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Little is known about methylphenidate (MPH) use and mortality outcomes.
To investigate the association between MPH use and mortality among children with an attention-deficit hyperactivity disorder (ADHD) diagnosis.
This population-based cohort study analysed data from Taiwan's National Health Insurance Research Database (NHIRD). A total of 68 096 children and adolescents aged 4–17 years with an ADHD diagnosis and prescribed MPH between 2000 and 2010 were compared with 68 096 without an MPH prescription, matched on age, gender and year of first ADHD diagnosis. All participants were followed to death, migration, withdrawal from the National Health Insurance programme or 31 December 2013. MPH prescriptions were measured on a yearly basis during the study period, and the association between MPH use and mortality was analysed using a repeated-measures time-dependent Cox regression model. The outcome measures included all-cause, unnatural-cause (including suicide, accident and homicide) and natural-cause mortality, obtained from linkage to the National Mortality Register in Taiwan.
The MPH group had lower unadjusted all-cause, natural-, unnatural- and accident-cause mortality than the comparison group. After controlling for potential confounders, MPH use was associated with a significantly lower all-cause mortality (adjusted hazard ratio AHR = 0.81, 95% CI 0.67–0.98, P = 0.027), delayed use of MPH was associated with higher mortality (AHR = 1.05, 95% CI 1.01–1.09) and longer MPH use was associated with lower mortality (AHR = 0.83, 95% CI 0.70–0.98).
MPH use is associated with a reduced overall mortality in children with ADHD in this cohort study, but unmeasured confounding cannot be excluded absolutely.
Attention-deficit/hyperactivity disorder (ADHD) is associated with a higher risk of burn injury than in the normal population. Nevertheless, the influence of methylphenidate (MPH) on the risk of burn injury remains unclear. This retrospective cohort study analysed the effect of MPH on the risk of burn injury in children with ADHD.
Data were from Taiwan's National Health Insurance Research Database (NHIRD). The sample comprised individuals younger than 18 years with a diagnosis of ADHD (n = 90 634) in Taiwan's NHIRD between January 1996 and December 2013. We examined the cumulative effect of MPH on burn injury risk using Cox proportional hazards models. We conducted a sensitivity analysis for immortal time bias using a time-dependent Cox model and within-patient comparisons using the self-controlled case series model.
Children with ADHD taking MPH had a reduced risk of burn injury, with a cumulative duration of treatment dose-related effect, compared with those not taking MPH. Compared with children with ADHD not taking MPH, the adjusted hazard ratio for burn injury was 0.70 in children taking MPH for <90 days (95% confidence interval (CI) 0.64–0.77) and 0.43 in children taking MPH for ≥90 days (95% CI 0.40–0.47), with a 50.8% preventable fraction. The negative association of MPH was replicated in age-stratified analysis using time-dependent Cox regression and self-controlled case series models.
This study showed that MPH treatment was associated with a lower risk of burn injury in a cumulative duration of treatment dose-related effect manner.
The present study assessed the effects of vegetarian and omnivorous diets on HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), TAG and the ratio of HDL-C to total cholesterol (TC) by gender.
HDL-C, LDL-C, TAG and HDL-C:TC were compared among three diet groups (vegan, ovo-lacto vegetarian and omnivorous). Multivariate linear regression analysis was performed to examine factors significantly and independently associated with vegetarian status and to estimate the β value of lipid profiles for the diet groups.
A cross-sectional study. Data were obtained from the Taiwanese Survey on the Prevalence of Hyperglycemia, Hyperlipidemia and Hypertension (TwSHHH).
The study comprised included 3257 men and 3551 women.
After adjusting for confounders, vegan and ovo-lacto vegetarian diets lowered LDL-C levels (β=−10·98, P=0·005 and β=−7·12, P=0·025, respectively) in men compared with omnivorous diet. There was a significant association between HDL-C and vegan diet (β=−6·53, P=0·004). In females, the β values of HDL-C, TAG and HDL-C:TC were −5·72 (P<0·0001), 16·51 (P=0·011) and −0·02 (P=0·012) for vegan diet, and −4·86 (P=0·002), 15·09 (P=0·008) and −0·01 (P=0·026) for ovo-lacto vegetarian diet, when compared with omnivorous diet.
Vegan diet was associated with lower HDL-C concentrations in both males and females. Because the ovo-lacto vegetarian diet was effective in lowering LDL-C, it may be more appropriate for males.
Ink jet technology is applied to the industry application of CPU cooling in this study. The PZT actuated micro-cooling device which generating the micro-scale liquid droplet is used in the CPU cooling of desktop and laptop PCs. It consists the advantages of long lifetime of operation, simple and easily manufactured of the structure with PZT actuator. Since the high latent heat transfer rate, 2260 J/g, of water droplet for the liquid-vapor phase change cooling system, it removes heat from the CPU surface effectively for over 100 W. In order to design an efficient cooling device, it is important to study the PZT material property varies after the laser cutting process and the dimensional effects of PZT actuator on the nozzle plate vibration mode. The frequency and amplitude of the voltage used to energize the PZT transducer are also important parameters that should be properly controlled in order to achieve the optimal liquid breakup conditions. It also reveals the low noise and power consumption in the CPU cooling system with some appropriate operational conditions.
The manipulator with a large degree of
redundancy is useful for realizing multiple tasks such as maneuvering
the robotic arms in the constrained workspace, e.g. the task
of maneuvering the end-effector of the manipulator along a pre-specified
path into a window. This paper presents an on-line technique
based on a posture generation rule to compute a null-space
joint velocity vector in a singularity-robust redundancy resolution method. This
rule suggests that the end of each link has to
track an implicit trajectory that is indirectly resulted from the
constraint imposed on tracking motion of the end-effector. A proper
posture can be determined by sequentially optimizing an objective function
integrating multiple criteria of the orientation of each link from
the end-effector toward the base link as the secondary task
for redundancy resolution, by assuming one end of the link
is clamped. The criteria flexibly incorporate obstacle avoidance, joint limits,
preference of posture in tracking, and connection of posture to
realize a compromise between the primary and secondary tasks. Furthermore,
computational demanding of the posture is reduced due to the
sequential link-by-link computation feature. Simulations show the effectiveness and flexibility
of the proposed method in generating proper postures for the
collision avoidance and the joint limits as a singularity-robust null-space
projection vector in maneuvering redundant robots within constrained workspaces.
This paper addresses the vibratory mechanics associated with frequency discrimination of basilar membrane within the cochlear of the inner ear. Periodic excitation is provided to the oval window, which results in generation of waves within the fluid-filled cochlear traveling towards the apex. These waves interact with the compliant basilar membrane structure causing its vibratory motion. Solution procedure of the fluid/structure model consists of a two-step process. First, a finite element calculation (ANSYS) solves for the membrane vibration with an initial harmonic pressure distribution. Second, a control volume analysis links the resultant vibratory motion with the fluid pressure acting on the basilar membrane, thus a pressure feedback loop is accomplished. Results show that dominant factors affecting vibratory characteristics of the basilar membrane are its structural geometry and attenuation of pressure wave as it travels away from the oval window. Calculations clearly capture the designed function of the basilar membrane, principally its frequency discrimination behavior.
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