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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.
This paper develops an analytical model for the plastic collapse of a statically indeterminate rectangular beam containing a crack. Limit analysis, elastic-plastic fracture mechanics, compliance and J-integral concepts are used to study JIC and dJ/da that influence the crack propagation. The relations among the plastic hinge, applied load, linear displacement, rotational angle and crack growth leads to a better understanding of the problem as a consequence of this study. The conclusions are: (1) Unstable ductile fracture occurs at the crack propagates before plastic collapse or at dJ/da is smaller than the minimum critical value. (2) LBB (leak-before-break) characteristic of the statically indeterminate rectangular beam is valid if the crack propagates before plastic collapse.
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