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While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.
Methods
Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.
Results
A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3–2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83–7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2–10.5%; RR: 1.56, 95% CI: 1.38–1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2–11.3%; RR: 1.60, 95% CI: 1.42–1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.
Conclusions
Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.
We developed a Handheld Integrating Sphere Snow Grain Sizer (HISSGraS) for field use to measure the specific surface area (SSA) of snow. In addition to snow samples, HISSGraS can directly measure snow surfaces and snow pit walls. The basic measurement principle is the same as that of the IceCube SSA instrument. The retrieval algorithm for SSA from reflectance employs two conversion equations formulated using spherical and nonspherical grain shape models. We observed SSAs using HISSGraS, IceCube and the gas adsorption method in a snowfield in Hokkaido, Japan. Intercomparison of the results confirmed that with HISSGraS direct measurement, SSA profile observations can be completed in just ~1/10 the time required for measurement of snow samples. Our results also suggest that HISSGraS and IceCube have similar accuracy when the same snow samples are measured using the same grain shape model. However, SSAs of near-surface snow layers measured using the three techniques exhibited some biases, possibly due to rapid snow metamorphism or melting during measurement and some technical issues with optical techniques. When excluding SSA data for the surface layer, which metamorphosed remarkably during measurement, IceCube- and HISSGraS-derived SSAs correlated strongly with those obtained by gas adsorption and HISSGraS accuracy is 21–34%.
Background: In healthcare facilities, hand hygiene is important for infection control. The WHO recommends monitoring the consumption of alcohol-based handrub (ABHR) and direct observation of hand hygiene practices to ensure compliance with hand hygiene practices. Monitoring of ABHR is widely used, but direct observation is not widely performed, particularly in small facilities and non–acute-care facilities. We evaluated the effects of direct observation of hand hygiene practices and monitoring of ABHR consumption, with feedback to staff, on ABHR consumption and hand hygiene compliance. Methods: We conducted a prospective intervention study over a 4-year period. Monitoring of ABHR consumption and direct observation of hand hygiene practices, with periodic feedback to staff, was implemented in 17 facilities of varying types: 5 large-scale acute-care facilities, 6 middle-to-small-scale acute-care facilities, and 6 non–acute-care facilities. Statistics for ABHR consumption were calculated before and after the implementation of direct observation of hand hygiene practices, and the change in ABHR consumption was calculated. The paired t test was used to assess the statistical significance of changes. A generalized linear mixed model analysis was performed to assess factors associated with ABHR consumption. Results: The total observation time was 1,225 months (625 months before direct observation, 600 months after direct observation), and the average observation time per facility was 36.0 months (± 27.5). All facilities implemented ABHR consumption monitoring within 1 month of starting the study. However, the mean time required to implement direct observation of hand hygiene practices was 24.7 (±19.1) months. There was a significant increase in ABHR consumption in large and middle-to-small-scale acute-care facilities (P < .0001) after implementing the direct observation. However, there was not a significant increase for ABHR consumption in non–acute-care facilities (P = .14). Multivariable regression analysis showed that the hospital ward type, duration of ABHR consumption monitoring, and duration of direct observation of hand hygiene practices were independently associated with ABHR consumption. Conclusions: ABHR consumption increased in all facilities that implemented direct observation, but the change was not statistically significant in non–acute-care facilities. The generalized linear mixed model analysis showed significant associations between ABHR consumption and hospital ward type and time to monitoring of ABHR consumption and direct observation of hand hygiene practices. Direct observation of hand hygiene practices should be implemented more widely. The effect of intervention intensity should be evaluated in future studies.
This paper describes the design and implementation of a 39 GHz 256-element hybrid active phased array antenna system with 16 individual digital transceivers, and its wireless multi-user, multi-input, multi-output verification. An earlier version of this paper was presented at the 2021 51st European Microwave Conference and was published in its Proceedings [1]. Using the prototype device, a single carrier transmission test assuming a mobile backhaul link and a MU-MIMO transmission test using a zero-forced orthogonal multi-beam based on channel reciprocity assuming an access link was performed. As a result, an EIRP of 43 dBm and a data rate of 5.5 Gbps in 1 GHz bandwidth single carrier 128QAM operation and an estimated total throughput of 2.4 Gbps by 3GPP TS38.214 [2] in 100 MHz bandwidth OFDM 8 MU-MIMO operation were achieved, respectively. As far as the author knows, this is the first demonstration for integrated access and backhaul (IAB) application that uses the 39 GHz band.
Infection countermeasures that consider patient characteristics are needed at psychiatric hospitals.
Method:
Based on the experience of implementing countermeasures against infection by COVID-19, which has become a pandemic disaster over the past few years. This report is on the current situation and issues of infection countermeasures in psychiatric hospitals.
Results:
Reasons for why it is difficult to take COVID-19 countermeasures in psychiatric hospitals included the following: for patient predispositions–it is difficult to promote understanding and practice of infection countermeasures such as proper wearing of masks, hand hygiene enforcement, zoning, etc. For environmental predispositions–it is difficult to ventilate because windows and doors cannot be opened, and it is difficult to isolate infected individuals as there are few private rooms. Countermeasures included the following: recreation should be limited to that which does not involve speaking and having everybody face the same direction, ensuring sufficient space between people during meals, installing ventilation equipment in hospital wards, handle care in private rooms until the hospitalized patient is judged to be not infectious, and conducting zoning and isolation on a hospital ward level. Results showed that although COVID-19 outbreaks occasionally occurred in hospital wards, this did not result in spread throughout the hospital.
Conclusion:
Future challenges include improving the quality of infection countermeasures in hospitals through thoroughly educating hospital personnel who are unaccustomed to taking infection countermeasures.
People with psychiatric disorders are one of the most vulnerable populations in disasters, and the 2011 Great East Japan Earthquake reported higher post-evacuation mortality rates among psychiatric inpatients. A psychiatric hospital evacuated after the nuclear accident was surveyed to gain valuable insights for future disaster preparedness.
Methods:
The authors interviewed two Odaka Akasaka Hospital (a private psychiatric hospital) staff responsible for evacuation due to the nuclear accident.
Results:
At the time of the earthquake, 104 patients had been admitted to the hospital. They were instructed to evacuate on the grounds that they existed within a 20 km radius of Fukushima Daiichi Nuclear Power Station. Although the evacuation process was extraordinarily demanding, the staff acted professionally, and no patient experienced a significant deterioration in health during the evacuation.
Conclusion:
It was reasonable to follow the evacuation order because of the difficulty of obtaining accurate information about radiation exposure and staff availability in high-risk situations. The staff’s knowledgeable and attentive care of the patients was one of the factors that enabled them to successfully carry out this severe evacuation. However, this may be related to the high mortality rate after the evacuation of patients who were separated from such caregivers.
Immiscible and incompressible liquid–liquid flows are considered in a Taylor–Couette geometry and analysed by direct numerical simulations coupled with the volume-of-fluid method and a continuum surface force model. The system Reynolds number $Re \equiv r_i \omega _i d / \nu$ is fixed to $960$, where the single-phase flow is in the steady Taylor vortex regime, whereas the secondary-phase volume fraction $\varphi$ and the system Weber number $We \equiv \rho r_i^2 \omega _i^2 d / \sigma$ are varied to study the interactions between the interface and the Taylor vortices. We show that different Weber numbers lead to two distinctive flow regimes, namely an advection-dominated regime and an interface-dominated regime. When $We$ is high, the interface is easily deformed because of its low surface tension. The flow patterns are then similar to the single-phase flow, and the system is dominated mainly by advection (advection-dominated regime). However, when $We$ is low, the surface tension is so large that stable interfacial structures with sizes comparable to the cylinder gap can exist. The background velocity field is modulated largely by these persistent structures, thus the overall flow dynamics is governed by the interface (interface-dominated regime). The effect of the interface on the global system response is assessed by evaluating the Nusselt number $Nu_{\omega }$ based on the non-dimensional angular velocity transport. It shows non-monotonic trends as functions of the volume fraction $\varphi$ for both low and high $We$. We explain how these dependencies are closely linked to the velocity and interfacial structures.
Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists.
Aims
The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes.
Method
A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme.
Results
All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending.
Conclusions
All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists.
The left-tailed unit-root tests of the panel analysis of nonstationarity in idiosyncratic and common components (PANIC) proposed by Bai and Ng (2004, Econometrica 72, 1127–1177) have standard local asymptotic power. We assess the size and power properties of the right-tailed version of the PANIC tests when the common and/or the idiosyncratic components are moderately explosive. We find that, when an idiosyncratic component is moderately explosive, the tests for the common components may have considerable size distortions, and those for an idiosyncratic component may suffer from the nonmonotonic power problem. We provide an analytic explanation under the moderately local to unity framework developed by Phillips and Magdalinos (2007, Journal of Econometrics 136, 115–130). We then propose a new cross-sectional (CS) approach to disentangle the common and idiosyncratic components in a relatively short explosive window. Our Monte Carlo simulations show that the CS approach is robust to the nonmonotonic power problem.
We explore how tax evasion by firms affects the growth- and welfare-maximizing rates of corporate income tax (CIT) in an endogenous growth model with productive public service. We show that the negative effect of CIT on growth is mitigated in the presence of tax evasion. This increases the benefit of raising the CIT rate for public service provision. Thus, in contrast to Barro [(1990) Journal of Political Economy 98, 103–125], the optimal tax rate is higher than the output elasticity of public service. Through numerical exercises, we demonstrate that the role of tax evasion by firms is quantitatively significant.
Emergency evacuation during disasters may have significant health impacts on vulnerable populations. The Japanese Government issued evacuation orders for surrounding residents of the Fukushima Daiichi nuclear power plant (FDNPP) immediately after the March 11, 2011, nuclear accident. Little is known of difficulties associated with the disaster-specific evacuation from health care facilities located in this area. Among the 338 patients hospitalized at Futaba Hospital, located 4.6 km west of FDNPP, at the time of the accident, 39 patients (11.5%), predominantly critically ill patients who were bedridden or disabled, died before the evacuation was completed. The shortage of hospital staff and disruption of infrastructure resulted in a lack of adequate care provision, such as infusion therapy or sputum suctioning, leading to premature death of some hospitalized patients during the emergency hospital evacuation. As hospital evacuation is sometimes unavoidable during disasters, potential health impacts of hospital evacuation should be recognized and reflected in disaster preparedness plans.
In recent years, the use of both molecular targeting agents (MTAs) and immune-checkpoint inhibitors (ICIs) tend to occupy important positions in systemic anticancer therapy (SACT). The objective of this study is to describe the predictors of SACT include both MTAs and ICIs near the end of life (EOL) and the effect on EOL care in patients with advanced cancer.
Methods
We analyzed all patients who died of advanced cancer from August 2016 to August 2019, and we analyzed the survival time of patients who underwent anticancer agents excluded due to the loss of information about the last administration of SACT. The primary endpoint of this study was to identify predictors during the last administration of SACT near EOL.
Results
In a multivariate analysis, the Eastern Cooperative Oncology Group performance status (ECOG-PS) (ORs 33.781) was significantly related factors within 14 days of death from the last administration of SACT. Age (ORs 0.412), ECOG-PS (ORs 11.533), primary cancer site of upper GI cancers (ORs 2.205), the number of comorbidities (ORs 0.207), MTAs (ORs 3.139), and ICIs (ORs 3.592) were significantly related factors within 30 days of death. The median survival time (MST) of patients with PS 3–4 was 29 days, while that of patients with both PS 0–2 was 76 days. The prevalence rate of delirium with MTAs was 17.5%, which was significantly lower than that of patients without it (31.8%). The prevalence rate of the mean dose of opioids in patients with ICIs was 97.9 mg/day, which was significantly higher than that of patients without it (44.9 mg/day).
Conclusions
Age, ECOG-PS, primary cancer site, the number of comorbidities, MTAs, and ICIs use were significant associated with SACT near EOL. Information on these factors may aid clinical decision making in referral to palliative care institutes.
This essay proposes that “milk kinship,” which upper-class individuals in premodern Japan formed with their milk kin—a menoto (wet nurse) and a menotogo (foster sibling)—occupies the core of an institutionalized erotic fosterage. In this “menoto system,” the surrogate mother's lactating body and erotic-affective labor became the connective tissue to bind two interclass families, creating a symbiosis that fortified the existing sociopolitical power structures. Around the tenth century, many vernacular tales started to feature menoto characters. While a typical menoto is the protagonist's homely, asexual, motherly confidante, her derivative construct—the menotogo of the protagonist—is often cast in an erotic light. In the four texts examined in this essay, menotogo valorize their erotic agencies to benefit their charges through sexual-affective labor or through an indirect method. The latter entails the formation of a “love square” in which two menotogo become lovers and then help their respective charges do the same.
Finite-amplitude hydromagnetic Rossby waves in the magnetostrophic regime are studied. We consider the slow mode, which travels in the opposite direction to the hydrodynamic or fast mode, in the presence of a toroidal magnetic field and zonal flow by means of quasi-geostrophic models for thick spherical shells. The weakly nonlinear long waves are derived asymptotically using a reductive perturbation method. The problem at the first order is found to obey a second-order ordinary differential equation, leading to a hypergeometric equation for a Malkus field and a confluent Heun equation for an electrical wire field, and is non-singular when the wave speed approaches the mean flow. Investigating its neutral non-singular eigensolutions for different basic states, we find the evolution is described by the Korteweg–de Vries equation. This implies that the nonlinear slow wave forms solitons and solitary waves. These may take the form of a coherent eddy, such as a single anticyclone. We speculate on the relation of the anticyclone to the asymmetric gyre seen in the Earth's fluid core, and in state-of-the-art dynamo direct numerical simulations.
The present study aimed to determine whether the number of hospitalizations in schizophrenia patients is associated with reduced cognitive performance, which may in turn imply that recurrences indirectly lead to a worsening in the disorder’s progression.
Methods
Cognitive performance in stable schizophrenia patients was assessed using the Brief Assessment of Cognition in Schizophrenia, Japanese-language version, on 30 patients who had not experienced any hospitalizations (G0), 57 patients who had experienced only one hospitalization (G1), 47 patients with two hospitalizations (G2), and 59 patients with three or more hospitalizations (G3).
Results
Significant differences in motor function and attention and processing speed were found between patients with G0 and those with G1. Significant differences in working memory and verbal fluency were found between patients with G1 and those with G2. Patients with G3 performed even more poorly in comparison with those with G1, showing deficits in verbal memory, working memory, executive function, and composite score. The patients with G3 displayed a greater range of impairment and demonstrated deficits in executive function compared with patients with G2. Finally, G2 and G3 performed more poorly than G0, with deficits in the various cognitive areas.
Conclusion
The number of hospitalizations predicted cognitive performance, which suggests that relapse or recurrence may have a long-term neuropsychological impact. Prospective follow-up studies must be completed to explore this effect further because better treatment adherence may have a protective effect on neurocognitive function.
After Japan’s major nuclear accident in 2011, approximately 150,000 Fukushima residents were ordered to evacuate. Beginning in 2015, the evacuation orders have been systematically lifted. However, the health impacts of allowing residents to return to homes in areas previously uninhabitable due to nuclear radiation remain poorly understood.
Declaring radiation levels to be safe does not necessarily eliminate the concerns of residents about the effects of radiation exposure. Rebuilding medical, welfare, and commercial infrastructure and services takes time. Nontangible community elements, such as mutually dependent social networks, also require time to be re-established. Nevertheless, the Japanese government prioritizes policies that encourage evacuees to return home as soon as it is safe to do so.
Post-disaster evacuation situations and subsequent return home pose substantial—and as yet relatively unknown—mental and physical health threats for those affected, especially those in vulnerable groups, such as the sick, the elderly, and children.
Here we report a case of an elderly female evacuee with dementia, who was prevented from returning home after her hometown evacuation order was lifted, began exhibiting marked behavioral abnormalities. Loss of emotional ties that were created while she was housed in temporary accommodation appeared to be a critical contributing factor.
N-acetylaspartate (NAA) levels and serum brain-derived neurotrophic factor (BDNF) levels in patients with first-episode schizophrenia psychosis and age- and sex-matched healthy control subjects were investigated. In addition, plasma levels of homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) were compared between the two groups.
Method:
Eighteen patients (nine males, nine females; age range: 13–52 years) were enrolled in the study, and 18 volunteers (nine males, nine females; age range: 15–49 years) with no current or past psychiatric history were also studied by magnetic resonance spectroscopy (MRS) as sex- and age-matched controls.
Results:
Levels of NAA/Cr in the left basal ganglia (p = 0.0065) and parieto-occipital lobe (p = 0.00498), but not in the frontal lobe, were significantly lower in patients with first-episode schizophrenia psychosis than in control subjects. No difference was observed between the serum BDNF levels of patients with first-episode schizophrenia psychosis and control subjects. In regard to the plasma levels of catecholamine metabolites, plasma MHPG, but not HVA, was significantly lower in the patients with first-episode psychosis than in control subjects. In addition, a significantly positive correlation was observed between the levels of NAA/Cr of the left basal ganglia and plasma MHPG in all subjects.
Conclusions:
These results suggest that brain NAA levels in the left basal ganglia and plasma MHPG levels were significantly reduced at the first episode of schizophrenia psychosis, indicating that neurodegeneration via noradrenergic neurons might be associated with the initial progression of the disease.