEs was over $27 billion, $6615 per exposed adult Tennessean. The monetized loss due to DALYs represents over $30 billion (in 2017 dollars) , $9,737 per exposed adult in Virginia. Conclusions: This study emphasizes the need to reduce ACEs which can be utilized to inform interventions to reduce the impact of ACEs in Tennessee and Virginia. Medical conditions attributable to childhood traumas can result in increased utilization of hospital services, psychiatric care, as well as care related to chronic conditions, which includes increased primary and specialty care utilization as well as the cost of medications. While medical expenses represent a significant burden, reduced quality of life resulting from ACE attributable conditions also represents a burden in disability adjusted life years (DALYs) and premature morbidity. As resources are limited and the burden of ACEs shown here is very high, there is the need for a wide range of prevention and treatment strategies to mitigate these effects.

RESUME La Trypanosomiase Humain Africaine (THA) demeure un problème de santé publique pour plusieurs pays en Afrique subsaharienne. Le contrôle de la THA est basé essentiellement sur la stratégie de dépistage actif suivi du traitement des personnes infectées. Le dépistage actif est réalisé par des unités mobiles spécialisées, bien que les services de santé fixes jouent un rôle important en détectant « passivement » des cas. Le dépistage reposait jadis sur la palpation ganglionnaire mais, depuis le développement du test d’agglutination sur carte (CATT), trois possibilités se sont offertes aux programmes de contrôle à savoir: i) continuer avec la palpation ganglionnaire ii) combiner la palpation ganglionnaire avec le CATT iii) recourir au CATT seul. Certains programmes comme celui de la République Démocratique du Congo (RDC) ont opté pour la combinaison en parallèle de la palpation ganglionnaire avec le CATT. Toute personne ayant une hypertrophie ganglionnaire cervicale et/ou un CATT positif est considéré comme suspecte de la THA. Elle sera soumise aux tests parasitologiques de confirmation à cause de la toxicité des médicaments anti-THA. Les tests parasitologiques classiques sont l’examen du suc ganglionnaire (PG), l’examen du sang à l’état frais (SF), la goutte épaisse colorée (GE). La sensibilité de cette séquence a été estimée insuffisante par plusieurs auteurs et serait à la base d’une grande perte de l’efficacité de la stratégie dépistage-traitement. D’autres techniques de concentration ont été développées comme la mini-Anion Exchange Concentration Technique (mAECT), la Centrifugation en Tube Capillaire (CTC) et le Quantitative Buffy Coat (QBC), mais ces techniques de concentration ne sont pas utilisées en routine. En RDC, une interruption des activités de contrôle en 1990 a eu comme conséquence une réémergence importante de la maladie du sommeil. Depuis 1998 les activités de contrôle ont été refinancées de manière structurée. Ce travail vise deux buts à savoir le plaidoyer pour la continuité des activités de contrôle et la rationalisation des stratégies de contrôle. Nous avons évalué l’évolution de la maladie du sommeil en rapport avec le financement, son impact sur les ménages ainsi que la communauté. L’exercice de rationalisation a porté sur les outils de dépistage et de confirmation. Nous avons d’abord évalué la validité des tests, leur faisabilité ainsi que les coûts et ensuite nous avons effectué une analyse décisionnelle formelle pour comparer les algorithmes de dépistage et pour les tests de confirmation. Pendant la période de refinancement structurel de la lutte contre la THA en RDC (1998-2003), le budget alloué aux activités a été doublé lorsqu’on le compare à la période précédente (1993-1997). Le nombre des personnes examinées a aussi doublé mais par contre le nombre des nouveaux cas de THA est passé d’un pic de 26 000 cas en 1998 à 11 000 en 2003. Le coût par personne examinée a été de 1,5 US$ et celui d’un cas détecté et sauvé à 300 US$. Pendant cette période, les activités ont été financées par l’aide extérieure à plus de 95%. Cette subvention pourrait laisser supposer que l’impact de la THA au niveau des ménages et des communautés est réduit mais lorsque nous avons abordé cet aspect, il s’est avéré que le coût de la THA au niveau des ménages équivaut à un mois de leur revenu et que la THA fait perdre 2145 DALYs dans la communauté. L’intervention par la stratégie de dépistage-traitement a permis de sauver 1408 DALYs à un coût de 17 US$ par DALYs sauvé. Ce coût classe l’intervention comme « good value for money ». Le recours au CATT seul s’est avéré comme la stratégie la plus efficiente pour le dépistage actif. Le gain marginal lorsque l’on ajoute la palpation ganglionnaire en parallèle est minime et n’est pas compensé par le coût élevé lié à un nombre important des suspects soumis aux tests parasitologiques. Les techniques de concentration ont une bonne sensibilité et leur faisabilité est acceptable. Leur ajout à l’arbre classique améliore la sensibilité de 29 % pour la CTC et de 42% pour la mAECT. Le coût de la CTC a été de 0,76 € et celui de la mAECT de 2,82 €. Le SF a été estimé très peu sensible. L’algorithme PG- GE-CTC-mAECT a été le plus efficient avec 277 € par vie sauvée et un ratio de coût-efficacité marginal de 125 € par unité de vie supplémentaire sauvée. L’algorithme PG-GE-CATT titration avec traitement des personnes avec une parasitologie négative mais un CATT positif à un seuil de 1/8 devient compétitif lorsque la prévalence de la THA est élevée. Il est donc possible dans le contexte actuel de réduire la prévalence de la THA mais à condition que les activités ne soient pas interrompues. Le recours à un algorithme recourant au CATT dans le dépistage actif et à la séquence PG-GE-CTC-mAECT est le plus efficient et une efficacité de 80%. La faisabilité et l’efficacité peut être différent d’un endroit à l’autre à cause de la focalisation de la THA. Il est donc nécessaire de réévaluer cet algorithme dans un autre foyer de THA en étude pilote avant de décider d’un changement de politique. Le recours à cet algorithme implique un financement supplémentaire et une volonté politique. SUMMARY Human African Trypanosomiasis (HAT) remains a major public health problem affecting several countries in sub-Saharan Africa. HAT control is essentially based on active case finding conducted by specialized mobile teams. In the past the population screening was based on neck gland palpation, but since the development of the Card Agglutination Test for Trypanosomiasis (CATT) three control options are available to the control program: i) neck gland palpation ii) CATT iii) neck gland palpation and CATT done in parallel . Certain programs such as the one in DRC opted for the latter, combining CATT and neck gland palpation. All persons having hypertrophy of the neck gland and/or a positive CATT test are considered to be a HAT suspect. Confirmation tests are necessary because the screening algorithms are not 100 % specific and HAT drugs are very toxic. The classic parasitological confirmation tests are lymph node puncture (LNP), fresh blood examination (FBE) and thick blood film (TBF). The sensitivity of this combination is considered insufficient by several authors and causes important losses of efficacy of the screening-treatment strategy. More sensitive concentration methods were developed such as the mini Anion Exchange Concentration Techniques (mAECT), Capillary Tube Centrifugation (CTC) and the Quantitative Buffy Coat (QBC), but they are not used on a routine basis. Main reasons put forward are low feasibility, high cost and long time of execution. In the Democratic Republic of Congo, HAT control activities were suddenly interrupted in 1990 and this led to an important re-emergence or the epidemic. Since 1998 onwards, control activities were financed again in a structured way. This works aims to be both a plea for the continuation of HAT control as well as a contribution to the rationalization of the control strategies. We analyzed the evolution of sleeping sickness in the light of its financing, and we studied its impact on the household and the community. We aimed at a rationalization of the use of the screening and confirmation tools. We first evaluated the validity of the tests, their feasibility and the cost and we did a formal decision analysis to compare screening and confirmation algorithms. The budget allocated to control activities was doubled during the period when structural aid funding was again granted (1998-2003) compared with the period before (1993-1997). The number of persons examined per year doubled as well but the number of cases found peaked at 26 000 in 1998 and dropped to 11 000 in the period afterwards. The cost per person examined was 1.5 US$ and per case detected and saved was 300 US$. The activities were financed for 95 % by external donors during this period. This subvention could give the impression that the impact of HAT on the household and the household was limited but when we took a closer look at this aspect we found that the cost at household level amounted to one month of income and that HAT caused the loss of 2145 DALYs in the community. The intervention consisting of active case finding and treatment allowed to save 1408 DALY’s at a cost of 17 US$ per DALY, putting the intervention in the class of “good value for money”. The use of CATT alone as screening test emerged as the most efficient strategy for active case finding. The marginal gain when neck gland palpation is added is minor and is not compensated by the high cost of doing the parasitological confirmation test on a high number of suspected cases. The concentration methods have a good sensitivity and acceptable feasibility. Adding them to the classical tree improves its sensitivity with 29 % for CTC and with 42 % for mAECT. The cost of CTC was 0.76 US$ and of mAECT was 2.82 US$. Sensitivity of fresh blood examination was poor. The algorithm LNP-TBF-CTC-mAECT was the most efficient costing 277 Euro per life saved and a marginal cost effectiveness ratio of 125 Euro per supplementary life saved. The algorithm LNP-TBF-CATT titration with treatment of persons with a negative parasitology but a CATT positive at a dilution of 1/8 and more becomes competitive when HAT prevalence is high. We conclude that it is possible in the current RDC context to reduce HAT prevalence on condition that control activities are not interrupted. Using an algorithm that includes CATT in active case finding and the combination LNP-TBF-CTC-mAECT is the most efficient with an efficacy of 80 %. Feasibility and efficacy may differ from one place to another because HAT is very focalized, so it is necessary to test this novel algorithm in another HAT focus on a pilot basis, before deciding on a policy change. Implementation of this algorithm will require additional financial resources and political commitment.