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In endoscopic cricopharyngeal myotomy, surgeons sometimes have concerns about performing an adequate incision with only a narrow intra-cavital view from one direction. In order to overcome these issues, fluoroscopic radiography was used during endoscopic cricopharyngeal myotomy.
Peri-operative fluoroscopic radiography was utilised to check the position of the diverticuloscope, and to confirm the extent of the incision during surgery. A balloon catheter was used to determine whether the cricopharyngeal muscle was sufficiently resected. Blood loss, peri-operative complications, and functional oral swallowing scale and penetration aspiration scale scores were evaluated.
In 12 out of 15 patients, intra-operative fluoroscopic radiography showed the diverticuloscope positioned in the post-cricoid area, and the cricopharyngeal muscle was raised and the surgery completed without adverse effect. Swallowing functions improved following surgery.
Intra-operative fluoroscopy might improve endoscopic cricopharyngeal myotomy by allowing surgeons to confirm the extent of resection, and by reducing peri-operative morbidity and complication rates.
We aimed to verify the effectiveness of real-time reverse transcription (rRT) polymerase chain reaction (PCR) for detecting cases of modified measles (M-Me) and for predicting super-spreader candidates through the experience of a measles outbreak dominated by M-Me in Yamagata, Japan, during March–April 2017. We applied rRT-PCR to specimens from 35 cases of M-Me, nine cases of typical measles (T-Me) and nine cases of prodromal stage of T-Me (P-Me). From rRT-PCR among the M-Me cases, peripheral blood mononuclear cells (PBMC) showed the highest positive rate (80.0%), followed by throat swab (48.6%), urine (33.3%) and serum (3.1%). The negative result of PBMC in M-Me cases was recovered by the result of a throat swab. In specimens of PBMC, throat swab and urine, M-Me group showed the significantly higher cycle of threshold (i.e., lower viral load) in the rRT-PCR than T-Me and P-Me groups, respectively. Furthermore, three super-spreaders in T-Me or P-Me showed an extremely low cycle of threshold in their throat swab specimens. rRT-PCR using PBMC and throat swab might be helpful for clinical management and measles control by certain detection of M-Me cases and by predicting super-spreading events resulting from measles cases with the high viral load.
Field surveys of supraglacial ponds on debris-covered glaciers in the Nepal Himalaya clarify that ice-cliff calving occurs when the fetch exceeds ∼80 m. Thermal undercutting is important for calving processes in glacial lakes, and subaqueous ice melt rates during the melt and freeze seasons are therefore estimated under simple geomorphologic conditions. In particular, we focus on the differences between valley wind-driven water currents in various fetches during the melt season. Our results demonstrate that the subaqueous ice melt rate exceeds the ice-cliff melt rate when the fetch is >20 m and water temperature is 2–4°C. Calculations suggest the onset of calving due to thermal undercutting is controlled by water currents driven by winds at the surface of the lake, which develop with expanding water surface.
In this chapter, Woo, Walton, and Takeuchi examine and summarize some cultural issues in the treatment of racial and ethnic minorities with mental health problems. They review some key data on the use of mental health services by ethnic minorities including consideration of access to services, use of services, and service outcomes. Many geographic areas have been dramatically altered by the rising racial, ethnic, and cultural diversity of the United States, creating different and sometimes novel approaches to the prevention and treatment of mental health problems. The authors examine a range of efforts to address these needs at provider, agency, and community levels. They ask you to consider the following questions in reading the chapter. As a society, how broadly are we willing to recognize and respond to growing culturally diverse mental health needs? What efforts can be made to resolve the mental health disparities among racial and ethnic minorities?
The Changing Demographics of the United States
The US population has become increasingly racially, ethnically, and culturally diverse. At the turn of the twentieth century and continuing until the 1950s, racial and ethnic minority groups, primarily consisting of African Americans, represented approximately 10–12 percent of the adult population (US Census Bureau, 1975). The number of immigrants has grown since the US Immigration Act of 1965, which replaced the national origin quota system favoring prioritized and skilled labor needed by the economy and family unification (Gordon, 1998; Keely, 1971). Representing a radical departure from the population at the beginning of the 1990s, racial and ethnic minorities were projected to comprise 38 percent of the total population in the year of 2015 and to reach 56 percent in 2060: Hispanic white, 25 percent; black, 14 percent; American Indian and Alaska Native, 1 percent; Asian, 9 percent; Native Hawaiian and other Pacific Islander, 0.29 percent; two or more races, 6 percent (US Census Bureau, 2014a). Though there have been changes in the manner in which the US Census Bureau defined racial categories (e.g., the 2000 Census allowed respondents to choose more than one racial group and created a new racial category encompassing Native Hawaiian/Pacific Islander), the shift in the population characteristics encompasses a dramatic change in the US demography.
A two-dimensional, finite-element calculation was performed to simulate the development of a snowdrift. The underlying two-dimensional topography was taken as the lower boundary, and this changed as the drift developed. The two-dimensional wind field was calculated from the Navier–Stokes equations. The calculation was performed until a quasi-steady state was reached, and the pattern of erosion and deposition was estimated by computing the divergence of snowdrift transport. Considering a snowdrift as a new surface, the wind field was then recalculated. Simulated results were compared with outdoor observations of the wind field and snowdrifts. The results were in fairly good agreement with each other, but more detailed research is regarded as being necessary.
In temperate zones, human respiratory syncytial virus (HRSV) outbreaks typically occur in cold weather, i.e. in late autumn and winter. However, recent outbreaks in Japan have tended to start during summer and autumn. This study examined associations of meteorological conditions with the numbers of HRSV cases reported in summer in Japan. Using data from the HRSV national surveillance system and national meteorological data for summer during the period 2007–2014, we utilized negative binomial logistic regression analysis to identify associations between meteorological conditions and reported cases of HRSV. HRSV cases increased when summer temperatures rose and when relative humidity increased. Consideration of the interaction term temperature × relative humidity enabled us to show synergistic effects of high temperature with HRSV occurrence. In particular, HRSV cases synergistically increased when relative humidity increased while the temperature was ⩾28·2 °C. Seasonal-trend decomposition analysis using the HRSV national surveillance data divided by 11 climate divisions showed that summer HRSV cases occurred in South Japan (Okinawa Island), Kyushu, and Nankai climate divisions, which are located in southwest Japan. Higher temperature and higher relative humidity were necessary conditions for HRSV occurrence in summer in Japan. Paediatricians in temperate zones should be mindful of possible HRSV cases in summer, when suitable conditions are present.
Recent studies have been revealing the properties of dwarf spheroidal galaxies (dSphs). Their low mass indicates that the dSphs may provide a clue to physical properties of the building blocks in the hierarchical structure formation. We select the Local Group dSphs as a sample. To obtain the information on the star formation history of dSphs, we investigate the relation between their metallicity and virial mass. According to our scenario, the star formation efficiency of the dSphs is low because of strong regulation. This is consistent with their high mass-to-light ratios. We also comment on the environmental effects on the dSphs.
We studied the statistical methods for the estimation of the luminosity function (LF) of galaxies by Monte Carlo simulations. After examining the performance of these methods, we analyzed the photometric redshift data of the Hubble Deep Field prepared by Fernández-Soto et al. (1999). We also derived luminosity density ρL at B- and I-band. Our B-band estimation is roughly consistent with that of Sawicki, Lin, & Yee (1997), but a few times lower at 2.0 < z < 3.0. The evolution of ρL(I) is found to be less prominent.
We have made a CO(J=2-1) observations using the Nobeyama 45m telescope aimed at examining the physical properties of the molecular gas in this object. The upper limit obtained is 1.8 mK (3σ) at a velocity resolution of 100 km s−1, which leads to an upper limit on the molecular gas mass of 5.3 × 1011M⊙, if we assume a line width of 250 km s−1 obtained in the CO(J = 5 - 4) line (rest-frame) and the Galactic CO-to-H2 conversion factor of 4.5 (M⊙ K km s−1 pc2). The line ratio between the 2–1 line and the 5–4 line as well as those from the 7–6 and the 4–3 lines (Omont et al. 1996, Nature, 382, 428) imply that the mean gas density is as high as 103–5 cm−3, which is comparable to that in nearby star burst galaxies (e.g., Solomon et al. 1992, ApJ, 387, L55).
We analyzed 10 dwarf spheroidal galaxies (dSphs) in the Local Group, and found two distinct sequences on the Mvir/L - Mvir plane: Mvir/L ∝ Mvir1.6 for Mvir < 108M⊙ whereas Mvir/L ≃ const. for Mvir > 108M⊙ (Mvir and L are the virial mass and the total luminosity of a dSph, respectively). We interpret the discontinuity as the threshold for the gas in dSphs to be blown away by successive supernovae. We succeeded in giving a quantitative explanation of the discontinuity mass of 108M⊙ as the blow-away condition. We further derived the above relation for the low-mass dSphs, assuming that the initial star formation rate of the dSphs is proportional to the inverse of the cooling time. The relation of high-mass dSphs is also explained along with the same consideration, with the condition that the gas cannot be blown away.
We investigate the dark matter (DM) content in the Local Group dwarf spheroidal galaxies (dSphs) by examining the correlations among their physical quantities. Two origins of the large velocity dispersions of the dSphs are possible:  the existence of DM and  tidal heating by the Galaxy. The correlation tests support both  and . We finally mention circumstantial evidence for the existence of DM in the dSphs.
The hypothetical object called “failed cluster” of galaxies is described by Tucker et al. (1995, ApJ, 444, 532) as a large cloud of X-ray emitting hot gas without any visible galaxies. They made extensive survey of this type of objects using Einstein IPC database and found only one candidate, 0806+20.
We have made a CO (J=2−1) observation using the Nobeyama 45m telescope aimed at examining physical properties of the molecular gas in the object. Upper limit obtained is 1.8 mK (3σ) at a velocity resolution of 100 km s−1, which leads to an upper limit on the molecular gas mass of 5.3 × 1011M⊙, if we assume a line width of 250 km s−1 obtained in J = 5–4 line and the Galactic CO-to-H2 conversion factor of 4.5 M⊙ K km s−1 pc2. The line ratio between 2–1 line and 5–4 line as well as those from 7–6 and 4–3 lines (Omont et al. 1996) imply that the mean gas density is as high as 103–5 cm−3, which is comparable to that in nearby star burst galaxies (e.g., Solomon et al. 1992).
Infrared Imaging Surveyor (IRIS, officially Astro-F) is a satellite which will be launched in the winter of 2003. The main purpose of the IRIS mission is an all sky survey in the mid- and far-IR with a flux limit much deeper than that of IRAS. In order to examine the performance of the survey and to find a suitable set of bandpasses for tracing galaxy evolution and picking up protogalaxy candidates as effective as possible using IRIS, we estimated the FIR galaxy counts based on a simple model with various sets of cosmological parameters and evolution types.
Recently reported infrared galaxy number counts and cosmic infrared background (CIRB) measures all suggest that galaxies have experienced a strong evolutionary phase. We statistically estimated the galaxy evolution history from these data. We treated the evolution of galaxy luminosity as a stepwise nonparametric form, in order to explore the most suitable evolutionary history which satisfies the constraint from the CIRB. We found that an order of magnitude increase of the far infrared luminosity at redshift z = 0.75 - 1.0 was necessary to reproduce the very high CIRB intensity at ~ 150 μm reported by Hauser et al. (1998). We note that too large an evolutionary factor at high z overpredicts the CIRB intensity around 1 mm. The evolutionary history also satisfies the constraints from galaxy number counts obtained by IRAS, ISO and SCUBA. The rapid evolution of the IR luminosity density required from the CIRB well reproduces the very steep slope of galaxy number counts obtained by ISO. Based on this result and the evolution of optical luminosity density, we quantitatively discuss the contribution of starburst galaxies. In addition, we present the performance of the Japanese IRIS galaxy survey.