Search results for: burden of proof

Authors: Ammar Asma, Bouafia Nabiha, Dhahri Meriem, Ben Cheikh Asma, Ezzi Olfa, Chafai Rim, Njah Mansour

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Despite recent advances in treatment of the lung cancer patients, the prognosis remains poor. Information is limited regarding health related quality of life (QOL) status of advanced lung cancer patients. The purposes of this study were: to assess patient reported symptom burden, to measure their QOL, and to identify determinant factors associated with QOL. Materials/Methods: A cross sectional study of 60 patients was carried out from over the period of 03 months from February 1st to 30 April 2016. Patients were recruited in two department of health care: Pneumology department in a university hospital in Sousse and an oncology unit in a University Hospital in Kairouan. Patients with advanced stage (III and IV) of lung cancer who were hospitalized or admitted in the day hospital were recruited by convenience sampling. We used a questionnaire administrated and completed by a trained interviewer. This questionnaire is composed of three parts: demographic, clinical and therapeutic information’s, QOL measurements: based on the SF-36 questionnaire, Symptom’s burden measurement using the Lung Cancer Symptom Scale (LCSS). To assess Correlation between symptoms burden and QOL, we compared the scores of two scales two by two using the Pearson correlation. To identify factors influencing QOL in Lung cancer, a univariate statistical analysis then, a stepwise backward approach, wherein the variables with p< 0.2, were carried out to determine the association between SF-36 scores and different variables. Results: During the study period, 60 patients consented to complete symptom and quality of life questionnaires at a single point time (72% were recruited from day hospital). The majority of patients were male (88%), age ranged from 21 to 79 years with a mean of 60.5 years. Among patients, 48 (80%) were diagnosed as having non-small cell lung carcinoma (NSCLC). Approximately, 60 % (n=36) of patients were in stage IV, 25 % in stage IIIa and 15 % in stage IIIb. For symptom burden, the symptom burden index was 43.07 (Standard Deviation, 21.45). Loss of appetite and fatigue were rated as the most severe symptoms with mean scores (SD): 49.6 (25.7) and 58.2 (15.5). The average overall score of SF36 was 39.3 (SD, 15.4). The physical and emotional limitations had the lowest scores. Univariate analysis showed that factors which influence negatively QOL were: married status (p<0.03), smoking cessation after diagnosis (p<0.024), LCSS total score (p<0.001), LCSS symptom burden index (p<0.001), fatigue (p<0.001), loss of appetite (p<0.001), dyspnea (p<0.001), pain (p<0.002), and metastatic stage (p<0.01). In multivariate analysis, unemployment (p<0.014), smoking cessation after diagnosis (p<0.013), consumption of analgesic (p<0.002) and the indication of an analgesic radiotherapy (p<0.001) are revealed as independent determinants of QOL. The result of the correlation analyses between total LCSS scores and the total and individual domain SF36 scores was significant (p<0.001); the higher total LCSS score is, the poorer QOL is. Conclusion: A built in support of lung cancer patients would better control the symptoms and promote the QOL of these patients.

Keywords: quality of life, lung cancer, metastasis, symptoms burden

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Authors: Pierre Mintom, Armel Assiene Agamou, Leslie Toukem, William Dakam, Christine Fernande Nyangono Biyegue

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Context: Hyperuricemia, the presence of high levels of uric acid in the blood, is a known precursor to the development of gout. Recent studies have suggested a strong association between hyperuricemia and disorders of lipoprotein metabolism, specifically hypercholesterolemia. Understanding the factors associated with these conditions in gout patients is essential for effective treatment and management. Research Aim: The objective of this study was to determine the prevalence of hyperuricemia, hypercholesterolemia, and the double burden of hyperuricemia-hypercholesterolemia in the gouty population. Additionally, the study aimed to identify the factors associated with these conditions. Methodology: The study utilized a database from a survey of 150 gouty patients recruited at the Laquintinie Hospital in Douala between August 2017 and February 2018. The database contained information on anthropometric parameters, biochemical markers, and the food and drugs consumed by the patients. Hyperuricemia and hypercholesterolemia were defined based on specific serum uric acid and total cholesterol thresholds, and the double burden was defined as the co-occurrence of hyperuricemia and hypercholesterolemia. Findings: The study found that the prevalence rates for hyperuricemia, hypercholesterolemia, and the double burden were 61.3%, 76%, and 50.7% respectively. Factors associated with these conditions included hypertriglyceridemia, atherogenicity index TC/HDL ratio, atherogenicity index LDL/HDL ratio, family history, and the consumption of specific foods and drinks. Theoretical Importance: The study highlights the strong association between hyperuricemia and dyslipidemia, providing important insights for guiding treatment strategies in gout patients. Additionally, it emphasizes the significance of nutritional education in managing these metabolic disorders, suggesting the need to address eating habits in gout patients. Data Collection and Analysis Procedures: Data was collected through surveys and medical records of gouty patients. Information on anthropometric parameters, biochemical markers, and dietary habits was recorded. Prevalence rates and associated factors were determined through statistical analysis, employing odds ratios to assess the risks. Question Addressed: The study aimed to address the prevalence rates and associated factors of hyperuricemia, hypercholesterolemia, and the double burden in gouty patients. It sought to understand the relationships between these conditions and determine their implications for treatment and nutritional education. Conclusion: Findings show that it’s exists an association between hyperuricemia and hypercholesterolemia in gout patients, thus creating a double burden. The findings underscore the importance of considering family history and eating habits in addressing the double burden of hyperuricemia-hypercholesterolemia. This study provides valuable insights for guiding treatment approaches and emphasizes the need for nutritional education in gout patients. This study specifically focussed on the sick population. A case–control study between gouty and non-gouty populations would be interesting to better compare and explain the results observed.

Keywords: gout, hyperuricemia, hypercholesterolemia, double burden

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Authors: Tarnai Tena, Strinić Dean

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Chronic non-communicable diseases are today the leading cause of mortality, morbidity and mortality disability at the world level and in Croatia. Among them are the most represented precisely cardiovascular diseases (CVD), so today we are talking about their global card epidemic. From 2018 to 2021, cardiovascular diseases are the leading cause of death for both women and men in the Dubrovnik- Neretva County. With regard to the COVID-19 pandemic, which has taken over, without forgetting how much these patients are additionally affected, we are still talking about the primary cause of sickness and death in the population of this county and region. In this record, we present collected data processed according to gender and disease classification. We also bring a kind of overview because, for years, we have been following how the population of one of the origins of the Mediterranean diet has been struggling with cardiovascular diseases.

Keywords: cardiovascular disease, burden, COVID-19, epidemiology, ishemic heart disease, cardiovascular medicine

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Authors: Timothy T. Hsieh

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Current patent venue transfer laws under 28 U.S.C. § 1404(a) e.g., the Gilbert factors from Gulf Oil Corp. v. Gilbert, 330 U.S. 501 (1947) are too malleable in that they often lead to frequent mandamus orders from the U.S. Court of Appeals for the Federal Circuit (“Federal Circuit”) overturning district court rulings on venue transfer motions. Thus, this paper proposes a more robust two-step burden-shifting framework that replaces the eight Gilbert factors. Moreover, a brief history of venue transfer patterns in the seven most active federal patent district courts is covered, with special focus devoted to the venue transfer orders from Judge Alan D Albright of the U.S. District Court for the Western District of Texas. A comprehensive data summary of 45 case sets where the Federal Circuit ruled on writs of mandamus involving Judge Albright’s transfer orders is subsequently provided, with coverage summaries of certain cases including four precedential ones from the Federal Circuit. This proposed two-step burden shifting framework is then applied to these venue transfer cases, as well as Federal Circuit mandamus orders ruling on those decisions. Finally, alternative approaches to remedying the frequent reversals for venue transfer will be discussed, including potential legislative solutions, adjustments to common law framework approaches to venue transfer, deference to the inherent powers of Article III U.S. District Judge, and a unified federal patent district court. Overall, this paper seeks to offer a more robust and consistent three-step burden-shifting framework for venue transfer and for the Federal Circuit to follow in administering mandamus orders, which might change somewhat in light of Western District of Texas Chief Judge Orlando Garcia’s order on redistributing Judge Albright’s patent cases.

Keywords: Patent law, venue, judge Alan Albright, minimum contacts, western district of Texas

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Authors: Fabiha Tanzeem

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BACKGROUND: Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures of the bone and deterioration of bone tissue. Fragility fracture due to osteoporosis is the most significant complication of osteoporosis. The increasing prevalence of fragility fractures presents a growing burden on the global economy. There is a rapidly evolving need to improve awareness of the costs associated with these types of fractures and to review current policies and practices for the prevention and management of the disease. This systematic review will identify and describe the direct and indirect costs associated with osteoporotic fragility fractures from a global perspective from the included studies. The review will also find out whether the costs required for the treatment of fragility fractures due to osteoporosis impose an economic burden on the global healthcare system. METHODS: Four major databases were systematically searched for direct and indirect costs of osteoporotic fragility fracture studies in the English Language. PubMed, Cochrane Library, Embase and Google Scholar were searched for suitable articles published between 1990 and July 2020. RESULTS: The original search yielded 1166 papers; from these, 27 articles were selected for this review according to the inclusion and exclusion criteria. In the 27 studies, the highest direct costs were associated with the treatment of pelvic fractures, with the majority of the expenditure due to hospitalization and surgical treatments. It is also observed that most of the articles are from developed countries. CONCLUSION: This review indicates the significance of the economic burden of osteoporosis globally, although more research needs to be done in developing countries. In the treatment of fragility fractures, direct costs were the main reported expenditure in this review. The healthcare costs incurred globally can be significantly reduced by implementing measures to effectively prevent the disease. Raising awareness in children and adults by improving the quality of the information available and standardising policies and planning of services requires further research.

Keywords: systematic review, osteoporosis, cost of illness

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Authors: Caroline Seo, Jennifer Stephens, Kirstin H. Heinrich

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Background: Clostridiodes (formerly Clostridium) difficile infection (CDI) is an anaerobic, spore-forming bacterium with manifestations including diarrhea, pseudomembranous colitis and toxic megacolon. Despite general understanding that CDI may be associated with marked burden on patients’ health, there has been limited information available on the humanistic burden of CDI. The objective of this literature review was to summarize the published data on the humanistic burden of CDI globally, in order to better inform future research efforts and increase awareness of the patient perspective in this disease. Methods: A comprehensive literature review of the past 15 years (2002-2017) was conducted using MEDLINE, Embase and Cumulative Index of Nursing and Allied Health Literature. Additional searches were conducted from conference proceedings (2015-2017). Articles selected were studies specifically designed to examine the humanistic burden of illness associated with adult patients with CDI. Results: Of 3,325 articles or abstracts identified, 33 remained after screening and full text review. Sixty percent (60%) were published in 2016 or 2017. Data from the United States or Western Europe were most common. Data from Brazil, Canada, China and Spain also exist. Thirteen (13) studies used validated patient-reported outcomes instruments, mostly EQ-5D utility and SF-36 generic instruments. Three (3) studies used CDI-specific instruments (CDiff32, CDI-DaySyms). The burden of CDI impacts patients in multiple health-related quality of life (HRQOL) domains. SF-36 domains with the largest decrements compared to other GI diarrheal diseases (IBS-D and Crohn’s) were role physical, physical functioning, vitality, social functioning, and role emotional. Reported EQ-5D utilities for CDI ranged from 0.35-0.42 compared to 0.65 in Crohn’s and 0.72 in IBS-D. The majority of papers addressed physical functioning and mental health domains (67% for both). Across various studies patients reported weakness, lack of appetite, sleep disturbance, functional dependence, and decreased activities of daily lives due to the continuous diarrhea. Due to lack of control over this infection, CDI also impacts the psychological and emotional quality of life of the patients. Patients reported feelings of fear, anxiety, frustration, depression, and embarrassment. Additionally, the type of disease (primary vs. recurrent) may impact mental health. One study indicated that there is a decrement in SF-36 mental scores in patients with recurrent CDI, in comparison to patients with primary CDI. Other domains highlighted by these studies include pain (27%), social isolation (27%), vitality and fatigue (24%), self-care (9%), and caregiver burden (0%). Two studies addressed work productivity, with 1 of these studies reporting that CDI patients had the highest work productivity and activity impairment scores among the gastrointestinal diseases. No study specifically included caregiver self-report. However, 3 studies did provide mention of patients’ worry on how their diagnosis of CDI would impact family, caregivers, and/or friends. Conclusions: Despite being a serious public health issue there has been a paucity of research on the HRQOL among those with CDI. While progress is being made, gaps exist in understanding the burden on patients, caregivers, and families. Future research is warranted to aid understanding of the CDI patient perspective.

Keywords: burden, Clostridiodes, difficile, humanistic, infection

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Authors: Ahmed El Naggar, Homyan Saleh

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Dams are crucial for flood control, water supply, and the creation of hydroelectric power. Every dam has a water conveyance system, such as a spillway, providing the safe discharge of catastrophic floods when necessary. Spillway design has historically been investigated in laboratory research owing to the absence of suitable full-scale flow monitoring equipment and safety problems. Prototype measurements of aerated flows are urgently needed to quantify projected scale effects and provide missing validation data for design guidelines and numerical simulations. In this work, an image-based investigation of free-surface flows on a tiered spillway was undertaken at the laboratory (fixed camera installation) and prototype size (drone video) (drone footage) (drone footage). The drone videos were generated using data from citizen science. Analyses permitted the measurement of the free-surface aeration inception point, air-water surface velocities, fluctuations, and residual energy at the chute's downstream end from a remote site. The prototype observations offered full-scale proof of concept, while laboratory results were efficiently confirmed against invasive phase-detection probe data. This paper stresses the efficacy of image-based analyses at prototype spillways. It highlights how citizen science data may enable academics better understand real-world air-water flow dynamics and offers a framework for a small collection of long-missing prototype data.

Keywords: remote sensing, aerated flows, large dams, proof of concept, dam spillways, air-water flows, prototype operation, remote sensing, inception point, optical flow, turbulence, residual energy

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Authors: Ying Yi Wu

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The study of finite groups is a central topic in algebraic structures, and one of the most fundamental questions in this field is the classification of finite groups up to isomorphism. In this paper, we investigate the cyclic property of groups of prime order, which is a crucial result in the classification of finite abelian groups. We prove the following statement: If p is a prime, then every group G of order p is cyclic. Our proof utilizes the properties of group actions and the class equation, which provide a powerful tool for studying the structure of finite groups. In particular, we first show that any non-identity element of G generates a cyclic subgroup of G. Then, we establish the existence of an element of order p, which implies that G is generated by a single element. Finally, we demonstrate that any two generators of G are conjugate, which shows that G is a cyclic group. Our result has significant implications in the classification of finite groups, as it implies that any group of prime order is isomorphic to the cyclic group of the same order. Moreover, it provides a useful tool for understanding the structure of more complicated finite groups, as any finite abelian group can be decomposed into a direct product of cyclic groups. Our proof technique can also be extended to other areas of group theory, such as the classification of finite p-groups, where p is a prime. Therefore, our work has implications beyond the specific result we prove and can contribute to further research in algebraic structures.

Keywords: group theory, finite groups, cyclic groups, prime order, classification.

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Authors: Soheib Fergani

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This paper concerns with the formal asymptotic stability guarantees, analysis and evaluation of a nonlinear controlled unmanned aerial vehicles (uav) for trajectory tracking purpose. As the system has been recognised as an under-actuated non linear system, the control strategy has been oriented towards a hierarchical control. The dynamics of the system and the mission purpose make it mandatory to provide an absolute proof of the vehicle stability during the maneuvers. For this sake, this work establishes the complete theoretical proof for an implementable control oriented strategy that asymptotically stabilizes (GAS and LISS) the system and has never been provided in previous works. The considered model is reorganized into two partly decoupled sub-systems. The concidered control strategy is presented into two stages: the first sub-system is controlled by a nonlinear backstepping controller that generates the desired control inputs to stabilize the second sub-system. This methodology is then applied to a harware in the loop uav simulator (SiMoDrones) that reproduces the realistic behaviour of the uav in an indoor environment has been performed to show the efficiency of the proposed strategy.

Keywords: UAV application, trajectory tracking, backstepping, sliding mode control, input to state stability, stability evaluation

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Authors: Tasawar Nawaz

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Migration has once again become a lively topic in Europe and UK, in particular. A burgeoning concern in the public debate, however, is driven by the fear that migrants are fiscal burden because they drain public resources by drawing on the generous social transfers introduced in Europe to prevent social exclusion. This study challenges these beliefs by gathering empirical evidence through a qualitative research approach on the subject matter. The analysis suggests that UK provides a rich social and economic environment for intellectual profiles especially, human intellectual capital of migrants to flourish and add value to the exchequer. Contrary to the beliefs held by politicians and general public, the empirical evidence suggests that migrants add higher fiscal contribution by working longer hours, paying consistent taxes, and bringing skills which UK may lack thus, are not fiscal burdens on the UK exchequer.

Keywords: austerity, European union, human intellectual capital, migrants, social welfare, United Kingdom

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Authors: Joel Mintz, Kyle Huntley, Waseem Wahood, Samuel Raine, Farzanna Haffizulla

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The effect of different state government interventions on COVID-19 health outcomes is currently unknown. Stay at home (SAH) orders, all non-essential business closures and school closures in the Northeastern US were examined. A linear correlation between the peak number of new daily COVID-19 positive tests, hospitalizations and deaths per capita and the elapsed time between government issued guidance and a fixed number of COVID-19 deaths in each state was performed. Earlier government interventions were correlated with lower peak healthcare burden. Statewide closures of schools and non-essential businesses showed significantly greater (p<.001) correlation to peak COVID-19 disease burden as compared to a statewide SAH. The implications of these findings require further study to determine the effectiveness of these interventions.

Keywords: Coronavirus, epidemiology, government intervention, public health, social distancing

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Authors: Yu A. Pluttsova , O. V. Vakhnina , K. B. Zhogova

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Nowadays, many devices operate under conditions of enhanced humidity, temperature drops, fog, and vibration. To ensure long-term and uninterruptable equipment operation under adverse conditions, one applies moisture-proof films on products and electronics components, which helps to prevent corrosion, short circuit, allowing a significant increase in device lifecycle. The reliability of such moisture-proof films is mainly determined by their coating uniformity without gaps and cracks. Unprotected product edges, as well as pores in films, can cause device failure during operation. The work objective was to develop an effective, affordable, and profit-proved method for determining the presence of through defects of protective polymer films on the surface of parts made of iron and its alloys. As a diagnostic reagent, one proposed water solution of potassium ferricyanide (III) in hydrochloric acid, this changes the color from yellow to blue according to the reactions; Feº → Fe²⁺ and 4Fe²⁺ + 3[Fe³⁺(CN)₆]³⁻ → Fe ³⁺4[Fe²⁺(CN)₆]₃. There was developed the principle scheme of technological process for determining the presence of polymer films through defects on the surface of parts made of iron and its alloys. There were studied solutions with different diagnostic reagent compositions in water: from 0,1 to 25 mass fractions, %, of potassium ferricyanide (III), and from 5 to 25 mass fractions, %, of hydrochloride acid. The optimal component ratio was chosen. The developed method consists in submerging a part covered with a film into a vessel with a diagnostic reagent. In the polymer film through defect zone, the part material (ferrum) interacts with potassium ferricyanide (III), the color changes to blue. Pilot samples were tested by the developed method for the presence of through defects in the moisture-proof coating. It was revealed that all the studied parts had through defects of the polymer film coating. Thus, the claimed method efficiently reveals polymer film coating through defects on parts made of iron or its alloys, being affordable and profit-proved.

Keywords: diagnostic reagent, metal parts, polimer films, through defects

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Authors: Shireen Ibish

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Physical inactivity and unhealthy diets have contributed to a global burden of disease with increased relation to non-communicable diseases, increased risk of colon and breast cancer, high prevalence of depression, reduced quality of life and early death. The World Health Organisation’s facts on Obesity show a tripling in prevalence across the European Region since the 1980s. This has lead to a huge public health burden, being responsible for and 10-13% of deaths (fourth largest cause of global mortality) and 2-8% of health costs in the Region. In the UK alone, the present cost of physical inactivity has been estimated to be £8.2 billion. In 2002 a paper published in the International Journal of Epidemiology on ‘sedentary’ lifestyle, put into figures the increasingly worrying statistics across European countries. “Percentages of sedentary lifestyles across European countries ranged between 43.3% (Sweden) and 87.8% (Portugal)”. This was especially so amongst obese subjects, less- educated people, and smokers. While in the UK’s “50% of adult population in the UK is predicted to be obese by 2050.” Sports and Exercise Medicine, as a specialty, has a lot to offer in targeting this globally increasing epidemic. The worrying figures and the increasing knowledge of combating and preventing this issue have lead to increased awareness amongst the medical profession and more targeted interventions to reduce the burden of disease. “The public health element of the specialty is critical – this is not simply a specialty for the management of elite athletes’ medical conditions – it is central to the promotion of exercise as a means of disease prevention, to enhance well-being and in the management of disease.” WHO advised on creating National policies, encouraging and providing opportunities for greater physical activity, and improve the affordability, availability and accessibility of healthy foods. In the UK various different movements have been established to target this problem. The Motivate2Move, Move Eat Treat and guidelines advising specialties on targeting and encouraging exercise in the population (Sport and Exercise Medicine A Fresh Approach).

Keywords: sedentary lifestyle, obesity, public health burden, medicine

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Authors: Chinlun Lai, Lunjyh Jiang

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Due to the heavy burden and pressure of caring for infants, an integrated automatic baby watching system based on IoT smart sensing and deep learning machine vision techniques is proposed in this paper. By monitoring infant body conditions such as heartbeat, breathing, body temperature, sleeping posture, as well as the surrounding conditions such as dangerous/sharp objects, light, noise, humidity and temperature, the proposed system can analyze and predict the obvious/potential dangerous conditions according to observed data and then adopt suitable actions in real time to protect the infant from harm. Thus, reducing the burden of the caregiver and improving safety efficiency of the caring work. The experimental results show that the proposed system works successfully for the infant care work and thus can be implemented in various life fields practically.

Keywords: baby care system, Internet of Things, deep learning, machine vision

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Authors: Harjinder Kaur

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GST was implemented by government with the expectation to reform the taxation system of India. So this study basically seeks to understand the consumers’ awareness, knowledge and perception about the implementation of GST. To conduct this study, 100 respondents of all demographic profile were randomly selected from the Punjab region of India. To investigate the relationship between demographic profile and level of awareness and knowledge about GST, one way ANOVA test was used and it is found that there is a significant relationship between gender, age and qualification and level of awareness and knowledge. Furthermore, due to the lack of information on GST, the respondents had a high negative perception. The study also reveals that the implementation of GST has resulted in higher prices for goods and services and thus this tax may cause burden to people. Also after implementation of GST financial issues such as inflation, rising cost of living, economic instability have impacted many Indian consumers in terms of their spending. But at the same time it is also perceived that GST is designed to remove the burden of many indirect taxes and aims to develop the more efficient tax system which increases the revenue of country.

Keywords: goods and service tax, consumers awareness, knowledge, perception

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Authors: A. Shirazibeheshti, T. Radwan, A. Ettefaghian, G. Wilson, C. Luca, Farbod Khanizadeh

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Anticholinergic medication has been associated with events such as falls, delirium, and cognitive impairment in older patients. To further assess this, anticholinergic burden scores have been developed to quantify risk. A risk model based on clustering was deployed in a healthcare management system to cluster patients into multiple risk groups according to anticholinergic burden scores of multiple medicines prescribed to patients to facilitate clinical decision-making. To do so, anticholinergic burden scores of drugs were extracted from the literature, which categorizes the risk on a scale of 1 to 3. Given the patients’ prescription data on the healthcare database, a weighted anticholinergic risk score was derived per patient based on the prescription of multiple anticholinergic drugs. This study was conducted on over 300,000 records of patients currently registered with a major regional UK-based healthcare provider. The weighted risk scores were used as inputs to an unsupervised learning algorithm (mean-shift clustering) that groups patients into clusters that represent different levels of anticholinergic risk. To further evaluate the performance of the model, any association between the average risk score within each group and other factors such as socioeconomic status (i.e., Index of Multiple Deprivation) and an index of health and disability were investigated. The clustering identifies a group of 15 patients at the highest risk from multiple anticholinergic medication. Our findings also show that this group of patients is located within more deprived areas of London compared to the population of other risk groups. Furthermore, the prescription of anticholinergic medicines is more skewed to female than male patients, indicating that females are more at risk from this kind of multiple medications. The risk may be monitored and controlled in well artificial intelligence-equipped healthcare management systems.

Keywords: anticholinergic medicines, clustering, deprivation, socioeconomic status

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Authors: Rainner Roweder

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Theme: The present paper aims to analyze the specificity of the judicial evidence linked to the subjects of dignity and personality rights, otherwise known as moral rights, in the determination of the truth and formation of the judicial reasoning in cases concerning these areas. This research is about the way courts in Brazilian domestic law search for truth and handles evidence in cases involving moral rights that are abundant and important in Brazil. The main object of the paper is to analyze the effectiveness of the evidence in the formation of judicial conviction in matters related to morally controverted rights, based on the Brazilian, and as a comparison, the Latin American legal systems. In short, the rights of dignity and personality are moral. However, the evidential legal system expects a rational demonstration of moral rights that generate judicial conviction or persuasion. Moral, in turn, tends to be difficult or impossible to demonstrate in court, generating the problem considered in this paper, that is, the study of the moral demonstration problem as proof in court. In this sense, the more linked to moral, the more difficult to be demonstrated in court that right is, expanding the field of judicial discretion, generating legal uncertainty. More specifically, the new personality rights, such as gender, and their possibility of alteration, further amplify the problem being essentially an intimate manner, which does not exist in the objective, rational evidential system, as normally occurs in other categories, such as contracts. Therefore, evidencing this legal category in court, with the level of security required by the law, is a herculean task. It becomes virtually impossible to use the same evidentiary system when judging the rights researched here; therefore, it generates the need for a new design of the evidential task regarding the rights of the personality, a central effort of the present paper. Methodology: Concerning the methodology, the Method used in the Investigation phase was Inductive, with the use of the comparative law method; in the data treatment phase, the Inductive Method was also used. Doctrine, Legislative, and jurisprudential comparison was the technique research used. Results: In addition to the peculiar characteristics of personality rights that are not found in other rights, part of them are essentially linked to morale and are not objectively verifiable by design, and it is necessary to use specific argumentative theories for their secure confirmation, such as interdisciplinary support. The traditional pragmatic theory of proof, for having an obvious objective character, when applied in the rights linked to the morale, aggravates decisionism and generates legal insecurity, being necessary its reconstruction for morally charged cases, with the possible use of the “predictive theory” ( and predictive facts) through algorithms in data collection and treatment.

Keywords: moral rights, proof, pragmatic proof theory, insufficiency, Brazil

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Authors: Bruno Mazorra Roig

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In the realm of cost-sharing mechanisms, the vulnerability to Sybil strategies, where agents can create fake identities to manipulate outcomes, has not yet been studied. In this paper, we delve into the intricacies of different cost-sharing mechanisms proposed in the literature, highlighting its non-Sybil-resistance nature. Furthermore, we prove that under mild conditions, a Sybil-proof cost-sharing mechanism for public excludable goods is at least (n/2 + 1)−approximate. This finding reveals an exponential increase in the worst-case social cost in environments where agents are restricted from using Sybil strategies. We introduce the concept of Sybil Welfare Invariant mechanisms, where a mechanism maintains its worst-case welfare under Sybil strategies for every set of prior beliefs with full support even when the mechanism is not Sybil-proof. Finally, we prove that the Shapley value mechanism for public excludable goods holds this property and so deduce that the worst-case social cost of this mechanism is the nth harmonic number Hn under the equilibrium of the game with Sybil strategies, matching the worst-case social cost bound for cost-sharing mechanisms. This finding carries important implications for decentralized autonomous organizations (DAOs), indicating that they are capable of funding public excludable goods efficiently, even when the total number of agents is unknown.

Keywords: game theory, mechanism design, cost sharing, false-name proofness

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Authors: Rob van den Dam

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Today’s Internet of Things (IoT) comprises more than a billion intelligent devices, connected via wired/wireless communications. The expected proliferation of hundreds of billions more places us at the threshold of a transformation sweeping across the communications industry. Yet, we found that the IoT architecture and solutions that currently work for billions of devices won’t necessarily scale to tomorrow’s hundreds of billions of devices because of high cost, lack of privacy, not future-proof, lack of functional value and broken business models. As the IoT scales exponentially, decentralized networks have the potential to reduce infrastructure and maintenance costs to manufacturers. Decentralization also promises increased robustness by removing single points of failure that could exist in traditional centralized networks. By shifting the power in the network from the center to the edges, devices gain greater autonomy and can become points of transactions and economic value creation for owners and users. To validate the underlying technology vision, IBM jointly developed with Samsung Electronics the autonomous decentralized peer-to- peer proof-of-concept (PoC). The primary objective of this PoC was to establish a foundation on which to demonstrate several capabilities that are fundamental to building a decentralized IoT. Though many commercial systems in the future will exist as hybrid centralized-decentralized models, the PoC demonstrated a fully distributed proof. The PoC (a) validated the future vision for decentralized systems to extensively augment today’s centralized solutions, (b) demonstrated foundational IoT tasks without the use of centralized control, (c) proved that empowered devices can engage autonomously in marketplace transactions. The PoC opens the door for the communications and electronics industry to further explore the challenges and opportunities of potential hybrid models that can address the complexity and variety of requirements posed by the internet that continues to scale. Contents: (a) The new approach for an IoT that will be secure and scalable, (b) The three foundational technologies that are key for the future IoT, (c) The related business models and user experiences, (d) How such an IoT will create an 'Economy of Things', (e) The role of users, devices, and industries in the IoT future, (f) The winners in the IoT economy.

Keywords: IoT, internet, wired, wireless

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Authors: Qiongpeng Dan, Xiyao Li, Qiong Zhang, Yongzhen Peng

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The nutrients removal from wastewater is of great significance for global wastewater recycling and sustainable reuse. Traditional nitrogen and phosphorus removal processes are very dependent on the input of aeration and carbon sources, which makes it difficult to meet the low-carbon goal of energy saving and emission reduction. This study reported a proof-of-concept demonstration of integrating anammox and enhanced biological phosphorus removal (EBPR) by flocs management in a single-stage hybrid bioreactor (biofilms and flocs) for simultaneous nitrogen and phosphorus removal (SNPR). Excellent removal efficiencies of nitrogen (97.7±1.3%) and phosphorus (97.4±0.7%) were obtained in low C/N ratio (3.0±0.5) municipal wastewater treatment. Interestingly, with the loss of flocs, anammox bacteria (Ca. Brocadia) was highly enriched in biofilms, with relative and absolute abundances reaching up to 12.5% and 8.3×1010 copies/g dry sludge, respectively. The anammox contribution to nitrogen removal also rose from 32.6±9.8% to 53.4±4.2%. Endogenous denitrification by flocs was proven to be the main contributor to both nitrite and nitrate reduction, and flocs loss significantly promoted nitrite flow towards anammox, facilitating AnAOB enrichment. Moreover, controlling the floc's solid retention time at around 8 days could maintain a low poly-phosphorus level of 0.02±0.001 mg P/mg VSS in the flocs, effectively addressing the additional phosphorus removal burden imposed by the enrichment of phosphorus-accumulating organisms in biofilms. This study provides an update on developing a simple and feasible strategy for integrating anammox and EBPR for SNPR in mainstream municipal wastewater.

Keywords: anammox process, enhanced biological phosphorus removal, municipal wastewater, sustainable nutrients removal

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Authors: John Acord, Ankita Batla, Kiran Khepar, Maude Schmidt, Charlotte Allen, Russ Bradford

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Objectives: Despite the availability oftreatment options, Parkinson’s disease (PD) continues to impact heavily on a patient’s quality of life (QoL), as many symptoms that bother the patient remain unexplored and untreated in clinical settings. The aims of this research were to understand the burden of PDsymptoms from a patient perspective, particularly those which are the most persistent and debilitating, and to determine if current treatments and treatment algorithms adequately focus on their resolution. Methods: A13-question, online, patient-reported survey was created based on the MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)and symptoms listed on Parkinson’s Disease Patient Advocacy Groups websites, and then validated by 10 Parkinson’s patients. In the survey, patients were asked to choose both their most common and their most bothersome symptoms, whether they had received treatment for those and, if so, had it been effective in resolving those symptoms. Results: The most bothersome symptoms reported by the 111 participants who completed the survey were sleep problems (61%), feeling tired (56%), slowness of movements (54%), and pain in some parts of the body (49%). However, while 86% of patients reported receiving dopamine or dopamine like drugs to treat their PD, far fewer reported receiving targeted therapies for additional symptoms. For example, of the patients who reported having sleep problems, only 33% received some form of treatment for this symptom. This was also true for feeling tired (30% received treatment for this symptom), slowness of movements (62% received treatment for this symptom), and pain in some parts of the body (61% received treatment for this symptom). Additionally, 65% of patients reported that the symptoms they experienced were not adequately controlled by the treatments they received, and 9% reported that their current treatments had no effect on their symptoms whatsoever. Conclusion: The survey outcomes highlight that the majority of patients involved in the study received treatment focused on their disease, however, symptom-based treatments were less well represented. Consequently, patient-reported symptoms such as sleep problems and feeling tired tended to receive more fragmented intervention than ‘classical’ PD symptoms, such as slowness of movement, even though they were reported as being amongst the most bothersome symptoms for patients. This research highlights the need to explore symptom burden from the patient’s perspective and offer Customised treatment/support for both motor and non-motor symptoms maximize patients’ quality of life.

Keywords: survey, patient reported symptom burden, unmet needs, parkinson's disease

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Authors: Loizos A. Hadjivasiliou, May Chehab

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Confronted with the human tragedy unfolding in the Mediterranean during the 2011-2016 period, the European Union introduced for the first time the “hotspot approach”, the establishment of facilities for initial reception, identification registration, and fingerprinting of asylum seekers and migrants arriving in the EU by sea, at the frontline Member States. However, the lack of a comprehensive collective policy on migration management and border security left the Mediterranean Member States, mainly Italy, Greece, and Cyprus, struggling to overcome these challenges. The current study sheds light on the implementation of the hotspot approach as the frontispiece of the European response to the migration challenges, which, limited to the operational and financial support of the hosting member states, leads to heterogeneous burden-sharing. Within this framework, it highlights the fact that the implementation of the hotspots as a panacea carries the risk of transforming the Mediterranean member states into giant hotspots with unpredictable consequences for the future of the Schengen area.

Keywords: asylum, burden sharing, hotspots, migration management policy, Schengen area

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Authors: Teo Hao Jing, Shane Ho Ken Wae, Lee Jin Yu, Burra Venkata Durga Kumar

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Current distributed healthcare systems face the challenge of interoperability of health data. Storing electronic health records (EHR) in local databases causes them to be fragmented. This problem is aggravated as patients visit multiple healthcare providers in their lifetime. Existing solutions are unable to solve this issue and have caused burdens to healthcare specialists and patients alike. Blockchain technology was found to be able to increase the interoperability of health data by implementing digital access rules, enabling uniformed patient identity, and providing data aggregation. Consortium blockchain was found to have high read throughputs, is more trustworthy, more secure against external disruptions and accommodates transactions without fees. Therefore, this paper proposes a blockchain-based model for data management applications. In this model, a consortium blockchain is implemented by using a delegated proof of stake (DPoS) as its consensus mechanism. This blockchain allows collaboration between users from different organizations such as hospitals and medical bureaus. Patients serve as the owner of their information, where users from other parties require authorization from the patient to view their information. Hospitals upload the hash value of patients’ generated data to the blockchain, whereas the encrypted information is stored in a distributed cloud storage.

Keywords: blockchain technology, data management applications, healthcare, interoperability, delegated proof of stake

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Authors: Kajori Banerjee, Laxmi Kant Dwivedi

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“Health transition” is defined to be “a process through which high levels of mortality, morbidity and disability are reduced to low levels by influencing cultural, social and behavioural factors”. Life expectancy in India has been on the rise and parallel the burden of disease and disability has also risen noticeably. Borrowing data from Indian Census (2001, 2011), this study identifies the gender-wise burden of disability by calculating disability free life expectancy (DFLE) and life lived with disability (LWD). Sullivan’s method of calculating DFLE using proportion of disabled is used for this purpose. The change in person years lived with disability in the decade 2001-11 is further decomposed using Arriaga’s method into mortality and disability effects (ME and DE) to check the magnitude and direction of contribution of mortality and disability. Nationally, along with DFLE, LWD has amplified too. Despite having the highest life expectancy and DFLE, LWD in Kerala, was highest for both sexes in 2001. But in 2011, the LWD was highest among the males of Orissa and females of Rajasthan. For the overall population, DE is positive for the prime working age groups of 20-40years indicating that there has been an increase in the disability proportion holding mortality constant for 2001-2011. Females exhibit higher positive DE implying greater loss of healthy years due to disability than males. The findings call for an immediate attention to the causes of rising disability burden among the working population, especially females, as this might heavily effect the availability of quality labour force and its relative economic output in the Indian labour market. This also hints at the degrading quality of the elongated life and needs to be given the required attention to enhance the quality of life lead in the Nation.

Keywords: disability-free life expectancy, disability effect, life expectancy, mortality effect

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Authors: Devina Jain

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The choice between single-use drinking glasses and reusable glasses is of major concern to our lifestyles, and hence, the environment. This study is aimed at comparing three systems - a disposable paper cup, a disposable cup and a reusable stainless steel cup or glass - with respect to their effect on the environment to find out which one is more advantageous for reducing the impact on the environment. Life Cycle Assessment was conducted using modeling software, Umberto NXT Universal (Version 7.1). For the purpose of this study, the cradle to grave approach was considered. Results showed that cleaning is of a very strong influence on the environmental burden by these drinking systems, with a contribution of up to 90 to 100%. Thus, the burden is determined by the way in which the utensils are washed, and how much water is consumed. It maybe seems like a small, insignificant daily practice. In the short term, it would seem that paper and plastic cups are a better idea, since they are easy to acquire and do not need to be stored, but in the long run, we can say that steel cups will have less of an environmental impact. However, if the frequency of use and the number of glasses employed per use are of significance to decide the appropriateness of the usage, it is better to use disposable cups and glasses.

Keywords: disposable glass, life cycle assessment, paper, plastic, reusable glass, stainless steel

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Authors: Koko Wangjam, Naresh Kumar Sharma

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The concern for most public health policies and decision- makers is the equitable distribution of health care resource of the nation. Also, in public health care system, the primary aim is assuaging the burden of the disease. Objective: This paper captures and evaluates some important theories in equity in health with its relevance with the ART program in India. Methodology: The paper is exploratory and descriptive study based on secondary data. The sources of secondary data are published official reports from NACO (National AIDS Control Organisation), United Nations AIDS Program (UNAIDS), World Health Organisation (WHO) etc. Observation: The roll-out of the ART program in 2004 by the Govt. of India made a paradigm shift in HIV/AIDS scenario in the country. Conclusion: There are many theoretical injunctions in most of the principles and approaches in existing theories of health equity. The enervation of HIV infection by taking ART drugs had helped in curbing the prevalence and the fact that it is provided at free of cost has proven this program to be an epitome in distributive justice in public health.

Keywords: art program, burden of the disease, health equity, hiv/aids

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Authors: Hashem Sazegar

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Legendre’s conjecture states that there is a prime number between n^2 and (n + 1)^2 for every positive integer n. In this paper we prove that every composite number between n2 and (n + 1)2 can be written u^2 − v^2 or u^2 − v^2 + u − v that u > 0 and v ≥ 0. Using these result as well as induction and residues (modq) we prove Legendre’s conjecture.

Keywords: bertrand-chebyshev theorem, landau’s problems, goldbach’s conjecture, twin prime, ramanujan proof

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Authors: Gabriella Zarlenga, Martha L. Hall

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Introduction: Premature infants are at risk for neurodevelopmental deficits and hospital readmissions, which can increase the financial burden on the health care system and families. Kangaroo care (skin-to-skin contact) is a practice that can improve preterm infant health outcomes. Preterm infants can acquire adequate body temperature, heartbeat, and breathing regulation through lying directly on the mother’s abdomen and in between her breasts. Due to some infant’s condition, kangaroo care is not a feasible intervention. The purpose of this proof-of-concept research project is to create a device which simulates skin-to-skin contact for pre-term infants not eligible for kangaroo care, with the aim of promoting baby’s health outcomes, reducing the incidence of serious neonatal and early childhood illnesses, and/or improving cognitive, social and emotional aspects of development. Methods: The study design is a proof-of-concept based on a three-phase approach; (1) observational study and data analysis of the standard of care for 2 groups of pre-term infants, (2) design and concept development of a novel device for pre-term infants not currently eligible for standard kangaroo care, and (3) prototyping, laboratory testing, and evaluation of the novel device in comparison to current assessment parameters of kangaroo care. A single center study will be conducted in an area hospital offering Level III neonatal intensive care. Eligible participants include newborns born premature (28-30 weeks of age) admitted to the NICU. The study design includes 2 groups: a control group receiving standard kangaroo care and an experimental group not eligible for kangaroo care. Based on behavioral analysis of observational video data collected in the NICU, the device will be created to simulate mother’s body using electrical components in a thermoplastic polymer housing covered in silicone. It will be designed with a microprocessor that controls simulated respiration, heartbeat, and body temperature of the 'simulated caregiver' by using a pneumatic lung, vibration sensors (heartbeat), pressure sensors (weight/position), and resistive film to measure temperature. A slight contour of the simulator surface may be integrated to help position the infant correctly. Control and monitoring of the skin-to-skin contact simulator would be performed locally by an integrated touchscreen. The unit would have built-in Wi-Fi connectivity as well as an optional Bluetooth connection in which the respiration and heart rate could be synced with a parent or caregiver. A camera would be integrated, allowing a video stream of the infant in the simulator to be streamed to a monitoring location. Findings: Expected outcomes are stabilization of respiratory and cardiac rates, thermoregulation of those infants not eligible for skin to skin contact with their mothers, and real time mother Bluetooth to the device to mimic the experience in the womb. Results of this study will benefit clinical practice by creating a new standard of care for premature neonates in the NICU that are deprived of skin to skin contact due to various health restrictions.

Keywords: kangaroo care, wearable technology, pre-term infants, medical design

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Authors: Maria Klitgaard Christensen, Carmen Lim, Sukanta Saha, Danielle Cannon, Finley Prentis, Oleguer Plana-Ripoll, Natalie Momen, Kim Moesgaard Iburg, John J. McGrath

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Introduction: About a third of the world’s population will develop a mental disorder over their lifetime. Having a mental disorder is a huge burden in health loss and cost for the individual, but also for society because of treatment cost, production loss and caregivers’ cost. The objective of this study is to synthesize the international published literature on the economic burden of mental disorders. Methods: Systematic literature searches were conducted in the databases PubMed, Embase, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to 1980 until May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses, (2) diagnosis of at least one mental disorder, (3) samples based on the general population, and (4) outcome in monetary units. 13,640 publications were screened by their title/abstract and 439 articles were full-text screened by at least two independent reviewers. 112 articles were included from the systematic searches and 31 articles from snowball searching, giving a total of 143 included articles. Results: Information about diagnosis, diagnostic criteria, sample size, age, sex, data sources, study perspective, study period, costing approach, cost categories, discount rate and production loss method and cost unit was extracted. The vast majority of the included studies were from Western countries and only a few from Africa and South America. The disorder group most often investigated was mood disorders, followed by schizophrenia and neurotic disorders. The disorder group least examined was intellectual disabilities, followed by eating disorders. The preliminary results show a substantial variety in the used perspective, methodology, costs components and outcomes in the included studies. An online tool is under development enabling the reader to explore the published information on costs by type of mental disorder, subgroups, country, methodology, and study quality. Discussion: This is the first systematic review synthesizing the economic cost of mental disorders worldwide. The paper will provide an important and comprehensive overview over the economic burden of mental disorders, and the output from this review will inform policymaking.

Keywords: cost-of-illness, health economics, mental disorders, systematic review

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Authors: Ashutosh Biswas, Poonam Coushic, Kalpana Baruah, Paras Singla, A. C. Dhariwal, Pawana Murthy

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Burden of Dengue in Northern India Ashutosh Biswas, Poonam Coushic, Kalpana Baruah, Paras Singla, AC Dhariwal, Pawana Murthy. All India Institute of Medical Sciences, NVBDCP,WHO New Delhi, India Aim: This study was conducted to estimate the burden of dengue in capital region of India. Methodology:Seropositivity of Dengue for IgM Ab, NS1 Ag and IgG Ab were performed among the blood donors’ samples from blood bank, those who were coming to donate blood for the requirement of blood for the admitted patients in hospital. Blood samplles were collected through out the year to estimate seroprevalance of dengue with or without outbreak season. All the subjects were asymptomatic at the time of blood donation. Results: A total of 1558 donors were screened for the study. On the basis of inclusion/ exclusion criteria, we enrolled 1531subjects for the study.Twenty seven donors were excluded from the study, out of which 6 were detected HIV +ve, 11 were positive for HBsAg and 10 were found positive for HCV.Mean age was 30.51 ± 7.75 years.Of 1531subjects, 18 (1.18%) had a past history of typhoid fever, 28 (1.83%) had chikungunya fever, 9 (0.59%) had malaria and 43 subjects (2.81%) had a past history of symptomatic dengue infection.About 2.22% (34) of subjects were found to have sero-positive for NS1 Ag with a peak point prevalence of 7.14% in the month of October and sero-positive of IgM Ab was observed about 5.49% (84)with a peak point prevalence of 14.29% in the month of October. Sero-prevalnce of IgGwas detected in about 64.21% (983) of subjects. Conclusion: Acute asymptomatic dengue (NS1 Ag+ve) was observed in 7.14%, as the subjects were having no symptoms at the time of sampling. This group of subjects poses a potential public health threat for transmitting dengue infection through blood transfusion (TTI) in the community as evident by presence of active viral infection due to NS1Ag +VE. Therefore a policy may be implemented in the blood bank for testing NS1 Ag to look for active dengue infection for preventing dengue transmission through blood transfusion (TTI). Acute or Subacute dengue infection ( IgM Ab+ve) was observed from 5.49% to 14.29% which is a peak point prevalence in the month of October. About 64.21% of the population were immunized by natural dengue infection ( IgG Ab+ve) in theNorthern province of India. This might be helpful for implementing the dengue vaccine in a region. Blood samples in blood banks should be tested for dengue before transfusion to any other person to prevent transfusion transmitted dengue infection as we estimated upto 7.14% positivity of NS1 Ag in our study which indicates presence of dengue virus in blood donors’ samples.

Keywords: Dengue Burden, Seroprevalance, Asymptomatic dengue, Dengue transmission through blood transfusion

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