Body Mass Index–Mortality Relationship in Severe Hypoglycemic Patients With Type 2 Diabetes

AbstractBackgroundHypoglycemia is associated with a higher risk of death. This study analyzed various body mass index (BMI) categories and mortalities of severe hypoglycemic patients with type 2 diabetes mellitus (DM) in a hospital emergency department.MethodsThe study included 566 adults with type 2 diabetes who were admitted to 1 medical center in Taiwan between 2008 and 2009 with a diagnosis of severe hypoglycemia. Mortality data, demographics, clinical characteristics and the Charlson’s Comorbidity Index were obtained from the electronic medical records. Patients were stratified into 4 study groups as determined by the National institute of Health (NiH) and World Health organization classification for BMi, and the demographics were compared using the analysis of variance and χ2 test. Kaplan-Meier’s analysis and the Cox proportional-hazards regression model were used for mortality, and adjusted hazard ratios were adjusted for each BMi category among participants.ResultsAfter controlling for other possible confounding variables, BMI <18.5 kg/m2 was independently associated with low survival rates in the Cox regression analysis of the entire cohort of type 2 DM patients who encountered a hypoglycemic event. Compared to patients with normal BMI, the mortality risk was higher (adjusted hazard ratios = 4.9; 95% confidence interval [CI] = 2.4-9.9) in underweight patients. Infection-related causes of death were observed in 101 cases (69.2%) and were the leading cause of death.ConclusionsAn independent association was observed between BMI less than 18.5 kg/m2 and mortality among type 2 DM patient with severe hypoglycemic episode. Deaths were predominantly infection related

Low-Resolution Tactile Image Recognition for Automated Robotic Assembly Using Kernel PCA-Based Feature Fusion and Multiple Kernel Learning-Based Support Vector Machine

In this paper, we propose a robust tactile sensing image recognition scheme for automatic robotic assembly. First, an image reprocessing procedure is designed to enhance the contrast of the tactile image. In the second layer, geometric features and Fourier descriptors are extracted from the image. Then, kernel principal component analysis (kernel PCA) is applied to transform the features into ones with better discriminating ability, which is the kernel PCA-based feature fusion. The transformed features are fed into the third layer for classification. In this paper, we design a classifier by combining the multiple kernel learning (MKL) algorithm and support vector machine (SVM). We also design and implement a tactile sensing array consisting of 10-by-10 sensing elements. Experimental results, carried out on real tactile images acquired by the designed tactile sensing array, show that the kernel PCA-based feature fusion can significantly improve the discriminating performance of the geometric features and Fourier descriptors. Also, the designed MKL-SVM outperforms the regular SVM in terms of recognition accuracy. The proposed recognition scheme is able to achieve a high recognition rate of over 85% for the classification of 12 commonly used metal parts in industrial applications

Clonal spread of multidrug-resistant Acinetobacter baumannii in eastern Taiwan

Background and PurposeThis study was conducted to investigate the molecular epidemiology and antimicrobial susceptibility of multidrug-resistant (MDR) Acinetobacter baumannii to three types of antibiotics.MethodsOne hundred and thirty-four specimens of MDR A baumannii were collected from three branches (Taipei, Dalin, and Hualien branches) of Buddhist Tzu Chi Hospital, which are located in northern, southern, and eastern Taiwan, during 2007. Genotyping was performed by pulsed-field gel electrophoresis. Antibiotic susceptibilities to colistin, rifampicin, and tigecycline were determined. The synergistic effects of rifampin and colistin were also evaluated.ResultsAntibiotic susceptibility testing showed that 10.4%, 47.8% and 45.5% of the MDR A baumannii isolates are resistant to colistin, rifampicin, and tigecycline, respectively. A majority of the rifampicin-resistant isolates (62.7%) were found in the Haulien branch, whereas 62.2% of tigecycline-resistant isolates were found in the Taipei branch. The combination of colistin and rifampicin had a synergistic effect on all of the isolates. Genotyping by pulsed-field gel electrophoresis identified 17, 23, and 11 pulsotypes in the Taipei, Dalin, and Haulien branches, respectively. Furthermore, 74.5% of isolates in the Haulien branch were identified as one of three pulsotypes. Among 37 rifampicin-resistant and 22 tigecycline-resistant MDR A baumannii isolates found in the Haulien branch, 51.3% (19/37) and 50% (11/22) of the isolates belonged to the same clone, respectively.ConclusionThis study confirms the high prevalence of resistance to rifampicin and tigecycline in MDR A baumannii in the three hospitals that were studied, and the high proportion of identical strains that exist in eastern Taiwan

Taiwan Oscillation Network

The Taiwan Oscillation Network (TON) is a ground-based network to measure solar intensity oscillations to study the internal structure of the Sun. K-line full-disk images of 1000 pixels diameter are taken at a rate of one image per minute. Such data would provide information onp-modes withl as high as 1000. The TON will consist of six identical telescope systems at proper longitudes around the world. Three telescope systems have been installed at Teide Observatory (Tenerife), Huairou Solar Observing Station (near Beijing), and Big Bear Solar Observatory (California). The telescopes at these three sites have been taking data simultaneously since October of 1994. Anl – v diagram derived from 512 images is included to show the quality of the data

Comparison of Skull Motions in Six Degrees of Freedom Between Two Head Supports During Frameless Radiosurgery by CyberKnife

Introduction: Maintaining immobilization to minimize skull motion is important during frameless radiosurgery. This study aimed to compare the intrafractional skull motions between two head supports.Methods: With 6D skull tracking system, 4,075 image records from 45 patients receiving radiosurgery by CyberKnife were obtained. Twenty-three patients used TIMO head supports (CIVCO) (Group A) and twenty-two patients used Silverman head supports (CIVCO) with MoldCare cushions (ALCARE) (Group B). The skull motions in X (superior-inferior), Y (right-left), Z (anterior-posterior) axes, 3D (three-dimensional) vector, Roll, Pitch and Yaw between the two groups were compared and the margins of planning target volume were estimated.Results: The translational motions in Group A were similar in three axes at initial but became different after 10 min, and those in Group B were less prominent in the Y axis. The rotational errors in Group A were most obvious in Yaw, but those in Group B were stationary in three axes. The motions in the X axis, 3D vector, Pitch and Yaw in Group B were significantly smaller than those in Group A; conversely, the motions in the Z axis in Group B were larger. To cover the 95% confidence intervals, margins of 0.77, 0.79, and 0.40 mm in the X, Y, and Z axes, respectively, were needed in Group A, and 0.69, 0.50, and 0.51 mm were needed in Group B.Conclusions: Both head supports could provide good immobilization during the frameless radiosurgery. Silverman head support with MoldCare cushion was better than TIMO head support in the superior-inferior direction, 3D vector, Pitch and Yaw axes, but worse in the anterior-posterior direction

Effect of patient decision aids on choice between sugammadex and neostigmine in surgeries under general anesthesia: a multicenter randomized controlled trial

Background Shared decision making using patient decision aids (PtDAs) was established over a decade ago, but few studies have evaluated its efficacy in Asian countries. We therefore evaluated the application of PtDAs in a decision conflict between two muscle relaxant reversal agents, neostigmine and sugammadex, and sequentially analyzed the regional differences and operating room turnover rates. Methods This multicenter, outcome-assessor-blind, randomized controlled trial included 3,132 surgical patients from two medical centers admitted between March 2020 and August 2020. The patients were randomly divided into the classical and PtDA groups for pre-anesthesia consultations. Their clinicodemographic characteristics were analyzed to identify variables influencing the choice of reversal agent. On the day of the pre-anesthesia consultation, the patients completed the four SURE scale (sure of myself, understand information, risk-benefit ratio, encouragement) screening items. The operating turnover rates were also evaluated using anesthesia records. Results Compared with the classical group, the PtDA group felt more confident about receiving sufficient medical information (P < 0.001), felt better informed about the advantages and disadvantages of the medications (P < 0.001), exhibited a superior understanding of the benefits and risks of their options (P < 0.001), and felt surer about their choice (P < 0.001). Moreover, the PtDA group had a significantly greater tendency to choose sugammadex over neostigmine (P < 0.001). Conclusions PtDA interventions in pre-anesthesia consultations provided surgical patients with clear knowledge and better support. PtDAs should be made available in other medical fields to enhance shared clinical decision-making