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Geographical distribution of the incidence of gastric cancer in Bhutan

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World Journal of Gastroenterology 2015年第38期21卷 10883-10889页

作者： Tashi Dendup james m.richter Yoshio Yamaoka Kinley Wangchuk Hoda m malaty Department of Surgery Jigme Dorji Wangchuck National Referral Hospital massachusetts General Hospital Harvard Medical SchoolMGH Gastroenterology AssociatesHarvard University Department of Environmental and Preventive medicine Oita University Faculty of Medicine microbiology Unit Department of Laboratory MedicineJigme Dorji Wangchuck National Referral Hospital Department of medicine Baylor College of Medicine

AIm: To estimate the prevalence of gastric cancer(GC) in a cohort of patients diagnosed with GC and to compare it with patients diagnosed with all other types of gastro-intestinal(GI) cancer during the same ***: Between 2008 and 2013,five-year period,the medical records of all GI cancer patients who underwent medical care and confirm diagnosis of cancer were reviewed at the National Referral Hospital,Thimphu which is the only hospital in the country where surgical and cancer diagnosis can be made. Demographic information,type of cancer,and the year of diagnosis were ***: There were a total of 767 GI related cancer records reviewed during the study period of which 354(46%) patients were diagnosed with GC. There were 413 patients with other GI cancer including; esophagus,colon,liver,rectum,pancreas,gall bladder,cholangiocarcinoma and other GI tract cancers. The GC incidence rate is approximately 0.9/10000 per year(367 cases/5years per 800000 people). The geographic distribution of GC was the lowest in the south region of Bhutan 0.3/10000 per year compared to the central region 1.4/10000 per year,Eastern region 1.2/10000 per year,and the Western region 1.1/10000 per year. moreover,GC in the South part was significantly lower than the other GI cancer in the same region(8% vs 15%; OR = 1.8,95%CI: 1.3-3.1,P = 0.05). Among GC patients,38% were under the age of 60 years,mean age at diagnosis was 62.3(± 12.1) years with male-to-female ratio 1:0.5. The mean age among patients with all other type GI cancer was 60 years(± 13.2) and male-tofemale ratio of 1:0.7. At time of diagnosis of GC,342(93%) were at stage 3 and 4 of and by the year 2013; 80(23%) GC patients died compared to 31% death among patients with the all other GI cancer(P = 0.08).CONCLUSION: The incidence rate of GC in Bhutan is twice as high in the United States but is likely an underestimate rate because of unreported and undiagnosed cases in the villages. The high incidence of GC in Bhuta

关键词： Gastric cancer mortality Epidemiology Bhutan

Assessing the prevalence of young children living in households prepared for COVID-19 in 56 low-and middle-income countries

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Global Health Research and Policy 2022年第1期7卷 389-400页

作者： Chunling Lu Yiqun Luan Sara N.Naicker S.V.Subramanian Jere R.Behrman Jody Heymann Alan Stein Linda m.richter Division of Global Health Equity Brigham&Women’s HospitalBostonMAUSA Department of Global Health&Social medicine Harvard Medical SchoolBostonMAUSA The Heller School for Social Policy and manage-ment Brandeis UniversityWalthamMAUSA DSI-NRF Centre of Excellence in Human Development University of WitwatersrandJohannesburgSouth Africa Harvard Center for Population and Development Studies CambridgeMAUSA Department of Social and Behavioral Sciences Harvard T.H.Chan School of Public HealthBostonMAUSA Center for Geographic Analysis Harvard UniversityCambridgeMAUSA Department of Economics University of PennsylvaniaPhiladelphiaPAUSA WORLD Policy Analysis Center University of CaliforniaLos AngelesLos AngelesCAUSA Department of Psychiatry University of OxfordOxfordUK mRC/Wits Rural Public Health and Health Transitions Research Unit(Agincourt) Faculty of Health SciencesSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa Africa Health Research Institute DurbanKwaZulu-NatalSouth Africa

Background:The COVID-19 pandemic and governments’attempts to contain it are negatively affecting young children’s health and development in ways we are only beginning to understand and *** to the pandemic are driven largely by confining children and families to their *** study aims to assess the levels of and associated socioeconomic disparities in household preparedness for protecting young children under the age of five from being exposed to communicable diseases,such as COVID-19,in low-and middle-income countries(LmICs).methods:Using data from nationally representative household surveys in 56 LmICs since 2016,we estimated the percentages of young children under the age of five living in households prepared for communicable diseases(e.g.,COVID-19)and associated residential and wealth disparities at the country-and *** was defined on the basis of space for quarantine,adequacy of toilet facilities and hand hygiene,mass media exposure at least once a week,and phone *** within countries were measured as the absolute gap in two domains—household wealth and residential area-and compared across regions and country income ***:The final data set included 766,313 children under age *** average,19.4%of young children in the 56 countries lived in households prepared for COVID-19,ranging from 0.6%in Ethiopia in 2016 to 70.9%in Tunisia in *** close to 90%of countries(50),fewer than 50%of young children lived in prepared *** children in rural areas or in the poorest households were less likely to live in prepared households than their ***:A large portion of young children under the age of five in LmICs were living in households that did not meet all preparedness guidelines for preventing COVID-19 and caring for patients at *** study highlights the need to ensure all families in LmICs have the means to prevent the spread of the pandemic or other communicable

关键词： Child Child development Developing Countries Preparedness COVID-19 Pandemics Communicable diseases Quarantine Hand hygiene Toilet facilities mass media Telephone

Hospital readmissions in decompensated cirrhotics: Factors pointing toward a prevention strategy

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World Journal of Gastroenterology 2017年第37期23卷 6868-6876页

作者： Siamak m Seraj Emily J Campbell Sarah K Argyropoulos Kara Wegermann Raymond T Chung james m.richter massachusetts General Hospital Division of Gastroenterology Duke University Hospital Department of Medicine Harvard medical School

AIm To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission *** We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013(n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariateanalyses were performed to describe variables associated with *** One hundred thirty-two patients(59.4%) were readmitted at least once during the study period. median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient *** Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. more initiatives are needed to develop enhanced, longitudinal post-discharge systems.

关键词： Chronic disease Re-hospitalizations Liver disease Readmissions Cirrhosis Chronic care

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PTB高精度紫外线光谱响应率分度

实用测试技术 2002年第1期28卷 46-48,36页

作者： m.richter 李燕中国测试技术研究院成都610021

PTB以低温电替代辐射计为基础 ,建立了波长范围在 2 0 0nm～ 4 0 0nm之间的光电探测器光谱响应率标准。为了获得低不确定度连续波长范围的标准 ,组合使用了存储环BESSYⅠ的色散同步加速器辐射和准单色激光辐射。利用单色同步加速器辐射... 详细信息

PTB以低温电替代辐射计为基础 ,建立了波长范围在 2 0 0nm～ 4 0 0nm之间的光电探测器光谱响应率标准。为了获得低不确定度连续波长范围的标准 ,组合使用了存储环BESSYⅠ的色散同步加速器辐射和准单色激光辐射。利用单色同步加速器辐射和激光辐射的特性 ,在 4 0 0nm～ 2 0 0nm的光谱范围内 ,探测器校准已达到了 1 0 - 3 和 5× 1 0 - 3 之间的相对标准不确定度。

关键词：光电子探测器 PTB 紫外线光谱响应率分度

Toward the Fourth Industrial Revolution on Real-Time Customization

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Journal of Systems Science and Systems Engineering 2020年第2期29卷 127-142页

作者： james m.Tien College of Engineering University of MiamiCoral GablesFlorida 33146USA

The outputs of a national economy can be partitioned into three sets of products:tangible goods(due to manufacturing,construction,extraction and agriculture),intangible services(due to an act of useful effort),and an integration of services and goods or,as initially defined by Tien(2012),***,these products can also be considered in terms of their relation to the first three Industrial Revolutions:the First Industrial Revolution(circa 1800)was primarily focused on the production of goods;the Second Industrial Revolution(circa 1900)was primarily focused on the mass production of goods;and the Third Industrial Revolution(circa 2000)has been primarily focused on the mass customization of goods,services or *** this follow-up paper,the Third Industrial Revolution of mass customization continues to accelerate in its evolution and,in many respects,is subsuming the earlier Industrial Revolutions of production and mass *** importantly,with the advent of real-time decision making,artificial intelligence,Internet of Things,mobile networks,and other advanced digital technologies,customization has been extensively enabled,thereby advancing mass customization into a Fourth Industrial Revolution of real-time ***,the moral,ethical,security and employment problems associated with both mass and real-time customization must be carefully assessed and mitigated,especially in regard to unintended *** ahead and with the advance of artificial general intelligence,this Fourth Industrial Revolution could be forthcoming in about the middle of the 21st Century;it would allow for multiple activities to be simultaneously tackled in real-time and in a customized manner.

关键词： Industrial revolutions big data goods services servgoods connected production mass customization real-time decision making Internet of Things artificial intelligence general

THE NEXT INDUSTRIAL REVOLUTION:INTEGRATED SERVICES AND GOODS

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Journal of Systems Science and Systems Engineering 2012年第3期21卷 257-296页

作者： james m.TIEN College of Engineering University of MiamiCoral GablesFlorida 33146USA

The outputs or products of an economy can be divided into services products ana gooas products （due to manufacturing, construction, agriculture and mining）. To date, the services and goods products have, for the most part, been separately mass produced. However, in contrast to the first and second industrial revolutions which respectively focused on the development and the mass production of goods, the next - or third - industrial revolution is focused on the integration of services and/or goods; it is beginning in this second decade of the 21st Century. The Third Industrial Revolution （TIR） is based on the confluence of three major technological enablers （i.e., big data analytics, adaptive services and digital manufacturing）; they underpin the integration or mass customization of services and/or goods. As detailed in an earlier paper, we regard mass customization as the simultaneous and real-time management of supply and demand chains, based on a taxonomy that can be defined in terms of its underpinning component and management foci. The benefits of real-time mass customization cannot be over-stated as goods and services become indistinguishable and are co-produced - as ＂servgoods＂ - in real-time, resulting in an overwhelming economic advantage to the industrialized countries where the consuming customers are at the same time the co-producing producers.

关键词： Big data decision analytics goods adaptive services digital manufacturing value chain supply chain demand chain mass production mass customization industrial revolution

manufacturing of Long Products made of Innovative Lightweight materials

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Acta metallurgica Sinica(English Letters) 2015年第12期28卷 1496-1502页

作者： Karsten richter Roland müller Andreas Kunke Verena Kr? usel Dirk Landgrebe Fraunhofer Institute for machine Tools and Forming Technology (IWU) Professorship Forming and Joining (UFF) Technische Universit?t Chemnitz

The processing of innovative lightweight materials to sheet metal components and assemblies with globally or locally defined properties is the object of this work. It takes a load-dependent design of components and assemblies, for example, based on the composition of different construction materials or a targeted setting of component areas with specified characteristics to fully exploit the lightweight potential when substituting conventionally used materials. Different process chains for the manufacturing of roll-formed long products made of magnesium alloys and high-strength steels with locally defined properties will be presented in this paper. Depending on the kind of material to be formed and the desired product characteristics, different temperature managements are needed for capable processes. Due to limited formability at room temperature, magnesium alloys require a heating of the forming zones above 200–225 °C throughout the bending process in order to activate additional gliding planes and to avoid any failures in the radii. The realization of local hardening effects requires at least one process-integrated heat treatment when roll forming manganese–boron steels. For both processes, it is imperative to realize a heating and cooling down or quenching appropriate for the manufacturing of long products with the required quality. Additionally, proper line speeds that allow a continuously operated economical production have to be considered. Research results including design, FEA, realization and experimentation of the mentioned process chains and strategies will be described in detail.

关键词： Roll forming Heat treatment Lightweight component Light metals manganese steels AZ31 magnesium alloy

ON INTEGRATION AND ADAPTATION IN COmPLEX SERVICE SYSTEmS

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Journal of Systems Science and Systems Engineering 2008年第4期17卷 385-415页

作者： james m.TIEN College of Engineering University of miami Coral GablesFloridaUSA

The services sector employs a large and growing proportion of workers in the industrialized nations, and it is increasingly dependent on information and communication technologies. While the interdependences, similarities and complementarities of manufacturing and services are significant, there are considerable differences between goods and services, including the shift in focus from mass production to mass customization （whereby a service is produced and delivered in response to a customer＇s stated or imputed needs）. In general, services can be considered to be knowledge-intensive agents or components which work together as providers and consumers to create or co-produce value. Like manufacturing systems, an efficient service system must be an integrated system of systems, leading to greater connectivity and interdependence. Integration must occur over the physical, temporal, organizational and functional dimensions, and must include methods concerned with the component, the management, and the system. moreover, an effective service system must also be an adaptable system, leading to greater value and responsiveness. Adaptation must occur over the dimensions of monitoring, feedback, cybernetics and learning, and must include methods concerned with space, time, and system. In sum, service systems are indeed complex, especially due to the uncertainties associated with the human-centered aspects of such systems. moreover, the system complexities can only be dealt with methods that enhance system integration and adaptation. The paper concludes with several insights, including a plea to shift the current misplaced focus on developing a science or discipline for services to further developing a systems engineering approach to services, an approach based on the integration and adaptation of a host of sciences or disciplines （e.g., physics, mathematics, statistics, psychology, sociology, etc.）. In fact, what is required is a services-related transdisciplinary - beyond a s

关键词： Services service system system components system integration system adaptation system of systems decision informatics real-time decision making

BIG DATA:UNLEASHING INFORmATION

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Journal of Systems Science and Systems Engineering 2013年第2期22卷 127-151页

作者： james m.TIEN College of Engineering University of Miami

At present, it is projected that about 4 zettabytes （or 10^＊＊21 bytes） of digital data are being generated per year by everything from underground physics experiments to retail transactions to security cameras to global positioning systems. In the U. S., major research programs are being funded to deal with big data in all five sectors （i.e., services, manufacturing, construction, agriculture and mining） of the economy. Big Data is a term applied to data sets whose size is beyond the ability of available tools to undertake their acquisition, access, analytics and/or application in a reasonable amount of time. Whereas Tien （2003） forewarned about the data rich, information poor （DRIP） problems that have been pervasive since the advent of large-scale data collections or warehouses, the DRIP conundrum has been somewhat mitigated by the Big Data approach which has unleashed information in a manner that can support informed - yet, not necessarily defensible or valid - decisions or choices. Thus, by somewhat overcoming data quality issues with data quantity, data access restrictions with on-demand cloud computing, causative analysis with correlative data analytics, and model-driven with evidence-driven applications, appropriate actions can be undertaken with the obtained information. New acquisition, access, analytics and application technologies are being developed to further Big Data as it is being employed to help resolve the 14 grand challenges （identified by the National Academy of Engineering in 2008）, underpin the 10 breakthrough technologies （compiled by the massachusetts Institute of Technology in 2013） and support the Third Industrial Revolution of mass customization.

关键词： Big data data acquisition data access data analytics data application decision informatics products processes adaptive services digital manufacturing mass customization third industrial revolution