Distributed two-time-scale methods over clustered networks

In this paper, we consider consensus problems over a network of nodes, where the network is divided into a number of clusters. We are interested in the case where the communication topology within each cluster is dense as compared to the sparse communication across the clusters. Moreover, each cluster has one leader which can communicate with other leaders in different clusters. The goal of the nodes is to agree at some common value under the presence of communication delays across the clusters. Our main contribution is to propose a novel distributed two-time-scale consensus algorithm, which pertains to the separation in network topology of clustered networks. In particular, one scale is to model the dynamic of the agents in each cluster, which is much faster (due to the dense communication) than the scale describing the slowly aggregated evolution between the clusters (due to the sparse communication). We prove the convergence of the proposed method in the presence of uniform, but possibly arbitrarily large, communication delays between the leaders. In addition, we provided an explicit formula for the convergence rate of such algorithm, which characterizes the impact of delays and the network topology. Our results shows that after a transient time characterized by the topology of each cluster, the convergence of the two-time-scale consensus method only depends on the connectivity of the leaders. Finally, we validate our theoretical results by a number of numerical simulations on different clustered networks

Suicide attempt in a rural area of Vietnam: Incidence, methods used and access to mental health care

OBJECTIVES: The study aims to determine the incidence of suicide attempt, describe the methods used, and assess use of health care services including mental health care after suicide attempt in a rural area of Vietnam. METHODS: All suicide attempters (104) during 2003-2007 were listed, diagnosed and re-evaluated by trained physicians according to the research criteria of the WHO Multicentre Study of Attempted Suicide. All attempters were interviewed by trained medical staff to investigate methods used, socio-demographic characteristics and use of health services. RESULTS: The yearly incidence was 10.2 per 100000 person-years, 10.6 per 100000 in males and 9.8 per 100000 in females. 99% of cases committed suicide attempt by poisoning, 62.6% by pesticides and 36.3% by pharmaceutical drugs. 34.3% reported having been in contact with somatic care and 13.2% had received mental health care. Among those who reported some treatment received, 47.5% had been in contact with official health care services, 8.1% had pharmacy keepers' consultation or were treated by traditional healers and 4% reported self treatment. CONCLUSION: The incidence of suicide attempt was lower in this population compared to other settings. While the majority of attempters use pesticides, many had used psychotropic drugs. Contact with mental health services following the attempt was very limited in this setting. Suicide prevention for this high risk group should focus on reducing access to pesticides and psychotropic drugs. Mental health services should be made more accessible in rural areas

Patterns of care and follow-up care of patients with uveal melanoma in German-speaking countries: a multinational survey of the German Dermatologic Cooperative Oncology Group (DeCOG)

Purpose Uveal melanoma (UM) is an orphan cancer of high unmet medical need. Current patterns of care and surveillance remain unclear as they are situated in an interdisciplinary setting. Methods A questionnaire addressing the patterns of care and surveillance in the management of patients with uveal melanoma was distributed to 70 skin cancer centers in Austria, Germany and Switzerland. Frequency distributions of responses for each item of the questionnaire were calculated. Results 44 of 70 (62.9%) skin cancer centers completed the questionnaire. Thirty-nine hospitals were located in Germany (88.6%), three in Switzerland (6.8%) and two in Austria (4.5%). The majority (68.2%) represented university hospitals. Most patients with metastatic disease were treated in certified skin cancer centers (70.7%, 29/41). Besides, the majority of patients with UM were referred to the respective skin cancer center by ophthalmologists (87.2%, 34/39). Treatment and organization of follow-up of patients varied across the different centers. 35.1% (14/37) of the centers stated to not perform any screening measures. Conclusion Treatment patterns of patients with uveal melanoma in Germany, Austria and Switzerland remain extremely heterogeneous. A guideline for the treatment and surveillance is urgently needed

Population-Based Incidence Rates of First-Ever Stroke in Central Vietnam

Introduction: Stroke incidence data with methodologically acceptable design in Southeast Asia countries is limited. This study aimed to determine incidence of age-, sex- and subtype-specific firstever stroke (FES) in Vietnam. Methods: We conducted a hospital-based retrospective study, targeting all stroke cases hospitalized at a solo-provider hospital in our study site of Nha Trang from January 2009 to December 2011 with International Classification of Diseases, 10th revision (ICD-10) codes I60-69. We calculated positive predictive values (PPVs) of each ICD-10-coded stroke by conducting a detailed case review of 190 randomly selected admissions with ICD-10 codes of I60-I69. These PPVs were then used to estimate annual incident stroke cases from the computerized database. National census data in 2009 was used as a denominator. Results: 2,693 eligible admissions were recorded during the study period. The crude annual incidence rate of total FES was 90.2 per 100,000 population (95% CI 81.1-100.2). The ageadjusted incidence of FES was 115.7 (95% CI 95.9-139.1) when adjusted to the WHO world populations. Importantly, age-adjusted intracerebral hemorrhage was as much as one third of total FES: 36.9 (95% CI 26.1-51.0). Conclusions: We found a considerable proportion of FES in Vietnam to be attributable to intracerebral hemorrhage, which is as high or exceeding levels seen in high-income countries. A high prevalence of improperly treated hypertension in Vietnam may underlie the high prevalence of intracerebral hemorrhagic stroke in this population