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The Republic of the Union of Myanmar (Myanmar) has had a long history of military rule where fighting regularly breaks out between the government and ethnic armed groups. Virtually from the time of independence, there have been armed conflicts between State armed forces and various ethnic armed groups, with serious humanitarian consequences. Unlike the other armed conflicts in the Asia-Pacific region, such as in Indonesia, the Philippines and Thailand, the long-running ethnic armed conflicts in Myanmar have drawn only occasional attention from the international community. The situation in Rakhine State is an example. It was only in 2017, after decades of repression, abuse and outright criminality leading to a humanitarian catastrophe, that the situation of the Rohingya captured the world’s attention.
A 16-year-old boy with learning disability presented with nocturnal pharmaco-resistant focal seizures consisting of right arm/axilla pain, sometimes followed by tonic-clonic movements of right arm/leg since 8 years of age. He was on valproate and levetiracetam and had failed multiple drugs in the past. Family history and examination were unremarkable.
Background: Continuous electroencephalographic (cEEG) monitoring is essential to diagnosing non-convulsive seizures (NCS), reported to occur in 7-46% of at-risk critically ill patients. However, cEEG is labour-intensive, and given scarcity of resources at most centres cEEG is feasible in only selected patients. We aim to evaluate the clinical utility of cEEG at our centre in order to optimize further cEEG allocation among critically ill patients. Methods: Using a clinical database, we identified critically ill children who underwent cEEG monitoring in 2016, 2017 and 2018. We abstracted underlying diagnoses, indication for cEEG monitoring, cEEG findings, and associated changes in management. Results: Over this three year period, 928 cEEGs were performed. Among the 100 studies analyzed to date, primary indications for monitoring were characterization of events of unclear etiology (32%), diagnosis of NCS (30%), and monitoring of therapy for seizures (17%). Seizures were captured in 31% of patients (22% subclinical only, 5% electroclinical only, 4% both), which resulted in a treatment change in 90% of cases. Non-epileptic events were captured in 26% of patients. Conclusions: cEEG yielded clinically meaningful information in 57% of cases, frequently resulting in management changes. Subgroup analyses by cEEG indication and ICU location will be presented.
In April 2017, some of the health impacts of the 2011 Great East Japan Earthquake, tsunamis, and resultant Fukushima Daiichi nuclear power plant disaster (Okuma, Fukushima Prefecture, Japan) were presented at the 19th Congress of the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) in Toronto, Canada. A panel discussion was then opened by asking audience members about their experiences in their own countries, and how they would suggest taking steps to reach the goals of the Sendai Framework for Disaster Risk Reduction 2015-2030. This paper summarizes the presentation and panel discussion, with a particular focus on the common problems identified in understanding and reducing health risks from disasters in multiple countries, such as the ethical and practical difficulties in decision making on evacuating vulnerable populations that arose similarly during the Fukushima nuclear disaster in 2011 and Hurricane Ike’s approach to Galveston (Texas USA) in 2008. This paper also highlights the need for greater integration of research, for example through increased review and collation of evidence from different disaster settings to identify common problems and possible solutions, which was identified in this panel session as a precursor to fulfilling the goals of the Sendai Framework.
Leppold C, Ochi S, Nomura S, Murray V. The Great East Japan Earthquake, tsunamis, and Fukushima Daiichi nuclear power plant disaster: lessons for evidence integration from a WADEM 2017 presentation and panel discussion. Prehosp Disaster Med. 2018;33(4):424–427
Diel vertical migration of the cutlassfish Trichiurus japonicus larvae were investigated by consecutive 24-h collections at 3-h intervals at a station in the central Seto Inland Sea, Japan in June and September. Only one larva was collected in June 2017, while 224 and 40 larvae were collected in September 2016 and 2017, respectively. Larvae were present only at depths of ≥ 11 m during the day, whereas they were present at depths of 1, 6, 11 and 16 m during the night. Migration was observed in larvae in which swim bladder formation was completed. A similar pattern, namely nocturnal occurrence at shallow depths only of the developed larvae, was observed in another 24-h survey, suggesting that the swim bladder regulates the upward movement of larvae at night.
Local health facilities play a critical role in mitigating the deterioration of health after catastrophic disasters. However, limited information is available on clinic damage. Therefore, the National Institute of Public Health conducted surveillance on clinic damage after the 2011 Great East Japan Earthquake (GEJE) to identify risk factors.
A cross-sectional study using a paper-based questionnaire was conducted that targeted 728 clinics located in coastal areas in the 3 prefectures most affected by the GEJE.
The risk of building damage was inversely correlated with distance from the coast, whereas the risk of ceasing operations was significantly correlated with building damage and some specialties of clinics, namely, internal medicine and pediatrics.
In mountainous countries like Japan, clinics often need to be built in coastal areas, where the majority of residents live. This surveillance revealed that clinics built in readily accessible locations and that provide care with high needs are more likely to get damaged by tsunamis. As clinics are often the frontline health facilities in disaster settings, local disaster plans need to include plans to reinforce disaster preparedness among clinics. For effective planning and resource allocation, nationwide hazard vulnerability analysis using a global standard will be helpful. (Disaster Med Public Health Preparedness. 2018; 12: 291–295)
Although much attention is now being paid to the health risks associated with nuclear disasters, reliable information is lacking. We retrospectively evaluated the health effects of living in highly contaminated radioactive areas in Japan.
The health evaluation was conducted in Tamano district, Fukushima prefecture, in 2011 and 2012. The surface deposition density of cesium in Tamano was 600 to 1000 kBq/m2 shortly after the Fukushima nuclear accident. Clinical parameters included body mass index, blood pressure, and laboratory examinations for blood cell counts, glucose levels, and lipid profiles. A screening program for internal and external exposure was also implemented.
One hundred fifty-five residents participated in the health evaluation. Significant decreases in average body mass index and blood pressure were observed from 2011 to 2012. Annual internal exposure levels did not exceeded 1 mSv in any participants. The levels of external exposure ranged from 1.3 to 4.3 mSv/y measured in the first test period but decreased to 0.8 to 3.6 mSv/y in the second test period.
These findings suggest that inhabiting nuclear contaminated areas is not always associated with short-term health deterioration and that radiation exposure can be controlled within safety limitations. (Disaster Med Public Health Preparedness. 2016;10:34–37)
Hospital preparedness against disasters is key to achieving disaster mitigation for health. To gain a holistic view of hospitals in Japan, one of the most disaster-prone countries, a nationwide surveillance of hospital preparedness was conducted.
A cross-sectional, paper-based interview was conducted that targeted all of the 8701 registered hospitals in Japan. Preparedness was assessed with regard to local hazards, compliance to building code, and preparation of resources such as electricity, water, communication tools, and transportation tools.
Answers were obtained from 6122 hospitals (response rate: 70.3%), among which 20.5% were public (national or city-run) hospitals and others were private. Eight percent were the hospitals assigned as disaster-base hospitals and the others were non-disaster-base hospitals. Overall compliance to building code, power generators, water tanks, emergency communication tools, and helicopter platforms was 90%, 84%, 95%, 43%, and 22%, respectively.
Major vulnerabilities in logistics in mega-cities and stockpiles required for chronic care emerged from the results of this nationwide surveillance of hospitals in Japan. To conduct further intensive surveillance to meet community health needs, appropriate sampling methods should be established on the basis of this preliminary study. Holistic vulnerability analysis of community hospitals will lead to more robust disaster mitigation at the local level. (Disaster Med Public Health Preparedness. 2015;9:614–618)
Introduction: Evaluating the suitability for surgery in patients with epilepsy requires determining if the epilepsy is focal or generalized. Presurgical workups can indicate focal epilepsy in certain cases of generalized epilepsy (GE). The purpose of this study was to identify distinctive features which characterize patients with primary GE that mimics focal epilepsy. Method: We retrospectively identified 19 children with generalized interictal discharges during scalp video-EEG (SVEEG) and underwent invasive monitoring and/or epilepsy surgery. Two children did not undergo resective surgery due to final diagnosis of primary GE (Group A). Seventeen children underwent a resective surgery (Group B). Scalp video-EEG, MEG, MRI, and intracranial video EEG (IVEEG) were reviewed. Results: On (SVEEG), the frequency of generalized spike-and-waves (GSW) was 3Hz in Group A and 1.5-2.5Hz in Group B. Group A had only absence seizures , whereas 80% in Group B had multiple types of seizures. Both groups had lateralized MEG dipoles. One patient in Group A had a focal MRI abnormality. In Group A, IVEEG showed GSW of 3 Hz frequency with inconsistent leading. In Group B, IVEEG showed consistent localization of ictal and interictal high frequency oscillations. Conclusion: Children with generalized 3 Hz spike-and-waves and only absence seizures may be a contraindication of resective surgery even though some presurgical workup shows focality.
When disasters that affect a wide area occur, external medical relief teams play a critical role in the affected areas by helping to alleviate the burden caused by surging numbers of individuals requiring health care. Despite this, no system has been established for managing deployed medical relief teams during the subacute phase following a disaster.
After the Great East Japan Earthquake and tsunami, the Ishinomaki Medical Zone was the most severely-affected area. Approximately 6,000 people died or were missing, and the immediate evacuation of approximately 120,000 people to roughly 320 shelters was required. As many as 59 medical teams came to participate in relief activities. Daily coordination of activities and deployment locations became a significant burden to headquarters. The Area-based/Line-linking Support System (Area-Line System) was thus devised to resolve these issues for medical relief and coordinating activities.
A retrospective analysis was performed to examine the effectiveness of the medical relief provided to evacuees using the Area-Line System with regards to the activities of the medical relief teams and the coordinating headquarters. The following were compared before and after establishment of the Area-Line System: (1) time required at the coordinating headquarters to collect and tabulate medical records from shelters visited; (2) time required at headquarters to determine deployment locations and activities of all medical relief teams; and (3) inter-area variation in number of patients per team.
The time required to collect and tabulate medical records was reduced from approximately 300 to 70 minutes/day. The number of teams at headquarters required to sort through data was reduced from 60 to 14. The time required to determine deployment locations and activities of the medical relief teams was reduced from approximately 150 hours/month to approximately 40 hours/month. Immediately prior to establishment of the Area-Line System, the variation of the number of patients per team was highest. Variation among regions did not increase after establishment of the system.
This descriptive analysis indicated that implementation of the Area-Line System, a systematic approach for long-term disaster medical relief across a wide area, can increase the efficiency of relief provision to disaster-stricken areas.
YamanouchiS, IshiiT, MorinoK, FurukawaH, HozawaA, OchiS, KushimotoS. Streamlining of Medical Relief to Areas Affected by the Great East Japan Earthquake with the “Area-based/Line-linking Support System”Prehosp Disaster Med. 2014;29(6):1-9.
In catastrophic events, a key to reducing health risks is to maintain functioning of local health facilities. However, little research has been conducted on what types and levels of care are the most likely to be affected by catastrophic events.
The Great East Japan Earthquake Disaster (GEJED) was one of a few “megadisasters” that have occurred in an industrialized society. This research aimed to develop an analytical framework for the holistic understanding of hospital damage due to the disaster.
Hospital damage data in Miyagi Prefecture at the time of the GEJED were collected retrospectively. Due to the low response rate of questionnaire-based surveillance (7.7%), publications of the national and local governments, medical associations, other nonprofit organizations, and home web pages of hospitals were used, as well as literature and news sources. The data included information on building damage, electricity and water supply, and functional status after the earthquake. Geographical data for hospitals, coastline, local boundaries, and the inundated areas, as well as population size and seismic intensity were collected from public databases. Logistic regression was conducted to identify the risk factors for hospitals ceasing inpatient and outpatient services. The impact was displayed on maps to show the geographical distribution of damage.
Data for 143 out of 147 hospitals in Miyagi Prefecture (97%) were obtained. Building damage was significantly associated with closure of both inpatient and outpatient wards. Hospitals offering tertiary care were more resistant to damage than those offering primary care, while those with a higher proportion of psychiatric care beds were more likely to cease functioning, even after controlling for hospital size, seismic intensity, and distance from the coastline.
Implementation of building regulations is vital for all health care facilities, irrespective of function. Additionally, securing electricity and water supplies is vital for hospitals at risk for similar events in the future. Improved data sharing on hospital viability in a future event is essential for disaster preparedness.
OchiS, NakagawaA, LewisJ, HodgsonS, MurrayV. The Great East Japan Earthquake Disaster: Distribution of Hospital Damage in Miyagi Prefecture. Prehosp Disaster Med. 2014;29(3):1-8.
Telecommunication systems are important for sharing information among health institutions to successfully provide medical response following disasters.
The aim of this study was to clarify the problems associated with telecommunication systems in the acute phase of the Great East Japan Earthquake (March 11, 2011).
All 72 of the secondary and tertiary emergency hospitals in Miyagi Prefecture were surveyed to evaluate the telecommunication systems in use during the 2011 Great Japan Earthquake, including satellite mobile phones, multi-channel access (MCA) wireless systems, mobile phones, Personal Handy-phone Systems (PHS), fixed-line phones, and the Internet. Hospitals were asked whether the telecommunication systems functioned correctly during the first four days after the earthquake, and, if not, to identify the cause of the malfunction. Each telecommunication system was considered to function correctly if the hospital staff could communicate at least once in every three calls.
Valid responses were received from 53 hospitals (73.6%). Satellite mobile phones functioned correctly at the highest proportion of the equipped hospitals, 71.4%, even on Day 0. The MCA wireless system functioned correctly at the second highest proportion of the equipped hospitals. The systems functioned correctly at 72.0% on Day 0 and at 64.0% during Day 1 through Day 3. The main cause of malfunction of the MCA wireless systems was damage to the base station or communication lines (66.7%). Ordinary (personal or general communication systems) mobile phones did not function correctly at any hospital until Day 2, and PHS, fixed-line phones, and the Internet did not function correctly at any area hospitals that were severely damaged by the tsunami. Even in mildly damaged areas, these systems functioned correctly at <40% of the hospitals during the first three days. The main causes of malfunction were a lack of electricity (mobile phones, 25.6%; the Internet, 54.8%) and damage to the base stations or communication lines (the Internet, 38.1%; mobile phones, 56.4%).
Results suggest that satellite mobile phones and MCA wireless systems are relatively reliable and ordinary systems are less reliable in the acute period of a major disaster. It is important to distribute reliable disaster communication equipment to hospitals and plan for situations in which hospital telecommunications systems do not function.
KudoD, FurukawaH, NakagawaA, AbeY, WashioT, ArafuneT, SatoD, YamanouchiS, OchiS, TominagaT, KushimotoS. Reliability of Telecommunications Systems Following a Major Disaster: Survey of Secondary and Tertiary Emergency Institutions in Miyagi Prefecture During the Acute Phase of the 2011 Great East Japan Earthquake. Prehosp Disaster Med. 2014;29(1):1-5.
Mo3Ru5MPd (M = Ru, Rh, Pd) as the simulated materials for the undissolved residue in the nuclear fuel reprocessing were prepared by arc melting method. The physical properties and oxidation behavior of the alloys were evaluated from viewpoint of the safety and economy in the reprocessing. The electrical resistivity, ρ, of Mo3Ru5RhPd was shown to be 0.8 μΩm at room temperature. On the other hand, the ρ values of samples without Rh were marked at 0.4 μΩm. The thermal properties of the each sample had the different thermal transfer characteristics. In particular, although the thermal conductivities of Mo3Ru5RhPd and Mo3Ru5Pd2 samples show almost the same value, the lattice thermal conductivities of both samples showed different values. Oxidation behavior was analyzed using the thermogravity(TG) and differential thermal analyses(DTA). The TG curve of each sample by oxidation showed different results. These results indicate that the simulated materials of the alloys without Rh: Mo-Ru-Pd were not appropriate to simulate the thermophysical characteristics of the typical simulated materials with undissolved residue Mo-Ru-Rh-Pd alloys. Therefore, in the spent nuclear fuel reprocessing, the mock test of reprocessing without to use Rh is difficult to carry out.
In preparation for actual repository implementation, designs that could be tailored to specific sites need to be considered. This requires a paradigm shift in design philosophy, moving away from a single reference design towards a flexible and systematic “catalogue” of engineered barrier components and associated repository infrastructure. To support this development, novel methodology for both developing and comparing repository design options for Japanese vitrified high-level radioactive waste (HLW) has been examined. This paper will outline the background of the project and, in particular, some novel approaches examined for facilitating optimisation of practical repository designs. It is complemented by a companion paper - Matsumoto et al: Application of Formal Knowledge Engineering Approaches to Develop A Design Catalogue for A Japanese HLW Repository -, which describes the repository design process in more detail and illustrates results of first dry runs of the methodology.
The volunteer siting of disposal facilities for vitrified high-level radioactive waste (HLW) and TRU waste in Japan results in a particular need for flexibility to allow repositories to be tailored to specific sites. Instead of a single reference concept, a “catalogue” of designs for individual repository components is being developed, which can then be combined to form optimum solutions for particular site boundary conditions. As highlighted in a companion paper – Makino et al: Supporting Development of Practical Designs for a Japanese HLW Repository –, which puts the repository design process in the context of the Japanese HLW programme, the complexity of this work justifies use of advanced Knowledge Engineering approaches. In this paper three components are described – development of the knowledge base, assessing tacit system understanding and production of innovative solutions to resolve conflicts between requirements.
We investigated language representation in nine children (six male,
three female; 5.6–17.7 years of age) who underwent surgical
treatment of medically intractable epilepsy of the left hemisphere.
Although interhemispheric reorganization has been previously
documented in similar groups, this is the first study to systematically
evaluate possible intrahemispheric effects of early insult. All
cases had left hemisphere seizure foci and underwent extraoperative
stimulation mapping (ESM) for language localization prior to receiving
cortical resections. To compare ESM findings across subjects and to assess
intrahemispheric reorganization, we developed a novel
coregistration technique whereby independent raters plotted
two-dimensional (2D) ESM findings in 3D standard space. Expressive
language sites identified with ESM were compared with a structural
probability map of pars opercularis, or Broca's area. The
average difference between independent raters' estimates of 28
language sites was 3.9 mm (SD = 2.0), indicating excellent agreement; the
coregistration procedure permitted assessment of 2D ESM findings in 3D
standard space. We observed language sites in regions substantially
anterior and superior to canonical Broca's area, possibly reflecting
intrahemispheric reorganization. Findings suggest that left hemisphere
insult in young children may result in anterior displacement of language
within the frontal cortex. (JINS, 2007, 13,
505–516.)This study was drawn from a
thesis submitted by D.S.K. in partial fulfillment of requirements of the
MA degree through the Graduate Program in Psychology and the Collaborative
Program in Neuroscience at the University of Toronto (Ontario,
Effects of loading rate and temperature on tensile behavior have been studied in air using two kinds of orthogonal three-dimensional woven Si–Ti–C–O fiber-reinforced Si–Ti–C–O matrix composites, processed by polymer infiltration and pyrolysis (PIP) and chemical vapor infiltration (CVI). Since the interphase and porosity of the two composites are controlled in as similar a manner as possible, the effect of matrix processing method is understood. The strength of the PIP composite is greater than that of the CVI composite at room temperature, but they are almost the same at high temperatures. It was found that the PIP composite is more sensitive to loading rate than the CVI composite due to more glassy phases in the PIP composite.
We have reexamined accretion in a protobinary system with two dimensional numerical simulations. We consider protostars which rotate around the center of the mass with circular orbits. The accreting gas is assumed to flow in the orbital plane. It is injected from a circle whose radius is 5 times larger than the orbital separation of the binary. The injected gas has constant surface density, in fall velocity, and specific angular momentum. The accretion depends on the specific angular momentum of the injected gas, jinf. When jinf is small, the binary accretes the gas mainly through two channels: one through the Lagrangian point L2 and the other through L3. When jinf is large, the binary accretes the gas only through the L2 point. The primary accretes more than the secondary in both cases, although the L2 point is closer to the secondary. After flowing through the L2 point, the gas flows half around the secondary and through the L1 point to the primary. Only a small amount of gas flows back to the secondary and the rest forms a circumstellar ring around the primary. The accretion decreases the mass ratio, q = M2/M1, where M1 and M2 denote the masses of the primary and secondary, respectively. The accretion rate increases with time. When jinf is large, it is negligibly small in the first few rotation periods.
Shock pressure generated in aluminum targets due to the interaction
of 0.44 μm (3 ω of iodine laser) laser radiation has been
studied. The laser intensity profile was smoothed using phase zone
plates. Aluminum step targets were irradiated at an intensity
I ≈ 1014 W/cm2. Shock velocity in
the aluminum target was estimated by detecting the shock luminosity
from the target rear using a streak camera to infer the shock pressure.
Experimental results show a good agreement with the theoretical model
based on the delocalized laser absorption approximation. In the present
report, we explicitly discuss the importance of target thickness on the
shock pressure scaling.