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The pathogenesis of congenital diaphragmatic hernia (CDH) is largely unknown; however, vitamin A seems to play a role in diaphragmatic development. Previous, case-control studies reported that maternal dietary vitamin A intake was inversely associated with the risk of CDH. To our knowledge, however, there is no prospective evidence regarding this association. Our aim was to examine whether maternal intake of vitamin A was associated with CDH occurrence. Baseline data, from the Japan nationwide birth cohort study (2011-2014), on 89,658 mothers (mean age at delivery = 31·2 years) who delivered singleton live births, were analysed. We assessed dietary habits using a food-frequency questionnaire focused on the first trimester, and estimated the daily intakes of total vitamin A (retinol activity equivalents), retinol, provitamin A carotenoids, and vegetables. The occurrence of CDH was ascertained from medical records. A total of 40 cases of CDH were documented. The adjusted odds ratio (OR) of CDH occurrence for the high total vitamin A intake category (median = 468 μg/day) was 0·6 (95% confidence interval (CI) = 0·3, 1·2) with reference to the low intake category (230 μg/day). When we restricted to mothers with a pre-pregnancy body mass index of 18·5 to 24·9 kg/m2, vitamin A intake was inversely associated with the risk of their children being born with CDH (OR = 0·5, 95% CI = 0·2, 1·0). Even given the limited number of cases in the study, our findings provide additional evidence to link vitamin A with CDH.
To conceptualize a “good end of life” for people with dementia from the perspectives of bereaved family caregivers in Japan.
Design and participants:
A qualitative study using in-depth, semi-structured interviews focused on the family caregivers’ perceptions of their loved one’s experiences. Family caregivers who had lost their relatives with dementia more than six months previously were recruited using maximum variation sampling by cultural subpopulation. A thematic analysis was conducted.
From 30 interviews held, four main themes emerged. A good end of life for people with dementia means experiencing a “Peaceful Death” while “Maintaining Personhood” at a “Preferred Place” allowing for feelings of “Life Satisfaction.” A “Preferred Place” emerged as a basic requirement to achieving a good end of life according to the three other themes, in particular, “Maintaining Personhood.” However, the interviewees experienced difficulties in ensuring that their loved ones stayed at a “Preferred Place.”
Despite different cultural backgrounds, perceptions of a good end of life with dementia were remarkably similar between Japan and Western countries. However, recent societal changes in family structures and long-term care access in Japan may explain the theme of a comfortable place taking a central position. We suggest that these themes be considered and translated into care goals. They could supplement established end-of-life care goals for quality of life in dementia, which aim to maximize functioning and increase comfort.
TRIAL REGISTRATION NUMBER
Ethics Committee of the Graduate School and Faculty of Medicine, Kyoto University (R0808-2)
An experimental and numerical study on the inertial focusing of neutrally buoyant spherical particles suspended in laminar circular tube flows was performed at Reynolds numbers (
) ranging from 100 to 1000 for particle-to-tube diameter ratios of
. In the experiments, we measured the cross-sectional distribution of particles in dilute suspensions flowing through circular tubes several hundreds of micrometres in diameter. In the cross-section located at 1000 times the tube diameter from the tube inlet, all particles were highly concentrated on one annulus or two annuli, depending on
. At low
, the particles were focused on the so-called Segré–Silberberg (SS) annulus, in accordance with previous studies (regime (A)). At higher
, two particle focusing annuli appeared, with the outer annulus corresponding to the SS annulus (regime (B)). We call the annulus closer to the tube centre ‘the inner annulus’, although this term was used by Matas et al. (J. Fluid Mech., vol. 515, 2004, pp. 171–195) for a significantly broader annulus which included the transient accumulation of particles observed in regime (A). At even higher
, particles were focused on the inner annulus (regime (C)), indicating that the radial position of the SS annulus is no longer a stable equilibrium position. These experimental results were confirmed by a numerical simulation based on the immersed boundary method. The results of this study also indicate that the critical Reynolds numbers between two neighbouring regimes decrease with the increase of the particle-to-tube diameter ratio.
For recent years, we often hear the words, “never experienced before” on a weather forecast in Japan.
To evaluate our response to “Heisei 30-year July heavy rain” in the Hyogo Emergency Medical Operations Center.
Review our actions taken and exchanges of views with local government representatives in a time-related manner compared with public announcements of evacuation/sheltering warning.
A specialized warning of heavy rain was announced at 10:50 PM on Friday by the local meteorological observatory. At 11:50 PM, the emergency management headquarters of prefectural medical response was established in the hospital, but a connection could not be established to 10 regional health centers for the weekend. Water levels of some rivers were increasing nearly to flood levels, and an evacuation order was announced to hundreds of thousands of people. This situation continued for a few days throughout many regions. The information of flood or landslide probability was continuously monitored, but an attempt was made to decide the timing of cancellations of standby.
An ordinary response to disaster depends on a clear turning point, such as the occurrence time. In heavy rainfall, there are two issues. One is about actions to prevent disaster and another is a recognition of geographic points or surface. Many critiques to the response focus on the judgments and actions for prevention before a critical event. Lessons learned included the importance of preventive actions along with a timeline and the judgment of restoration.
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.
The Asia Pacific Conference on Disaster Medicine (APCDM) started in 1988 in Osaka, Japan, and the 14th conference was held from October 16-182, 2018, in Kobe.
To give a rundown of the 14th APCDM and a proposal for WADEM.
Retrospective analysis of participants, the category of presentations, and deliverables.
With “Building Bridges for Disaster Preparedness and Response” as its main theme, the 14th APCDM was held near the epicenter of the 1995 Great Hanshin Earthquake in Kobe. The total number of participants was 524 from 35 countries, not only from Asia and the Pacific but also Europe and the Americas. Its program had 10 lectures by distinguished speakers such as WADEM Board members and WHO (World Health Organization), four symposia, two panel, oral and 99 poster presentations. “Preparedness” and “Education and Training” were the categories with the largest number of presentations. The presidential lecture outlined improvements made in Japan since the Great Hanshin Earthquake (disaster base hospitals, disaster medical assistance teams, emergency medical information system, and disaster medical coordinators) and emphasized the importance of standardizing components for better disaster management. This idea was echoed in symposia and round-table discussions, where experts from WHO, JICA (Japan International Cooperation Agency), and ASEAN (The Association of Southeast Asian Nations) countries discussed other components such as SPEED (Surveillance in Post Extreme Emergency and Disasters) and standardization of Emergency Medical Teams.
Each country in the disaster-prone Asia-Pacific region has a different disaster management system. However, participants agreed in this conference that we can cope with disasters more efficiently by sharing the standardized components, from both academic and practical points of view. APCDM must provide these deliverables to WADEM, so both conferences can cooperate and contribute to disaster preparedness and prevention in the new era.
On March 11, 2011, the Great East Japan Earthquake and Tsunami hit the northeastern part of Japan, causing 15,895 deaths and 2,539 missing persons as of March 1, 2018. Moreover, many medical facilities were destroyed, resulting in the loss of medical information stored in paper records or on servers in hospitals and clinics.
To highlight the need for a backup system for saving all clinical information during disaster preparation.
In 2012, a prefectural medical network system - the Miyagi Medical and Welfare Information Network (MMWIN) - introduced a cloud backup data storage service for disasters. This system facilitates the sharing of clinical data among hospitals, clinics, pharmacies, and other care facilities. The backup system is based on the Standardized Structured Medical Information Exchange (SS-MIX), which enables data from medical record systems, developed by different vendors, to be stored in a common format. By the end of September 2018, the total backed up clinical data, including patients’ basic information, disease names, blood tests, and prescription list, reached 370 million items from 11.2 million persons. We renewed the system last year and initiated an image data sharing service this year. The number of facilities within the MMWIN was 948, while the number of opt-in patients exceeded 80,000.
Although the project was financed by the government, a usage fee was collected from the participating facilities. To sustain this project, it is crucial to improve the balance between cost and income by increasing the number of participating facilities and decreasing maintenance cost. Thus, our clinical information backup system for disasters facilitates information sharing among medical facilities.
On March 11, 2011, the Great East Japan Earthquake struck the northeastern coast of Japan with the magnitude nine. Ishinomaki medical zone was affected most severely with 328 evacuation shelters and approximately 50,000 evacuees. The Ishinomaki Zone Joint Relief Team gathered information directly from all evacuation shelters using assessment sheets. Based on this assessment data, various measures were carried out for environmental improvement of the shelters. To prepare for the next major disaster, a software program called Rapid Assessment System of Evacuation Center Condition - Gonryo and Miyagi (RASECC-GM) was developed, which computerizes the whole process, including entering, tabulating, and managing of shelter assessment data.
To verify the feasibility, usability, and accuracy of RASECC-GM, a verification test was performed using mock shelter data on October 23-26, 2018, to coincide with Logistics Training Course of Medical Logistics for Disasters held by Iwate Medical University.
On October 22, 2018 at four simulated disaster relief and health care branches, participants at each branch were asked to enter two mock shelter data items, submit a closed shelter request, and register a new shelter using RASECC-GM, respectively. The next day participants were asked to enter two mock shelter data items per branch while offline and upload the data to the server when next online. The uploaded data was checked for accuracy and whether it could be viewed on the management screen. After the test, a questionnaire survey was given to participants to verify the feasibility and usability of RASECC-GM.
It was confirmed that RASECC-GM functioned almost correctly. All participants answered that input operation was easy to understand, and 90.9% of participants could input without a mistake and did not feel stress when inputting data.
RASECC-GM appeared to be useful to shelter assessment, but further improvements are needed for practical use.
Formerly Hua  proved that if A is a division ring with centre Z and if there exists a natural number n such that an ∈ Z for every a ∈ A, then A is commutative; this generalizes Wedderburn's theorem on finite division rings. Another generalization of Wedderburn's theorem, due to Jacobson , asserts that every algebraic division algebra over a finite field is commutative. On the other hand, a theorem of Noether and Jacboson  states that every noncommutative algebraic division algebra contains an element which is not contained in the centre Z and is separable over Z.
The purpose of the present work is to give, as a continuation of the writer's study of Galois theory for general rings (, , ), a kind of Galois theory for general, non-commutative and non-semisimple rings, which includes, at least in its main features, the Kaloujnine-Jacobson Galois theory of non-normal fields (; cf. , ). To deal with the non-commutativity we bring to the fore certain double-moduli rather than self-composites, while the non-semisimplicity is manipulated by the method and idea used in the writer's above mentioned study on (normal) Galois theory and commuter systems of nonsemisimple rings. (For the normal Galois theory of rings cf. , , , , , besides the above.) Some of our arguments may even serve to make some simplification in Jacobson's treatment of ordinary fields.
Current evidence suggests that the aetiology of congenital gastrointestinal (GI) tract atresia is multifactorial, and not based solely on genetic factors. However, there are no established modifiable risk factors for congenital GI tract atresia. We used data from a Japanese nationwide birth cohort study launched in 2011, and examined whether fish consumption in early pregnancy was associated with congenital GI tract atresia. We analysed data of 89 495 women (mean age at delivery=31·2 years) who delivered singleton live births without chromosomal anomalies. Based on the results of the FFQ, we estimated the daily intake of fish and n-3 PUFA consumption in early pregnancy. We defined a composite outcome (oesophageal atresia, duodenal atresia, jejunoileal atresia and/or anorectal malformation) as congenital GI tract atresia. In this population, median fish intake was 31·9 g/d, and seventy-four cases of congenital GI tract atresia were identified. Fish consumption in early pregnancy was inversely associated with the composite outcome (multivariable-adjusted OR for the high v. low consumption category=0·5, 95 % CI 0·3, 1·0). For all the specific types of atresia, decreased OR were observed in the high consumption category, although not statistically significant. Reduced atresia occurrence was observed even beyond the US Food and Drug Administration’s recommended consumption of no more than 340 g/week. Also, n-3 PUFA-rich fish and n-3 PUFA consumptions tended to be inversely associated with atresia. Fish consumption in early pregnancy may be a preventive factor for congenital GI tract atresia.
Electronic structures of single crystal pentacene are of great interest for the elucidation of charge carrier transport in organic semiconductor materials. Experimental observation of valence band dispersion was recently achieved on single crystal samples of pentacene; however, its intrinsic properties are still unresolved because past experiments were performed on specimens with surface oxides formed by exposure to the ambient atmosphere. In this work, X-ray photoelectron spectroscopy (XPS) and angle-resolved ultraviolet photoelectron spectroscopy (ARUPS) were conducted on single-crystal pentacene samples prepared without ambient exposure. The XPS results confirmed the reduction of the abundance of oxide impurities on the present samples. The ARUPS measurements clearly resolved the valence band structures of the single-crystal pentacene in four symmetry directions of the surface Brillouin zone, indicating anisotropy of at least a factor of 2.4 for the intermolecular transfer integral and hole effective mass at the valence band maximum.
Corona images from 1971 and a Landsat image from 2002 are used to assess glacier variations in the last 30 years in the western Terskey-Alatoo range (a part of the Tien Shan), in the northeast of the Kyrgyz Republic. The glaciers have shrunk during this period. The 269 mountain glaciers measured in the study area had an original combined area of 245 km2, which has decreased 18.4 km2, representing a loss of 8% of the original glacier coverage in 1971. Individual glaciers covering <1km2 account for 28% of the combined glacial coverage, but loss from these small glaciers represents 38% of the total decrease in area. The relative change of area is larger for small-scale glaciers, and its contribution to shrinkage of glacier area is high. This shrinkage has been linked to climate changes as recorded at local stations. Many small-scale glaciers are distributed around Issyk-Kul lake, and rapid glacier reduction is expected in this area in the future.
The tunnel field-effect transistor (TFET) is one of the candidates replacing conventional metal–oxide–semiconductor field-effect transistors to realize low-power-consumption large-scale integration (LSI). The most significant issue in the practical application of TFETs concerns their low tunneling current. Si is an indirect-gap material having a low band-to-band tunneling probability and is not favored for the channel. However, a new technology to enhance tunneling current in Si-TFETs utilizing the isoelectronic trap (IET) technology was recently proposed. IET technology provides a new approach to realize low-power-consumption LSIs with TFETs. The present paper reviews the state-of-the-art research and future prospects of Si-TFETs with IET technology.
To explore how evacuees obtained health care information at their evacuation destinations after the Great East Japan Earthquake.
We conducted semi-structured interviews of 11 evacuees who moved to City A in Kyoto Prefecture following the Great East Japan Earthquake. The interviews explored how the evacuees obtained health care information, including the main factors of influence. The interviews were transcribed and analyzed to identify trends by using the constant comparative method.
Four categories emerged from 6 concepts. Mother-children evacuees and family evacuees tended to obtain health care information in different ways. Family evacuees had moved as a family unit and had obtained their health care information from local neighbors. Mother-children evacuees were mothers who had moved with their children, leaving behind other family members. These evacuees tended to obtain information from other mother-children evacuees. At the time of evacuation, we found 2 factors, emotions and systems, influencing how mother-children evacuees obtained health care information.
We found 2 different ways of obtaining health care information among mother-children evacuees and other evacuees. At the time of evacuation, 2 factors, emotions and systems, influenced how mother-children evacuees obtained health care information. Community-building support should be a priority from an early stage after a disaster for health care management. (Disaster Med Public Health Preparedness. 2017;11:729–734)
Fabricated stainless steel structures are susceptible to stress corrosion
cracking (SCC), despite being placed in chloride-containing natural water or
humid atmospheres. The present paper describes a model that can define the
conditions under which SCC is initiated and propagated, based on analyses of
actual SCC incidents induced at welded flanges of cylindrical stainless steel
Whenever the vitrified radioactive waste canister storage conditions deviate from
normal and appropriate conditions due to earthquakes or tsunamis, the exposed
canisters are expected to suffer SCC within 400 hours to 7 years, according to
the analytical results obtained such as degree of sensitization, residual stress
distribution, chloride ion concentration, and temperature.