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Virtual reality exposure therapy (VRET) is currently being used to treat social anxiety disorder (SAD); however, VRET's magnitude of efficacy, duration of efficacy, and impact on treatment discontinuation are still unclear.
We conducted a meta-analysis of studies that investigated the efficacy of VRET for SAD. The search strategy and analysis method are registered at PROSPERO (#CRD42019121097). Inclusion criteria were: (1) studies that targeted patients with SAD or related phobias; (2) studies where VRET was conducted for at least three sessions; (3) studies that included at least 10 participants. The primary outcome was social anxiety evaluation score change. Hedges' g and its 95% confidence intervals were calculated using random-effect models. The secondary outcome was the risk ratio for treatment discontinuation.
Twenty-two studies (n = 703) met the inclusion criteria and were analyzed. The efficacy of VRET for SAD was significant and continued over a long-term follow-up period: Hedges' g for effect size at post-intervention, −0.86 (−1.04 to −0.68); three months post-intervention, −1.03 (−1.35 to −0.72); 6 months post-intervention, −1.14 (−1.39 to −0.89); and 12 months post-intervention, −0.74 (−1.05 to −0.43). When compared to in vivo exposure, the efficacy of VRET was similar at post-intervention but became inferior at later follow-up points. Participant dropout rates showed no significant difference compared to in vivo exposure.
VRET is an acceptable treatment for SAD patients that has significant, long-lasting efficacy, although it is possible that during long-term follow-up, VRET efficacy lessens as compared to in vivo exposure.
To examine the associations of salt perception with salt intake and blood pressure levels in general populations, we performed a cross-sectional study in two communities where salt intake level is different, Akita and Osaka in Japan. Taste perception (detection for certain taste and recognition for salt taste) was determined using a Na-impregnated test strip for 1024 Akita and 1199 Osaka adults aged 30–74 years. The proportions of detection for 0·1 % salt were 61, 62, 79, and 79 % in Akita men, Osaka men, Akita women and Osaka women, respectively. The corresponding proportions of not recognising of 1·6 % salt taste (>1·6 %) were 34, 30, 16 and 21 %. Detection threshold was higher in Akita than in Osaka for women aged 60–74 years, and recognition threshold was lower in Akita than in Osaka for women aged 30–59 and 60–74 years. The high detection (≥0·4 %) and recognition (>1·6 %) thresholds of salt taste were associated with higher salt intake scores for Akita men aged 30–59 years, whose detection and recognition thresholds tended be positively associated with systolic and diastolic blood pressures (SBP and DBP) after adjustment for potential confounders. Among Akita elderly men, detection threshold tended to be positively associated with SBP and DBP, while among Akita middle-aged women, recognition threshold was associated with SBP. In conclusion, the high thresholds of salt perception were inversely associated with salt intake for Akita middle-aged men and with blood pressure levels for Akita middle-aged and elderly men and middle-aged women.
In 2005, the Medical Treatment and Supervision (MTS) Act was enacted in Japan to hospitalize the criminally insane and to promote a self-supporting lifestyle after deinstitutionalization. As of October 2010, 490 patients remain hospitalized in 23 highly secure forensic hospitals. Most patients are diagnosed with chronic schizophrenia and exhibit symptoms of drug resistance. Battering is the most common criminal act they have committed.
The increased prevalence of the combination of criminal insanity with drug dependence is a common problem in other countries as well. It is a serious problem that diversity in prison medical care has not been achieved.
A characteristic feature of care for criminally insane patients in Japan is that they must live in a residential district where a public health center is located and close to forensic hospitals after deinstitutionalization. Although there may be concerns about social prejudice against psychiatric disorders, this limited area would help support rehabilitation of patients because medical staff can easily know the whereabouts, psychiatric condition and aspects, of daily life for each patient through frequent reports obtained from home-visiting nurses. As a result, patients who have been successfully deinstitutionalized lead a self-supporting lifestyle without treatment interruption or repetition of similar criminal acts.
In this presentation, we will show the current status of forensic care in Japan, analyze its characteristics and problems described above, and make suggestions for the treatment of the criminally insane in countries with a small national land area such as Japan.
Ambulances with physicians, known as Doctor Car, and Tokyo DMAT are the two prehospital care systems responsible for medical team dispatch in the Tokyo area. While there are 25 designated hospitals for DMAT, Doctor Car is only available at four hospitals. Our hospital incorporates both systems. While the prehospital care system must be utilized at the time of disaster, Doctor Car was dispatched 418 times in 2017, and the use of DMAT is less than ten times per year.
To review the past disaster responses of our hospital.
The study reviews three cases where our hospital responded to mass casualty incidents and disasters with either Doctor Car or DMAT. The first case was the treatment of crush syndrome caused by a collapsed parking slope. It took more than 24 hours for the rescue, in which the team treated patients during transport and at the hospital. The second case was our response to a mass stabbing incident committed at a facility for the disabled. In collaboration with the onsite rescue team, we conducted triage, hemostasis, transfusion, etc. The third case was caused by a fire in a building under construction. We provided treatments like triage and tracheal intubation on the spot.
Because paramedics are allowed to conduct only a limited amount of treatments, dispatch of the medical team to the site is effective.
For a medical team to be effective at the dispatched site, the team must be accustomed not only to the specific need of medical care during disasters but also prehospital medical care, which may include the abilities to ensure safety during transport and on-site and adapt to the prehospital environment. Doctor Car is a useful way to realize such abilities.
This paper presents a modified genetic algorithm (GA) using a new crossover operator (ADX) and a novel statistic correlation mutation algorithm (CAM). Both ADX and CAM work with population information to improve existing individuals of the GA and increase the exploration potential via the correlation mutation. Solution-based methods offer better local improvement of already known solutions while lacking at exploring the whole search space; in contrast, evolutionary algorithms provide better global search in exchange of exploitation power. Hybrid methods are widely used for constrained optimization problems due to increased global and local search capabilities. The modified GA improves results of constrained problems by balancing the exploitation and exploration potential of the algorithm. The conducted tests present average performance for various CEC’2015 benchmark problems, while offering better reliability and superior results on path planning problem for redundant manipulator and most of the constrained engineering design problems tested compared with current works in the literature and classic optimization algorithms.
Life history traits, such as clutch size, egg size (weight), developmental periods of eggs, and female body (abdomen) size, were investigated in Japanese species of the genus Elasmostethus Fieber (Hemiptera: Acanthosomatidae): E. amabilis Yamamoto, E. brevis Lindberg, E. humeralis Jakovlev, E. interstinctus (Linnaeus), E. kerzhneri Yamamoto, and E. nubilus (Dallas). With the exception of clutch size, significant differences were observed in the traits among species. No species exhibited maternal care of eggs. These data form a solid basis for future comparative analyses in the family Acanthosomatidae, which contains both subsocial and asocial species.
A significantly lower fractional anisotropy (FA) value has been shown in anterior parts of the corpus callosum in patients with bipolar disorder.
We investigated the association between abnormal corpus callosum integrity and interhemispheric functional connectivity (IFC) in patients with bipolar disorder.
We examined the association between FA values in the corpus callosum (CC-FA) and the IFC between homotopic regions in the anterior cortical structures of bipolar disorder (n=16) and major depressive disorder (n=22) patients with depressed or euthymic states.
We found a positive correlation between the CC-FA and IFC values between homotopic regions of the ventral prefrontal cortex and insula cortex, and significantly lower IFC between these regions in bipolar disorder patients.
The abnormal corpus callosum integrity in bipolar disorder patients is relevant to the IFC between homotopic regions, possibly disturbing the exchange of emotional information between the cerebral hemispheres resulting in emotional dysregulation.
To control an input energy for a load, an impedance control with a gap distance of an electron beam diode was studied using an intense pulsed-power generator. The output current of the pulsed-power generator as a function of the gap distance of electron beam diode was measured. It indicated that the behaviors of the experimentally obtained peak current and the theoretically obtained space-charge limited current were found to decrease with an increase in the gap distance. The input energy for the load was estimated from the output current, which decreased with an increase in the gap distance. It also revealed the space-charge limited current suppresses the input energy for the load with a decade.
The aim of this study was to shed light on damage to water supply facilities and the state of water resource operation at disaster base hospitals in Miyagi Prefecture (Japan) in the wake of the Great East Japan Earthquake (2011), in order to identify issues concerning the operational continuity of hospitals in the event of a disaster.
In addition to interview and written questionnaire surveys to 14 disaster base hospitals in Miyagi Prefecture, a number of key elements relating to the damage done to water supply facilities and the operation of water resources were identified from the chronological record of events following the Great East Japan Earthquake.
Nine of the 14 hospitals experienced cuts to their water supplies, with a median value of three days (range = one to 20 days) for service recovery time. The hospitals that could utilize well water during the time that water supply was interrupted were able to obtain water in quantities similar to their normal volumes. Hospitals that could not use well water during the period of interruption, and hospitals whose water supply facilities were damaged, experienced significant disruption to dialysis, sterilization equipment, meal services, sanitation, and outpatient care services, though the extent of disruption varied considerably among hospitals. None of the hospitals had determined the amount of water used for different purposes during normal service or formulated a plan for allocation of limited water in the event of a disaster.
The present survey showed that it is possible to minimize the disruption and reduction of hospital functions in the event of a disaster by proper maintenance of water supply facilities and by ensuring alternative water resources, such as well water. It is also clear that it is desirable to conclude water supply agreements and formulate strategic water allocation plans in preparation for the eventuality of a long-term interruption to water services.
MatsumuraT, OsakiS, KudoD, FurukawaH, NakagawaA, AbeY, YamanouchiS, EgawaS, TominagaT, KushimotoS. Water Supply Facility Damage and Water Resource Operation at Disaster Base Hospitals in Miyagi Prefecture in the Wake of the Great East Japan Earthquake. Prehosp Disaster Med. 2015;30(2):1-5.
This study aimed to clarify the management of emergency electric power and the operation of radiology diagnostic devices after the Great East Japan Earthquake.
Timing of electricity restoration, actual emergency electric power generation, and whether radiology diagnostic devices were operational and the reason if not were investigated through a questionnaire submitted to all 14 disaster base hospitals in Miyagi Prefecture in February and March 2013.
Commercial electricity supply resumed within 3 days after the earthquake at 13 of 14 hospitals. Actual emergency electric power generation was lower than pre-disaster estimates at most of the hospitals. Only 4 of 11 hospitals were able to generate 60% of the power normally consumed. Under emergency electric power, conventional X-ray and computed tomography (CT) scanners worked in 9 of 14 (64%) and 8 of 14 (57%) hospitals, respectively. The main reason conventional X-ray and CT scanners did not operate was that hospitals had not planned to use these devices under emergency electric power. Only 2 of the 14 hospitals had a pre-disaster plan to allocate emergency electric power, and all devices operated at these 2 hospitals.
Pre-disaster plans to allocate emergency electric power are required for disaster base hospitals to effectively operate radiology diagnostic devices after a disaster. (Disaster Med Public Health Preparedness. 2014;8:548-552)
A survey was conducted to describe the characteristics of patients treated for hypothermia after the Great East Japan Earthquake.
Written questionnaires were distributed to 72 emergency medical hospitals in Miyagi Prefecture. Data were requested regarding inpatients with a temperature less than 36ºC admitted within 72 hours after the earthquake. The availability of functional heating systems and the time required to restore heating after the earthquake were also documented.
A total of 91 inpatients from 13 hospitals were identified. Tsunami victims comprised 73% of the patients with hypothermia. Within 24 hours of the earthquake, 66 patients were admitted. Most patients with a temperature of 32ºC or higher were treated with passive external rewarming with blankets. Discharge without sequelae was reported for 83.3% of patients admitted within 24 hours of the earthquake and 44.0% of those admitted from 24 to 72 hours after the earthquake. Heating systems were restored within 3 days of the earthquake at 43% of the hospitals.
Hypothermia in patients hospitalized within 72 hours of the earthquake was primarily due to cold-water exposure during the tsunami. Many patients were successfully treated in spite of the post-earthquake disruption of regional social infrastructure.(Disaster Med Public Health Preparedness. 2014;0:1-11)
Consumption of seafood contaminated with Vibrio parahaemolyticus causes foodborne infections, which are on the rise owing to increased consumption of raw seafood in Asia, Europe, North America, and other regions. V. parahaemolyticus infections have been common in Japan since the 1960s. Following an epidemic in 1997, the Japanese Ministry of Health, Labour, and Welfare instituted regulations for seafood in 1999, which appear to be reducing V. parahaemolyticus infections. In this review, we describe the scientific findings for these regulations. Analyses of the V. parahaemolyticus serotypes and isolate characteristics in samples from infected patients and contaminated seafood are discussed. In addition, based on the results of a survey, we show that new food safety regulations have led to improvements in food hygiene at many seafood retail shops, food service facilities, and restaurants. This example from Japan could be of immense help to control foodborne infections in other countries.
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.
We previously revealed that Japanese encephalitis virus (JEV) seroprevalence was 4·5% in pigs on Ishigaki Island from 2005 to 2007. However, a partial E gene sequence (151 bp) of the JEV genome (JEV/sw/Ishigaki/1/2005) was detected in one pig. Phylogenetic analysis showed that JEV/sw/Ishigaki/1/2005 belonged to genotype III and to the same lineages isolated in Taiwan from 2006 to 2008. Serum samples were collected from 128 pigs on Ishigaki from 2009 to 2010, 24 wild boars on Ishigaki from 2008 to 2010, and 117 wild boars on Iriomote Island from 2008 to 2010. Four (3·1%) pigs on Ishigaki were positive for JEV antibody, but all wild boars on the island were negative. Fifty-two (44·4%) wild boars on Iriomote were positive for JEV antibody, in contrast to a seroprevalence of 3·7% in 2000 and 2004. JEV on Iriomote and/or in Taiwan might be related to transmission on Ishigaki.
To clarify advance measures for business continuity taken by disaster base hospitals involved in the Great East Japan Earthquake.
The predisaster situation regarding stockpiles was abstracted from a 2010 survey. Timing of electricity and water restoration and sufficiency of supplies to continue operations were investigated through materials from Miyagi Prefecture disaster medicine headquarters (prefectural medical headquarters) and disaster base hospitals (14 hospitals) in Miyagi Prefecture after the East Japan earthquake.
The number of hospitals with less than 1 day of stockpiles in reserve before the disaster was 7 (50%) for electricity supplies, 8 (57.1%) for water, 6 (42.9%) for medical goods, and 6 (42.9%) for food. After the disaster, restoration of electricity and water did not occur until the second day or later at 8 of 13 (61.5%) hospitals, respectively. By the fourth postdisaster day, 14 hospitals had requested supplies from the prefectural medical headquarters: 9 (64.3%) for electricity supplies, 2 (14.3%) for water trucks, 9 (64.3%) for medical goods, and 6 (42.9%) for food.
The lack of supplies needed to continue operations in disaster base hospitals following the disaster clearly indicated that current business continuity plans require revision. (Disaster Med Public Health Preparedness. 2013;0:1-6)
We present new on-sky results for the Subaru Coronagraphic Extreme Adaptive Optics imager (SCExAO) verifying and quantifying the contrast gain enabled by key components: the closed-loop coronagraphic low-order wavefront sensor (CLOWFS) and focal plane wavefront control (“speckle nulling”). SCExAO will soon be coupled with a high-order, Pyramid wavefront sensor which will yield > 90% Strehl ratio and enable 106–107 contrast at small angular separations allowing us to image gas giant planets at solar system scales. Upcoming instruments like VAMPIRES, FIRST, and CHARIS will expand SCExAO's science capabilities.
The crystal structure of Al7O3N5 was characterized by laboratory X-ray powder diffraction (CuKα1). The title compound is trigonal with a space group R3m (centrosymmetric). The hexagonal unit-cell dimensions (Z = 3) are a = 0.305 06(1) nm, c = 5.7216(1) nm, and V = 0.461 11(2) nm3. The initial structural model was derived by the charge-flipping method and refined by the Rietveld method. The final structural model showed the positional disordering of two of the four Al sites. The maximum-entropy method-based pattern fitting method was used to confirm the validity of the split-atom model, in which conventional structure bias caused by assuming intensity partitioning was minimized. The disordered crystal structure was successfully described by overlapping five types of domains with ordered atom arrangements. The distribution of atomic positions in one of the five types of domains can be achieved in the space group R3m. The atom arrangements in the four other domains are non-centrosymmetric with the space group R3m. Two of the four types of domains are related by a pseudo-symmetrical inversion, and the two remaining domains also have each other in the inversion pseudo-symmetry.