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Most of the results available on the inverse problem of determining loads acting on elastic beams or plates under transverse vibration refer to single beam or single plate. In this paper, we consider the determination of sources in multi-span systems obtained by connecting either two Euler–Bernoulli elastic beams or two rectangular Kirchhoff–Love elastic plates. The material of the structure is assumed to be homogeneous and isotropic. The transverse load is of the form g(t)f(x), where g(t) is a known function of time and f(x) is the unknown term depending on the position variable x. Under slight a priori assumptions, we prove a uniqueness result for f(x) in terms of observations of the dynamic response taken at interior points of the structure in an arbitrary small interval of time. A numerical implementation of the method is included to show the possible application of the results in the practical identification of the source term.
The genus Neomonoceratina, which dominated the ostracod assemblage in the uppermost part of the Akasaki Formation (Miroku Group) of the Kyushu Island, Japan, is associated with the benthic foraminifer Ammonia cf. beccarii, mollusca Terebralia? sp. and Anomia sp., and the oogonium of Charophyceae, indicating a marine-to-brackish estuarine environment involving inflowing freshwater. This is the first record of Eocene coastal-estuarine ostracods from the eastern margin of the Eurasian continent and demonstrates that different pre-Neogene coastal-estuarine ostracod assemblages flourished in this region. The assemblages comprised five ostracod species (including one novel species) assigned to the genera Neomonoceratina, Paijeiborchella, Propontocypris and Parakrithella. These species exhibited genus-level links with the Eocene borehole cores along the continental shelf of the East China Sea and other areas of Kyushu. Fossil data of characteristic Eocene coastal-estuarine genera collected worldwide indicate that different characteristic genera inhabited each region. For example, Neomonoceratina originated on the Indian subcontinent by the Early Paleocene period at the latest, along with the northern drift of the Indian subcontinent. These species subsequently diversified west and east with the equatorial current and counter-current via the Tethys and reached the eastern margin of the Eurasian continent among the various eastwards-migrating species, where one genus ultimately adapted to the coastal-estuarine environment. Notably, the coastal-estuarine ostracod assemblage of the eastern margin of the Eurasian continent differs completely from that of the Tethys during the Eocene period. Our results suggest that coastal-estuarine ostracod assemblages are a powerful tool for palaeogeographic reconstruction.
Introduction: Amiodarone may be used for shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), but the effect of prehospital use upon neurological outcomes still unclear. Methods: A prospective province-wide, population based observational study was conducted from January 2006 to March 2016. Adult emergency medical service-treated non-traumatic OHCA patients who received at least one electric defibrillation were included. Amiodarone was administered to patients with VF/ pVT by paramedics based on their clinical assessment, according to provincial guidelines. The outcome of interest was favorable neurological outcomes to hospital discharge, defined as modified Rankin scale of 3 or less. Multivariable logistic regression was performed to compare the proportion of patients with the primary outcome between amiodarone and non-amiodarone groups, further stratified by the number of electrical defibrillation. In addition, to mitigate the potential selection bias, the same logistic regression was conducted in 1:1 propensity score matched groups adjusting for baseline covariates. Results: Of 3,374 overall OHCA patients, 915 (27.1%) were managed with amiodarone. In the amiodarone group, 150 / 915 (16.4 %) patients had a favorable neurological outcome, compared to 455/2,459 (18.5%) in the non-amiodarone group (crude odds ratio [OR] 0.86, 95% CI 0.71 to 1.06). In the multiple logistic regression model, prehospital amiodarone was associated with increased probability of favorable neurological outcomes (adjusted OR 2.11, 95% CI 1.46 to 3.05). With stratification by the number of electrical defibrillation performed, amiodarone treated group showed higher probability of favorable neurological outcomes (1 or 2: adjusted OR 2.71, 95% CI 1.33 to 5.50, 3 and more: adjusted OR 1.67, 95% CI 0.99 to 2.39). Similarly, in 1:1 propensity matched cohort including 882 OHCA patients, the adjusted association persisted (adjusted OR 2.14, 95% CI 1.33 to 3.44). Conclusion: Prehospital administration of amiodarone to non-traumatic OHCA patients was associated with better neurological recovery, especially in those who received fewer electrical defibrillations.
Introduction: Sodium bicarbonate (SB) is still widely used for resuscitation in out-of- hospital cardiac arrest (OHCA) despite limited clinical indications but the effect on neurological recovery is unclear. Methods: From 2006 to 2016, we prospectively conducted a province-wide population-based observational study of adult non-traumatic OHCA patients managed by EMS. According to provincial guidelines, paramedics administered SB to OHCA patients based on their clinical assessment. Outcome of interest was favorable neurological outcome at hospital discharge, defined as CPC of 1 and 2 or modified Rankin scale of 3 or less. We performed multivariable logistic regression, comparing the proportion of outcome between SB and non-SB groups, further stratified by the median of the length of resuscitation. We also applied propensity score matching technique adjusting for baseline characters to the same model to reduce potential selection bias. Results: Of 13,008 OHCA patients, 4,699 (36.1%) were managed with SB. In the SB treated group, 64 / 4,699 (1.3%) patients had favorable neurological outcomes, compared to 823 / 8,309 (9.9%) in the non-SB treated group (crude odds ratio [OR] 0.12, 95% CI 0.09 to 0.16). In logistic regression model, SB was associated with decreased probability of favorable outcomes (adjusted OR 0.63, 95% CI 0.45 to 0.89). Similarly, with stratification by length of resuscitation, the SB group had a lower probability of favorable outcomes (≦24 min: adjusted OR 0.68, 95% CI 0.46 to 1.02, >24 min: adjusted OR 0.47, 95% CI 0.23 to 0.97). In 1:1 propensity matched cohort including 5,126 OHCA patients, the adjusted association also persisted (adjusted OR 0.59, 95% CI 0.39 to 0.89). Conclusion: Prehospital administration of SB to OHCA patients was associated with worse neurological outcomes and the trend persisted even after stratification by resuscitation length.
Introduction: ST-elevation myocardial infarction (STEMI) presenting to the ED is a significant health burden. The provision of IV morphine with doses titrated to provide comfort is recommended in the AHA STEMI Guidelines, yet there is limited evidence of safety in this setting. The primary objective of this study was to measure potential harm associated with the provision of IV morphine in STEMI patients presenting to the ED. Methods: This was a two centre retrospective chart review from an urban, inner city, academic ED with an annual census of 85,000 visits, and an affiliated community hospital with 35,000 annual visits. Consecutive patients from April 2009 to January 2015 presenting to the 2 EDs with a diagnosis of STEMI were identified in the ED database. Eight trained research assistants, blinded to the study hypothesis, used standardized data collection templates. The primary investigator double collected 20% of all data to ensure completeness and accuracy. Results: We included 311 patients with STEMI (124 received morphine [M]; 187 no morphine [nM]). The ages of the two groups were similar (mean 64 yrs [M] & 67 yrs [nM]; median 63 yrs [M] & 66 yrs [nM]; IQR 45-81 [M] and 45.5-86.5 [nM]); as were the proportion of female patients (21.0% [M] & 23.5% [nM]. The pre-STEMI Charlson comorbidity scores (mean 2.6), median time to first ECG (11 min [M] & 16 min [nM]), and mean time-to-needle for PCI (96.8 min [M] & 92.0 min [nM]) were similar between groups. The mean CCU length of stay (LOS) (9.3 days vs 6.3 days) and hospital LOS (7.4 days vs 4.6 days) were longer for patients receiving morphine than those not receiving morphine. Rates of congestive heart failure, acute kidney injury and cardiac arrest in hospital were unchanged between the groups. Unadjusted mortality was similar (10.5% [M] vs 13.3% [nM]) between groups. Binary logistic regression controlling for age, Charlson score, first and peak troponin values demonstrated an association between receiving morphine in the ED and an increased risk of death at 30 days (OR 8.1; 95% CI 7.1.-9.1). Conclusion: The provision of morphine to patients with STEMI in the ED may be associated with increased CCU and hospital LOS. When controlling for age, pre-STEMI Charlson score, first and peak troponin values, receiving morphine was associated with an increased risk of death at 30 days. Further research to elucidate this association is warranted.
Introduction: Sepsis protocols call for the acquisition of blood cultures in septic emergency department (ED) patients.However, the criteria for blood cultures are vague, they are costly, only positive 8-12% of the time, with up to half of these being false positives. The objective of this study was to establish if positive blood cultures could be excluded in low-risk sepsis patients with levels of CRP below 20 ml/L. Methods: This was a multicenter prospective cohort study of 765 ED patients at St Paul’s and Mount St Joseph’s hospitals in Vancouver with sepsis (2 or more SIRS criteria and infection) and none of: immuncompromised, injection drug use, indwelling vascular device or septic shock (SBP<90 mmhg). Consecutive patients with sepsis had CRP and blood cultures obtained at the same time.OUTCOMES. True positive blood cultures, false positive blood cultures, positive blood cultures that changed patient management. True and false positive blood cultures were based on Infectious Disease Society of America Guidelines, and change in management was defined as change in type or length of antibiotic therapy and was blindly adjudicated by a medical microbiologist. Results: 765 ED patients with sepsis met inclusion criteria. Mean age was 48.3 years and 57% were male. Blood cultures were positive in 99/765 (12.9%) subjects, of which 19 were false positive (19.2%). CRP was >20 mg/L in 595/765 (77.8%) of patients. Of 170 subjects with a CRP<20 mg/L, 3 had a positive blood culture (1.8%; 95% CI 0.1%- 5%). Management was not changed in any patient with a positive blood culture and CRP level<20 mg/L. Of 19 subjects with a false positive blood culture, CRP was <20 mg/L for 6 (31.6%). Conclusion: In this cohort of low-risk sepsis patients, based on a CRP of <20 mg/L, acquisition of blood cultures could be safely avoided in 22.2% of patients, at significant savings to the health care system.
Introduction: Survival for victims of out-of-hospital cardiac arrest (OHCA) is typically between 8 and 12%. We sought to report the trends in survival in British Columbia (BC) over a 10-year period. Methods: The BC Resuscitation Outcomes Consortium prospectively collected detailed prehospital and hospital data on consecutive non-traumatic OHCAs from 2006 to 2016 within BC’s four metropolitan areas. We included EMS-treated adult patients without DNR orders. To describe baseline characteristics we organized patient characteristics in three time periods: 2006-09, 2010-13, and 2014-16 (first and last periods reported below). The primary and secondary endpoints were survival at hospital discharge and return of spontaneous circulation (ROSC). We tested the significance of year-by-year trends in baseline characteristics, and performed multivariable Poisson regression, using calendar year as an independent variable, to calculate risk-adjusted rates for survival. Results: Between January 1, 2006 and March 31, 2016 there were a total of 26 433 non-traumatic OHCAs, with 15 145 included in this study. There were significant decreases in the proportion with initial shockable cardiac rhythms (28% to 23%) and bystander witnessed arrests (42% to 39%), however significant increases in the proportion with bystander CPR (40% to 49%) and ALS treatment (86% to 97%), and the median chest compression fraction (0.81 to 0.87). There was a significant increase in the median time until termination of resuscitation in those who did not achieve ROSC (27 to 32 minutes), and a significant decrease in the proportion of patients who were transported in absence of ROSC (17% to 6.5%). There was a significant improvement in achieving ROSC (44% to 48%; adjusted rate ratio per year 1.02, 95% CI 1.01 to 1.02) and survival at hospital discharge (10% to 14%; adjusted rate ratio per year 1.05, 95% CI 1.04 to 1.06). Both subgroups of initial shockable (adjusted rate ratio per year 1.04, 95% CI 1.03 to 1.05) and non-shockable (adjusted rate ratio per year 1.08, 95% CI 1.06 to 1.12) cardiac rhythms demonstrated survival improvement. Conclusion: Despite a significant decrease in those with initial shockable rhythms, out-of-hospital cardiac arrest survival in BC’s metropolitan regions increased by approximately 40% over a 10-year period. During this time there were system changes and quality of care improvements as provided by bystanders and professionals.
The radiocarbon dating laboratory has been in operation since 1984 at the Radiation Center of Osaka Prefecture (OR), predecessor of the Research Center of Radioisotopes, University of Osaka Prefecture. We use liquid scintillation counting (LSC), following sample conversion to methanol through combustion and LiAlH4 reduction. This method was developed by Yamada et al. (Yamada, Higashimura and Shidei 1966; Yamada and Kobashigawa 1986). In cooperation with Yamada, we somewhat modified their procedure: 1) sample charcoal is burned at 700° in the presence of CuO needles and Sulfix grains to remove sulfur and halogen compounds produced during the combustion; 2) the combustion is carried out by using N2-O2 mixed gas of minimized O2 content and stopped when a small amount of the charcoal still remains unchanged, because precise investigation of methanol preparation revealed that O2 gas stimulates byproduct formation during LiAlH4 reduction (Shibata et al. 1985; Shibata et al. 1993). Usually, methanol is prepared directly from sample charcoal in a reaction apparatus (“direct method”). When the sample quantity is insufficient, generated CO2 is isolated as CaCO3 and diluted with inactive commercial CaCO3 if necessary (< 40 g of CaCO3 yield). Then CaCO3 is hydrolyzed with HCl to CO2 for methanol preparation in the usual way (“separate method”). We use standard oxalic acid SRM 4990C (HOxII) for determination of modern 14C (Stuiver 1983). The acid is oxidized to CO2 using the wet method of Valastro, Land and Valera (1977) followed by methanol preparation in the same manner as for unknown samples.
It is widely received that resistive switching in electrode (EL)/metal oxide (MO)/EL cell is caused by formation and rupture of a conductive filament (CF) consisting of oxygen vacancies, VO’s. However, driving forces that migrate VO’s are not elucidated yet. Considering an experimental fact that good data endurance more than 106 cycles is often observed, an isotropic driving force that gathers oxygen vacancies and form a CF for set switching is required instead of an electric field drift that is widely received as the driving force of set switching.
In this paper, we reexamined driving forces and succeeded in reproducing pulse response data for wide rise time, trise, range by simulating VO migration assuming Fick and Soret diffusion, without including the electric-field drift. Therefore, it was suggested that controlling T distribution considering the waveforms of write/erase pulses and the thermodynamic parameters of ELs as well as MO is crucial for the optimization of switching speed of ReRAM.
The probiotic Lactobacillus gasseri SBT2055 (LG2055) has anti-obesity effects. Obesity is closely correlated with inflammation in adipose tissue, and maintaining adipose tissue in a less-inflamed state requires intestinal integrity or a barrier function to protect the intestine from the disruption that can be caused by a high-fat diet (HFD). Here, we examined the anti-inflammatory and intestinal barrier-protecting effects of LG2055 in C57BL/6 mice fed a normal-fat diet (NFD), HFD, or the HFD containing LG2055 (HFD-LG) for 21 weeks. HFD-LG intake significantly prevented HFD-induced increases in body weight, visceral fat mass, and the ratio of inflammatory-type macrophages to anti-inflammatory ones in adipose tissue. Mice fed the HFD showed higher intestinal permeability to a fluorescent dextran administered by oral administration and an elevated concentration of antibodies specific to lipopolysaccharides (LPS) in the blood compared with those fed the NFD, suggesting an increased penetration of the gut contents into the systemic circulation. These elevations of intestinal permeability and anti-LPS antibody levels were significantly suppressed in mice fed the HFD-LG. Moreover, treatment with LG2055 cells suppressed an increase in the cytokine-induced permeability of Caco-2 cell monolayers. These results suggest that LG2055 improves the intestinal integrity, reducing the entry of inflammatory substances like LPS from the intestine, which may lead to decreased inflammation in adipose tissue.
Introduction: Emergency medical services (EMS) have the opportunity to treat allergic reactions anaphylactic reactions rapidly. However, the rate of recognition and treatment is unknown. Methods: This was a retrospective cohort study conducted at two urban emergency departments from 2007 to 2012 including adult patients with allergy and anaphylaxis, both of which were predefined by explicit criteria. The patients of interest were those attended by EMS and transported to hospital. The primary outcome was the proportion of patients who met anaphylaxis criteria in the prehospital setting, but who did not have epinephrine administered. The secondary outcome was the proportion of patients who did not meet anaphylaxis criteria, yet had epinephrine administered. Results: Of 2819 overall patients, 491 (17.4%) arrived by EMS. The median age was 38 (IQR 27 to 49) and 60.9% were female. For the 151 (30.8%) patients with anaphylaxis, 55 received ephinephrine, (36.4%, 95% CI 27.4 to 47.4%). For the 340 (69.2%) patients without anaphylaxis, 28 received ephinephrine (8.2%, 95% CI 5.5 to 11.9%). Conclusion: For patients with anaphylaxis and allergic reactions who are managed by EMS, there may be a mismatch between illness severity and treatment.
Introduction: H1-antihistamines are often used to treat allergic reactions, however, the influence of H1-antihistamines on progression to anaphylaxis remains unclear. Among patients initially presenting with allergic reactions, we investigated whether H1-antihistamines were associated with a lower proportion of patients progressing to anaphylaxis during observation. Methods: This was a retrospective cohort study conducted at two urban EDs from 2007 to 2012. We included adult patients with allergy and excluded those who met criteria of anaphylaxis at first evaluation by medical professionals and/or received antihistamines before the evaluation. Primary outcomes of interest were the number of patients who developed anaphylaxis during observation at ED and/or transportation by EMS. Secondary outcomes were the number of biphasic reactions and severe anaphylaxis (defined as sBP<90; SpO2<92%; and/or confusion, collapse, loss of conscious, or incontinence). Logistic regression was performed comparing primary and secondary outcomes between H1-antihistamine treated and non-treated groups with propensity score adjustment of the baseline covariates. Number needed to treat (NNT) was calculated by adjusted absolute risk reduction of H1-antihistamine compared to non H1-antihistamine use on primary outcome. Results: This study included 1717 patients with allergic reactions, of whom 1228 were treated with H1-antihistamines. In the H1-antihistamine group 1.0% and 0.2% developed anaphylaxis and severe anaphylaxis, respectively; in the non-H1-antihistamine group 2.6% and 0.6% developed anaphylaxis and severe anaphylaxis, respectively. There were no biphasic reactions (0%, 95% confidence interval [CI] 0 to 0.17%). Administration of H1-antihistamines was associated with a lower incidence of subsequent anaphylaxis (adjusted odds ratio [OR] 0.23, 95% CI 0.10 to 0.53; NNT to benefit 49.1, 95% CI 41.6 to 83.3). There were no significant associations between H1-histamines administration and secondary outcomes. Conclusion: Among ED patient with allergic reactions, H1-antihistamine administration was associated with a lower likelihood of progression to anaphylaxis. These findings suggest that H1-antihistamines should be administered early in the care of patients with allergic reactions.
In the SELenological and ENgineering Explorer (SELENE) project which is the Japanese lunar program to be launched in 2003 by the Institute of Space and Astronautical Science (ISAS) and National Space Development Agency of Japan (NASDA), we measure angular distance between a radio transmitter on a relay satellite, that on the Moon and quasars by differential VLBI and determine amplitudes of the physical librations, gravitational harmonic coefficients of the Moon and lunar ephemeris with an accuracy one or two orders higher than before in cooperation with 4-way Doppler measurements and two-way Doppler and ranging measurements using the lunar orbiter and the relay satellite. We are proposing another selenodetic mission, In situ Lunar Orientation Measurement (ILOM) to study lunar rotational dynamics by direct observations of the lunar physical libration from the lunar surface with an accuracy of 1 milliarcsecond in a post-SELENE project which will be launched about three years after SELENE. Year-long trajectories of the stars provide information on various components of the physical librations and we will also try to detect the lunar free librations in order to investigate the lunar mantle and the liquid core.
In the 2000s, radiocarbon in dissolved inorganic carbon was measured during 7 revisit cruises along the lines of the World Ocean Circulation Experiment in the Pacific Ocean. Comparison of 14C data along these lines from the 1990s and 2000s revealed decadal changes of 14C concentration in the thermocline, most of which were due to temporal changes in the bomb-produced 14C. Vertical profiles and vertical-integrated inventories of the bomb 14C in the subarctic and equatorial regions did not change appreciably. In the southern subtropical region, 14C decreased in the upper thermocline from the surface to ∼500 m depth. In contrast, 14C increased in the lower thermocline below ∼500 m depth. The opposing directions in 14C change resulted in small temporal changes in the total inventory of bomb 14C. On the other hand, the water-column inventory significantly decreased in the northwestern subtropical region due to the 14C decrease in the upper thermocline. These decadal changes in bomb 14C indicate that the turnover time of thermocline circulation in the northwestern subtropical region is faster than that in the southern subtropical region, and imply an interbasin transport of bomb 14C from the North Pacific to other basins.
The present study aimed to investigate the correlation between mothers’ and children’s vegetable intake and whether children are conscious about their vegetable intake.
Cross-sectional study. Self-administered questionnaires for mothers and children, consisting of items regarding diet history, were distributed to children via homeroom teachers. We created dummy exposure variables for each quartile of mothers’ vegetable intake. Multiple regression analysis was performed with children’s vegetable intake as the outcome variable.
Two public elementary schools in a residential district of Tokyo, Japan.
Study participants were upper-grade children (aged 10–12 years) and their mothers (332 pairs of mothers and children).
The mean vegetable intake in mothers and children was 310 (sd 145) g/d and 276 (sd 105) g/d, respectively. A positive linear relationship was found between mothers’ and children’s vegetable intake even after adjustment for considerable covariates (P<0·001). When stratified by children’s consciousness, the positive linear relationship was more pronounced in children who were conscious of eating all their vegetables (P<0·001 for interaction with children’s consciousness).
Mothers’ vegetable intake was significantly correlated with children’s vegetable intake. However, this correlation was stronger in children who were conscious of eating all their vegetables. Our findings suggest that enhancing mother’s vegetable intake and health consciousness of children are indispensable prerequisites for increasing vegetable intake among children.
Although outbreaks of acute respiratory infection (ARI) at shelters are hypothesized to be associated with shelter crowding, no studies have examined this relationship. We conducted a retrospective study by reviewing medical records of evacuees presenting to one of the 37 clinics at the shelters in Ishinomaki city, Japan, during the 3-week period after the Great Eastern Japan Earthquake and tsunami in 2011. On the basis of a locally weighted scatter-plot smoothing technique, we categorized 37 shelters into crowded (mean space <5·5 m2/per person) and non-crowded (⩾5·5 m2) shelters. Outcomes of interest were the cumulative and daily incidence rate of ARI/10 000 evacuees at each shelter. We found that the crowded shelters had a higher median cumulative incidence rate of ARI [5·4/10 000 person-days, interquartile range (IQR) 0–24·6, P = 0·04] compared to the non-crowded shelters (3·5/10 000 person-days, IQR 0–8·7) using Mann–Whitney U test. Similarly, the crowded shelters had an increased daily incidence rate of ARI of 19·1/10 000 person-days (95% confidence interval 5·9–32·4, P < 0·01) compared to the non-crowded shelters using quasi-least squares method. In sum, shelter crowding was associated with an increased incidence rate of ARI after the natural disaster.
Our aim was to determine if stapes surgery is useful for treating inflammatory ear diseases.
Materials and methods:
Thirteen patients underwent single-stage or staged surgery for stapes fixation due to tympanosclerosis alone or with cholesteatoma. Operative criteria were: no tympanic membrane retraction, perforation or adhesion; middle-ear cavity with aeration >1 year; a fixed stapes. Computed tomography was used to analyse the relation between operative success and pre-operative pneumatisation.
Success rate at six months was 75 per cent. Hearing results were stable with little deterioration and no complications. Patients with poor pneumatisation had good results (with improved air–bone gap) only after staged surgery. Well-aerated ears heard better even with single-stage surgery.
Pre-operative computed tomography and intra-operative findings are necessary to determine the pneumatisation status of tympanic mastoid cavities. If criteria approved, poorly pneumatised patients underwent staged surgery. Stapedectomy achieved good hearing results for inflammatory middle-ear disease with stapes fixation.