Temporal trend analysis of avoidable mortality in Taiwan, 1971-2008: overall progress, with areas for further medical or public health investment

BACKGROUND: Avoidable mortality (AM), or “unnecessary untimely death,” is considered an indicator of health care quality. We investigated trends in the age-standardized mortality rates (ASMRs) and associated standard expected years of life lost (SEYLL) for deaths amenable to medical care or public health measures in Taiwan from 1971-2008, with an emphasis on identifying areas where additional medical or public health investment may help reduce the burden of AM. METHODS: Taiwan’s ASMRs per 100,000 for AM and other causes of death were calculated using data from the National Death Certificate Registry in five-year bins from 1971 to 2008. SEYLL rates per 100,000 were calculated annually from 1971 to 2008 using the same data source. RESULTS: ASMR for almost all AM and other causes of death declined dramatically from 1971 to 2008 except for lung cancer (16.6% and 7.4% increase among men and women, respectively) and breast cancer (109.8% increase among women). In the same period, SEYLL due to lung cancer increased from 269.2 to 555.7 for men and 249.7 to 342.5 for women. For women, SEYLL due to breast cancer increased from 263.5 in 1971 to 659.3 in 2008. There were gender-specific differences in the reduction (or increase) in AM rates, with women showing larger rates of reduction or smaller rates of increase. Among men, AM fell by 65.9% from 1971-1975 to 2006-2008, and deaths from other causes increased by 15.6%. Among women, AM and deaths from other causes fell by 80.8% and 59.8% respectively. SEYLL decreased, respectively among males and females, from 23,147.3 and 24,081.1 in 1971 to 11,261.8 and 5,929.6 in 2008. CONCLUSION: From 1971 to 2008, Taiwan experienced a dramatic reduction in most AM and corresponding SEYLL except for lung cancer (for both males and females) and breast cancer (for females). Additional effort should be devoted to public health measures to combat the rising prevalence of smoking in Taiwan, which may be responsible for the increasing AM from lung cancer. If AM in breast cancer continues unabated in the future, greater policy emphasis on the early detection and treatment of breast cancer may also be warranted

Impact of Altered Airway Pressure on Intracranial Pressure, Perfusion, and Oxygenation: A Narrative Review.

OBJECTIVES: A narrative review of the pathophysiology linking altered airway pressure and intracranial pressure and cerebral oxygenation. DATA SOURCES: Online search of PubMed and manual review of articles (laboratory and patient studies) of the altered airway pressure on intracranial pressure, cerebral perfusion, or cerebral oxygenation. STUDY SELECTION: Randomized trials, observational and physiologic studies. DATA EXTRACTION: Our group determined by consensus which resources would best inform this review. DATA SYNTHESIS: In the normal brain, positive-pressure ventilation does not significantly alter intracranial pressure, cerebral oxygenation, or perfusion. In injured brains, the impact of airway pressure on intracranial pressure is variable and determined by several factors; a cerebral venous Starling resistor explains much of the variability. Negative-pressure ventilation can improve cerebral perfusion and oxygenation and reduce intracranial pressure in experimental models, but data are limited, and mechanisms and clinical benefit remain uncertain. CONCLUSIONS: The effects of airway pressure and ventilation on cerebral perfusion and oxygenation are increasingly understood, especially in the setting of brain injury. In the face of competing mechanisms and priorities, multimodal monitoring and individualized titration will increasingly be required to optimize care

Characteristic length of random knotting for cylindrical self-avoiding polygons

We discuss the probability of random knotting for a model of self-avoiding polygons whose segments are given by cylinders of unit length with radius $r$. We show numerically that the characteristic length of random knotting is roughly approximated by an exponential function of the chain thickness $r$.Comment: 5 pages, 4 figure

Hybrid fuzzy and sliding-mode control for motorised tether spin-up when coupled with axial vibration

A hybrid fuzzy sliding mode controller is applied to the control of motorised tether spin-up coupled with an axial oscillation phenomenon. A six degree of freedom dynamic model of a motorised momentum exchange tether is used as a basis for interplanetary payload exchange. The tether comprises a symmetrical double payload configuration, with an outrigger counter inertia and massive central facility. It is shown that including axial elasticity permits an enhanced level of performance prediction accuracy and a useful departure from the usual rigid body representations, particularly for accurate payload positioning at strategic points. A special simulation program has been devised in MATLAB and MATHEMATICA for a given initial condition data case

Metastatic seminoma and grade 1 follicular lymphoma presenting concurrently in a supraclavicular lymph node: a case report

An asymptomatic 67-year-old man presented with a left supraclavicular lymph node that enlarged over a 2-month period which was biopsied. Pathologic features were consistent with involvement by metastatic seminoma and follicular lymphoma, follicular pattern, grade 1 (of 3). Staging Positron Emission Tomography/Computed Tomography scans indicated several areas of enlarged lymph nodes. The patient completed chemotherapy with bleomycin, etoposide, and cisplatin chemotherapy. This is the first reported case of metastatic seminoma and follicular lymphoma occurring in the same lymph node. No obvious pathophysiologic link exists between these two malignancies and there are no shared common risk factors. Given the natural history of these two malignancies, if this patient develops recurrent lymphadenopathy, it will be difficult to identify whether the enlarged lymph nodes represent recurrent seminoma or follicular lymphoma without a biopsy of each pathologically enlarged node. Similarly, Fluorodeoxyglucose- Positron Emission Tomography is known to be active in both seminoma and follicular lymphoma, making this scan non-specific in this patient. Finally, this patient had no baseline elevation in any germ cell tumor marker. Thus, serum tumor markers cannot be relied upon as surrogates for response to chemotherapy or as identifiers of relapsed seminoma

Inclined Surface Locomotion Strategies for Spherical Tensegrity Robots

This paper presents a new teleoperated spherical tensegrity robot capable of performing locomotion on steep inclined surfaces. With a novel control scheme centered around the simultaneous actuation of multiple cables, the robot demonstrates robust climbing on inclined surfaces in hardware experiments and speeds significantly faster than previous spherical tensegrity models. This robot is an improvement over other iterations in the TT-series and the first tensegrity to achieve reliable locomotion on inclined surfaces of up to 24\degree. We analyze locomotion in simulation and hardware under single and multi-cable actuation, and introduce two novel multi-cable actuation policies, suited for steep incline climbing and speed, respectively. We propose compelling justifications for the increased dynamic ability of the robot and motivate development of optimization algorithms able to take advantage of the robot's increased control authority.Comment: 6 pages, 11 figures, IROS 201

Electric Field Control of Soliton Motion and Stacking in Trilayer Graphene

The crystal structure of a material plays an important role in determining its electronic properties. Changing from one crystal structure to another involves a phase transition which is usually controlled by a state variable such as temperature or pressure. In the case of trilayer graphene, there are two common stacking configurations (Bernal and rhombohedral) which exhibit very different electronic properties. In graphene flakes with both stacking configurations, the region between them consists of a localized strain soliton where the carbon atoms of one graphene layer shift by the carbon-carbon bond distance. Here we show the ability to move this strain soliton with a perpendicular electric field and hence control the stacking configuration of trilayer graphene with only an external voltage. Moreover, we find that the free energy difference between the two stacking configurations scales quadratically with electric field, and thus rhombohedral stacking is favored as the electric field increases. This ability to control the stacking order in graphene opens the way to novel devices which combine structural and electrical properties