In this paper,we consider the graph of the product of continuous functions in terms of Hausdorff and packing dimensions.More precisely,we show that,given a real number 1≤β≤2,any real-valued continuous function in C...In this paper,we consider the graph of the product of continuous functions in terms of Hausdorff and packing dimensions.More precisely,we show that,given a real number 1≤β≤2,any real-valued continuous function in C([0,1])can be decomposed into a product of two real-valued continuous functions,each having a graph of Hausdorff dimensionβ.In addition,a product decomposition result for the packing dimension is obtained.This work answers affirmatively two questions raised by Verma and Priyadarshi[14].展开更多
Morocco wants its 12 regions to play the role as the main lever of its public policies to initiate harmonized spatial multidimensional development. In the context of this goal and Morocco’s openness over the past two...Morocco wants its 12 regions to play the role as the main lever of its public policies to initiate harmonized spatial multidimensional development. In the context of this goal and Morocco’s openness over the past two decades to bilateral and multilateral cooperation in an effort toward regional integration, this article studies the convergence of 389 regions in 36 countries(Morocco and 35 of its partner member countries in the Organization for Economic Co-operation and Development(OECD)) between 2000 and 2019 in terms of well-being. To this end, we considered the territorial dimension of β-convergence models for well-being and its four domains(economic, social, environmental, and governance). Then, we adapted the absolute β-convergence model by taking into account the existence of spatial heterogeneity according to five specifications of spatial models. Thus, apart from environmental domain, we found that β-convergence of regions is significant for well-being and three of its domains(economic, social, and governance). These convergences are made by a spatially autocorrelated error model(SEM). However, the speed and period of convergence are relatively low for social domain, partly explaining the very exacerbated tensions at the territorial level. The fastest convergence was achieved in governance domain, followed by economic domain. This suggests that emerging countries must pay particular attention to national public action in favor of social cohesion at the territorial level. The lack of convergence in environmental domain calls for common actions for all countries at the supranational level to protect the commons at the territorial level.展开更多
Prepandemic time trends in mortality from chronic liver disease(CLD)differed according to specific cause of death(decreasing for liver cirrhosis,stable or increasing for liver cancer),etiology(increasing for nonalcoho...Prepandemic time trends in mortality from chronic liver disease(CLD)differed according to specific cause of death(decreasing for liver cirrhosis,stable or increasing for liver cancer),etiology(increasing for nonalcoholic fatty liver disease,generally decreasing for other etiologies),and world region(decreasing in areas with the highest burden of hepatitis B virus,increasing in Eastern Europe and other countries).The coronavirus disease 2019(COVID-19)pandemic affected mortality of patients with CLD both directly,with a higher risk for severe illness and death depending on age,stage and etiology of the disease,and indirectly,through social isolation and loss of support,harmful drinking,and difficulties in access to care.Nevertheless,only sparse data are available on variations in CLD as a cause of death during the pandemic.In the USA,in 2020-2021 a growth in mortality was registered for all liver diseases,more marked for alcoholic liver disease,especially among young people aged 25-44 years and in selected ethnic groups.COVID-19 related deaths accounted only for a minor part of the excess.Further data from mortality registers of other countries are warranted,preferably adopting the so-called multiple cause-of-death approach,and extended to deaths attributed to viral hepatitis and liver cancer.展开更多
Metabolic syndrome (MetS) has been and remains a highly controversial topic. There is a close association of (MetS) with a group of symptoms associated with diseases of the heart, blood vessels, arteries, and accelera...Metabolic syndrome (MetS) has been and remains a highly controversial topic. There is a close association of (MetS) with a group of symptoms associated with diseases of the heart, blood vessels, arteries, and accelerated aging. To find out and discover whether the distribution of these associations or the totals of (MetS) components differ from one gender to another or from one ethnicity to another, 110 subjects were selected as a sample at the National Institute of Diabetes, Nutrition and Metabolic Diseases (N.C.Paulescu) In Bucharest, 110 subjects in divided between 47 Males, 63 females with an age range of 54 years for age groups 35 - 65 years. The pathological conditions in the present study were divided into 2 groups: G1: Patients who have metabolic syndrome. G2: Patients without metabolic syndrome. This study, therefore, aims to diagnose metabolic syndrome according to the criteria approved by ATP III (MetS), also known as insulin resistance syndrome or Syndrome X, which is defined as (a group of several conditions that together increase a person’s risk of developing diabetes and increased heart disease), a disease that is achieved by the presence of 3 or more than 5 components that are considered as parameters or directories (MetS);such as “High level of obesity;High triglyceride levels;High blood sugar level;Decrease in HDL, or good cholesterol and High blood pressure,” but not in a condition in which the person has blood pressure. To achieve this goal, a sample of 110 subjects was selected. An increase in the number of patients with metabolic syndrome at a rate of prevalence (71.1%) of type II Diabetes Patients is among those 110 diabetes patients. Especially among the large age groups, by approximately 55%, Metabolic syndrome was diagnosed in 81 patients, and an apparent increase in the number of female patients with metabolic syndrome (44 females, 37 men). Results have also shown that the metabolic syndrome criterions evolved intrinsically among type 2 diabetes patients with high blood pressure as the highest incidence (79.01%). In contrast, the low level of the high-density lipoprotein had come as the minimal incidence (38.39%). The finding confirmed in this study the data indicates that (MetS) is expected in the category of patients with type 2 diabetes, with an estimated rate of up to 70%. In general, and for people with diabetes in particular, new lifestyles and new health interventions must be followed regarding type 2 diabetes in Romania and the world at large in order to stop or neutralize the burdens, complications, and risk of heart disease in patients with diabetes.展开更多
BACKGROUND Minimally invasive surgery had been tailored to individual cases of gastric subepithelial tumors(SETs)after comparing the clinical outcomes of endoscopic resection(ER),laparoscopic resection(LR),and hybrid ...BACKGROUND Minimally invasive surgery had been tailored to individual cases of gastric subepithelial tumors(SETs)after comparing the clinical outcomes of endoscopic resection(ER),laparoscopic resection(LR),and hybrid methods.AIM To study the use of Goldilocks principle to determine the best form of minimally invasive surgery for gastric SETs.METHODS In this retrospective study,194 patients of gastric SETs with high probability of surgical intervention were included.All patients underwent tumor resection in the operating theater between January 2013 and December 2021.The patients were divided into two groups,ER or LR,according to the tumor characteristics and the initial intent of intervention.Few patients in the ER group required further backup laparoscopic surgery after an incomplete ER.The patients who had converted open surgery were excluded.A logistic regression model was used to assess the associations between patient characteristics and the likelihood of a treatment strategy.The area under the curve was used to assess the discriminative ability of tumor size and Youden’s index to determine the optimal cut-off tumor size.RESULTS One-hundred ninety-four patients(100 in the ER group and 94 in the LR group)underwent tumor resection in the operating theater.In the ER group,27 patients required backup laparoscopic surgery after an incomplete ER.The patients in the ER group had small tumor sizes and shorter procedure durations while the patients in the LR group had large tumor sizes,exophytic growth,malignancy,and tumors that were more often located in the middle or lower third of the stomach.Both groups had similar durations of hospital stays and a similar rate of major postoperative complications.The patients in the ER group who underwent backup surgery required longer procedures(56.4 min)and prolonged stays(2 d)compared to the patients in the LR group without the increased rate of major postoperative complications.The optimal cut-off point for the tumor size for laparoscopic surgery was 2.15 cm.CONCLUSION Multidisciplinary teamwork leads to the adoption of different strategies to yield efficient clinical outcomes according to the tumor characteristics.展开更多
AIM:To examine the links between quality of sleep and the severity of intestinal symptoms in irritable bow-el syndrome(IBS).METHODS:One hundred and forty-two outpatients(110female,32 male)who met the Rome Ⅲ criteria ...AIM:To examine the links between quality of sleep and the severity of intestinal symptoms in irritable bow-el syndrome(IBS).METHODS:One hundred and forty-two outpatients(110female,32 male)who met the Rome Ⅲ criteria for IBS with no psychiatric comorbidity were consecutively en-rolled in this study.Data on age,body mass index(BMI),and a set of life-habit variables were recorded,and IBS symptoms and sleep quality were evaluated using the questionnaires IBS Symptom Severity Score(IBS-SSS)and Pittsburgh Sleep Quality Index(PSQI).The associa-tion between severity of IBS and sleep disturbances was evaluated by comparing the global IBS-SSS and PSQI score(Pearson's correlation and Fisher's exact test)and then analyzing the individual items of the IBS-SSS and PSQI questionnaires by a unitary bowel-sleep model based on item response theory(IRT).RESULTS:IBS-SSS ranged from mild to severe(120-470).The global PSQI score ranged from 1 to 17(median 5),and 60 patients were found to be poor sleepers(PSQI>5).The correlation between the global IBS-SSS and PSQI score indicated a weak association(r=0.2 and 95% CI:-0.03 to 0.35,P<0.05),which becomes stronger using our unitary model.Indeed,the IBS and sleep disturbances severities,estimated as latent variables,resulted significantly high intra-subject cor-relation(posterior mean of r=0.45 and 95% CI:0.17 to 0.70,P<0.05).Moreover,the correlations between patient features(age,sex,BMI,daily coffee and alcohol intake)and IBS and sleep disturbances were also ana-lyzed through our unitary model.Age was a signif icant regressor,with patients≤50 years old showing more severe bowel disturbances(posterior mean=-0.38,P<0.05)and less severe sleep disturbances(posterior mean=0.49,P<0.05)than older patients.Higher daily coffee intake was correlated with a lower sever-ity of bowel disturbances(posterior mean=-0.31,P<0.05).Sex(female)and daily alcohol intake(modest)were correlated with less severe sleep disturbances.CONCLUSION:The unitary bowel-sleep model based on IRT revealed a strong positive correlation between the severity of IBS symptoms and sleep disturbances.展开更多
AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were en...AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were enrolled. Sequential Organ Failure Assessment (SOFA) score was assessed immediately preceding the start of the study. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded on the first, fourth, seventh, and fourteenth day of the study period. GRV was measured every 4 h during enteral feeding. The relationship be-tween mean daily GRV and SOFA scores and the correlation between mean daily GRV and mean APACHE Ⅱ score of all patients were evaluated and compared. RESULTS: Of the 61 patients, 43 patients were survivors and 18 patients were non-survivors. The mean daily GRV increased as SOFA scores increased (P < 0.001, analysis of variance). Mean APACHE Ⅱ scores of all patients correlated with mean daily GRV (P = 0.011, Pearson correlation) during the study period. Patients with decreasing GRV in the first 2 d had better survival than patients without decreasing GRV (P = 0.017, log rank test). CONCLUSION: GRV is higher in more severely ill medical ICU patients. Patients with decreasing GRV had lower ICU mortality than patients without decreasing GRV.展开更多
We investigate the consistency and asymptotic normality of nearest-neighbor density estimator of a sample data process based on α-mixing assumption. We extend the correspondent result under independent identical cases.
Purpose:The main objective of this work is to show the potentialities of recently developed approaches for automatic knowledge extraction directly from the universities’websites.The information automatically extracte...Purpose:The main objective of this work is to show the potentialities of recently developed approaches for automatic knowledge extraction directly from the universities’websites.The information automatically extracted can be potentially updated with a frequency higher than once per year,and be safe from manipulations or misinterpretations.Moreover,this approach allows us flexibility in collecting indicators about the efficiency of universities’websites and their effectiveness in disseminating key contents.These new indicators can complement traditional indicators of scientific research(e.g.number of articles and number of citations)and teaching(e.g.number of students and graduates)by introducing further dimensions to allow new insights for“profiling”the analyzed universities.Design/methodology/approach:Webometrics relies on web mining methods and techniques to perform quantitative analyses of the web.This study implements an advanced application of the webometric approach,exploiting all the three categories of web mining:web content mining;web structure mining;web usage mining.The information to compute our indicators has been extracted from the universities’websites by using web scraping and text mining techniques.The scraped information has been stored in a NoSQL DB according to a semistructured form to allow for retrieving information efficiently by text mining techniques.This provides increased flexibility in the design of new indicators,opening the door to new types of analyses.Some data have also been collected by means of batch interrogations of search engines(Bing,www.bing.com)or from a leading provider of Web analytics(SimilarWeb,http://www.similarweb.com).The information extracted from the Web has been combined with the University structural information taken from the European Tertiary Education Register(https://eter.joanneum.at/#/home),a database collecting information on Higher Education Institutions(HEIs)at European level.All the above was used to perform a clusterization of 79 Italian universities based on structural and digital indicators.Findings:The main findings of this study concern the evaluation of the potential in digitalization of universities,in particular by presenting techniques for the automatic extraction of information from the web to build indicators of quality and impact of universities’websites.These indicators can complement traditional indicators and can be used to identify groups of universities with common features using clustering techniques working with the above indicators.Research limitations:The results reported in this study refers to Italian universities only,but the approach could be extended to other university systems abroad.Practical implications:The approach proposed in this study and its illustration on Italian universities show the usefulness of recently introduced automatic data extraction and web scraping approaches and its practical relevance for characterizing and profiling the activities of universities on the basis of their websites.The approach could be applied to other university systems.Originality/value:This work applies for the first time to university websites some recently introduced techniques for automatic knowledge extraction based on web scraping,optical character recognition and nontrivial text mining operations(Bruni&Bianchi,2020).展开更多
AIM:To translate into Serbian and to investigate the validity of the cross-culturally adapted the chronic liver disease questionnaire(CLDQ).METHODS:The questionnaire was validated in 103 consecutive CLD patients treat...AIM:To translate into Serbian and to investigate the validity of the cross-culturally adapted the chronic liver disease questionnaire(CLDQ).METHODS:The questionnaire was validated in 103 consecutive CLD patients treated between October 2009 and October 2010 at the Clinic for Gastroenterology,Clinical Centre of Serbia,Belgrade(Serbia).Exclusion criteria were:age < 18 years,psychiatric disorders,acute complications of CLD(acute liver failure,variceal bleeding,and spontaneous bacterial peritonitis),hepatic encephalopathy(grade > 2)and liver transplantation.Evaluation of the CLDQ was done based on the following parameters:(1)acceptance is shown by the proportion of missing items;(2)internal reliabilities were assessed for multiple item scales by using Cronbach alpha coefficient;and(3)in order to assess whether the allocation of items in the domain corresponds to their distribution in the original questionnaire(construction validity),an exploratory factor analysis was conducted.Discriminatory validity was determined by comparing the corresponding CLDQ score/sub-score in patients with different severity of the diseases.RESULTS:The Serbian version of CLDQ questionnaire completed 98% patients.Proportion of missing items was 0.06%.The total time needed to fill the questionnaire was ranged from 8 to 15 min.Assistance in completing the questionnaire required 4.8% patients,while 2.9% needed help in reading,and 1.9% involved writing assistance.The mean age of the selected patients was 53.8 ± 12.9 years and 54.4% were men.Average CLDQ score was 4.62 ± 1.11.Cronbach's alpha for the whole scale was 0.93.Reliability for all domains was above 0.70,except for the domain "Activity"(0.49).The exploratory factor analysis model revealed 6 factors with eigenvalue of greater than 1,explaining 69.7% of cumulative variance.The majority of the items(66%)in the Serbian version of the CLDQ presented the highest loading weight in the domain assigned by the CLDQ developers:"Fatigue"(5/5),"Emotional function"(6/8),"Worry"(5/5),"Abdominal symptoms"(0/3),"Activity"(0/3),"Systemic symptoms"(3/5).The scales "Fatigue" and "Worry" fully corresponded to the original.The factor analysis also revealed that the factors "Activity" and "Abdominal symptoms" could not be replicated,and two new domains "Sleep" and "Nutrition" were established.Analysis of the CLDQ score/sub-score distribution according to disease severity demonstrated that patients without cirrhosis had lower total CLDQ score(4.86 ± 1.05)than those with cirrhosis Child's C(4.31 ± 0.97).Statistically significant difference was detected for the domains "Abdominal symptoms" [F(3)= 5.818,P = 0.001] and "Fatigue" [F(3)= 3.39,P = 0.021].Post hoc analysis revealed that patients with liver cirrhosis Child's C had significantly lower sub-score "Abdominal symptoms" than patients without cirrhosis or liver cirrhosis Child's A or B.For domain "Fatigue",patients with cirrhosis Child's C had significantly lower score,than non-cirrhotic patients.CONCLUSION:The Serbian version of CLDQ is well accepted and represents a valid and reliable instrument in Serbian sample of CLD patients.展开更多
This study explores how doctors and patients in Papua New Guinea(PNG)perceive informed consent in medical settings.Doctors and patients from National Capital District and Central Province who responded to the survey w...This study explores how doctors and patients in Papua New Guinea(PNG)perceive informed consent in medical settings.Doctors and patients from National Capital District and Central Province who responded to the survey were the participants of the study.Researchers asked the participants to fill out questionnaires regarding their knowledge about informed consent for each group,namely,the doctors and participants.From those who responded,six randomly selected participants were chosen to join the focus group discussion which aimed to get experiences from the doctors and patients regarding medical procedures.Results show that both doctors and patients lack knowledge of the legalities of informed consent.Based on the experiences of doctors,they do not use consent forms when seeking permission from patients.Patients,on the other hand,do not see consent forms as important and only served as a formality.Customs,culture surrounding PNG were found to have an impact on how patients perceived informed consent.展开更多
This work is based on an on-going research on medical informed consent in Papua New Guinea(PNG)with 19 doctors from hospitals,health care centers and private medical establishments in the National Capital District and...This work is based on an on-going research on medical informed consent in Papua New Guinea(PNG)with 19 doctors from hospitals,health care centers and private medical establishments in the National Capital District and Central Province who voluntarily participated in the study.The authors conducted an examination of doctors’understanding of informed consent for medical procedures through a qualitative interview study and we describe our findings.We saw a need to involved patients in decision-making about their care,ethical imperative and concerns about litigation and their complaints highlighted the issue of informed consent.In order for the patients to make an informed decision about medical procedure,the doctors involved in the proposed treatment should conduct the informed consent discussion.The discussion should include the treatment,the risks and benefits of treatment,and alternative therapies with associated risks and benefits.We studied doctors’perspectives of gaining informed consent for routine medical procedures.We used qualitative study methods using structured interviews selected by purposive sampling.The data collected were entered into a data base and were analyzed thematically.The discussion is based on review of legal decisions,commentaries and our personal experience in studying medical malpractice cases.We have utilized case reports and several informative writings that have appeared in the world literature,as well as selections from vast amounts of material available in USA,UK,Australia,India and PNG.The current informed consent processes do not appear to be ideal for many doctors in PNG.In particular,there are inhibiting factors that affect patients from making medical informed decisions,doctors find time not enough to run discussions on informed consent,Department of Health does not have a standard informed consent form,patients complain about no consent form,and they have not signed consent forms.These are but some issues that affect patients when trying to make informed decisions.We say that informed consent process flows from the relationship between doctor and patient,however when this does not occur,serious legal and ethical consequences may result.This report is not intended to be specific advice on any private legal matter.展开更多
To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy.METHODSDeath certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cau...To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy.METHODSDeath certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups.RESULTSHCV infection was mentioned in 1.6% (n = 27730) and HBV infection in 0.2% (n = 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV.CONCLUSIONPopulation ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virus-related chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance.展开更多
Let X be a Minkowski plane, i.e., a real two dimensional normed linear space. We use projections to give a definition of the angle Aq(x, y) between two vectors x and y in X, such that x is Birkhoff orthogonal to y i...Let X be a Minkowski plane, i.e., a real two dimensional normed linear space. We use projections to give a definition of the angle Aq(x, y) between two vectors x and y in X, such that x is Birkhoff orthogonal to y if and only if Aq(x,y)=π/2. Some other properties of this angle are also discussed.展开更多
Amnyotrophic lateral sderosis(ALS),also alled Lou Gchrig's disase,is an rreversible disase that is aused bythe degeneration and death of motor newons.Approximately 5-10%of cases are familial AIS(fALS),and the othe...Amnyotrophic lateral sderosis(ALS),also alled Lou Gchrig's disase,is an rreversible disase that is aused bythe degeneration and death of motor newons.Approximately 5-10%of cases are familial AIS(fALS),and the other cases are sporadic ALS(sALS).Gene mutations have been identifed both in fAIS and sALS patients.In this study,w disauss the four ALS-nelated genes,C9orf72,SODI,FUS,and TARDBP,and review the microRNAs(miRNAs)that are asociated with AlS and other neurological disordes from the litemature.A phylogentic analysis is used toexplore potential miRNAs that an be taken into acount when studying the dfference in pathology for AIS induced by the fowr genes and other ncurological discases such as frontotemporal dementia,spinal muscular atrophy,and narcolepsy.We found several miRNAs that an be taken into account to study the diference in pathology betwen AIS and other neurological disorders.展开更多
In this paper, we analyze US stock market with a new 5-factor model in Zhou and Li (2016) [1]. Data we use are 48 industry portfolios (Jul. 1963-Jan. 2017). Parameters are estimated by MLE. LR and KS are used for mode...In this paper, we analyze US stock market with a new 5-factor model in Zhou and Li (2016) [1]. Data we use are 48 industry portfolios (Jul. 1963-Jan. 2017). Parameters are estimated by MLE. LR and KS are used for model diagnostics. Model comparison is done with AIC. The results show Fama-French 5 factors are still alive. This new model in Zhou and Li (2016) [1] fits the data better than the one in Fama and French (2015) [2].展开更多
This paper presents a study of sustainable regional development using multi-criteria analysis. The aim of this paper is to provide an evaluation framework that can be used for the assessment of sustainable regional de...This paper presents a study of sustainable regional development using multi-criteria analysis. The aim of this paper is to provide an evaluation framework that can be used for the assessment of sustainable regional development using multi criteria linked to development scenarios set by stakeholders. This study was carried out in Jambi Province in Indonesia where balancing sustainable development is constrained by the fact that conservation areas make up the majority of the region. The study employs four alternative policy scenarios for regional sustainable development: (1) business as usual; (2) development based on regional competitiveness; (3) development based on local resources; and (4) regional development based on non-extractive scenario. These four scenarios were assessed using the FLAG Model and the Imprecise Decision Model. Results from analysis show that development policy scenarios based on utilization of local resources and non-extractive economic activities are the most sustainable way of regional development. The study shows the trade-off among policy scenarios must be faced by policy makers in the region either to pursue high economic growth at the cost of the environment or vice versa.展开更多
The major challenges militating against the proper practice of informed consent identified in our desk top review are related to cultural issues of the people.Many patients continue to value strongly their kinship tie...The major challenges militating against the proper practice of informed consent identified in our desk top review are related to cultural issues of the people.Many patients continue to value strongly their kinship ties with the past and believe in the traditional methods of healing sickness.The patients must be given some information about what the doctor proposes to do.The underlying spirit of informed consent is new in PNG,and it strives against the traditional attitudes of doctors that they know it best for the patients and the strong culture in customs and patients’misconceptions that affect their perceptions in making important health care decisions.Majority of the patients have some notion of informed consent,however not many people understand what it is.They still hang onto their traditional customs,beliefs and opinions that affect their health care decisions;they often look to their village elders,family and parents for advice in times of sickness or death in the family but where the law implies consent it is not often obtained.Summarization of current laws,reports of legal cases,and personal experiences were examined.Special requirements must be prescribed when patients are subjected to medical treatment.Documentation of a well-defined process,not only on paper,may not only protect the medical doctor from exposure to liability but increases the patient’s autonomy in decisions concerning health and encourages compliance with treatment;and advances the interests of both patient and doctor.Lack of informed consent can reinforce a claim of medical malpractice,and could well undermine relevant health care policy to protect patient autonomy.展开更多
The presence of dispersion/variability in any process is understood and its careful monitoring may furnish the performance of any process. The interquartile range (IQR) is one of the dispersion measures based on lower...The presence of dispersion/variability in any process is understood and its careful monitoring may furnish the performance of any process. The interquartile range (IQR) is one of the dispersion measures based on lower and upper quartiles. For efficient monitoring of process dispersion, we have proposed auxiliary information based Shewhart-type IQR control charts (namely IQRr and IQRp charts) based on ratio and product estimators of lower and upper quartiles under bivariate normally distributed process. We have developed the control structures of proposed charts and compared their performances with the usual IQR chart in terms of detection ability of shift in process dispersion. For the said purpose power curves are constructed to demonstrate the performance of the three IQR charts under discussion in this article. We have also provided an illustrative example to justify theory and finally closed with concluding remarks.展开更多
This study focuses on the dynamics of drug concentration in the blood.In general,the concentration level of a drug in the blood is evaluated by themean of an ordinary and first-order differential equation.More precise...This study focuses on the dynamics of drug concentration in the blood.In general,the concentration level of a drug in the blood is evaluated by themean of an ordinary and first-order differential equation.More precisely,it is solved through an initial value problem.We proposed a newmodeling technique for studying drug concentration in blood dynamics.This technique is based on two fractional derivatives,namely,Caputo and Caputo-Fabrizio derivatives.We first provided comprehensive and detailed proof of the existence of at least one solution to the problem;we later proved the uniqueness of the existing solution.The proof was written using the Caputo-Fabrizio fractional derivative and some fixed-point techniques.Stability via theUlam-Hyers(UH)technique was also investigated.The application of the proposedmodel on two real data sets revealed that the Caputo derivative wasmore suitable in this study.Indeed,for the first data set,the model based on the Caputo derivative yielded a Mean Squared Error(MSE)of 0.03095 with a corresponding best value of fractional order of derivative of 1.00360.Caputo-Fabrizio-basedderivative appeared to be the second-best method for the problem,with an MSE of 0.04324 for a corresponding best fractional derivative order of 0.43532.For the second experiment,Caputo derivative-based model still performed the best as it yielded an MSE of 0.04066,whereas the classical and the Caputo-Fabrizio methods were tied with the same MSE of 0.07299.Another interesting finding was that the MSE yielded by the Caputo-Fabrizio fractional derivative coincided with the MSE obtained from the classical approach.展开更多
基金supported by the NSFC (11701001,11626030)the Support Plan for Outstanding Young Talents in Colleges in Anhui Province (Key project) (gxyqzD2020021)the Scientific Research Project of Colleges and Universities in Anhui Province,2023。
文摘In this paper,we consider the graph of the product of continuous functions in terms of Hausdorff and packing dimensions.More precisely,we show that,given a real number 1≤β≤2,any real-valued continuous function in C([0,1])can be decomposed into a product of two real-valued continuous functions,each having a graph of Hausdorff dimensionβ.In addition,a product decomposition result for the packing dimension is obtained.This work answers affirmatively two questions raised by Verma and Priyadarshi[14].
文摘Morocco wants its 12 regions to play the role as the main lever of its public policies to initiate harmonized spatial multidimensional development. In the context of this goal and Morocco’s openness over the past two decades to bilateral and multilateral cooperation in an effort toward regional integration, this article studies the convergence of 389 regions in 36 countries(Morocco and 35 of its partner member countries in the Organization for Economic Co-operation and Development(OECD)) between 2000 and 2019 in terms of well-being. To this end, we considered the territorial dimension of β-convergence models for well-being and its four domains(economic, social, environmental, and governance). Then, we adapted the absolute β-convergence model by taking into account the existence of spatial heterogeneity according to five specifications of spatial models. Thus, apart from environmental domain, we found that β-convergence of regions is significant for well-being and three of its domains(economic, social, and governance). These convergences are made by a spatially autocorrelated error model(SEM). However, the speed and period of convergence are relatively low for social domain, partly explaining the very exacerbated tensions at the territorial level. The fastest convergence was achieved in governance domain, followed by economic domain. This suggests that emerging countries must pay particular attention to national public action in favor of social cohesion at the territorial level. The lack of convergence in environmental domain calls for common actions for all countries at the supranational level to protect the commons at the territorial level.
文摘Prepandemic time trends in mortality from chronic liver disease(CLD)differed according to specific cause of death(decreasing for liver cirrhosis,stable or increasing for liver cancer),etiology(increasing for nonalcoholic fatty liver disease,generally decreasing for other etiologies),and world region(decreasing in areas with the highest burden of hepatitis B virus,increasing in Eastern Europe and other countries).The coronavirus disease 2019(COVID-19)pandemic affected mortality of patients with CLD both directly,with a higher risk for severe illness and death depending on age,stage and etiology of the disease,and indirectly,through social isolation and loss of support,harmful drinking,and difficulties in access to care.Nevertheless,only sparse data are available on variations in CLD as a cause of death during the pandemic.In the USA,in 2020-2021 a growth in mortality was registered for all liver diseases,more marked for alcoholic liver disease,especially among young people aged 25-44 years and in selected ethnic groups.COVID-19 related deaths accounted only for a minor part of the excess.Further data from mortality registers of other countries are warranted,preferably adopting the so-called multiple cause-of-death approach,and extended to deaths attributed to viral hepatitis and liver cancer.
文摘Metabolic syndrome (MetS) has been and remains a highly controversial topic. There is a close association of (MetS) with a group of symptoms associated with diseases of the heart, blood vessels, arteries, and accelerated aging. To find out and discover whether the distribution of these associations or the totals of (MetS) components differ from one gender to another or from one ethnicity to another, 110 subjects were selected as a sample at the National Institute of Diabetes, Nutrition and Metabolic Diseases (N.C.Paulescu) In Bucharest, 110 subjects in divided between 47 Males, 63 females with an age range of 54 years for age groups 35 - 65 years. The pathological conditions in the present study were divided into 2 groups: G1: Patients who have metabolic syndrome. G2: Patients without metabolic syndrome. This study, therefore, aims to diagnose metabolic syndrome according to the criteria approved by ATP III (MetS), also known as insulin resistance syndrome or Syndrome X, which is defined as (a group of several conditions that together increase a person’s risk of developing diabetes and increased heart disease), a disease that is achieved by the presence of 3 or more than 5 components that are considered as parameters or directories (MetS);such as “High level of obesity;High triglyceride levels;High blood sugar level;Decrease in HDL, or good cholesterol and High blood pressure,” but not in a condition in which the person has blood pressure. To achieve this goal, a sample of 110 subjects was selected. An increase in the number of patients with metabolic syndrome at a rate of prevalence (71.1%) of type II Diabetes Patients is among those 110 diabetes patients. Especially among the large age groups, by approximately 55%, Metabolic syndrome was diagnosed in 81 patients, and an apparent increase in the number of female patients with metabolic syndrome (44 females, 37 men). Results have also shown that the metabolic syndrome criterions evolved intrinsically among type 2 diabetes patients with high blood pressure as the highest incidence (79.01%). In contrast, the low level of the high-density lipoprotein had come as the minimal incidence (38.39%). The finding confirmed in this study the data indicates that (MetS) is expected in the category of patients with type 2 diabetes, with an estimated rate of up to 70%. In general, and for people with diabetes in particular, new lifestyles and new health interventions must be followed regarding type 2 diabetes in Romania and the world at large in order to stop or neutralize the burdens, complications, and risk of heart disease in patients with diabetes.
基金The study was approved by the Institutional Review Board of Changhua Christian Hospital(approval No.220117).
文摘BACKGROUND Minimally invasive surgery had been tailored to individual cases of gastric subepithelial tumors(SETs)after comparing the clinical outcomes of endoscopic resection(ER),laparoscopic resection(LR),and hybrid methods.AIM To study the use of Goldilocks principle to determine the best form of minimally invasive surgery for gastric SETs.METHODS In this retrospective study,194 patients of gastric SETs with high probability of surgical intervention were included.All patients underwent tumor resection in the operating theater between January 2013 and December 2021.The patients were divided into two groups,ER or LR,according to the tumor characteristics and the initial intent of intervention.Few patients in the ER group required further backup laparoscopic surgery after an incomplete ER.The patients who had converted open surgery were excluded.A logistic regression model was used to assess the associations between patient characteristics and the likelihood of a treatment strategy.The area under the curve was used to assess the discriminative ability of tumor size and Youden’s index to determine the optimal cut-off tumor size.RESULTS One-hundred ninety-four patients(100 in the ER group and 94 in the LR group)underwent tumor resection in the operating theater.In the ER group,27 patients required backup laparoscopic surgery after an incomplete ER.The patients in the ER group had small tumor sizes and shorter procedure durations while the patients in the LR group had large tumor sizes,exophytic growth,malignancy,and tumors that were more often located in the middle or lower third of the stomach.Both groups had similar durations of hospital stays and a similar rate of major postoperative complications.The patients in the ER group who underwent backup surgery required longer procedures(56.4 min)and prolonged stays(2 d)compared to the patients in the LR group without the increased rate of major postoperative complications.The optimal cut-off point for the tumor size for laparoscopic surgery was 2.15 cm.CONCLUSION Multidisciplinary teamwork leads to the adoption of different strategies to yield efficient clinical outcomes according to the tumor characteristics.
文摘AIM:To examine the links between quality of sleep and the severity of intestinal symptoms in irritable bow-el syndrome(IBS).METHODS:One hundred and forty-two outpatients(110female,32 male)who met the Rome Ⅲ criteria for IBS with no psychiatric comorbidity were consecutively en-rolled in this study.Data on age,body mass index(BMI),and a set of life-habit variables were recorded,and IBS symptoms and sleep quality were evaluated using the questionnaires IBS Symptom Severity Score(IBS-SSS)and Pittsburgh Sleep Quality Index(PSQI).The associa-tion between severity of IBS and sleep disturbances was evaluated by comparing the global IBS-SSS and PSQI score(Pearson's correlation and Fisher's exact test)and then analyzing the individual items of the IBS-SSS and PSQI questionnaires by a unitary bowel-sleep model based on item response theory(IRT).RESULTS:IBS-SSS ranged from mild to severe(120-470).The global PSQI score ranged from 1 to 17(median 5),and 60 patients were found to be poor sleepers(PSQI>5).The correlation between the global IBS-SSS and PSQI score indicated a weak association(r=0.2 and 95% CI:-0.03 to 0.35,P<0.05),which becomes stronger using our unitary model.Indeed,the IBS and sleep disturbances severities,estimated as latent variables,resulted significantly high intra-subject cor-relation(posterior mean of r=0.45 and 95% CI:0.17 to 0.70,P<0.05).Moreover,the correlations between patient features(age,sex,BMI,daily coffee and alcohol intake)and IBS and sleep disturbances were also ana-lyzed through our unitary model.Age was a signif icant regressor,with patients≤50 years old showing more severe bowel disturbances(posterior mean=-0.38,P<0.05)and less severe sleep disturbances(posterior mean=0.49,P<0.05)than older patients.Higher daily coffee intake was correlated with a lower sever-ity of bowel disturbances(posterior mean=-0.31,P<0.05).Sex(female)and daily alcohol intake(modest)were correlated with less severe sleep disturbances.CONCLUSION:The unitary bowel-sleep model based on IRT revealed a strong positive correlation between the severity of IBS symptoms and sleep disturbances.
基金Supported by Kaohsiung Veterans General Hospital, Grant No.VGHKS 94-082
文摘AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were enrolled. Sequential Organ Failure Assessment (SOFA) score was assessed immediately preceding the start of the study. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded on the first, fourth, seventh, and fourteenth day of the study period. GRV was measured every 4 h during enteral feeding. The relationship be-tween mean daily GRV and SOFA scores and the correlation between mean daily GRV and mean APACHE Ⅱ score of all patients were evaluated and compared. RESULTS: Of the 61 patients, 43 patients were survivors and 18 patients were non-survivors. The mean daily GRV increased as SOFA scores increased (P < 0.001, analysis of variance). Mean APACHE Ⅱ scores of all patients correlated with mean daily GRV (P = 0.011, Pearson correlation) during the study period. Patients with decreasing GRV in the first 2 d had better survival than patients without decreasing GRV (P = 0.017, log rank test). CONCLUSION: GRV is higher in more severely ill medical ICU patients. Patients with decreasing GRV had lower ICU mortality than patients without decreasing GRV.
基金Sponsored by the National Natural Science Foundation of China 10771163
文摘We investigate the consistency and asymptotic normality of nearest-neighbor density estimator of a sample data process based on α-mixing assumption. We extend the correspondent result under independent identical cases.
基金This work is developed with the support of the H2020 RISIS 2 Project(No.824091)and of the“Sapienza”Research Awards No.RM1161550376E40E of 2016 and RM11916B8853C925 of 2019.This article is a largely extended version of Bianchi et al.(2019)presented at the ISSI 2019 Conference held in Rome,2–5 September 2019.
文摘Purpose:The main objective of this work is to show the potentialities of recently developed approaches for automatic knowledge extraction directly from the universities’websites.The information automatically extracted can be potentially updated with a frequency higher than once per year,and be safe from manipulations or misinterpretations.Moreover,this approach allows us flexibility in collecting indicators about the efficiency of universities’websites and their effectiveness in disseminating key contents.These new indicators can complement traditional indicators of scientific research(e.g.number of articles and number of citations)and teaching(e.g.number of students and graduates)by introducing further dimensions to allow new insights for“profiling”the analyzed universities.Design/methodology/approach:Webometrics relies on web mining methods and techniques to perform quantitative analyses of the web.This study implements an advanced application of the webometric approach,exploiting all the three categories of web mining:web content mining;web structure mining;web usage mining.The information to compute our indicators has been extracted from the universities’websites by using web scraping and text mining techniques.The scraped information has been stored in a NoSQL DB according to a semistructured form to allow for retrieving information efficiently by text mining techniques.This provides increased flexibility in the design of new indicators,opening the door to new types of analyses.Some data have also been collected by means of batch interrogations of search engines(Bing,www.bing.com)or from a leading provider of Web analytics(SimilarWeb,http://www.similarweb.com).The information extracted from the Web has been combined with the University structural information taken from the European Tertiary Education Register(https://eter.joanneum.at/#/home),a database collecting information on Higher Education Institutions(HEIs)at European level.All the above was used to perform a clusterization of 79 Italian universities based on structural and digital indicators.Findings:The main findings of this study concern the evaluation of the potential in digitalization of universities,in particular by presenting techniques for the automatic extraction of information from the web to build indicators of quality and impact of universities’websites.These indicators can complement traditional indicators and can be used to identify groups of universities with common features using clustering techniques working with the above indicators.Research limitations:The results reported in this study refers to Italian universities only,but the approach could be extended to other university systems abroad.Practical implications:The approach proposed in this study and its illustration on Italian universities show the usefulness of recently introduced automatic data extraction and web scraping approaches and its practical relevance for characterizing and profiling the activities of universities on the basis of their websites.The approach could be applied to other university systems.Originality/value:This work applies for the first time to university websites some recently introduced techniques for automatic knowledge extraction based on web scraping,optical character recognition and nontrivial text mining operations(Bruni&Bianchi,2020).
基金Supported by Grant from the Ministry of Education and Science of the Republic of Serbia,No. 175087 to Pekmezovic TD,Kisic Tepavcevic DB and Trajkovic GZ
文摘AIM:To translate into Serbian and to investigate the validity of the cross-culturally adapted the chronic liver disease questionnaire(CLDQ).METHODS:The questionnaire was validated in 103 consecutive CLD patients treated between October 2009 and October 2010 at the Clinic for Gastroenterology,Clinical Centre of Serbia,Belgrade(Serbia).Exclusion criteria were:age < 18 years,psychiatric disorders,acute complications of CLD(acute liver failure,variceal bleeding,and spontaneous bacterial peritonitis),hepatic encephalopathy(grade > 2)and liver transplantation.Evaluation of the CLDQ was done based on the following parameters:(1)acceptance is shown by the proportion of missing items;(2)internal reliabilities were assessed for multiple item scales by using Cronbach alpha coefficient;and(3)in order to assess whether the allocation of items in the domain corresponds to their distribution in the original questionnaire(construction validity),an exploratory factor analysis was conducted.Discriminatory validity was determined by comparing the corresponding CLDQ score/sub-score in patients with different severity of the diseases.RESULTS:The Serbian version of CLDQ questionnaire completed 98% patients.Proportion of missing items was 0.06%.The total time needed to fill the questionnaire was ranged from 8 to 15 min.Assistance in completing the questionnaire required 4.8% patients,while 2.9% needed help in reading,and 1.9% involved writing assistance.The mean age of the selected patients was 53.8 ± 12.9 years and 54.4% were men.Average CLDQ score was 4.62 ± 1.11.Cronbach's alpha for the whole scale was 0.93.Reliability for all domains was above 0.70,except for the domain "Activity"(0.49).The exploratory factor analysis model revealed 6 factors with eigenvalue of greater than 1,explaining 69.7% of cumulative variance.The majority of the items(66%)in the Serbian version of the CLDQ presented the highest loading weight in the domain assigned by the CLDQ developers:"Fatigue"(5/5),"Emotional function"(6/8),"Worry"(5/5),"Abdominal symptoms"(0/3),"Activity"(0/3),"Systemic symptoms"(3/5).The scales "Fatigue" and "Worry" fully corresponded to the original.The factor analysis also revealed that the factors "Activity" and "Abdominal symptoms" could not be replicated,and two new domains "Sleep" and "Nutrition" were established.Analysis of the CLDQ score/sub-score distribution according to disease severity demonstrated that patients without cirrhosis had lower total CLDQ score(4.86 ± 1.05)than those with cirrhosis Child's C(4.31 ± 0.97).Statistically significant difference was detected for the domains "Abdominal symptoms" [F(3)= 5.818,P = 0.001] and "Fatigue" [F(3)= 3.39,P = 0.021].Post hoc analysis revealed that patients with liver cirrhosis Child's C had significantly lower sub-score "Abdominal symptoms" than patients without cirrhosis or liver cirrhosis Child's A or B.For domain "Fatigue",patients with cirrhosis Child's C had significantly lower score,than non-cirrhotic patients.CONCLUSION:The Serbian version of CLDQ is well accepted and represents a valid and reliable instrument in Serbian sample of CLD patients.
文摘This study explores how doctors and patients in Papua New Guinea(PNG)perceive informed consent in medical settings.Doctors and patients from National Capital District and Central Province who responded to the survey were the participants of the study.Researchers asked the participants to fill out questionnaires regarding their knowledge about informed consent for each group,namely,the doctors and participants.From those who responded,six randomly selected participants were chosen to join the focus group discussion which aimed to get experiences from the doctors and patients regarding medical procedures.Results show that both doctors and patients lack knowledge of the legalities of informed consent.Based on the experiences of doctors,they do not use consent forms when seeking permission from patients.Patients,on the other hand,do not see consent forms as important and only served as a formality.Customs,culture surrounding PNG were found to have an impact on how patients perceived informed consent.
文摘This work is based on an on-going research on medical informed consent in Papua New Guinea(PNG)with 19 doctors from hospitals,health care centers and private medical establishments in the National Capital District and Central Province who voluntarily participated in the study.The authors conducted an examination of doctors’understanding of informed consent for medical procedures through a qualitative interview study and we describe our findings.We saw a need to involved patients in decision-making about their care,ethical imperative and concerns about litigation and their complaints highlighted the issue of informed consent.In order for the patients to make an informed decision about medical procedure,the doctors involved in the proposed treatment should conduct the informed consent discussion.The discussion should include the treatment,the risks and benefits of treatment,and alternative therapies with associated risks and benefits.We studied doctors’perspectives of gaining informed consent for routine medical procedures.We used qualitative study methods using structured interviews selected by purposive sampling.The data collected were entered into a data base and were analyzed thematically.The discussion is based on review of legal decisions,commentaries and our personal experience in studying medical malpractice cases.We have utilized case reports and several informative writings that have appeared in the world literature,as well as selections from vast amounts of material available in USA,UK,Australia,India and PNG.The current informed consent processes do not appear to be ideal for many doctors in PNG.In particular,there are inhibiting factors that affect patients from making medical informed decisions,doctors find time not enough to run discussions on informed consent,Department of Health does not have a standard informed consent form,patients complain about no consent form,and they have not signed consent forms.These are but some issues that affect patients when trying to make informed decisions.We say that informed consent process flows from the relationship between doctor and patient,however when this does not occur,serious legal and ethical consequences may result.This report is not intended to be specific advice on any private legal matter.
文摘To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy.METHODSDeath certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups.RESULTSHCV infection was mentioned in 1.6% (n = 27730) and HBV infection in 0.2% (n = 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV.CONCLUSIONPopulation ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virus-related chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance.
文摘Let X be a Minkowski plane, i.e., a real two dimensional normed linear space. We use projections to give a definition of the angle Aq(x, y) between two vectors x and y in X, such that x is Birkhoff orthogonal to y if and only if Aq(x,y)=π/2. Some other properties of this angle are also discussed.
基金supported by the Ministry of Science and Technology 107-2118-M-009-002-MY2,Taiwan.
文摘Amnyotrophic lateral sderosis(ALS),also alled Lou Gchrig's disase,is an rreversible disase that is aused bythe degeneration and death of motor newons.Approximately 5-10%of cases are familial AIS(fALS),and the other cases are sporadic ALS(sALS).Gene mutations have been identifed both in fAIS and sALS patients.In this study,w disauss the four ALS-nelated genes,C9orf72,SODI,FUS,and TARDBP,and review the microRNAs(miRNAs)that are asociated with AlS and other neurological disordes from the litemature.A phylogentic analysis is used toexplore potential miRNAs that an be taken into acount when studying the dfference in pathology for AIS induced by the fowr genes and other ncurological discases such as frontotemporal dementia,spinal muscular atrophy,and narcolepsy.We found several miRNAs that an be taken into account to study the diference in pathology betwen AIS and other neurological disorders.
文摘In this paper, we analyze US stock market with a new 5-factor model in Zhou and Li (2016) [1]. Data we use are 48 industry portfolios (Jul. 1963-Jan. 2017). Parameters are estimated by MLE. LR and KS are used for model diagnostics. Model comparison is done with AIC. The results show Fama-French 5 factors are still alive. This new model in Zhou and Li (2016) [1] fits the data better than the one in Fama and French (2015) [2].
文摘This paper presents a study of sustainable regional development using multi-criteria analysis. The aim of this paper is to provide an evaluation framework that can be used for the assessment of sustainable regional development using multi criteria linked to development scenarios set by stakeholders. This study was carried out in Jambi Province in Indonesia where balancing sustainable development is constrained by the fact that conservation areas make up the majority of the region. The study employs four alternative policy scenarios for regional sustainable development: (1) business as usual; (2) development based on regional competitiveness; (3) development based on local resources; and (4) regional development based on non-extractive scenario. These four scenarios were assessed using the FLAG Model and the Imprecise Decision Model. Results from analysis show that development policy scenarios based on utilization of local resources and non-extractive economic activities are the most sustainable way of regional development. The study shows the trade-off among policy scenarios must be faced by policy makers in the region either to pursue high economic growth at the cost of the environment or vice versa.
文摘The major challenges militating against the proper practice of informed consent identified in our desk top review are related to cultural issues of the people.Many patients continue to value strongly their kinship ties with the past and believe in the traditional methods of healing sickness.The patients must be given some information about what the doctor proposes to do.The underlying spirit of informed consent is new in PNG,and it strives against the traditional attitudes of doctors that they know it best for the patients and the strong culture in customs and patients’misconceptions that affect their perceptions in making important health care decisions.Majority of the patients have some notion of informed consent,however not many people understand what it is.They still hang onto their traditional customs,beliefs and opinions that affect their health care decisions;they often look to their village elders,family and parents for advice in times of sickness or death in the family but where the law implies consent it is not often obtained.Summarization of current laws,reports of legal cases,and personal experiences were examined.Special requirements must be prescribed when patients are subjected to medical treatment.Documentation of a well-defined process,not only on paper,may not only protect the medical doctor from exposure to liability but increases the patient’s autonomy in decisions concerning health and encourages compliance with treatment;and advances the interests of both patient and doctor.Lack of informed consent can reinforce a claim of medical malpractice,and could well undermine relevant health care policy to protect patient autonomy.
文摘The presence of dispersion/variability in any process is understood and its careful monitoring may furnish the performance of any process. The interquartile range (IQR) is one of the dispersion measures based on lower and upper quartiles. For efficient monitoring of process dispersion, we have proposed auxiliary information based Shewhart-type IQR control charts (namely IQRr and IQRp charts) based on ratio and product estimators of lower and upper quartiles under bivariate normally distributed process. We have developed the control structures of proposed charts and compared their performances with the usual IQR chart in terms of detection ability of shift in process dispersion. For the said purpose power curves are constructed to demonstrate the performance of the three IQR charts under discussion in this article. We have also provided an illustrative example to justify theory and finally closed with concluding remarks.
基金supported through the Annual Funding Track by the Deanship of Scientific Research,Vice Presidency for Graduate Studies and Scientific Research,King Faisal University,Saudi Arabia[Project No.AN000273],granted after a successful application by M.A.
文摘This study focuses on the dynamics of drug concentration in the blood.In general,the concentration level of a drug in the blood is evaluated by themean of an ordinary and first-order differential equation.More precisely,it is solved through an initial value problem.We proposed a newmodeling technique for studying drug concentration in blood dynamics.This technique is based on two fractional derivatives,namely,Caputo and Caputo-Fabrizio derivatives.We first provided comprehensive and detailed proof of the existence of at least one solution to the problem;we later proved the uniqueness of the existing solution.The proof was written using the Caputo-Fabrizio fractional derivative and some fixed-point techniques.Stability via theUlam-Hyers(UH)technique was also investigated.The application of the proposedmodel on two real data sets revealed that the Caputo derivative wasmore suitable in this study.Indeed,for the first data set,the model based on the Caputo derivative yielded a Mean Squared Error(MSE)of 0.03095 with a corresponding best value of fractional order of derivative of 1.00360.Caputo-Fabrizio-basedderivative appeared to be the second-best method for the problem,with an MSE of 0.04324 for a corresponding best fractional derivative order of 0.43532.For the second experiment,Caputo derivative-based model still performed the best as it yielded an MSE of 0.04066,whereas the classical and the Caputo-Fabrizio methods were tied with the same MSE of 0.07299.Another interesting finding was that the MSE yielded by the Caputo-Fabrizio fractional derivative coincided with the MSE obtained from the classical approach.