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To examine whether the issue and dissemination of national guidelines in the Manual of Antimicrobial Stewardship had an impact on reducing antibiotic use for acute respiratory tract infection (ARTI) and gastroenteritis.
An interrupted time-series analysis was performed using a large nationwide database from June 2016 to June 2018. Outpatients with ARTI or gastroenteritis aged ≥6 years were identified. The outcome measures were any antibiotic use and broad-spectrum antibiotic use. The season-adjusted changes in the rate of antibiotic prescriptions for 2 periods before and after the guideline issue date were examined.
There were 13,177,735 patients with ARTI and 300,565 patients with gastroenteritis during the study period. Among patients with ARTI, there was a significant downward trend in antibiotic use during the 2-year study period (−0.06% per week; 95% CI, −0.07% to −0.04%). However, there was no significant change in trends of antibiotic use between the pre-issue period and post-issue period (trend difference, −0.01% per week; 95% CI, −0.10% to 0.07%). Similarly, for patients with gastroenteritis, there was no significant change in the trends of antibiotic use between the pre-issue period and post-issue period (trend difference, −0.02% per week; 95% CI, −0.04% to 0.01%). Similar associations were observed in analyses for broad-spectrum antibiotic use.
Despite the issue of national guidelines to promote the appropriate use of antibiotics, there were no significant changes in trends of antibiotic use for outpatients with ARTI or gastroenteritis between the pre-issue and post-issue periods.
Development of high-efficiency solar cell modules and new application fields are significant for the further development of photovoltaics (PV) and creation of new clean energy infrastructure based on PV. Especially, development of PV-powered EV applications is desirable and very important for this end. This paper shows analytical results for efficiency potential of various solar cells for choosing candidates of high-efficiency solar cell modules for automobile applications. As a result of analysis, Si tandem solar cells are thought to be some of their candidates. This paper also overviews efficiency potential and recent activities of various Si tandem solar cells such as III-V/Si, II-VI/Si, chalcopyrite/Si, perovskite/Si and nanowire/Si tandem solar cells. The III-V/Si tandem solar cells are expected to have a high potential for various applications because of high efficiency with efficiencies of more than 36% for 2-junction and 42 % for 3-junction tandem solar cells under 1-sun AM1.5 G, lightweight and low-cost potential. Recent results for our 28.2 % efficiency and Sharp’s 33% mechanically stacked InGaP/GaAs/Si 3-junction solar cell are also presented. Approaches to automobile application by using III-V/Si tandem solar cells and static low concentration are presented.
Thiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer. However, it has not been recognized to date in bereaved partners after spousal loss from cancer.
From a series of bereaved partners who lost a spouse to cancer, we report on those who developed TD after bereavement.
Case 1 was a 57-year-old woman who sought consultation at our “bereavement clinic.” Her husband had been diagnosed with pancreatic cancer one year earlier and had died one month previously. At the first visit, she was observed to suffer depression, anxiety, and decreased appetite. Neurological, blood, and biochemical examinations did not reveal any noteworthy findings. She was diagnosed with uncomplicated bereavement. Detailed examination revealed that her appetite had been markedly decreased for approximately five weeks. The diagnosis of TD was supported by her abnormally low serum thiamine level. Case 2 was a bereaved 73-year-old male who had lost his wife to hypopharyngeal cancer one month previously after a five-year illness. He had shown a lack of energy for the month preceding his wife's death, but because there was no improvement after her death, his family recommended he seek consultation at our “bereavement clinic.” He was suffering from major depressive disorder. Detailed examination revealed that his appetite had been decreased for more than two weeks. Again, the diagnosis of TD was supported by his abnormally low serum thiamine level.
Significance of results
These reports demonstrate that there is a possibility that bereaved could develop TD after the loss of a loved one. TD should be considered whenever there is a loss of appetite lasting for more than 2 weeks, and medical staff should pay careful attention to the physical condition of the bereaved to prevent complications because of TD.
Thiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer; however, TD has not been recognized in the family caregivers of cancer patients to date.
From a series of cancer patient caregivers, we reported an aged family caregiver who developed TD while caring for the cancer patient.
The caregiver was a 90-year-old male. He had been accompanying his wife, who was diagnosed with colon cancer 4 years previously, on hospital visits as the primary caregiver, but because of psychological issues, he was recommended to visit the psycho-oncology department's “caregiver's clinic” for a consultation. Detailed examination revealed that his appetite had been only about 50% of usual from about one year before, and he had lost 12 kg in weight in one year. The diagnosis of TD was supported by his abnormally low serum thiamine level.
Significance of the results
This report demonstrates that there is a possibility that care providers could develop TD from the burdens associated with caregiving. TD should be considered whenever there is a loss of appetite lasting for more than 2 weeks, and medical staff should pay careful attention to the physical condition of care providers to prevent complications resulting from TD.
In this proceeding paper, we introduce the recent results of Galactic maser astrometry by mainly focusing on those obtained with Japanese VLBI array VERA. So far we have obtained parallaxes for 86 sources including preliminary results, and combination with the data obtained with VLBA/BeSSeL provides astrometric results for 159 sources. With these most updated results we conduct preliminary determinations of Galactic fundamental parameters, obtaining R0 = 8.16 ± 0.26 kpc and Θ0 = 237 ± 8 km/s. We also derive the rotation curve of the Milky Way Galaxy and confirm the previous results that the rotation curve is fairly flat between 5 kpc and 16 kpc, while a remarkable deviation is seen toward the Galactic center region. In addition to the results on the Galactic structure, we also present brief overviews on other science topics related to masers conducted with VERA, and also discuss the future prospect of the project.
We have detected [C I] 3P1–3P0 emissions in the gaseous debris disks of 49 Ceti and β Pictoris with the 10 m telescope of the Atacama Submillimeter Telescope Experiment, which is the first detection of such emissions. The line profiles of [C I] are found to resemble those of CO(J=3–2) observed with the same telescope and the Atacama Large Millimeter/submillimeter Array. This result suggests that atomic carbon (C) coexists with CO in the debris disks, and is likely formed by the photodissociation of CO. Assuming an optically thin [C I] emission with the excitation temperature ranging from 30 to 100 K, the column density of C is evaluated to be (2.2 ± 0.2) × 1017 and (2.5 ± 0.7) × 1016 cm−2 for 49 Ceti and β Pictoris, respectively. The C/CO column density ratio is thus derived to be 54 ± 19 and 69 ± 42 for 49 Ceti and β Pictoris, respectively. These ratios are higher than those of molecular clouds and diffuse clouds by an order of magnitude. The unusually high ratios of C to CO are likely attributed to a lack of H2 molecules needed to reproduce CO molecules efficiently from C. This result implies a small number of H2 molecules in the gas disk; i.e., there is an appreciable contribution of secondary gas from dust grains.
In 2014, the Ministry of Health, Labor and Welfare (MHLW) in Japan began to assume a cost-effectiveness perspective. Some expensive pharmaceutical and medical devices have been regulated, which resulted in a drastic change of the healthcare system.
The Japanese National Insurance Claims Database (NDB) is an administrative database based on claims data from Medical Insurance Claims since 2008. The government enacted the Act on Assurance of Medical Care for Elderly People during health care reform in 2008. In 2006, the MHLW commenced discussions on a framework for the optimization of the healthcare expenses, which aimed to evaluate the structure of the increase in healthcare expenditure.
The NDB was developed as a tool for investigation and analysis by the MHLW in the context of the Healthcare reform. In addition, the NDB was used for the development of academic research in order to contribute to the implementation and evaluation of healthcare policy management.
A major strength of the NDB is its exhaustiveness or completeness of insurance claims. The NDB collects data from all insured people nationwide and covers all medical institutions in Japan.
We applied to the Expert Meeting on Provision of Medical Insurance Claims to examine the research plan, items extracted, and data management. Inpatient and Outpatient information was extracted on medical procedures and payment. Diagnoses for both inpatients and outpatients are coded according to the International Classification of Diseases Tenth Edition (ICD-10). The coding of treatments and surgeries follow Japan's local procedure and surgical coding, which was specifically developed for insurance claims.
We generated any personally traceable patient ID from the “hash ID” generated by patient name, sex, date of birth, and insurer number with the aim of protecting personal identifying information in the NDB. The disease of stroke was defined to analyze the database for cost-effectiveness analysis, and to connect disease information to. The prescription claims information described pharmaceutical names, prescription date, total dose, and number of days.
Our study showed the new standard way of analysis for cost-effectiveness analysis using the Japanese National Insurance Claims Database.
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.
The elemental composition and microscopic-level shape of inclusions inside industrial materials are considered important factors in fracture analytical studies. In this work, a three-dimensional (3D) microscopic elemental analysis system based on a serial sectioning technique was developed to observe the internal structure of such materials. This 3D elemental mapping system included an X-ray fluorescence analyzer and a high-precision milling machine. Control signals for the X-ray observation process were automatically sent from a data I/O system synchronized with the precision positioning on the milling machine. Composite specimens were used to confirm the resolution and the accuracy of 3D models generated from this system. Each of the two specimens was composed of three metal wires of 0.5 mm diameter braided into a single twisted wire that was placed inside a metal pipe; the pipe was then filled with either epoxy resin or Sn. The milling machine was used to create a mirror-finish cross-sectional surface on these specimens, and elemental analyses were performed. The twisted wire structure was clearly observed in the resulting 3D models. This system enables automated investigation of the 3D internal structure of materials as well as the identification of their elemental components.
We have demonstrated a 5-inch flexible color liquid crystal display (LCD) and organic light emitting display (OLED) driven by low-voltage operation organic TFT. In order to achieve high-quality and high-resolution moving images, OTFTs with high performances such as a high mobility, high ON/OFF ratio, low sub-threshold slope (SS) and low operating voltage, are developed. We fabricated pentacene-based low-voltage operation OTFT with a Ta2O5 gate dielectric prepared at a low temperature process. The resulting OTFT array showed a high mobility of 0.3-0.4 cm2/Vs, ON/OFF ratio over 107, VTH=2.7V, and low SS=0.3 V/decade. OTFTs with solution-processable materials such as fluoropolymer gate dielectric and liquid-crystalline semiconducting polymers, PBTTT, were also investigated. Electrical characteristics and stabilities of these devices will be discussed. In the final section, we will demonstrate OTFT-driven flexible displays. Both of the flexible LC device and the OLED device were successfully integrated on the pentacene-based OTFT arrays. Printing and lamination techniques were introduced to assemble the flexible LC device. Phosphorescent polymer materials, which can be patterned by ink-jet printing, were used for emitting layer of OLED. Color moving images were successively shown on the resulting 5-inch displays using an active-matrix driving technique of the OTFT at a low driving voltage of 15V.
Stability of Pd-Co-Ni-Cu-P metallic glass was investigated in terms of free energy using first principle cluster calculations, thermal analysis, and photoemission spectroscopy measurements. We found that the internal energy of the Pd-based metallic glasses is dominated by the electronic structure near the Fermi level. The analyses on the electronic structure and local atomic arrangements indicate that the substitution of cobalt or a hypothetical atom Co0.5Cu0.5 for nickel in the Pd40Ni40P20 metallic glass decreases the free energy of the Pd-Ni-P metallic glass by increasing entropy without altering significantly internal energy. On the basis of the idea mentioned above, we prepared Pd28Co24Ni24P24, Pd25Co25Ni25P25 and Pd40Co40/3Ni40/3Cu40/3P20 metallic glasses. These metallic glasses certainly showed the nearly highest TX, which directly reflect the activation energy against crystallization, among the Pd-based metallic glasses ever reported.
Electrode materials consisting of Cu, Ti and Ni were formed on Bi-doped n-type Mg2Si by means of a monobloc plasma-activated sintering (PAS) technique. Due to the difference in thermal expansion coefficients between Ti and Mg2Si, rather high residual thermal stresses gave rise to the introduction of cracks, which were mainly located in the Mg2Si layer, when Ti was used as the electrode material. In the case of the Cu electrodes, monobloc sintering could not be performed in a reproducible manner because Cu melts abruptly and effuses at around 973K, which is 100 K lower than the sintering temperature that is required for Mg2Si of good crystalline quality. When compared with the results for Cu and Ti, the monobloc PAS process for Ni was both stable and reproducible. The room-temperature I-V characteristics of Ni electrodes were considered to be adequate for practical applications, with durable Mg2Si-electrode junction properties being realized at a practical operating temperature of 600 K with ΔT = 500 K. The highest open circuit voltage (VOC) observed was 41 mV at ΔT = 500 K (between 873 K and 373 K) for Ni electrodes fabricated using the monobloc PAS process. The voltage (V) and current (I) values with a 10 Ohm load were ∼ 48 mV and ∼ 2 mA at ΔT = 500 K.
The relative benefit of replacing saturated fatty acid with linoleic acids is still being debated because a linoleic acid-enriched diet increases oxidative and inflammatory stresses, although it is associated with a reduction in serum cholesterol levels. The present study was conducted to evaluate the effect of dietary supplementation of linoleic acid-rich (HL) fat, compared with a saturated fatty acid-rich (SF) fat on atherosclerotic lesion areas, serum and liver cholesterol levels, oxidative stress (urinary isoprostanes and serum malondialdehayde) and inflammatory stress (expression of aortic monocyte chemoattractant protein-1; MCP-1) in apo E-deficient mice. Male and female apo E-deficient mice (8 weeks old; seven to eight per group) were fed an AIN-76-based diet containing SF fat (50 g palm oil and 50 g lard/kg) or HL fat (100 g high-linoleic safflower-seed oil/kg) for 9 weeks. Compared with the SF diet, the HL diet lowered atherosclerosis (P<0·05). It reduced serum total cholesterol levels (P<0·05), increased HDL-cholesterol levels (P<0·05) and lowered liver esterified cholesterol levels (P<0·01). The HL diet-fed mice showed increased expression of MCP-1 mRNA (P<0·05), serum levels of malondialdehayde (P<0·05) and urinary excretion of 2,3-dinor-5,6-dihydro-8-iso-prostaglandin F2α; P<0·05). These results suggest that having biomarkers in vivo for oxidative stress and inflammatory status of endothelial cells does not necessarily indicate predisposition to an increased lesion area in the aortic root in apo E-deficient mice fed an HL or SF diet.
Adequate fruit and vegetable intake has been suggested to protect against colorectal cancer. However, several recent prospective studies have reported no association. We therefore examined the association between fruit and vegetable intakes and the risk of colorectal cancer in a prospective cohort study in Japan.
Between June and August 1990, 47 605 Japanese men and women completed a self-administered questionnaire, including a food-frequency questionnaire. We divided the subjects into quartiles based on their self-reported fruit and vegetable consumption. There were 165 colon cancer and 110 rectal cancer incidences identified during 7 years of follow-up, to the end of December 1997. We used Cox proportional hazards models to estimate the relative risk (RR) of developing colorectal cancer according to the level of fruit and vegetable consumption, applying adjustments for potential confounders.
No statistically significant association was observed between fruit and vegetable consumption and the risk of colorectal cancer. The multivariate RR of colon cancer in the highest quartile of fruit and vegetable intake compared with the lowest was 1.13 (95% confidence interval (CI) 0.73–1.75), the RR for vegetables alone was 1.24 (95% CI 0.79–1.95) and that for fruit alone was 1.45 (95% CI 0.85–2.47). The corresponding multivariate RRs for rectal cancer were 1.12 (95% CI 0.67–1.89), 1.14 (95% CI 0.67–1.93) and 1.41 (95% CI 0.73–2.73).
We found no association between the consumption of fruit and vegetables and the risk of colorectal cancer among the Japanese population.
Adhesion between swollen hydrogels was studied using a simple tack-evaluation technique by a point contact in air at room temperature. The hydrogel used here was poly(sodium acrylate) (PSA) gel physically cross-linked by aluminum ions. The adhesion force and the separation energy showed a power-law increase with separation velocity, normal force, and waiting period prior to separate. Effects of the degrees of protonation in PSA as well as of dehydration on the adhesive properties are also presented. The results are discussed in terms of the surface molecular interaction and the bulk elastic and viscous properties.
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