Intolerable Burden Research Articles

A Low-Latency Approach for RFF Identification in Open-Set Scenarios

Radio frequency fingerprint (RFF) identification represents a promising technique for lightweight device authentication. However, current research on RFF primarily focuses on the close-set recognition assumption. Moreover, the high computational complexity and excessive latency during the identification stage represent an intolerable burden for Internet of Things (IoT) devices. In this paper, we propose a deep-learning-based RFF identification framework in relation to open-set scenarios. Specifically, we leverage a simulated training scheme, in which we strategically designate certain devices as simulated unknowns. This allows us to fine-tune our extractor to better handle open-set recognition. Additionally, we construct an exemplar set that only contains representative RFF features to further reduce time consumption in the identification stage. The experiments are carried out on a hardware platform involving LoRa devices and using a USRP N210 software-defined radio receiver. The results show that the proposed framework can achieve 90.23% accuracy for rogue device detection and 93.85% accuracy for legitimate device classification. Furthermore, it is observed that using an exemplar set consisting of half the total data size can reduce the time overhead by 58% compared to using the entire dataset.

An intolerable burden: Racist territoriality in theUnited StatesSupreme Court's Insular Cases

AbstractThe Insular Cases are a set of early twentieth‐century US Supreme Court cases establishing the legal relationship between the United States and its territorial acquisitions. The Insular Cases have received limited scholarly attention in geography, despite their integral role in continuing to deny full constitutional protections to over 3.5 million American citizens and nationals. Informed by conceptualisations of territory as both process and political technology, political geography offers a critical lens through which to interpret the spatial implications of the Insular Cases. This article conducts a discourse analysis of the Insular Cases, tracing the US Supreme Court's creation of incorporated and unincorporated territorial statuses as they are positioned within contemporaneous racist logic and international norms. I argue that, by inventing differentiated categories of territory, the Insular Cases sought to spatially accommodate white supremacist imaginaries. This paper advances political geography by centring the judicial production of American territorial categories, and adds a geographic perspective to existing literature that interrogates the white supremacist, imperialist source of territorial status today.

The Clinical Impact of Switching Basal Insulin to Insulin Degludec in Patients With Diabetes in Saudi Arabia: A Retrospective One-Group Pretest-Posttest Design Study.

Diabetes is a health problem that has an enormous and intolerable public health burden on the individual, family, and community. Diabetes affects nearly one-fifth of adults in Saudi Arabia and is expected to double by 2030. The study aims to evaluate the impact of switching patients from conventional basal insulin analogues to insulin degludec during a 90-day follow-up period. This was a retrospective observational pretest-posttest cohort study conducted at King Abdulaziz University Hospital between June 2019 and August 2020. Adult patients with diabetes who switched their basal insulin to insulin degludec were included and evaluated for its impact on insulin doses, hemoglobin A1c (HbA1c), hypoglycemic events, and/or body weight changes during a 90-day follow-up period. Out of 718 patients, 107 patients were included in the study, with 60.7% being females and their mean (± SD) age was 62.2 ± 14.6 years. There was a significant decrease in the mean baseline of HbA1c from 9.2% to 8.7% after 90 days of follow-up (P<0.001). A statistically significant reduction was noted in the total insulin requirements from a baseline of 71.70 (± 42.4) units to 46.5 (± 29) units, P=0.001, after switching to insulin degludec. However, there were no statistically significant differences in the body weight from the baseline mean (± SD) of 80.5 kg (± 19.4) to 79.9 kg (± 19.9), P=0.68, after switching to insulin degludec. Lastly, there were no statistically significant differences in the reported hypoglycemic episodes from a baseline of 48.7% vs 37.3% after 90 days of follow-up (P = 0.166). Switching to the novel insulin degludec conferred better blood glucose control and dose reduction. There was no increase in the frequency of hypoglycemic episodes or body weight.

Assessment of knowledge and awareness of safe disposal of unused or expired medication in Saudi Arabia: A cross-sectional study

BackgroundPoor waste management of unused or expired medications jeopardizes healthcare staff, employees who oversee medical waste, patients and their families, the neighboring population, and environmental contamination. In addition, the inappropriate treatment or disposal of that waste leads to. In addition, medical waste disposal exerts an intolerable burden on the economy of health care facilities. Currently, there is a lack of data in community settings regarding adequate methods of medication disposal in Saudi Arabia. Aim of the StudyThe current study aimed to evaluate current knowledge and awareness of the safe disposal of unused or expired medicines in the Saudi Arabia. MethodA survey study was conducted in Saudi Arabia within 5 months from October 2021–February 2022. The survey was distributed to participants via social media channels. The questionnaire was constituted of 16 items divided into three sections: demographic information, quantification, and characterization of unused and expired medication at home, and practice and attitude regarding the disposal of unused or expired medication. ResultsThe survey was taken by 1105 participants and 1100 (99.54%) participants completed the survey. The study found that (49.1%) of participants stored medicines at home and these medicines were mainly stored in the refrigerator (64.4%). Household trash was the most frequent method of disposal (79.5%). Non-prescribed medicines (67%) were mainly stored as unused or expiry medicines at home followed by prescribed medicines (51.9%). The main reason for the storage of unused/expired medicines at home was stopped medication after recovery (68.5%). Only 8.4% of participants had received appropriate education or training related to the correct disposal of medication. The best-practiced method to increase community awareness regarding the disposal of unused or expiry medicine was awareness through social networking (70.3%). In conclusion, patients’ education regarding safe medication disposal and availability of medication disposal program is necessary to improve appropriate medication waste methods and decrease possible environmental harm.

Wildcat Imaginaries

Abstract The demand for a Cost of Living Adjustment (COLA), made by graduate students at the University of California, Santa Cruz (UCSC), culminated in the wildcat strikes of 2019–20 across the University of California system. Graduate students made a seemingly impossible request of the University of California as it currently operates. The impossibility is not financial: a 60 percent increase in wages, in keeping with the COLA demand, is not unreasonable or impossible but remains the bare minimum to bring graduate students out of an intolerable rent burden. The impossibility of the demand therefore resides in the system's resistance to conceiving of students as “workers.” By insisting on graduate students' status as workers, the COLA struggle implicates the university in the production of low-waged and unwaged academic labor. This struggle demonstrates a commonality between students and a whole class of low-waged and precarious workers at the university that includes university staff, lecturers, and service workers. Extreme precarity that triggered the wildcat strike was intensified by police repression of the picket and the unfolding of the COVID-19 pandemic. As they grapple with the questions of university abolition, the authors of this article examine the structural violences of universities at large, while being attentive to the particularities of the UCSC wildcat strike. The authors draw on the wildcat imaginaries that emerged, in both inchoate and more developed formations, during the strike and offered a glimpse of a possible abolitionist future.

Intolerable Burden of Malaria among Primitive Tribal Community in Odisha: Examining the Fundamental Cause

This study seeks to examine the living conditions, working conditions, and health seeking behaviour for malaria among Kondho community after one is infected with malaria. The residential surroundings of those diagnosed with malaria positive cases were extremely conducive for mosquito breeding. For instance, the majority of households threw garbage near their house, went for open defecation, the cowshed was beside their houses, and above all the houses were mostly situated in the jungle or near thick forest. Sub-centre followed by the community health centres was the first point of contact in most cases but medical care was sought only after routine life was affected. While malaria treatment plans are changing towards administering more powerful drugs as a result of chloroquine resistance but not as much has been done in the ground to prevent malaria at the first place. Therefore, together with continuing curative care for malaria—more emphasis is needed on its prevention. Community, civil society and the government need to work in tandem to improve the living and working conditions of backward communities particularly those living in malaria endemic zone so as to be able to take effective preventive measures for malaria.

Leakage localization using pressure sensors and spatial clustering in water distribution systems

AbstractLeakages in water distribution systems (WDSs) are a worldwide problem, which can result in an intolerable burden in satisfying the water demands of the consumers. There is an urgent demand to develop technologies that can detect and localize the leakage in a timely and efficient manner. The monitoring data of the WDS is a typical time series, and there is a certain spatiotemporal correlation between the data provided by the devices distributed at different locations of the WDS. This paper proposes a novel model-based method for WDS leakage localization. The method is characterized by (1) developing the dominant sensor sequence for each candidate leakage node to improve the localization accuracy based on the spatial correlation analysis; (2) utilizing multiple time steps of the measurements which are temporal varying correlated; (3) ranking leakage regions and nodes by their possibility to contain the true leakage. A realistic WDS is used to evaluate the performance of the method. Results show that the method can accurately and efficiently localize the leakage.

The New Perceptions on Life of Iranian Patients with Ankylosing Spondylitis: A Qualitative Study

Various studies suggest that ankylosing spondylitis (AS) as a chronic inflammatory disease with many disabilities can have impacts on different aspects of patients’ life. Despite many quantitative studies, only few qualitative studies have thus far been published on this subject. For the first time, the present study aims at gaining insight into the life experience of Iranian AS patients. We performed a content analysis through semi-structured interviews with twenty-eight patients diagnosed with AS, including three females and twenty-five males with an average age of 38.5 years, to gain insight into their experiences. Whatever the patients expressed was written and transcribed verbatim. Then, we did analysis of the results after each interview. The detailed information completely extracted from the interviews was classified as sub-themes and main themes. Three main themes were identified by the analysis: (i) “Always with pain” describing the effects were found in regard to pain on patients’ life, (ii) “The perceived limitation” describing many difficulties that people may face in the society as a result of their disease, and (iii) “Fearing the unknown future” which implies to both patients and their families have concerns about the future and what will happen. Our research findings in line with other qualitative studies showed that AS disease puts a heavy and intolerable burden on patients and their family. It seems that the experiences of people living with AS can be useful to meet challenges caused by the disease and it can enhance their coping with the disease.

P317 Societal cost-of-illness of Inflammatory Bowel Disease has rapidly increased over the years and differs between continents: A systematic review

Abstract Background With increasing incidence of Inflammatory Bowel Disease (IBD) in developing countries and increasing prescription rates for biologics globally, knowledge on the cost burden of IBD and cost drivers is essential for health policy makers worldwide. We conducted a systematic review to determine cost-of-illness of IBD and assess time trends and geographical differences. Methods A systematic review of population-based studies that estimated cost-of-illness of IBD and were published in Embase, Medline, Web of Science and Google Scholar. Studies on interventions and those reporting costs for a subset of patients defined by phenotype or treatment were excluded, as these do not give a representative estimate of the cost-of-illness of IBD. Only studies published in English were included. Methodology of all included studies was assessed and costs were adjusted to 2018 US dollars. Results In total, 4,837 unique studies were screened on title and abstract and 4,730 excluded. After full-text screening, 64 of the remaining 107 studies were included in the systematic review. The study methodologies differed considerably, with large differences in perspective, valuation method and source population. Mean annual healthcare costs for prevalent Crohn′s disease (CD) cases in the last 10 years were in Asia $4,463; Europe $12,396 and North America $17,508. Costs for prevalent ulcerative colitis (UC) patients in the same period were $1,654, $7,206 and $13,569 respectively. For CD, the cost drivers moved from inpatient (61% of total costs) in 1995 to medication costs (77%) in 2016. Similar trends were identified for UC (1998: 50% and 36% versus 2016: 9%, and 82% for inpatient and medication costs, respectively). This cost trend is primarily attributable to an increase in medication costs in all four geographical areas, while in- and outpatient costs were relatively stable during the same time period. The annual costs of absenteeism and presenteeism per prevalent case of CD were $5,638 in Asia and $6,485 in Europe. For UC these costs were $4,828 and $6,414 respectively. Annual costs of absenteeism and presenteeism in North America were $20,074 per patient for a combined cohort of UC and CD patients. Conclusion Per patient costs for IBD are increasing worldwide, with highest costs in North America and lowest in Asia. This is primarily due to an increase in medication costs. Productivity costs are substantial and might even exceed healthcare costs. Biologic therapy was expected to decrease inpatient costs by reducing hospitalisations and surgery, but this does not appear to be the case. Continuing growth of these costs can lead to an intolerable burden on healthcare systems worldwide.

Pandemics (coronavirus disease-2019), experiences, lessons learn, and the future

The coronavirus disease 2019 (COVID-19) pandemic is the defining global health crisis of our time andthe greatest challenge we have faced since World War Two. Since its emergence in Asia in 2019, thevirus has spread everywhere except Antarctica. We have now reached the tragic milestone of more than2 million deaths, and the human family is suffering under an almost intolerable burden of loss. However,the pandemic is much more than a health crisis, it’s also an unprecedented socioeconomic crisis. Stressingevery one in the countries, it has the potential to create devastating social, economic, and political effectsthat will leave deep and long-standing scars. Every day, people are losing jobs and income, with noway of knowing when normality will return. Small island nations, heavily dependent on tourism, haveempty hotels and deserted beaches. We have been supporting countries since the very early stages ofthis crisis, donating essential protective medical equipment. As the response evolves, and after assessingthe immediate, medium- and long-term needs, we are moving into the socioeconomic response. It willrequire all of society to limit the spread of COVID-19 and to cushion the potentially devastating impactit may have vulnerable economies. We must rebuild trust and cooperation, within and among nations, andbetween people and their governments.

A burden on future generations? How we learned to hate deficits and blame the baby boomers

The idea that public borrowing places an intolerable burden on posterity is as old as the institution of public debt itself. But the debate over deficit-spending assumed an entirely new scope and import with the rise of the fiscal state in the early twentieth century, as governments assumed greater responsibilities with regard to public welfare and found themselves subject to a new kind of conflict concerning the uses and distribution of public income. In this context, the intergenerational argument against social welfare spending became an important tool in the fight against class redistribution. With a focus on American debates, this article provides a historical sociology of the idea that deficits constitute a burden on future generations, identifying the key historical turning points when this idea acquired new political resonance. In particular, the article investigates how we learned to blame baby boomers for the alleged ills of government deficit-spending and how this now ubiquitous motif of public discourse was reintroduced by the Virginia school public choice theorist James M. Buchanan and later refined by the chief proponent of generational accounting, Laurence Kotlikoff.

Intolerable Burden of Impetigo in Endemic Settings: A Review of the Current State of Play and Future Directions for Alternative Treatments.

Impetigo (school sores) is a common superficial bacterial skin infection affecting around 162 million children worldwide, with the highest burden in Australian Aboriginal children. While impetigo itself is treatable, if left untreated, it can lead to life-threatening conditions, such as chronic heart and kidney diseases. Topical antibiotics are often considered the treatment of choice for impetigo, but the clinical efficacy of these treatments is declining at an alarming rate due to the rapid emergence and spread of resistant bacteria. In remote settings in Australia, topical antibiotics are no longer used for impetigo due to the troubling rise of antimicrobial resistance, demanding the use of oral and injectable antibiotic therapies. However, widespread use of these agents not only contributes to existing resistance, but also associated with adverse consequences for individuals and communities. These underscore the urgent need to reinvigorate the antibiotic discovery and alternative impetigo therapies in these settings. This review discusses the current impetigo treatment challenges in endemic settings in Australia and explores potential alternative antimicrobial therapies. The goals are to promote intensified research programs to facilitate effective use of currently available treatments, as well as developing new alternatives for impetigo.

Tracking of Multiple Closely Spaced Extended Targets Based on Prediction-Driven Measurement Sub-Partitioning Algorithm

For multiple extended target tracking, the accuracy of measurement partitioning directly affects the target tracking performance, so the existing partitioning algorithms tend to use as many partitions as possible to obtain accurate estimates of target number and states. Unfortunately, this may create an intolerable computational burden. What is worse is that the measurement partitioning problem of closely spaced targets is still challenging and difficult to solve well. In view of this, a prediction-driven measurement sub-partitioning (PMS) algorithm is first proposed, in which target predictions are fully utilized to determine the clustering centers for obtaining accurate partitioning results. Due to its concise mathematical forms and favorable properties, redundant measurement partitions can be eliminated so that the computational burden is largely reduced. More importantly, the unreasonable target predictions may be marked and replaced by PMS for solving the so-called cardinality underestimation problem without adding extra measurement partitions. PMS is simple to implement, and based on it, an effective multiple closely spaced extended target tracking approach is easily obtained. Simulation results verify the benefit of what we proposed—it has a much faster tracking speed without degrading the performance compared with other approaches, especially in a closely spaced target tracking scenario.

Выкупные платежи в крестьянских бюджетах Воронежской губернии XIX - начала ХХ в.

The paper aims to identify socio-economic status of the Voronezh province peasantry in the second half of the XIX - at the beginning of the XX century. The article considers processes of social stratification among the Voronezh province peasantry, analyses the peasants’ taxes and ascertains a place of redemption payments in the structure of their tax payments. The researcher reveals causes of arrears among the peasants and describes the measures taken by the state bodies to solve the peasants’ debt problems. The research findings are as follows: the author proves that due to low profitability from agriculture and frequent natural disasters, redemption payments were an intolerable burden for the peasants. Scientific originality of the study lies in the fact that the problem of redemption payments of the Voronezh province peasants, in particular, the place of these payments in the structure of their tax payments, is still poorly investigated.

An Intolerable Burden: Suicide, Intended Self-Injury and Diabetes

Diabetes mellitus can refer to any 1 of a series of metabolic disorders having a common feature of inadequate insulin production capable of maintaining appropriate glycemic levels (1). Type 2 diabetes mellitus (T2D) represents the most common form of the disease, affecting some 90% to 95% of those diagnosed with the disorder (1). With rising rates of obesity, a diagnosis of T2D increasingly occurs in adolescents and early adulthood (1), but largely remains a disease of adults. In contrast, type 1 diabetes mellitus (T1D) is an autoimmune disorder in which the body’s immune system destroys the insulin-producing beta cells, rendering a situation in which individuals become dependent on lifelong exogenous insulin replacement (2).

Editors' note: The intolerable burden

In “The intolerable burden,” Ludwig Gutmann describes the anguish he felt when an 80-year-old patient with Guillain-Barré syndrome, who reluctantly agreed to intubation despite previously being DNI, died after being palliatively extubated, at her request. He acknowledges feeling distressed that (1) the patient may not have understood that the burdens of intubation and weakness were temporary, despite the fact that he'd given her and her family an optimistic prognosis, (2) the ICU team complied with her wishes, rather than sedating her and continuing treatment with IVIG, and (3) the ICU team did not “negotiate” with her and her family after extubation and instead focused on comfort and administered analgesics as needed. In response to this essay, Dr. Todd Janus notes that he believes intubating this patient, who was previously DNI, and keeping her intubated when she asked to be extubated is a “horror” and reports that he believes that there is no role for paternalism in modern medicine. Dr. Gutmann agrees that paternalism is no longer appropriate, but comments that “there are moments when physicians need to be forceful in influencing the decision-making process, especially when the patient's judgment appears flawed and prevents the strong possibility of a good outcome.” It is imperative that we, as clinicians, be both transparent and thorough when we communicate with patients and their families. Ultimately, the principle of autonomy dictates that patients and their legal decision makers must be allowed to make uncoerced, independent choices, but we must facilitate the decision-making process by educating them with the information they need to do so. In “The intolerable burden,” Ludwig Gutmann describes the anguish he felt when an 80-year-old patient with Guillain-Barré syndrome, who reluctantly agreed to intubation despite previously being DNI, died after being palliatively extubated, at her request.

Author response: The intolerable burden.

I read Dr. Janus' comment with interest. Patients and families do have the right to reject the recommendations of physicians. However, patients should have a clear understanding of the options and their implications. It is the physician's responsibility to guide the decision-making process of patients and their families to achieve the optimal outcome.

Do out-of-pocket costs affect medication adherence in adults with rheumatoid arthritis? A systematic review.

For individuals with a chronic condition, long-term management of their medication can be difficult and as a result non-adherence is common among this cohort. In patients with rheumatoid arthritis (RA), the introduction of biologic agents was a revolutionary treatment but the high costs of this medication might limit their utilisation. This systematic review aimed to determine whether out-of-pocket (OOP) costs affect adherence to RA medications in adults with a diagnosis of RA. Twelve databases were searched to identify primary peer-reviewed articles, written in English from inception to April 2016 that referred to the relationship between adherence to RA medication and OOP costs. The CASP check list was used to assess the quality rating of the included studies. Six articles were identified in the review and all were considered as high quality studies. Among them, three directly considered the association between OOP costs and medication adherence as their main objective. Although the population and the methods of the studies varied widely, there was an inverse relationship between OOP costs and medication adherence in patients with RA. The findings of this review suggest that OOP costs can contribute to non-adherence to RA medication in patients with RA. Therefore, health policy makers globally should identify the appropriate OOP amount so these costs do not affect adherence whilst simultaneously ensuring that costs are not an intolerable burden for governments, providers and insurers.

Human Rights That Influence The Mentally Ill Patient In South African Medical Law: A Discussion of Sections 9; 27; 30 and 31 of the Constitution

The personalised nature of mental illness obscures from general view the intolerable burden of private and public distress that people with serious mental illness carry. Invariably the mentally ill person encounters rejection and humiliation that are in some way tantamount to a "second illness." The combination either disrupts or puts beyond reach the usual personal and social life stages of marriage, family life, raising children, sexual relationships, the choice of treatment, affordable housing, transportation, education and gainful employment. As a result of their lack of financial and social support and their experience of rejection from society, persons with mental illness tend to neglect themselves and their diet, and frequently delay seeking treatment. Against this background, this contribution critically focuses on the human rights that influence the mentally ill patient in South African medical law. Specific attention is paid to the relevance and meaning of sections 9 (the equality clause), 27 (access to health care services), 30 and 31 (language, culture and religion) of the Constitution of the Republic of South Africa, 1996.

Following the Ions through a Mass Spectrometer with Atmospheric Pressure Interface: Simulation of Complete Ion Trajectories from Ion Source to Mass Analyzer.

Ion trajectory simulation is an important and useful tool in instrumentation development for mass spectrometry. Accurate simulation of the ion motion through the mass spectrometer with atmospheric pressure ionization source has been extremely challenging, due to the complexity in gas hydrodynamic flow field across a wide pressure range as well as the computational burden. In this study, we developed a method of generating the gas flow field for an entire mass spectrometer with an atmospheric pressure interface. In combination with the electric force, for the first time simulation of ion trajectories from an atmospheric pressure ion source to a mass analyzer in vacuum has been enabled. A stage-by-stage ion repopulation method has also been implemented for the simulation, which helped to avoid an intolerable computational burden for simulations at high pressure regions while it allowed statistically meaningful results obtained for the mass analyzer. It has been demonstrated to be suitable to identify a joint point for combining the high and low pressure fields solved individually. Experimental characterization has also been done to validate the new method for simulation. Good agreement was obtained between simulated and experimental results for ion transfer though an atmospheric pressure interface with a curtain gas.