E-Voting Solution for Romanian Parliament

Every year hundreds of millions of people vote in a variety of settings in many countries around the world. People vote in public elections to choose government leaders and also in private elections to determine the course of action for groups that people are organized in such as non-governmental organizations, unions, associations and corporations (shareholders). Voting is a widely spread, rather democratic, way of making decisions. More and more governments and private organizations realize that the use of new technologies such as the Internet can have beneficial impacts on elections - i.e. higher voter turnout and lower costs of conducting elections. The rules governing elections tend to be highly specialized to meet the specific needs of each type of organization. Most elections, however, require integrity, privacy and authentication.e-voting, elections, democracy, ngo, unions, government

Factors which influence mortality in patients with Infective Endocarditis

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Infective Endocarditis (IE) is a severe rising incidence pathology with high mortality. The incidence of IE is 3-10 cases per 100,000 people/year. The most common complications in IE that lead to death are: Congestive Heart Failure (CHF) - 33.4%, stroke 17.9%, and embolic events - 34.3%. Early and adequate initiation of antibiotic therapy significantly reduces mortality by 25-50%, and the frequency of embolic events in 13 patients out of 1,000 in the first week of treatment and 1.2 to 1,000 after two weeks of appropriate treatment, and early surgery can improve the evolution of EI. with an estimated overall survival of 74.8 ± 4.1% at 10 years. Despite improvements in the diagnosis, treatment and management of EI, the pathology remains associated with severe complications and high mortality. Aim of the study. The purpose of the research is: to evaluate the factors which influence mortality in patients with Infective Endocarditis in Republic of Moldova. Materials and methods. There were retrospectively evaluated 161 patients with clinically definitive diagnosis of IE according the Duke and J. Li criteria, admitted between 2013 - 2019 at the Institute of Cardiology and Municipal Hospital „Holy Trinity”, Chisinau, Republic of Moldova. Patients were devided in two groups deaths (D) 31 (19.3%) and alive (A) 130 (80.7%). The following characteristics were studied: age, gender, type of IE, injection drug use, Diabetes Mellitus, haemoculture, presence of Staphylococcus aureus, vegetations and their features, C-reactive protein, ASL-O, left ventricular ejection fraction and other complications. Data collection was based on the review of available medical charts, reports from the echocardiography laboratory, and accessible valve surgery reports during the study period. Data analysis was performed with statistical software Epi Info (CDC, Atlanta, ver. 7.2.2.16). Odds Ratio (OR) is used to estimate the strength of the association between risk factors, and outcomes of mortality, so OR> 1 means that the risk of the outcome is increased by the exposure. Variables were compared using two-tailed t-test and statistical significance was defined by p ≤ 0.05. Results. The most affected age in both groups was 45-64 years, 51.6% for group D, and 56.2.4% for group A, with a mean age of 57.7 ± 12.3 years for group D and 51.3 ± 13.7 years for group A. Nevertheless, the cases of death exceeded in group >65 years 29% vs 16.9% (OR 2.0; 95% CI, 0.82-4-94; p = 0.124). In both groups prevailed men with 64.5% and respectively 76.2%, but it is observed an increase of prevalence to 35.5% for women in group D (OR 1.8; 95% CI, 0.76-4.06; p = 0.184). Acute onset IE was more frequently in group D 41.9% vs 37.7 in group A (OR 1.2; 95% CI, 0.54-2.65; p = 0.890), as well prosthetic valve IE (PVIE) 16.1% vs 12.3% (OR 1.4; 95% CI, 0.46-4.07; p = 0.570). Diabetes mellitus predominated in group D 29% vs 12.3% in group A (OR 4.0; 95% CI, 1.51-10.7; p <0.05). Blood culture was positive in 51.6% of patients in group D and 23.8% in group A (OR 3.4; 95% CI, 1.51-7.67; p <0.05), and prevailing in both groups Staphylococcus aureus (OR 4.4; 95% CI, 1.47-13.42; p <0.05) and Staphylococcus epidermidis (OR 4.7; 95% CI, 1.09-19.83; p <0.05) as pathogens. We observed in both groups vegetations in more then 70% of patients, but in the group D, 19.4% vs 14.6% were affected more valves, with predominating in group D middle size vegetations 32.3% vs. 23.1% (OR 1.6; 95% CI, 0.67-3.73; p = 0.287) and big size 12.9% vs 6.9% (OR 1.9; 95% CI, 0.57-6.95; p = 0.272). The most affected valves in group D was the tricuspid one 12.9% vs 11.5% (OR 1.1; 95% CI, 0.35-3.69; p = 0.832). Group D had an increased rate of CHF 61.3% vs 53.8% NYHA class III (OR 1.4; 95% CI, 0.61- 3.02; p = 0.453) and class IV 25.8% vs 10.8% (OR 2.9; 95% CI, 1.08-7.66; p <0.05). Embolic events occurred in 61.3% in group D and in 14.6% of patients in alive group (OR 9.3; 95% CI, 3.87-22.1; p <0.001). Also, the renal damage was higher in group D, Acute Kidney Failure (AKF) 12.9% vs 3.1% (OR 4.7; 95% CI, 1.09-19.83; p <0.05), Chronic Kidney Disease (CKD) 38.7% vs 9.2% (OR 6.2; 95% CI, 2.44- 15.8; p <0.001). Septic shock (SS) was more frequently in group D 29% vs. 4.6% (OR 8.5; 95% CI, 2.74-26.1; p <0.001). Conclusions. According to Odds Ratio we found in our study 36 factors that can influence mortality in patients with infective endocarditis, nevertheless only 17 of them proved to have statistical significance difference. Therefore, these factors in our study were: Diabetes Mellitus (OR 4.0; 95% CI, 1.51-10.7; p < 0.05); positive blood culture (OR 3.4; 95% CI, 1.51-7.67; p < 0.05); Staphylococcus aureus (OR 4.4; 95% CI, 1.47-13.42; p < 0.05); Staphylococcus epidermidis (OR 4.7; 95% CI, 1.09-19.83; p < 0.05); Congestive Heart Failure class IV NYHA (OR 2.9; 95% CI, 1.08-7.66; p < 0.05); embolic events (OR 9.3; 95% CI, 3.87-22.1; p < 0.001) with the following clinically most important pulmonary embolism (OR 6.2; 95% CI, 2.17-17.9; p < 0.001), stroke (OR 3.7; 95% CI, 1.17-11.5; p < 0.05), Acute Kidney Failure (OR 4.7; 95% CI, 1.09-19.83; p < 0.05), Chronic Kidney Disease (OR 6.2; 95% CI, 2.44-15.8; p < 0.001) and Septic shock (OR 8.5; 95% CI, 2.74-26.1; p < 0.001)

Pulmonary complications of infective endocarditis: a case report

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Infective endocarditis (IE) is a severe septic disease, with the most frequent localization of the microbial graft on native or prosthetic valves, which causes serious complications and high mortality. The annual incidence of IE is 3-10 cases per 100,000 persons, with an increasing tendency in elderly patients, whereas the overall mortality, according to the Global Burden of Disease (GBD) estimates, is 1 per 100,000 persons, representing 65,000 deaths in 2013 [1,2]. The high mortality of patients with IE is mostly caused by cardiovascular, pulmonary and renal complications. Pulmonary complications occur in 10-65% of cases, more commonly in patients with right sided IE: septic pulmonary embolism, pulmonary infarction, pneumonia, pulmonary abscesses, pleural effusion, empyema, pneumothorax and fungal aneurysms of the pulmonary arteries [3&#93]

Catching Element Formation In The Act

Gamma-ray astronomy explores the most energetic photons in nature to address some of the most pressing puzzles in contemporary astrophysics. It encompasses a wide range of objects and phenomena: stars, supernovae, novae, neutron stars, stellar-mass black holes, nucleosynthesis, the interstellar medium, cosmic rays and relativistic-particle acceleration, and the evolution of galaxies. MeV gamma-rays provide a unique probe of nuclear processes in astronomy, directly measuring radioactive decay, nuclear de-excitation, and positron annihilation. The substantial information carried by gamma-ray photons allows us to see deeper into these objects, the bulk of the power is often emitted at gamma-ray energies, and radioactivity provides a natural physical clock that adds unique information. New science will be driven by time-domain population studies at gamma-ray energies. This science is enabled by next-generation gamma-ray instruments with one to two orders of magnitude better sensitivity, larger sky coverage, and faster cadence than all previous gamma-ray instruments. This transformative capability permits: (a) the accurate identification of the gamma-ray emitting objects and correlations with observations taken at other wavelengths and with other messengers; (b) construction of new gamma-ray maps of the Milky Way and other nearby galaxies where extended regions are distinguished from point sources; and (c) considerable serendipitous science of scarce events -- nearby neutron star mergers, for example. Advances in technology push the performance of new gamma-ray instruments to address a wide set of astrophysical questions.Comment: 14 pages including 3 figure

The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories:A systematic analysis for the Global Burden of Disease Study 2019

Importance Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.Objective To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence Review The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.Findings In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and Relevance In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation