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In recent years, the demand for high performance thermal insulations has increased. While foam and aerogels have been researched for high performance thermal insulation, novel material design is required for further improvement. A porous silica has been found to have the potential to form a new thermal insulation material. However, porous silica is a powder and is difficult to form the porous compact. Therefore, we propose a composite insulation of powdered porous silica (p-SiO2), carbon nanotubes (CNTs) and sodium carboxy methyl cellulose (CMC). The fine voids and bulky structure of p-SiO2 greatly suppress gas and solid heat transfer. The composite of CNT can improve the moldability and enhance the mechanical properties. The moldability of thermal insulating materials improved even with the addition of 1 wt% CNT. With the addition of 1 wt% CNT, the increase in thermal conductivity was less than 0.01 W⋅m-1⋅K-1.
There are three meninges covering the brain: the dura mater, the arachnoid mater, and the pia mater.
The dura mater is the thickest and strongest membrane, and is firmly attached to the inner surface of the cranial bone, especially along the sutures. It contains the meningeal arteries.
The arachnoid mater is a thin membrane under the dura mater. Its inner surface has numerous thin trabeculae extending downward, into the subarachnoid space.
The pia mater is a thin membrane that covers the surface of the brain, entering the grooves and fissures.
Due to the tight adhesion of the dura mater to the inner skull, significant force is required to separate them. In contrast, separation of the dura from the subarachnoid mater can occur with relatively little force.
The middle meningeal artery arises from the external carotid artery. It enters the foramen spinosum and branches into the anterior, middle, and posterior branches with various patterns. It is a common source of bleeding in acute epidural hematomas (EDHs).
The bridging veins connect the cortical superficial veins to the sagittal sinus in the dura. They are a common source of bleeding in acute subdural hematomas (SDHs).
Severe bleeding in complex pelvic fractures usually originates from branches of the internal iliac artery, presacral venous plexus, fractured bones, and soft tissues. Major iliac vascular injuries are encountered in about 10% of patients with severe pelvic fracture.
The abdominal aorta bifurcates into the two common iliac arteries at the L4-L5 level. The iliac veins are located posterior and to the right of the common iliac arteries. The ureter crosses over the bifurcation of the common iliac artery as it branches into the external and internal iliac arteries.
The internal iliac artery is about 4 cm long. At the level of the greater sciatic foramen, it divides into the anterior and posterior trunks. It supplies numerous splanchnic and muscular branches and terminates as the internal pudendal artery, which is a potential source of hemorrhage in anterior ring disruptions. Hemorrhage following pelvic fracture can occur from any branch.
The most commonly injured internal iliac artery branches (in decreasing order of frequency) are the superior gluteal, internal pudendal, and obturator arteries.
The superior gluteal artery is the largest branch of the internal iliac artery. It exits the pelvis through the greater sciatic foramen above the piriformis muscle. It provides blood supply to gluteus medius and minimus muscles.
The internal pudendal artery passes through the greater sciatic foramen, courses around the sciatic spine, and enters the perineum through the lesser sciatic foramen.
The obturator artery courses along the lateral pelvic wall and exits the pelvis through the obturator canal. In 30% of cases, the obturator artery is perfused from both internal and external iliac arteries, making angioembolization more complicated.
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a compliant, endovascular balloon designed to occlude the thoracic or lower abdominal aorta in hemorrhagic shock, for temporary control of bleeding in the abdomen or pelvis.
The REBOA catheter is placed through a sheath in the right or left common femoral artery, accessed using anatomic landmarks, ultrasound guidance, or with open surgical technique. The balloon is then inflated in the thoracic or abdominal aorta, effectively acting as a minimally invasive aortic cross-clamp.
The procedure for placing a REBOA takes only a few minutes.
REBOA is ideally suited for hypotensive patients with abdominal or pelvic bleeding and can be placed in the emergency room, intensive care unit, or the operating theater.
REBOA balloon placement can be guided and confirmed using external landmarks, X-ray, fluoroscopy, or ultrasound. Balloon inflation volumes are titrated based on invasive blood pressure monitoring, haptic feedback, and imaging.
REBOA is contraindicated in patients with intrathoracic, neck, or facial bleeding, in cases with high suspicion for blunt thoracic aortic injury, and in patients in cardiac arrest.
Aortic occlusion is a temporary, resuscitative measure and should be considered a transition to definitive care. After inflation, the patient should be immediately transported to the operating room or the interventional suite for definitive management of their traumatic injuries.
REBOA balloon inflation results in distal ischemia and as such, occlusion times should be minimized.
To help characterise the palaeogeographic and lacustrine environmental changes that resulted from the Holocene transgression and residual subsidence in the eastern Kanto Plain of central Japan, we analysed four drill cores and reviewed other core data from the southern part of the Lake Inba area. Fossil diatom assemblages yielded evidence of centennial-scale palaeogeographic and salinity responses to sea-level changes since the late Pleistocene. We determined that the seawater incursion into the Lake Inba area during the Holocene transgression occurred at approximately 9000 yr. We also recognised a late Holocene regression event corresponding to the Yayoi regression, considered to have occurred from ca. 3000 to ca. 2000 yr, and a subsequent transgression. Our data clarify some of the palaeogeographic changes that occurred in the Lake Inba area and document an overall trend toward lower salinity in the lake during the regression. In particular, the environment in Lake Inba changed from brackish to freshwater no later than 1000 yr. From the detailed palaeogeographic and palaeo-sea-level reconstruction, we recognised that residual subsidence occurred during the Holocene in this area. Thus, comparison of sea-level reconstructions based on modelling and fossil diatom assemblages is effective in interpreting Holocene long-term subsidence.
This study investigated the position of adduction thread attachment, pulling direction and fixation position in revision arytenoid adduction surgery performed in two patients with left vocal fold palsy in whom satisfactory speech improvement had not been obtained by arytenoid adduction and type 1 thyroplasty.
Revision arytenoid adduction surgery was performed with the vocal fold in the midline position in both cases. A type 1 thyroplasty procedure was subsequently added in one case because of worsened quality of speech following arytenoid adduction.
Results and conclusion
Although the arytenoid adduction procedure is conceptually well established, there is still room for debate concerning the actual surgical procedures used. The technique described in this report is effective, suggesting that it is worthy of recognition as an index procedure.
Uncertainty is caused not only by environmental changes, but also by social interference resulting from competition over food resources. Actually, foraging effort is socially facilitated, which, however, does not require incentive control by the dopamine system; Zajonc's “drive” theory is thus questionable. Instead, social adjustments may be pre-embedded in the limbic network responsible for decisions of appropriate effort-cost investment.
Ca-Mg-Si films were firstly prepared on (001)Al2O3 substrates by RF-magnetron sputtering method from Mg disc target together with Ca and Si chips. The composition of the deposited films was controlled by adjusting deposition temperature and Ca/Si area ratio of Ca and Si chips on Mg disk target. Ca0.32Mg0.33Si0.35 film deposited at 610 K consisted of a single phase of CaMgSi and this CaMgSi phase was stable after heat treated at 770 K under an atmospheric Ar with 5% -H2. As-deposited film shows the semiconductor behavior and have a power factor of 50 μW/(mK2) at 670 K, while annealed one showed the metallic behavior and its power factor down below 10 μW/(mK2) at 320-770 K. On the other hand, Ca0.27Mg0. 51Si0.2 film deposited at 590 K showed no obvious crystalline phase but became single phase of Ca7Mg7.25Si14 after heat treatment at 770 K under an atmospheric Ar with 5% -H2. As deposited film had a large power factor of 100 μW/(mK2) at 670 K. However, power factor decreased below 1 μW/(mK2) at 320-770K after the heat treatment at 770 K under an atmospheric Ar with 5% -H2.
A method for controlling the conduction-type in Mg2Si films without doping is investigated. Mg2Si films exhibit p-type conduction after a post-heat treatment up to 500 °C in atmospheric He. However, covering the films with Mg ribbon during a subsequent heat treatment at 500 °C converts the conduction to n-type, demonstrating that the heat treatment atmosphere can control the conduction type. Based on the reported first principles calculations suggesting that interstitial Mg and Mg vacancies in Mg2Si are the origins of n-type and p-type conduction, respectively, the post-heat treatment in He induces Mg vacancies due to the evaporation of Mg from the film, resulting in p-type conduction. The subsequent heat treatment when the film is covered with Mg ribbon fills the Mg vacancies and the additional interstitial Mg is incorporated, resulting in n-type conduction. These observations differ from the reported data for heat treatment of stable n-type conduction in non-doped Mg2Si-sintered bodies and may realize a novel control method for the conduction type in Mg2Si films.
Although support programs for children whose parents have cancer have been described and evaluated, formal research has not been conducted to document outcomes. We adapted a group intervention called CLIMB®, originally developed in the United States, and implemented it in Tokyo, Japan, for school-aged children and their parents with cancer. The purpose of this exploratory pilot study was to examine the feasibility, acceptability, and impact of the Japanese version of the CLIMB® Program on children's stress and parents' quality of life and psychosocial distress.
We enrolled children and parents in six waves of replicate sets for the six-week group intervention. A total of 24 parents (23 mothers and 1 father) diagnosed with cancer and 38 school-aged children (27 girls and 11 boys) participated in our study. Intervention fidelity, including parent and child satisfaction with the program, was examined. The impact of the program was analyzed using a quasiexperimental within-subject design comparing pre- and posttest assessments of children and parents in separate analyses.
Both children and parents experienced high levels of satisfaction with the program. Children's posttraumatic stress symptoms related to a parent's illness decreased after the intervention as measured by the Posttraumatic Stress Disorder–Reaction Index. No difference was found in children's psychosocial stress. The Functional Assessment of Chronic Illness Therapy scores indicated that parents' quality of life improved after the intervention in all domains except for physical well-being. However, no differences were found in parents' psychological distress and posttraumatic stress symptoms.
Significance of results:
Our results suggest that the group intervention using the CLIMB® Program relieved children's posttraumatic stress symptoms and improved parents' quality of life. The intervention proved the feasibility of delivering the program using manuals and training. Further research is needed to provide more substantiation for the benefits of the program.
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.
Monte Carlo (MC) simulations of the magnetization states of disordered self-assembled arrays of particles consisting of Co87Cu13 alloy are investigated. The assemblies of magnetic particles with ellipsoidal shapes and volumes ranging from 5 to 50 µm3 exhibit densities of about 3 × 106 particles per mm2. Magnetization was obtained in the framework of Stoner–Wohlfarth model extended to include phenomenological contributions of second-order magnetic anisotropy and coercivity mechanism with distinct configuration of easy axes of magnetization. MC simulations for assemblies containing no more than 100 particles with negligible magnetic interaction between each other and exhibiting saturation magnetization and magnetic anisotropy constant values close to those found for cobalt in bulk are in good agreement with experimental results. We evaluate and validate our computational modeling using samples having particles with different sizes and different angular distributions of the easy axis of magnetization. A simple numerical approach with minimum of parameters was used to take into account the coercive fields of the samples. Reasonable simulation results are generated based on realistic size distributions and angular distributions of easy axis of magnetization.
We study effects of deposition temperature on growth mode and surface morphology
of hetero-epitaxial (ZnO)x(InN)1-x (ZION) films on ZnO
templates. ZION films deposited at low temperature of RT-250oC grow
two dimensionally, whereas ZION films deposited at high temperature of
350-450oC grow three dimensionally. Growth mode is changed from
two-dimensional growth mode to three-dimensional one, because the critical
thickness where film strain begin to relax decreases with increasing the
deposition temperature. At high deposition temperatures, the number of point
defects in ZION films decreases because migration of adatoms on the growing
surface is enhanced. The strain energy in ZION films increases with increasing
the deposition temperature, since the strain energy is not released by point
defects. Therefore, lattice relaxation for the higher deposition temperature
begins at the smaller film thickness to release the strain energy. As a result,
ZION films with atomically-flat surface were obtained even at RT.
Many patients with head and neck cancer (HNC) suffer from psychological distress associated with dysfunction and/or disfigurement. Our aim was to evaluate the ratio of patients with persistence of psychological distress during hospitalization and identify the predictors of persistence or change in psychological distress among HNC patients.
We conducted a single-center longitudinal study with self-completed questionnaires. We evaluated psychological distress (the Hospital Anxiety and Depression Scale; HADS) and functional level (the Functional Assessment of Cancer Therapy–Head and Neck Scale; FACT–H&N) among patients during hospitalization at the Medical Hospital of Tokyo Medical and Dental University.
Of 160 patients, 117 (73.1%) completed the questionnaire at both admission and discharge. Some 42 (52.5%) patients reported persistent psychological distress. The physical well-being of patients with continued distress was significantly lower than that of other patients (21.7 ± 4.7, 19.4 ± 6.1, 19.5 ± 5.4; p < 0.01), and the emotional well-being of patients with continued distress was significantly lower than that in patients with no distress and reduced distress (22.3 ± 3.5, 20.5 ± 2.5; p < 0.01).
Significant of results:
Impaired physical and emotional function appears to be associated with persistent psychological distress among HNC patients. Psychological interventions focused on relaxation, cognition, or behavior may be efficacious in preventing such persistent distress.
Most cancer patients experience the time when a doctor must “break the bad news” to them, a time when it is necessary for patients to call upon their self-determination to aid in the battle with cancer. The purpose of our study was to clarify the percentage of times doctors deliver bad news to patients at the end of life in each of four different situations, and to define the most common recipients of this bad news. We compare these results for two timepoints: 2006 and 2012.
The study had a national cross-sectional design consisting of self-completed questionnaires sent to all hospitals that provide cancer care. We mailed them to hospital directors in January and February of 2012, requesting a reply. The results of the same survey in 2006 were employed as a point for comparison.
A total of 1224 questionnaires were returned during 2012. 1499 responses collected in 2006 were employed as reference data. Some hospital characteristics had changed over that interval; however, the new data obtained were representative for patients being treated in Japanese cancer care hospitals. In hospitals with 300–499, there were significant differences between 2006 and 2012 in the providing information about (“disclosure of cancer diagnosis,” “therapeutic options for treatment,” and “a life-prolonging treatment”). In addition, the likelihood of doctors delivering bad news to patients and family members (as opposed to family members only) at the end of life increased from 2006 to 2012.
Significance of Results:
Our results suggest that the overall incidence of bad news being disclosed has increased, especially in hub medical institutions for cancer care. Advanced treatment options or domestic legislation may have influenced the frequency or type of bad news.
This project compares access to the anterolateral part of the jugular foramen provided by the lateral microsurgical preauricular and the anterior endoscopic approaches, and defines the important landmarks involved in each approach.
The endoscopic transnasal/transmaxillary transpterygoid corridor provides a less invasive route for selected lesions in the jugular foramen than the traditional open route through the preauricular subtemporal infratemporal fossa approach. However, the anterior endoscopic approach provides a smaller channel to the jugular foramen than the preauricular approach.
The anterior endoscopic approach to the anterolateral part of the jugular foramen is a useful alternative to the lateral microsurgical preauricular approach in carefully selected cases. The vaginal process of the tympanic part of the temporal bone provides a valuable landmark to aid in accessing the jugular foramen in both procedures and can be drilled to open the foramen in the preauricular approach.