MPH, Faculty of Health Sciences, University of the Witwatersrand / Background: The increase use of highly active antiretroviral therapy (HAART) among patients with HIV infection and AIDS has led to increasing reports of metabolic abnormalities such as diabetes mellitus, hypertension, dyslipidaemia and obesity. Therefore, it is important to explore the burden of these diseases among HIV infected patients. Objectives: To determine the burden of metabolic diseases (hypertension, diabetes, obesity and dyslipidaemia) in patients attending HIV clinic at the Charlotte Maxeke Johannesburg Academic Hospital (JHBH). Methodology: It was a cross-sectional study. The study population included patients attending JHBH HIV clinic and on HAART for more than one year. A sample size of 304 patients, including 237 females and 67 males partook in this study. Anthropometric measurements were taken from patients and blood samples of these patients were sent to laboratory for lipograms, HbA1c, random glucose, CD4 lymphocytes counts as well as HIV viral load testing. The data was analysed with standard statistical software Epi-info version 6.0. Both descriptive and analytical statistics was used. Results: The prevalence of metabolic syndrome according to the IDF was 20.4 %; obesity (BMI 30 kg/m2) was 16.8% and patients that were overweight (BMI > 25 kg/m2 and BMI < 29.9 kg/m2) was 28.6%; hypercholesterolemia (TC 5.0 mmol/l) = 35.5%; HDL< 1.29 mmol\L in females was 58% and HDL <1.04 mmol/l in males was 36%; elevated triglycerides 1.7 mmol/l was 30% and only 16% was classified as being hypertensive (BP 140/90 mmHg and / or on Hypertensive medication). The majority of the patients (86.2%) had a CD4 lymphocyte count 200 X 106 cells/l and 84% of patients had less than detectable limits for viral loads (VL< 40 copies / μl), which has been reported as optimum levels for metabolic diseases in HAART recipients. Conclusion: These results clearly indicate that there is a growing burden of metabolic diseases among HIV patients on HAART attending the Johannesburg hospital HIV clinic. The current study also indicates that the metabolic disturbances are more frequent in women than in men, except for hypertension.

1 Abstract The title of the work: Burden of Proof in Civil Procedure The present diploma thesis deals with one of the few subjects, which are topical today, as in the past, in spite of all legislative changes - the burden of proof in the civil procedure. The burden of proof, which is the subject of this work, plays in the process of evidence an irreplaceable role, yet it is still a very underrated topic, which is not, in particular in legal theory, given appropriate attention. Legal theory is not too unified with regard to the burden of proof, the views of different authors on this institute differ. This is a very large, somewhat unclear issue. There are many theories regarding the functioning of the burden of proof and its distribution among the parties. The thesis does not claim to give an exhausting interpretation of this institute, as it is a very extensive issue, and its comprehensive processing would require at least the publication of a book, perhaps several books, but should outline the institute of the burden of proof and its function in the civil procedure. The burden of proof is not clearly defined in the legislation and the theory of burden of proof is very complicated and inconsistent, that is probably why there is a relatively extensive case-law of the courts, which increasingly emphasizes...

O envelhecimento populacional é um dos maiores triunfos da humanidade, porém um dos grandes desafios para os gestores de saúde. Associado ao processo do envelhecimento, o declínio da capacidade física e cognitiva pode ocorrer, levando o idoso à perda progressiva da autonomia e independência. Assim, a família é quem, geralmente, assume a responsabilidade do cuidado de forma despreparada, contribuindo para quadros depressivos, de ansiedade e de sobrecarga no cuidador. A falta de conhecimento sobre o idoso, na comunidade de Ribeirão Preto, bem como da sobrecarga da atividade de prestar cuidado no domicílio perfazem a relevância deste estudo. Os objetivos foram identificar e caracterizar idosos na comunidade de Ribeirão Preto, avaliar a função cognitiva e a independência funcional dos idosos e a sua relação com sexo, idade, estado civil e escolaridade e caracterizar os cuidadores familiares bem como descrever a sobrecarga e o desconforto emocional dos mesmos em relação à atividade do cuidar. Este representa um estudo epidemiológico, descritivo e transversal com idosos de 65 anos ou mais de idade e seus respectivos cuidadores, ambos os sexos, residentes na área urbana de Ribeirão Preto, São Paulo. Foram utilizados os seguintes instrumentos: Caracterização do idoso; Miniexame do Estado Mental (MEEM); Medida da Independência Funcional (MIF); Instrumento para Caracterização do Cuidador; Escala de Sobrecarga de Zarit; Self Reporting Questionnaire (SRQ-20). Do total de 574 idosos, que se caracterizaram pela média de 76,6 anos de idade, 67,8% do sexo feminino, 54,7% com baixa escolaridade, 19,7% com deficit cognitivo e 15,7% com algum grau de dependência funcional, 21,6% possuíam cuidadores. Dentre os 124 cuidadores estudados, 85,6% eram do sexo feminino, com média de 56,5 anos de idade, 37,9% com baixa escolaridade, 90,3% eram familiares (filhas e esposas principalmente), 79,8% residiam com o idoso, utilizando, em média, 12,4 horas diárias para o cuidar. Os resultados evidenciaram que os cuidadores apresentam leve a moderada sobrecarga. Após a regressão linear múltipla, a dependência funcional do idoso e as características dos cuidadores como sexo feminino e tempo em horas semanais para o cuidado diário foram os preditores da sobrecarga (p<0,05). Encontrou-se, também, que a sobrecarga é fator de risco para desconforto emocional (p<0,05). Sugerem-se outros estudos na área e intervenções com os cuidadores que residem na comunidade, utilizando instrumentos de avaliação, validados para a população brasileira. As pesquisas realizadas nessa área enfocam, na maioria das vezes, o cuidador de idoso com demência, o que trará não só resultados para os cuidadores como também para os pacientes, pois sem sobrecarga e desconfortos o cuidador estará renovado para cuidar. / Population aging represents one of the major advancements of humanity but it is also a great challenge to health managers. Decreased physical and cognitive abilities are associated to the aging process and lead to elderly individuals\' progressive loss of autonomy and independence. As a consequence, family members assume the responsibility to provide care with no previous preparedness, which leads caregivers to develop depressive conditions such as anxiety and burden. The lack of knowledge concerning elderly individuals in the community of Ribeirão Preto, SP, Brazil and burden that results from delivering care at home are the topic of this study. It identifies and characterizes elderly individuals in the community of Ribeirão Preto, evaluates their cognitive function and functional independence and relates these variables with gender, age, marital status, and schooling. Family caregivers are also characterized, while burden and emotional discomfort is evaluated in relation to the care activity. This epidemiological, descriptive and transversal study was carried out with 65 years old or older individuals and their respective caregivers, both genders, residents in the urban area of Ribeirão Preto, SP, Brazil. The following instruments were used: instrument to characterize the elderly individuals; Mini-mental State Examination (MMSE); Functional Independence Measure (FIM); instrument to characterize caregivers; Zarit Burden Scale; Self-Reporting Questionnaire (SRQ-20). The total of 574 elderly individuals were 76.6 years old in average, 67.8% were female, 54.7% had low levels of schooling, 19.7% had low cognitive performance and 15.7% some degree of functional dependence, while only 21.6% had caregivers. Among the 124 caregivers, 85.6% were female and 56.5 years old in average, 37.9% had low levels of schooling, 90.3% were family members (mainly daughters and wives), 79.8% lived with the elderly individual and spent in average 12.4 hours daily. The results evidenced that the caregivers present low to moderate burden. Multiple linear regression revealed that functional dependence of elderly individuals and caregivers\' characteristics such as being females and time of weekly hours spent in daily care were predictors of burden (p<0.05). Burden is also a risk factor for psychiatric morbidity (p<0.05). We suggest further studies in the field and investigations with caregivers in the community using evaluation instruments validated for the Brazilian population since research in the field usually focuses on caregivers of elderly individuals with dementia. These actions are expected to help caregivers and patients, since with no burden and discomfort, caregivers will be renovated to provide care.

Esta pesquisa tem como objetivo principal desenvolver um modelo capaz de captar como mudanças nas alíquotas dos tributos afetam as diferentes classes de renda e quais são seus impactos na arrecadação do governo. A justificativa para desenvolver o estudo é que as autoridades públicas, no Brasil, não dispõem de mecanismos que permitam fazer tal análise e, provavelmente, esse é um dos motivos pelos quais não foi dada a devida atenção à forma como os impostos indiretos recaem sobre a população. O modelo desenvolvido no presente estudo requer três informações fundamentais: a carga tributária por faixa de renda, a estimação da matriz de elasticidades Marshallianas e o padrão de consumo da população. As simulações são feitas com base nos microdados da POF de 2002-2003. Sendo assim, para alcançar os objetivos propostos pela tese, é feito um estudo detalhado da atual incidência do sistema tributário brasileiro, que vai da averiguação da carga tributária direta, indireta e total por faixa de renda até a estimação de um modelo de sacrifício eqüitativo. Buscou-se detalhar ao máximo as alíquotas dos impostos indiretos, tomando como base as normas tributárias da Federação, das Unidades da Federação e respectivas capitais. Cruzando essas informações com os microdados da POF de 2002-2003, foi possível verificar que o sistema tributário brasileiro é regressivo quando tomada como base a renda. Isso se deve em grande parte aos impostos indiretos, mais especificamente ao ICMS, ao PIS e à COFINS. Contudo, é importante ressaltar que a baixa participação dos impostos diretos não permite equilibrar a carga por faixa de renda. O IR tem uma taxa efetiva bem abaixo da alíquota que está prevista em lei e o IPTU chega a ser regressivo quando analisada a renda familiar total. O estudo também revelou que há diferenças regionais no comportamento dos impostos indiretos. No caso específico dos alimentos, que é um grupo de despesa relevante para as famílias de baixa renda, as maiores cargas foram verificadas nas regiões Norte e Nordeste. Na estimação da matriz de elasticidades Marshallianas a partir dos microdados da POF de 2002-2003 é usada a versão não-linear do sistema quase ideal de demanda (NL-AIDS) para 27 grupos de produtos. Como não é possível obter todos os preços necessários para os produtos nãoalimentícios na POF, foi necessário buscar informações de preços em outras fontes. Para estimar uma função de tributação pressupondo obediência ao princípio de sacrifício eqüitativo, é utilizada a forma proposta por Hoffmann, Silveira e Pintos-Payeras (2006). Os resultados sugerem que o coeficiente de aversão à desigualdade está aumentando no Brasil e isto pode ser interpretado como o desejo da sociedade por uma tributação mais justa. As simulações feitas mostram que o modelo desenvolvido no último capítulo apresenta um razoável desempenho para avaliar os efeitos das mudanças no sistema tributário. Certamente é um recurso adicional que pode ser usado pelas autoridades públicas antes de fazer alterações nas alíquotas tributárias. O modelo permitiu observar que quando é buscada maior progressividade do sistema tributário, é necessário combinar alterações nos impostos diretos e indiretos. / The main objective of this research is to develop a model that is able to evaluate how the effects of changes in tax rates are distributed among the different income classes as well as their impact in the government revenues. This study is relevant, because Brazilian public authorities do not have mechanisms for such analysis, and this is possibly one the reasons why the way indirect taxes affect the population has not been carefully considered so far. The model developed in this study requires three fundamental types of information: the tax burden per income class, the estimate of Marshalls elasticities matrix, and the populations pattern of consumption. Simulations are based on Household Budgeting Survey (POF-2002-2003) microdata. Thus, to reach the objectives proposed by this thesis, a detailed study of the current incidence of the Brazilian tax system was carried out, including the evaluation of direct, indirect and per-class tax burden and the estimation of a tax function assuming equitable sacrifice. Indirect tax rates were detailed as much as possible, considering the tax regulations of the country, states and their respective capital cities. Combining this information with the 2002-2003 POF database, it could be verified that the Brazilian tax system is regressive when based on income. This is mainly due to indirect taxes, and more specifically to Value added tax (ICMS), Social Security (PIS), and Social Security Financing Tax (COFINS). However, we must point out that the low participation of indirect taxes does not allow a balance of the tax burden per income class. Income tax has an effective rate well below the rate established by the law, and municipal tax on properties (IPTU) is regressive, when the total family income is analyzed. The study also showed that there are regional differences as to indirect taxes. Particularly in the case of food, which is a relevant expense group for low income families, higher tax burdens were found for the North and Northeast regions. Marshalls elasticities matrix was estimated using a non-linear version of the almost ideal demand system (NL-AIDS), considering 27 product groups out of the 2002-2003 POF database. As not all the necessary prices for non-food products could be obtained from the POF database, other information sources were used. Tax functions assuming equitable sacrifice were estimated using the procedure proposed by Hoffmann, Silveira and Pintos-Payeras (2006). The results suggest that the coefficient of aversion to inequality is increasing in Brazil and this can be interpreted as the populations desire for a fairer tax system. The simulations show that the model developed in the last chapter has a reasonable performance in the evaluation of the effect of changes in the tax system. It is certainly an additional instrument which can be used by public authorities before establishing changes in the tax rates. The model allowed us to observe that when a higher progressivity of the tax system is attempted, it is necessary to combine changes in direct and indirect taxes.

O adoecimento de um membro familiar costuma acarretar inúmeras alterações em toda a estrutura e dinâmica familiar. Com a progressão e o agravamento da doença, quando a pessoa se encontra sem possibilidade de tratamento modificador da doença, aumenta o sofrimento tanto da pessoa adoecida quanto de sua família. O cuidador familiar de pessoas idosas em cuidados paliativos sofre junto ao enfermo, podendo enfrentar sobrecarga física, emocional e social decorrente da tarefa de cuidar e da possibilidade da morte. Entretanto, são escassos os estudos que avaliam a sobrecarga desta população. O objetivo deste estudo é identificar e analisar a percepção de sobrecarga por parte do cuidador familiar de idosos em cuidados paliativos. Trata-se de uma pesquisa do tipo transversal, exploratório, de metodologia quantitativa, não probabilística, com uma casuística total composta por 100 pessoas. Essa casuística foi estratificada de acordo com escore obtido por meio da aplicação do protocolo Karnofsky Performance Scale (KPS) com os idosos (com 60 anos ou acima) em cuidados paliativos oncológicos: um grupo com 25 cuidadores familiares de idosos com KPS abaixo de 40%; um grupo com 25 cuidadores de idosos em cuidados paliativos oncológicos com KPS de 70%, 60% ou 50%; um grupo controle com 50 cuidadores familiares de idosos em cuidados paliativos oncológicos, com KPS maior ou igual a 80%. Durante a coleta de dados, além do KPS, foram aplicados o questionário de caracterização clínica e sociodemográfica e os protocolos: Questionário de Classificação Socioeconômica Brasil e o Caregiver Burden Scale (CBScale), validado no Brasil. Para análise dos dados, foi realizada estatística descritiva e as comparações com os grupos foram feitas por meio do Teste Exato de Fisher e de um modelo de regressão quantílica. As análises foram feitas pelo software SAS 9.0 e Stata versão 13. Os resultados indicaram que os cuidadores familiares são, em sua maioria, mulheres, filhas ou esposas, de meia idade a idade mais avançada, predominantemente, na faixa etária de 56 a 71 anos, com baixa escolaridade, pertencentes a classes sociais C e que não realizam nenhuma atividade remunerada. Os maiores índices de sobrecarga foram percebidos em cuidadores do sexo feminino e em cuidadores de idosos os quais apresentam menores escores relativos à capacidade funcional (avaliados pelo KPS). Conclui-se que o agravamento da doença, o declínio funcional do idoso e a possibilidade da sua morte mais próxima fazem aumentar a sobrecarga dos cuidadores, com impactos na sua saúde e qualidade de vida, o que indica a necessidade de oferecimento de serviços de apoio a essa população o mais precocemente possível / The illness of a family member often brings on numerous changes throughout the structure and family dynamics. With the progression and worsening of the disease, when the person has no possibility of modifying the disease treatment, the suffering of the ill person and the family increases. The family caregivers of the elderly in palliative care suffer with the ill person and may face physical, emotional and social burden from the task of caring for and the possibility of death. However, there are only few studies assessing the burden of this population. The aim of this study is to identify and analyze the perception of burden on the part of caregivers of seniors in palliative care. It is a cross-sectional survey, exploratory, quantitative methodology, non-probabilistic, with the full sample composed of 100 people. This sample was stratified according to the score obtained by applying the Karnofsky Performance Scale (KPS) to the elderly (aged 60 and above) in oncology palliative care: a group of 25 family caregivers of elderly patients with KPS below 40%; a group of 25 caregivers of elderly in oncology palliative care with KPS of 70%, 60% or 50%; a control group of 50 family caregivers of elderly in oncology palliative care, with KPS greater than or equal to 80%. During data collection, in addition to KPS, it was applied a questionnaire clinical and sociodemographic and protocols: Brazil Economic Classification Criteria and the Caregiver Burden Scale (CBScale), validated in Brazil. For data analysis, it was performed descriptive statistics and comparisons with groups; they were made by Fisher\'s exact test and a Regression Quantiles Model. The analyses were performed using the software SAS 9.0 and Stata version 13. The results indicated that family caregivers are mostly women, daughters or wives, from middle- aged to older ages predominantly in the age group of 56-71, poorly educated, and belonging to social classes C and they do not perform any remunerated activity. The largest burden rates were seen in female caregivers and caregivers of seniors who have lower scores related to functional capacity (assessed by KPS). In conclusion, the aggravation of the disease, the functional decline of the elderly and the possibility of death increase the burden on caregivers, with impacts on their health and quality of life, which indicates the need of offering support services to this population as soon as possible

Birks' unjust enrichment formula was intended to provide a common descriptive structure to all the instances where there was recovery. He did not, however, engage in an analysis of the various reasons why courts awarded restitution. My thesis seeks to fill this gap. I argue that without such an account Birks work is incomplete. According to Birks, for example, money and services both amounted to enrichments and so should be considered together. But there are some differences and similarities between money and services. In order to be able to group them together Birks needs to be able to say that the reasons for giving recovery in money and service cases are similar enough that they can be grouped together. The same goes for all the unjust factors. The point is, the generalisation that Birks sought to do, can only properly be done if one is attuned to the reasons why recovery is granted in each of those cases. If the reasons are similar then the generalisation makes sense. But if they are not then it does not make sense to so generalise. The argument of the thesis is that there three relevant principles to justifying unjust enrichment: the Property Principle, the Benefit-Burden Principle and the Autonomy Principle. The Property Principle states that one should not have property belonging to another. The Benefit-Burden Principle states that if one takes a benefit then one must bear the associated burdens; to put it more colloquially: you have to take the rough with the smooth. These first two principles provide reasons for considering a situation to be defective and the last principle provides a constraint for the operation of the first two. It is there to ensure that the imposition of liability will not unduly affect the autonomy of the defendant. Based on that the thesis proposes that the scope of the unjust enrichment formula be trimmed down to only cover defective transfers of money and other assets. For the other cases, a different analytical structure is needed. This is because the reasons for recovery in those cases are different.

This dissertation was conceived as an addendum to two self-published catalogs that American artist Chris Burden released, covering the years 1971–1977. It looks in-depth at the formative work the artist produced in college and graduate school, including minimalist sculpture, interactive environments, and performance art. Burden’s work is herewith examined in four chapters, each of which treats one or more related works, dividing the artist’s early career into developmental stages. In light of a wealth of new information about Burden and the atmosphere in which he was working in the late 1960s and early 1970s, this dissertation examines the artist’s work in relation to West Coast Minimalism, the Light and Space Movement, Environments, and Institutional Critique, above and beyond his well-known contribution to performance art, which is also covered herein. The dissertation also analyzes the social contexts in which Burden worked as having informed his practice, from the beaches of Southern California, to rock festivals and student protest on campus, and eventually out to the countercultural communes. The studies contained in the individual chapters demonstrate that close readings of Burden’s work can open up to formal and art-historical trends, as well as social issues that can deepen our understanding of these and later works. Benefitting from access to the artist’s estate, as well as archives collected at various institutions in Southern California, this dissertation is the first authoritative coverage of Chris Burden’s early career.

EVIDENCE IN TAX PROCEEDINGS Abstract The purpose of the thesis is on one hand to provide an overall view of the issue of burden of proof in tax proceedings. On the other hand the thesis gives a detailed look into unclear and problematic provisions of the Tax Code concerning the burden of proof of tax subjects as well as that of tax administrators. The reason for my analysis is that number of questions related to the burden of proof in tax proceedings are very often matter of disputes between tax subjects and tax administrators which in many cases has to be decided by the Czech Supreme Administrative Court. The thesis is composed of four chapters, each of them dealing with different aspects of evidence. Chapter One is introductory and deals with evidence in proceedings in general. It also defines basic terminology used in the thesis such as evidence, basic principles of process, burden of production or burden of persuasion. The Chapter Two explains specifics of evidence in tax proceedings. Chapter Three deals with the definition of evidence and mentions different types of evidence in tax proceedings. Chapter Four is focused on the key issue of evidence in tax proceedings - the concept of burden of proof. The chapter consists of five parts. Part One concerns burden of proof of taxpayers while Part Two looks...

The purpose of this research was to explore the gender differences in caregiver burden in Alzheimer’s patients in the Inland Empire. Currently, there are more than half a million Californians who live with Alzheimer’s disease (Ross, Brennan, Nazareno, & Fox, 2009) and this number is expected to double over the next few years. Due to an increase in the older population and the rise of informal caregivers, the study provided insight as to how males and females perceive caregiver burden and how each gender responds to caregiver burden. This exploratory study utilized a quantitative research design through the use of questionnaires which measured caregiver burden through the use of the Zarit Burden Interview. A total of 38 participants were recruited through support groups at the Inland Caregiver Resource Center. Though findings did not suggest a gender difference in caregiver burden, they did indicate that there was a relationship between ethnicity and gender in relation to the caregiver and care receiver relationship. Implications for social work practice include assessment for and aid in the development of gender appropriate resources for informal caregivers of Alzheimer’s patients.

Energy poverty is a topic often neglected in the discussion about global climate change. Apocalyptic prophecies about the negative future effects of climate change ignore the suffering of people around the globe whose lives could be drastically improved with access to reliable sources of energy. Though energy poverty from a global perspective is much more serious than energy poverty from a domestic perspective, high home energy bills are a serious cause for concern for many Americans. This research examines the relationship between regulation, the prices of electricity and natural gas, and the household energy burden, which is the ratio of household energy expenditures to household income. Where the household energy burden exceeds six percent of household income, households are at the brink of living with a high household energy burden. High household energy burdens can become a generational poverty trap, so understanding what contributes to a high household energy burden may help decision makers determine how to proceed when shaping energy-related and poverty-related policy.