Challenges toward Sustainability? Experiences and Approaches to Literary Tourism from Iran

Interdisciplinary narrative studies are of great importance in several disciplines, especially in the humanities and social sciences. Cultural tourism and its sub-disciplines, including the complex issue of ‘literary tourism’, is an interdisciplinary field of investigation, positioned in between geography and urban–rural studies. In Iran, this form of tourism has been neglected so far—with no distinction between urban and rural areas—despite a particularly rich literary heritage. The present study recognizes the challenge of literary tourism in Iran, delineating some possible actions to develop it as a future engine of economic growth, especially in rural districts. As a contribution to a refined comprehension of literary tourism development paths, a content analysis was run collecting views and textual data on literary tourism in Iran. The empirical results of this study indicate that the mentioned challenges can be classified into several main dimensions and a broader set of sub-themes. The possible actions responding to such challenges can be classified into more dimensions and a vast number of sub-themes. Actions reducing territorial disparities and fueling entrepreneurship in local communities are appropriate to stimulate the emergence (and, possibly, consolidation) of literary tourism districts in Iran, giving an original contribution to sustainable development especially—but not exclusively—in rural settlements

Willingness to pay for one quality-adjusted life year in Iran 14 Economics 1402 Applied Economics 11 Medical and Health Sciences 1117 Public Health and Health Services

Background: Recent years have witnessed a strong tendency to apply economic evidence as a guide for making health resource allocation decisions, especially those related to reimbursement policies. One such measure is the use of the cost-effectiveness threshold as a benchmark. This study explored the threshold for use in the health system of Iran by determining society's preferences. Methods: A cross-sectional household survey based on the contingent valuation method was administered to a representative general population of 1002 in Tehran, Iran from April to June 2015. The survey was intended to estimate the respondents' willingness-to-pay (WTP) preferences for one quality-adjusted life year (QALY) gained. The valuation scenarios featured 12 vignettes on mild to severe diseases that can change people's quality of life. The mean of WTP for QALY was estimated using different health instruments, and the determinants of such willingness were analyzed using the Heckman selection model. Results: WTP for QALY varied depending on the severity of a disease and the instrument used to determine health preferences. Mean low health state value were associated with high valuation. The best estimated WTP values ranged from US1032 to US2666 and 0.22-0.56 of Iran's local gross domestic product (GDP) per capita in 2014. Except for educational level, significant variables differed across different disease scenarios. Generally, a high health state valuation for target diseases, high income, high educational level, and being married were associated with high WTP for QALY. Conclusion: From the general public's perspective, the monetary value of QALY for mild to severe diseases with no risk of death was less than one GDP per capita. Therefore, the obtained valuation range is recommended as reference only for the adoption of interventions designed to improve quality of life. Future studies should estimate the threshold of interventions for life-threatening diseases or formulate transparent policies in such contexts. © 2019 The Author(s)

Association between vitamin D supplementation or serum vitamin D level and susceptibility to SARS-CoV-2 infection or COVID-19 including clinical course, morbidity and mortality outcomes? A systematic review

Objective To systemically review and critically appraise published studies of the association between vitamin D supplementation or serum vitamin D level and susceptibility to SARS-CoV-2 infection or COVID-19, including clinical course, morbidity and mortality outcomes. Design Systematic review. Data sources MEDLINE (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, MedRxiv and BioRxiv preprint databases. COVID-19 databases of the WHO, Cochrane, CEBM Oxford and Bern University up to 10 June 2020. Study selection Studies that assessed vitamin D supplementation and/or low serum vitamin D in patients acutely ill with, or at risk of, severe betacoronavirus infection (SARS-CoV, MERS-CoV, SARS-CoV-2). Data extraction Two authors independently extracted data using a predefined data extraction form and assessed risk of bias using the Downs and Black Quality Assessment Checklist. Results Searches elicited 449 papers, 59 studies were eligible full-text assessment and 4 met the eligibility criteria of this review. The four studies were narratively synthesised and included (1) a cross-sectional study (n=107) suggesting an inverse association between serum vitamin D and SARS-CoV-2; (2) a retrospective cohort study (348 598 participants, 449 cases) in which univariable analysis showed that vitamin D protects against COVID-19; (3) an ecological country level study demonstrating a negative correlation between vitamin D and COVID-19 case numbers and mortality; and (4) a case–control survey (n=1486) showing cases with confirmed/probable COVID-19 reported lower vitamin D supplementation. All studies were at high/unclear risk of bias. Conclusion There is no robust evidence of a negative association between vitamin D and COVID-19. No relevant randomised controlled trials were identified and there is no robust peer-reviewed published evidence of association between vitamin D levels and severity of symptoms or mortality due to COVID-19. Guideline producers should acknowledge that benefits of vitamin D supplementation in COVID-19 are as yet unproven despite increasing interest

Cost-effectiveness of bioimpedance-guided fluid management in patients undergoing haemodialysis: the BISTRO RCT

Background The BioImpedance Spectroscopy to maintain Renal Output randomised controlled trial investigated the effect of bioimpedance spectroscopy added to a standardised fluid management protocol on the risk of anuria and preservation of residual kidney function (primary trial outcomes) in incident haemodialysis patients. Despite the economic burden of kidney disease, the cost-effectiveness of using bioimpedance measurements to guide fluid management in haemodialysis is not known. Objectives To assess the cost-effectiveness of bioimpedance-guided fluid management against current fluid management without bioimpedance. Design Within-trial economic evaluation (cost–utility analysis) carried out alongside the open-label, multicentre BioImpedance Spectroscopy to maintain Renal Output randomised controlled trial. Setting Thirty-four United Kingdom outpatient haemodialysis centres, both main and satellite units, and their associated inpatient hospitals. Participants Four hundred and thirty-nine adult haemodialysis patients with > 500 ml urine/day or residual glomerular filtration rate > 3 ml/minute/1.73 m2. Intervention The study intervention was the incorporation of bioimpedance technology-derived information about body composition into the clinical assessment of fluid status in patients with residual kidney function undergoing haemodialysis. Bioimpedance measurements were used in conjunction with usual clinical judgement to set a target weight that would avoid excessive fluid depletion at the end of a dialysis session. Main outcome measures The primary outcome measure of the BioImpedance Spectroscopy to maintain Renal Output economic evaluation was incremental cost per additional quality-adjusted life-year gained over 24 months following randomisation. In the main (base-case) analysis, this was calculated from the perspective of the National Health Service and Personal Social Services. Sensitivity analyses explored the impact of different scenarios, sources of resource use data and value sets. Results The bioimpedance-guided fluid management group was associated with £382 lower average cost per patient (95% CI −£3319 to £2556) and 0.043 more quality-adjusted life-years (95% CI −0.019 to 0.105) compared with the current fluid management group, with neither values being statistically significant. The probability of bioimpedance-guided fluid management being cost-effective was 76% and 83% at commonly cited willingness-to-pay threshold of £20,000 and £30,000 per quality-adjusted life-year gained, respectively. The results remained robust to a series of sensitivity analyses. Limitations The missing data level was high for some resource use categories collected through case report forms, due to COVID-19 disruptions and a significant dropout rate in the informing BioImpedance Spectroscopy to maintain Renal Output trial. Conclusions Compared with current fluid management, bioimpedance-guided fluid management produced a marginal reduction in costs and a small improvement in quality-adjusted life-years. Results from both the base-case and sensitivity analyses suggested that use of bioimpedance is likely to be cost-effective. Future work Future work exploring the association between primary outcomes and longer-term survival would be useful. Should an important link be established, and relevant evidence becomes available, it would be informative to determine whether and how this might affect longer-term costs and benefits associated with bioimpedance-guided fluid management. Funding details This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number HTA 14/216/01 (NIHR136142)

Faisabilité d un système d émission réception analogique pour les communications sécurisées par le chaos

Ce travail de thèse consiste en l étude de la faisabilité de la réalisation analogique d un système de communication chaotique. Le mémoire est composé de deux parties principales: la première partie concerne la réalisation d un émetteur de signaux chaotiques. Pour cela, un oscillateur bien connu de type Colpitts est choisi afin de générer une porteuse chaotique destinée à chiffrer un message confidentiel. L approche utilisée est la méthode par inclusion. Ainsi l injection du message dans l oscillateur de Colpitts est obtenue à l aide d un miroir de courant. Le montage expérimental de l émetteur (oscillateur de Colpitts incluant le message) montre sa faisabilité. La deuxième partie de ce travail comprend la réalisation d un récepteur pour l émetteur chaotique considéré. La méthode proposée est basée sur la synchronisation unidirectionnelle de systèmes chaotiques à l aide d observateur. Deux types d observateurs sont utilisés pour reconstruire les états de l émetteur et le message. Le premier est un observateur adaptatif, qui estime simultanément les états et le message. Cet observateur possède la propriété de convergence exponentielle. Le deuxième observateur est un observateur à modes glissants qui, grâce à sa convergence en temps fini et son fonctionnement étape par étape, présente de meilleures performances. Cet observateur est alors réalisé de façon analogique et en basses fréquences afin de prouver la faisabilité de la méthode de synchronisation proposée.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF