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We conducted a preintervention–postintervention study to assess the effectiveness of a multimodal approach to reduce unnecessary urethral catheters in 5 Japanese intensive care units. After the intervention urethral catheter point prevalence decreased by 18%, from 79% preintervention to 61% postintervention, and catheter appropriateness increased by 28%, from 57% preintervention to 85% postintervention.
Pulmonary vein stenosis (PVS) is a condition with challenging treatment and leads to severe cardiac failure and pulmonary hypertension. Despite aggressive surgical or catheter-based intervention, the prognosis of PVS is unsatisfactory. This study aimed to assess the prognosis and to establish appropriate treatment strategies.
We retrospectively reviewed endovascular treatments for PVS (2001–2017) from the clinical database at the Okayama University Hospital.
A total of 24 patients underwent PVS associated with total anomalous pulmonary venous connection and 7 patients underwent isolated congenital PVS. In total, 53 stenotic pulmonary veins were subjected to endovascular treatments; 40 of them were stented by hybrid (29) and percutaneous procedures (11) (bare-metal stent, n = 34; drug-eluting stent, n = 9). Stent size of hybrid stenting was larger than percutaneous stenting. Median follow-up duration from the onset of PVS was 24 months (4–134 months). Survival rate was 71 and 49% at 1 and 5 years, respectively. There was no statistically significant difference between stent placement and survival; however, patients who underwent bare-metal stent implantation had statistically better survival than those who underwent drug-eluting stent implantation or balloon angioplasty. Early onset of stenosis, timing of stenting, and small vessel diameter of pulmonary vein before stenting were considered as risk factors for in-stent restenosis. Freedom from re-intervention was 50 and 26% at 1 and 2 years.
To improve survival and stent patency, implantation of large stent is important. However, re-intervention after stenting is also significant to obtain good outcome.
Recently, the risk of flood disasters due to concentrated heavy rains has been increasing in Japan. While some cases of hospital evacuation have been reported, standards for hospital evacuation have not been established and regional administrative evacuation plans do not include medical facilities.
To clarify the timeline for in-hospital vertical evacuation during a flood disaster.
A timeline was set for vertical evacuation as criteria of the hospital’s emergency response based on the Arakawa River Downstream Timeline, which is an estimate of the time until river flooding based on the water level of the Arakawa River located near the facility. The timeline was calculated backward from 0 hours to when the river floods. A drill was held for verification.
The timeline was based on the water level of the Arakawa River and objective evidence of risky transfer of critical patients; therefore, the decision to evacuate was made when the water level reached a dangerous level (-3 hours). However, this did not provide enough time to evacuate patients in all hospital departments simultaneously, resulting in a shortage of human resources. There was a planned shutdown of the electronic clinical record system at 0 hours to avoid water damage and evacuation of its server, but three hours were not enough to prepare patient clinical summaries.
There is a need for greater and earlier preparation for evacuation to reduce or discharge patients who can leave the hospital when a flood disaster is predicted. Only in-hospital vertical evacuation was considered because it is very risky to transfer critical patients without an evacuation order from government or municipal officials. In fact, over 10,000 patients would need to be evacuated in the region if the Arakawa River floods. Therefore, a regional plan is indispensable for such large scale and simultaneous hospital evacuations.
Due to the heatwave in Japan, the number of patients with heatstroke transported via ambulance hit the highest record according to the Tokyo fire department in 2018. Now, heatwaves are thought to be a natural disaster. Emergency medical professionals located in a Tokyo suburb covering 40,000 individuals experienced a wide range of challenges in patient care with heatstroke.
To assess the impact of the 2018 Japan heatwave on community emergency medical service.
Patients (aged ≥ 16 years) with heatstroke and who were transported to our hospital by ambulance from June to September of 2018 were included. Data were derived from prehospital records and electronic medical records. Weather data was referenced from a Japanese meteorological agency.
The number of all-cause cases was 1,764, and the total number of heatstroke cases was 51 (2.9%). Heatstroke cases were concentrated in July and August of 2018. The rate of males was 69%. The average age was 63 ± 23 years. Physical labor was associated with 31% of cases, such as sports in 7.8%. Hospitalization was required in 24%. ICU admission was required in 9.8%. There was no fetal case directly caused by heatstroke in this survey.
The risk factors of heatstroke considered to be male and elderly. About one-half of heatstroke patients were over 70 years old, and it may have been related to regional characteristics. As mentioned in the Heatstroke STUDY 2012 (Miyake, 2014), most cases which occurred inside residences were found that there was no air conditioner use. There was also an increased number of patients with heatstroke who made emergency visits by themselves. Further investigation is needed annually to estimate the effect of climate change. It is important to make a strong recommendation from public health agency about heatstroke prevention, including air conditioner use during hot weather.
Self-reported outcomes are considered to be useful to understand physical and mental conditions in daily life. Sleep quality is an important factor related to healthy lifestyle and work productivity, as well as to diseases. We examined the relationship of sleep condition with lifestyle and diseases based on self-reported sleep.
A Japanese employee-based health insurance claims database with annual medical check-up data was used. Individuals were questioned about sleep quality as: “Do you get enough rest by sleeping?” during the medical check-up. The prevalence of diseases and medical check-up data were compared between those who answered “Yes” or “No”.
Among 1,310,157 individuals who answered about sleep quality, 540,564 (41.3 percent) answered “No”. The female ratio was around 38 percent for both answers, and the average age was lower for those who answered “No” (45.3) than “Yes” (47.3). Matched individuals for same examination year, sex, and age were 536,218 in each group. Individuals diagnosed with sleep disorder were 8.7 percent of those who answered “No”, representing the highest relative risk (RR=1.64), followed by other anxiety disorders (RR = 1.47), and depressive episode (RR = 1.45), with statistical significance. Other diseases diagnosed in more than 200,000 patients, and which had significantly higher RRs in patients who answered “No”, included vasomotor and allergic rhinitis (RR = 1.09), disorders of refraction and accommodation (RR =1.02), acute upper respiratory infections (RR = 1.11), gastritis and duodenitis (RR = 1.17), and acute bronchitis (RR = 1.13). The RR of other diseases of the liver (RR = 1.13), diabetes (RR = 1.12), hypertension (RR = 1.08), and disorders of lipoprotein metabolism and other lipidaemias (RR = 1.06) were also significantly higher for those who answered “No”.
Sleep quality is suggested to be associated with various chronic diseases as well as mental disorders. Therefore, self-reported outcomes should be a useful tool to understand health-condition, prevent the onset and progression of diseases, and evaluate patient-centered care.
Diabetes causes complications and collateral diseases, reducing quality of life and increasing medical costs. The Japanese government has promoted measures for the prevention of diabetes aggravation. Although glycemic control is reported to prevent the development of complications, assessment of the effects on overall medical cost is insufficient. We examined the medical cost by the analysis of hemoglobin A1c (HbA1c) level.
A Japanese employee-based health insurance claims database with annual medical check-up data was analyzed. Excess medical cost was calculated as the difference between medical cost and standard medical cost (defined as the average medical cost for individuals of same age and sex). Percentage of excess medical cost was calculated by dividing excess medical cost by standard cost, and compared between individuals with or without treatment for diabetes.
Of 4,307,184 individuals with HbA1c data, four percent of them received treatment for diabetes. For treatment of 6.5 percent of HbA1c, excess medical cost increased to 124 percent. The medical cost increased by an additional 20.4 percent (95% CI: 17.1–23.8) when the HbA1c level increased one percent. Treatment for less than six percent of HbA1c caused an increase consistent with the HbA1c level. The relative risk of iron deficiency anemia, unspecified of those with less than six percent of HbA1c against those with seven to eight percent was the highest, 2.15.
An increase of medical cost for individuals with treatment for high HbA1c is likely associated with diabetic complication. The raise for individuals with lower HbA1c level may be related to anemia. Despite the younger age and healthier life of the analyzed individuals, since they were insured by employee-based health insurance who took regular medical check-ups, more expensive medical cost was observed for those having higher HbA1c level.
Mr. Shinjiro Koizumi and some younger members of Japan's National Diet suggested a new policy, “Health Gold License” which would introduce financial incentives to encourage population health management, with people receiving medical checkups receiving a reduction in coinsurance from the current 30 percent to 20 percent. In this research, to evaluate the policy, we adjusted confounding factors of those insured who receive medical checkups (Medical-Checkup Group) and those who do not (Non-Medical-Checkup Group) using claims data, and estimated the effect of medical checkups on medical costs.
We analyzed Japanese employee-based claims data provided by the Japan Medical Data Center Co. Ltd. for the 3 million insured from January 2005 to December 2015. Two regression models were developed. Under model A, explanatory variables were year, age, dummy variables for various hierarchical condition categories and for medical checkups. Under model B, explanatory variables were estimated medical costs per patient per month (PMPM) in 2012 and a dummy variable for medical checkups. We also simulated the financial impact if Japan introduced Health Gold License for all insured.
The coefficients of medical checkups in model A and in model B were -JPY4,816 PMPM and -JPY8,735 PMPM, respectively. The gap of medical costs between the Medical-Checkup Group and Non-Medical-Checkup Group was JPY4,588 PMPM, without any adjustment. If all of those insured received medical checkups, the breakeven coinsurance would be 27.2 percent.
The Medical-Checkup Group is less expensive than Non-Medical-Checkup Group by at least 30%, therefore, the break-even coinsurance for them would be 0 percent. However, because most of those insured have already gone to medical check-ups every year, if the coinsurance were reduced from 30 percent to 20 percent for all insured, the finance would be largely negative. The break-even as 27.2 percent, we believe, would not incentivize the Non-Medical-Checkup Group to receive medical checkups. Therefore, the coinsurance reduction proposed under Health Gold License is not fully justified financially.
Recently, a number of mobile apps to record symptoms and medication by patients themselves have been developed. These apps are expected to improve the patients' symptoms through self-management, and to enable a smooth decision making through effective communication between doctors and patients. “Itami Renrakucho” (Pain Diary, Welby Inc.) is one of these apps that records body pain, medication, physical conditions, and activity in life. We examined the relationship between pain and medication/activity based on its data.
Data between 25 December 2015 and 9 December 2016 were used. Medication and degree of pain (0-10, low < high) were recorded at morning, daytime, evening, and bedtime. Of ninteen activities, up to three were recorded about whether they could or could not do them. We compared the degree of pain among different frequency/timing of medication, or activities that they could or could not do.
Data included 708 individuals. Among 561 individuals who answered about pain, the mean (Standard Deviation, SD) degree was 5.0 (2.3). The mean degree in individuals taking 0, 1, 2, 3, and 4 times medication a day were 4.6, 5.0, 5.4, 5.5, and 6.2, respectively. Regarding medication timing and degree of pain in two consecutive time points (t0, t1), regression towards the mean occurred for individuals without medication in both time points. The degree changed more for individuals taking medicine only at t0, but not for those taking at both time points. Weaker pain was reported when they could do hanging laundry and rising early than when they could not, but they could do shopping, strolling and light exercise even having stronger pain.
We showed a tendency of relationship between pain and medication/activity based on the data from the app. More data and connecting to claims will help us to show characteristics of patients and diseases, select a treatment, and evaluate a medicine.
The Toda equation and its variants are studied in the filed of integrable systems. One particularly generalized time discretisation of the Toda equation is known as the discrete hungry Toda (dhToda) equation, which has two main variants referred to as the dhTodaI equation and dhTodaII equation. The dhToda equations have both been shown to be applicable to the computation of eigenvalues of totally nonnegative (TN) matrices, which are matrices without negative minors. The dhTodaI equation has been investigated with respect to the properties of integrable systems, but the dhTodaII equation has not. Explicit solutions using determinants and matrix representations called Lax pairs are often considered as symbolic properties of discrete integrable systems. In this paper, we clarify the determinant solution and Lax pair of the dhTodaII equation by focusing on an infinite sequence. We show that the resulting determinant solution firmly covers the general solution to the dhTodaII equation, and provide an asymptotic analysis of the general solution as discrete-time variable goes to infinity.
Ice originating near the inland ice divide of the ice sheet can reappear as marginal ice at the surface near the ice terminal in the ablation area. We have analyzed δ18O values and ion concentrations of the Skallen, Skarvsnes and Hamna terminal ice sections, located along the estuary line in the Sôya drainage basin, East Antarctica. The data suggest that the upper part of the Skallen terminal ice section could have originated from inland precipitation on the Shirase drainage basin during marine isotope stage (MIS) 5e, while the upper part of Skarvsnes and Hamna terminal ice sections could have originated from inland precipitation on the Sôya drainage basin. We calculate past elevation maps for the Antarctic ice sheet using the three-dimensional model, SICOPOLIS. This model suggests that the upstream portion of the Sôya drainage basin during the glacial period (MIS 2, 3 or 4) was located to the northeast of its present location. A flow history is proposed wherein ice from the inland Shirase drainage area flowed over the present ice-divide line from the Shirase to the Sôya drainage basin during the glacial period. The ice in the Sôya drainage basin then flowed to the marginal part of the sheet after the ice divide had assumed its present position.
Here we report a doping method based on charge transfer interaction for an easily obtainable carbon material, carbon black (acetylene carbon black and Ketjenblack), as a main raw material. The n-type doping of those carbon blacks, generally p-type material, was conducted with a molecular dopant, triphenylphosphine (tpp). The key was to modify the surface of carbon blacks with silver (Ag) nanoparticles to attach tpp molecules on the surface of Ag. Our method is expected to be used for the fabrication of functional devices (such as thermoelectric devices) from p- and n-type materials.
We have detected [C I] 3P1–3P0 emissions in the gaseous debris disks of 49 Ceti and β Pictoris with the 10 m telescope of the Atacama Submillimeter Telescope Experiment, which is the first detection of such emissions. The line profiles of [C I] are found to resemble those of CO(J=3–2) observed with the same telescope and the Atacama Large Millimeter/submillimeter Array. This result suggests that atomic carbon (C) coexists with CO in the debris disks, and is likely formed by the photodissociation of CO. Assuming an optically thin [C I] emission with the excitation temperature ranging from 30 to 100 K, the column density of C is evaluated to be (2.2 ± 0.2) × 1017 and (2.5 ± 0.7) × 1016 cm−2 for 49 Ceti and β Pictoris, respectively. The C/CO column density ratio is thus derived to be 54 ± 19 and 69 ± 42 for 49 Ceti and β Pictoris, respectively. These ratios are higher than those of molecular clouds and diffuse clouds by an order of magnitude. The unusually high ratios of C to CO are likely attributed to a lack of H2 molecules needed to reproduce CO molecules efficiently from C. This result implies a small number of H2 molecules in the gas disk; i.e., there is an appreciable contribution of secondary gas from dust grains.
The purpose of this study is to investigate the interannual variability of winter snow cover in the northern hemisphere, using the satellite-derived monthly snow cover data (NOAA/NESDIS) from 1967 to 1987. An empirical orthogonal function (EOF) analysis is made to see the typical pattern of snow cover variations during winter. EOF1, which represents about 40% of the total variance, shows concurrent snow cover patterns between Eurasia and North America. EOF2, which represents over 20% of the total variance, shows a negatively correlated pattern between the eastern and western parts of the continent in Eurasia and North America.
We examined time series of mean snow cover for key regions of the northern hemisphere to investigate variations depicted in the EOF patterns in more detail. We selected two key regions which represent continental-scale snow variation. One is the eastern part of Eurasia and the other is the western part of North America. The time series of the two key regions show an apparent one-year lag relationship of heavy snow cover years; winters with extensive snow cover over Eurasia tend to be followed by extensive snow cover over North America during the succeeding winters.
We have fabricated ZnInON (ZION), which is a pseudo-binary alloy of wurtzite ZnO and wurtzite InN and has a tunable band gap over the entire visible spectrum and a high optical absorption coefficient of 105 cm-1. ZION films grow two dimensionally at Ts = room temperature (RT) and 150°C, whereas they grow three dimensionally at Ts = 250 and 450°C. These films at RT and 150°C show a step-terrace structure with the step height of 0.27 nm, which corresponds to the height of a single-atomic-layer step and the half length of the c-lattice parameter of ZION. ZION film has the same a-lattice parameter of 0.325 nm as ZnO and a longer c-lattice parameter of 0.536 nm, indicating the coherent growth of ZION films on ZnO templates. ZION film grown at RT shows blue (2.89 and 3.08 eV) photoluminescence at RT.
ZnO films were fabricated by RF magnetron sputtering with nitrogen mediated crystallization (NMC) under various gas pressures. X-ray diffraction measurements show that the NMC-ZnO films are highly crystalline regardless of the gas pressure, and the full width at half maximum values of the (0002) rocking curves range from 0.032 to 0.044°. In contrast, atomic force microscopy (AFM) reveals that the gas pressure plays an important role in determining the surface morphology of the films. The root-mean-square (RMS) roughness decreases monotonically from 1.05 to 0.60 nm with increasing pressure from 0.2 to 0.7 Pa. However, the RMS roughness increases with further increases in the pressure, reaching 2.15 nm at 2.1 Pa. The height distribution of the NMC-ZnO films derived from the AFM images is narrowest at 0.7 Pa, indicating that the smooth surface obtained at 0.7 Pa can be attributed to spatially uniform nucleation occurring in a short time period. These results indicate that the sputtering gas pressure is a key parameter for controlling the surface morphology of NMC-ZnO films.
Here we report a facile and versatile procedure for the preparation of semiconductor-metal hybrid nanoparticles with an anisotropic structure consisting of bismuth telluride (Bi2Te3) and gold (Au) (or silver (Ag)) nanoparticles. We simply added flake-shaped Bi2Te3 nanoparticles (Bi2Te3 nanoflakes) and trisodium citrate to an aqueous Au or Ag precursor solution heated to boiling. The edge part of the Bi2Te3 nanoflake was preferentially modified with Au or Ag nanoparticles, and the Bi2Te3-Au hybrid nanoparticles had a broad peak of light absorption around the visible region and a higher thermoelectric power factor than ordinary Bi2Te3 nanoflakes. Because of the simplicity of the procedure, the hybrid nanoparticles are expected to be used as a new class of functional materials in the large scale production.
In the previous work, it is reported that the Spin-Seebeck effect (SSE), which refer to the generation of a spin current from a temperature gradient, can be enhanced by Fe interface treatment. Here, we investigated the Fe thickness (dFe) dependency of spin-Seebeck voltage (VSSE) and mixing conductance (gr) in Pt/Fe/Bi:YIG/SGGG system. As a result, magnitude of VSSE had a peak at dFe ≓ 1 ML (monolayer , ≓ 0.3 mm), and also increase of gr was saturated at this point. It suggests that VSSE increase with increasing gr when dFe is smaller than 1.0 ML. For the case in which dFe is larger than 1.0ML, however, VSSE decreases due to a spin current decay in Fe layer with a constant gr. These experimental results are consistent with previous theoretical works.