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To assess the impact of nationwide outpatient antimicrobial stewardship interventions in the form of financial incentives for providers and provider education when antimicrobials are deemed unnecessary for uncomplicated respiratory infections and acute diarrhea.
Methods:
We collected data from a large claims database from April 2013 through March 2020 and performed a quasi-experimental, interrupted time-series analysis. The outcome of interest was oral antimicrobial prescription rate defined as the number of monthly antimicrobial prescriptions divided by the number of outpatient visits each month. We examined the effects of financial incentive to providers (ie, targeted prescriptions for those aged ≤2 years) and provider education (ie, targeted prescriptions for those aged ≥6 years) on the overall antimicrobial prescription rates and how these interventions affected different age groups before and after their implementation.
Results:
In total, 21,647,080 oral antimicrobials were prescribed to 2,920,381 unique outpatients during the study period. At baseline, prescription rates for all age groups followed a downward trend throughout the study period. Immediately after the financial incentive implementation, substantial reductions in prescription rates were observed among only those aged 0–2 years (−47.5 prescriptions per 1,000 clinic visits each month; 95% confidence interval, −77.3 to −17.6; P = .003), whereas provider education immediately reduced prescription rates in all age groups uniformly. These interventions did not affect the long-term trend for any age group.
Conclusion:
These results suggest that the nationwide implementation of financial incentives and provider education had an immediate effect on the antimicrobial prescription but no long-term effect.
The left-tailed unit-root tests of the panel analysis of nonstationarity in idiosyncratic and common components (PANIC) proposed by Bai and Ng (2004, Econometrica 72, 1127–1177) have standard local asymptotic power. We assess the size and power properties of the right-tailed version of the PANIC tests when the common and/or the idiosyncratic components are moderately explosive. We find that, when an idiosyncratic component is moderately explosive, the tests for the common components may have considerable size distortions, and those for an idiosyncratic component may suffer from the nonmonotonic power problem. We provide an analytic explanation under the moderately local to unity framework developed by Phillips and Magdalinos (2007, Journal of Econometrics 136, 115–130). We then propose a new cross-sectional (CS) approach to disentangle the common and idiosyncratic components in a relatively short explosive window. Our Monte Carlo simulations show that the CS approach is robust to the nonmonotonic power problem.
Meal timing is a key factor in synchronising the circadian clock in peripheral tissues. Circadian disorders are associated with the metabolic syndrome. Previously, we demonstrated that a skipping breakfast regimen (SBR) with a high-fat diet increased body weight gain in rats. In this study, we investigated whether SBR with a normal diet led to abnormal lipid metabolism and muscle metabolism in mice. Male C57BL/6 mice were fed during zeitgeber time (ZT) 12–24 in the control group and ZT 16–24 in the SBR group for 2 weeks. SBR mice showed increased body weight gain and perirenal adipose tissue weight. The plantar muscle weight was decreased in the SBR group compared with that in the control group. Furthermore, SBR delayed the circadian oscillations in clock gene expression in peripheral tissues, such as the liver, adipose tissue and muscle, as well as the oscillations in the expression of lipid metabolism-related genes in the liver and adipose tissue. These results suggest that skipping breakfast over a long period of time is associated with a risk of obesity, the metabolic syndrome and muscle loss, such as sarcopenia.
First responders to disasters are at risk of developing post-traumatic stress disorder (PTSD). The trajectories of post-traumatic stress symptom severity differ among individuals, even if they are exposed to similar events. These trajectories have not yet been reported in non-Western first responders.
Aims
We aimed to explore post-traumatic stress symptom severity trajectories and their risk factors in first responders to the 2011 Great East Japan Earthquake (GEJE) – a historically large earthquake that resulted in a tsunami and a nuclear disaster.
Method
A total of 55 632 Japan Ground Self-Defense Force (JGSDF) personnel dispatched to the GEJE were enrolled in this 7-year longitudinal cohort study. PTSD symptom severity was measured using the Impact of Event Scale-Revised. Trajectories were identified using latent growth mixture models (LGMM). Nine potential risk factors for the symptom severity trajectories were analysed using multinomial logistic regression.
Results
Five symptom severity trajectories were identified: ‘resilient’ (54.8%), ‘recovery’ (24.6%), ‘incomplete recovery’ (10.7%), ‘late-onset’ (5.7%), and ‘chronic’ (4.3%). The main risk factors for the four non-resilient trajectories were older age, personal disaster experiences and working conditions. These working conditions included duties involving body recovery or radiation exposure risk, longer deployment length, later or no post-deployment leave and longer post-deployment overtime.
Conclusions
The majority of first responders to GEJE were resilient and developed few or no PTSD symptoms. A substantial minority experienced late-onset and chronic symptom severity trajectories. The identified risk factors can inform policies for prevention, early detection and intervention in individuals at risk of developing symptomatic trajectories.
Based on experiences following the Great East Japan Earthquake and nuclear power plant accident in 2011, Nuclear Emergency Core Hospitals (NECHs) were designated as centers for radiation disaster management in Japan. This study aimed to investigate their current status and identify areas for improvement.
Methods:
This cross-sectional study was conducted in October 2018. Demographic data were collected by a questionnaire with free text responses about attitudes toward NECHs. Considerations regarding risk communications during a radiation disaster were analyzed using qualitative text mining analysis.
Results:
A total of 36 hospitals participated in this study. Only 31% of NECHs anticipated a radiation disaster. The importance of business continuity plans and risk communications was shown. Text analysis identified 7 important categories for health care workers during a radiation disaster, including media response, communications to hospital staff, risk communications, radiation effects on children, planning for a radiation disaster in the region, rumors, and the role in the region.
Conclusion:
The radiation disaster medical system and NECHs in Japan were surveyed. The importance of risk communications, planning for a radiation disaster in each region, and the role in the region are identified as issues that need to be addressed.
This study investigated the incidence and risk factors of perioperative clinical seizure and epilepsy in children after operation for CHD. We included 777 consecutive children who underwent operation from January 2013 to December 2016 at Kanagawa Children’s Medical Center, Kanagawa, Japan. Perinatal, perioperative, and follow-up medical data were collected. Elastic net regression and mediation analysis were performed to investigate risk factors of perioperative clinical seizure and epilepsy. Anatomic CHD classification was performed based on the preoperative echocardiograms; cardiac surgery was evaluated using Risk Adjustment in Congenital Heart Surgery 1. Twenty-three (3.0%) and 15 (1.9%) patients experienced perioperative clinical seizure and epilepsy, respectively. Partial regression coefficient with epilepsy as the objective variable for anatomical CHD classification, Risk Adjustment in Congenital Heart Surgery 1, and the number of surgeries was 0.367, 0.014, and 0.142, respectively. The proportion of indirect effects on epilepsy via perioperative clinical seizure was 22.0, 21.0, and 33.0%, respectively. The 15 patients with epilepsy included eight cases with cerebral infarction, two cases with cerebral haemorrhage, and three cases with hypoxic-ischaemic encephalopathy; white matter integrity was not found. Anatomical complexity of CHD, high-risk cardiac surgery, and multiple cardiac surgeries were identified as potential risk factors for developing epilepsy, with a low rate of indirect involvement via perioperative clinical seizure and a high rate of direct involvement independently of perioperative clinical seizure. Unlike white matter integrity, stroke and hypoxic-ischaemic encephalopathy were identified as potential factors for developing epilepsy.
We show that a piecewise monotonic map with positive topological entropy satisfies the level-2 large deviation principle with respect to the unique measure of maximal entropy under the conditions that the corresponding Markov diagram is irreducible and that the periodic measures of the map are dense in the set of ergodic measures. This result can apply to a broad class of piecewise monotonic maps, such as monotonic mod one transformations and piecewise monotonic maps with two monotonic pieces.
Phloeocharinae is a small and likely non-monophyletic subfamily of rove beetles. The enigmatic genus Charhyphus Sharp, 1887 has long been placed in Phloeocharinae, whereas recent studies have found it to be phylogenetically very distant from the core members of this subfamily, suggesting the possibility that it actually deserves its own separate subfamily status. So far, the sole definitive fossil record for Charhyphus is known based on a single male from Eocene Baltic amber as represented by †Charhyphus balticus Shavrin, 2020. Here, we describe and illustrate another new Charhyphus species, †Charhyphus serratus sp. nov. Yamamoto & Shavrin, from Baltic amber based on a well-preserved female fossil. Considering the general proportions of the body and the head, this new species is most similar to †C. balticus. The new species differs from all known species by the development of strong serration of the lateral edges of the pronotum and features of the shape of the apical margin of the mesoventrite. By using X-ray micro-computed tomography, we succeeded in visualising not only the general habitus but also each individual body part, recovering a previously undocumented sclerite on the female internal genital segments in the genus. Morphological features of extinct and extant species of Charhyphus are briefly discussed. Figures of all extant Charhyphus species and a key for the genus are also provided. Our study is important for considering possible higher palaeodiversity, more common occurrence, and palaeobiogeography of Charhyphus.
At mass-gathering events of the Olympic and Paralympic Games, a well-organized, on-site medical system is essential. This study evaluated the vulnerabilities of the prehospital medical system of the TOKYO 2020 Olympic and Paralympic Games (TOKYO2020) to propose corrections that can be generalized to other mass gatherings. The healthcare failure mode and effect analysis (HFMEA) was adopted to analyze vulnerabilities of the on-site medical system proposed by the organizing committee of TOKYO2020. Processes from detecting a patient on the scene to completing transport to a hospital were analyzed. Ten processes with 47 sub-processes and 122 possible failure modes were identified. HFMEA revealed 9 failure modes as vulnerabilities: misidentification of patient, delayed immediate care at the scene, misjudgment of disposition from the on-site medical suite, and inappropriate care during transportation to hospital. Proposed corrections included surveillance to decrease blind spots, first aid brochures for spectators, and uniform protocol for health care providers at the scene. The on-site medical system amended by HFMEA seemed to work appropriately in TOKYO2020.
This study aimed to examine the prevalence of deep vein thrombosis (DVT) among evacuees in Minamiaso, a village which was temporarily isolated after the earthquakes, from the acute to recovery phase after the 2016 Kumamoto Earthquakes (GLIDE no: EQ-2016-000033-JPN).
Methods:
This prospective study, which was approved by Fukui University Medical Research Ethics Committee (approval no. 20160024 and 20160089), enrolled 181 evacuees (73.9 ± 11.6 y) who participated in a series of 3 DVT screenings using portable ultrasound machines conducted over 19 mo. All participants completed a questionnaire before the screenings, and none of the participants attended all 3 screenings. Data analysis was performed using EZR version 1.41.
Results:
The DVT prevalence was 14.3% (79.4 ± 8.2 y) at first screening of evacuees staying in shelters and 18.5% (71.5 ± 13.1 y) and 12.2% (72.8 ± 10.9 y) in second and third screenings of evacuees staying in temporary housing, respectively. Multivariate analysis revealed age ≥75 y and alcohol consumption as independent risk factors in the entire cohort and in patients aged ≤74 y, respectively.
Conclusions:
A high DVT prevalence over a long time period of 19 mo was observed where survivors were temporarily isolated after the disaster.
The brain is rich in long-chain PUFA, which play an essential role in its development and functions. Here, we examined the impact of maternal n-3 PUFA intake deficiency during gestation and lactation on the development of glial cells in the pup’s developing cerebral cortex. In addition, using myelination as indicator and the anti-myelin basic protein as measurement to establish the relationship between the number of glial fibrillary acidic protein (GFAP)-positive cells and the development of oligodendrocytes, we determined the myelination state of the somatosensory cortex at postnatal day 14. Rat dams were fed either a control (Cont) or an n-3 PUFA-deficient (Def) diet for 60 d (acclimatisation: 14 d; gestation: 21 d; and lactation: 21 d). Pups lactated from dams throughout the experiment. The distribution pattern of astrocytes in pups on postnatal day 7 was immunohistochemically analysed using GFAP and brain lipid binding protein (BLBP) as markers for mature astrocytes and astrocyte-specific radial glial cells, respectively. It was observed that, when compared with Cont pups, GFAP-positive cells decreased, BLBP-positive cells increased and myelinated structures were sparser in the somatosensory cortices of Def pups. In the open field test on postnatal day 21, behavioural parameters did not differ between groups. Our results indicated that inhibited maturation of astrocytes caused by maternal n-3 PUFA deficiency hindered the development of brain glial cells of neonatal rats; hence, maternal n-3 PUFA intake during the gestation and lactation periods may have been crucial for the brain cell composition of pups.
This paper presents an extension of Kolmogorov's local similarity hypotheses of turbulence to include the influence of mean shear on the statistics of the fluctuating velocity in the dissipation range of turbulent shear flow. According to the extension, the moments of the fluctuating velocity gradients are determined by the local mean rate of the turbulent energy dissipation $\left \langle \epsilon \right \rangle$ per unit mass, kinematic viscosity $\nu$ and parameter $\gamma \equiv S (\nu /\left \langle \epsilon \right \rangle )^{1/2}$, provided that $\gamma$ is small in an appropriate sense, where $S$ is an appropriate norm of the local gradients of the mean flow. The statistics of the moments are nearly isotropic for sufficiently small $\gamma$, and the anisotropy of moments decreases approximately in proportion to $\gamma$. This paper also presents a report on the second-order moments of the fluctuating velocity gradients in direct numerical simulations (DNSs) of turbulent channel flow (TCF) with the friction Reynolds number $Re_\tau$ up to $\approx 8000$. In the TCF, there is a range $y$ where $\gamma$ scales approximately $\propto y^ {-1/2}$, and the anisotropy of the moments of the gradients decreases with $y$ nearly in proportion to $y^ {-1/2}$, where $y$ is the distance from the wall. The theoretical conjectures proposed in the first part are in good agreement with the DNS results.
How can we elicit honest responses in surveys? Conjoint analysis has become a popular tool to address social desirability bias (SDB), or systematic survey misreporting on sensitive topics. However, there has been no direct evidence showing its suitability for this purpose. We propose a novel experimental design to identify conjoint analysis’s ability to mitigate SDB. Specifically, we compare a standard, fully randomized conjoint design against a partially randomized design where only the sensitive attribute is varied between the two profiles in each task. We also include a control condition to remove confounding due to the increased attention to the varying attribute under the partially randomized design. We implement this empirical strategy in two studies on attitudes about environmental conservation and preferences about congressional candidates. In both studies, our estimates indicate that the fully randomized conjoint design could reduce SDB for the average marginal component effect (AMCE) of the sensitive attribute by about two-thirds of the AMCE itself. Although encouraging, we caution that our results are exploratory and exhibit some sensitivity to alternative model specifications, suggesting the need for additional confirmatory evidence based on the proposed design.
An outbreak of serotype 19A Streptococcus pneumoniae occurred among the residents of a relief facility. Pneumonia developed in 5 of 99 residents (attack rate, 5.1%). We obtained pharyngeal specimens from non-onset residents, and S. pneumoniae was isolated from 6 individuals (6.4%), 5 of whom had serotype 19A.
The availability of new research for IoT support and the human-centric perspective of industry 4.0 opens a gap to support operators in unleashing their creativity so they can provide improvements opportunities with IoT technology. This paper presents a case-study carried out in four Swedish manufacturing companies, where four different workshops were facilitated to support operators in the conceptualization of manufacturing improvements with IoT technologies. The empirical material gathered during these workshops has been analyzed in five different reflective sessions and discussed in light of previous research from industry 4.0, operators, and IoT support. Results indicate that operators can collaboratively create conceptual IoT solutions and that expressiveness in communicating their ideas and needs using IoT technology is more relevant than technical aspects and details of their proposed IoT solutions. This technological expressiveness is identified as a necessary skill to be cultivated on the shop floor and can potentially contribute to making a more effective and socially sustainable industrial landscape in the future.
We report the long-term results of percutaneous transluminal coronary balloon angioplasty for early appearing localised stenosis of the left anterior descending artery caused by Kawasaki disease in two 2-year-olds. One patient had 50% restenosis and newly appearing aneurysm at 21-year-old, and the other had no restenosis at 16-year-old. They had no symptoms or cardiac events for 20 years. It is useful in the early localised stenosis without aneurysm.
Conjoint survey experiments have become a popular method for analyzing multidimensional preferences in political science. If properly implemented, conjoint experiments can obtain reliable measures of multidimensional preferences and estimate causal effects of multiple attributes on hypothetical choices or evaluations. This chapter provides an accessible overview of the methodology for designing, implementing, and analyzing conjoint survey experiments. Specically, we begin by detailing a new substantive example: how do candidate attributes affect the support of American respondents for candidates running against President Trump in 2020? We then discuss the theoretical underpinnings and key advantages of conjoint designs. We next provide guidelines for practitioners in designing and analyzing conjoint survey experiments. We conclude by discussing further design considerations, common conjoint applications, common criticisms, and possible future directions.
In this chapter, we examine the problem of Buraku discrimination – a traditional type of discrimination specific to Japan of which few Japanese people are aware. Similar to, but not the same as, the caste system in South Asia, Buraku were areas in which those involved in certain occupations considered distasteful were required to reside. At its most simple, the Burakumin (‘Buraku people’) are those descended from those living in these areas, but Buraku discrimination is more complex than this. The United Nations CERD has called on the Japanese government to address the issue of Buraku discrimination and the government asserts that it is fully committed to doing so. However, traditional Buraku discrimination is now manifesting as hate speech and online discrimination. The Dowa policy – a special measure that had aimed to tackle the issue – ended in 2002 and no new measures were put in place until 2016, when an Act for Eliminating Discrimination against Buraku was finally passed. This chapter focuses on three incidents that occurred in the 2000s as instances of hate speech and clarifies the modern characteristics of Buraku discrimination.
Intakes of excess Na and insufficient K are two major contributors of heart diseases and stroke development. However, no precise study has previously been carried out on Na and K intakes among Indonesian adults. The present study aimed to estimate the Na and K intakes using two consecutive 24-h urine collections. Participants were community-dwelling adults aged between 20 and 96 years, randomly selected from a pool of resident registration numbers. Of the 506 participants, 479 (240 men and 239 women) completed urine collections. The mean Na excretion was 102·8 and 100·6 mmol/d, while the mean K excretion was 25·0 and 23·4 mmol/d for men and women, respectively. Na and K excretions were higher in participants with a higher BMI. A higher K excretion was associated only with younger age. More than 80 % of the participants consumed more than 5 g/d of salt (the upper limit recommended by the Indonesian government), whereas none of them consumed more than 3510 mg/d of K (the lower limit). The high Na and low K intakes, especially high Na among participants with high BMI, should be considered when future intervention programmes are planned in this country.