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The Diamond Princess cruise ship, carrying 3711 passengers and crew members, docked at Yokohama Port in Japan on February 3, 2020. A quarantine was immediately instituted because 1 passenger who had disembarked in Hong Kong was confirmed to have tested positive for coronavirus disease 2019 (COVID-19). After the quarantine began, all passengers and crew were tested using the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction assay on the ship, 696 of whom tested positive. In total, 769 patients, including 696 with COVID-19, required transport to a hospital. The Japan Disaster Medical Assistance Team (DMAT) successfully picked up and safely transported the COVID-19 patients using a novel classification system to prioritize patients. The Japan DMAT transported 203 patients to hospitals in Kanagawa and another 566 patients to hospitals in 15 different prefectures.
Triaging plays an important role in providing suitable care to a large number of casualties in a disaster setting. A Pediatric Physiological and Anatomical Triage Score (PPATS) was developed as a new secondary triage method. This study aimed to validate the accuracy of the PPATS in identifying injured pediatric patients who are admitted at a high frequency and require immediate treatment in a disaster setting. The PPATS method was also compared with the current triage methods, such as the Triage Revised Trauma Score (TRTS).
Methods:
A retrospective review of pediatric patients aged ≤15 years, registered in the Japan Trauma Data Bank (JTDB) from 2012 through 2016, was conducted and PPATS was performed. The PPATS method graded patients from zero to 22, and was calculated based on vital signs, anatomical abnormalities, and the need for life-saving interventions. It categorized patients based on their priority, and the intensive care unit (ICU)-indicated patients were assigned a PPATS ≥six. The accuracy of PPATS and TRTS in predicting the outcome of ICU-indicated patients was compared.
Results:
Of 2,005 pediatric patients, 1,002 (50%) were admitted to the ICU. The median age of the patients was nine years (interquartile range [IQR]: 6-13 years). The sensitivity and specificity of PPATS were 78.6% and 43.7%, respectively. The area under the receiver-operating characteristic (ROC) curve (AUC) was larger for PPATS (0.61; 95% confidence interval [CI], 0.59-0.63) than for TRTS (0.57; 95% CI, 0.56-0.59; P <.01). Regression analysis showed a significant correlation between PPATS and the Injury Severity Score (ISS; r2 = 0.353; P <.001), predicted survival rate (r2 = 0.396; P <.001), and duration of hospital stay (r2 = 0.252; P <.001).
Conclusion:
The accuracy of PPATS for injured pediatric patients was superior to that of current secondary triage methods. The PPATS method is useful not only for identifying high-priority patients, but also for determining the priority ranking for medical treatments and evacuation.
Triaging plays an important role in providing suitable care to the largest number of casualties in a disaster setting. We developed the Pediatric Physiological and Anatomical Triage score (PPATS) as a new secondary triage method.
Aim:
This study was performed to validate the accuracy of the PPATS in pediatric patients with burn injuries.
Methods:
A retrospective review of pediatric patients with burn injuries younger than 15 years old registered in the Japan Trauma Databank from 2004 to 2016 was conducted. The PPATS, which was assigned scores from 0 to 22, was calculated based on vital signs, anatomical abnormalities, and need for life-saving intervention. The PPATS categorized the patients by their priority and defined the intensive care unit (ICU)-indicated patients as those with PPARSs more than 6. This study compared the accuracy of prediction of ICU-indicated patients between the PPATS and Triage Revised Trauma Score (TRTS).
Results:
Among 87 pediatric patients, 62 (71%) were admitted to the ICU. The median age was 3 years (interquartile range: 1 to 9 years old). The sensitivity and specificity of the PPATS were 74% and 36%, respectively. The area under the receiver-operating characteristic curve was not different between the PPTAS [0.51 (95% confidence interval: -0.51–1.48) and the TRTS [0.51 (-1.17–1.62), p=0.57]. Regression analysis showed a significant association between the PPATS and the Injury Severity Score (ISS) (r2=0.39, p<0.01). On the other hand, there is no association between the TRTS and the ISS (r2=0.00, p=0.79).
Discussion:
The accuracy of the PPATS was not superior to that of current secondary-triage methods. However, the PPATS had the advantage of objectively determining the triage priority ranking based on the severity of the pediatric patients with burn injuries.
In July 2016, a mass-casualty stabbing attack took place at a facility for disabled persons located in Sagamihara City (Kanagawa Prefecture, Japan). The attack resulted in 45 casualties, including 19 deaths. The study hospital dispatched physicians to the field and admitted multiple casualties. This report aimed to review the physicians’ experiences and to provide insights for the formulation of response measures for similar incidents in the future.
Report:
This incident involved 30 emergency teams and 12 fire department teams, including those from neighboring fire departments. Five physicians from three medical institutions, including the study hospital, entered the field. The Simple Triage and Rapid Treatment (START) method was used on the field. The final field triage category count was: 20 red, four yellow, two green, and 19 black tags. All the casualties (n = 26) except for the 19 black tag casualties were transported to one of six neighboring medical institutions.
The median age of the transported casualties was 41 years (interquartile range [IQR] = 35.5 – 42.0). Three casualties (21.4%) were in hemorrhagic shock on arrival at the hospital. Twelve patients had multiple cervical stab wounds (median four wounds; IQR = 3.75 – 6.0). A total of 91.7% of these stab wounds were in mid-neck Zone II region. Of the 12 patients with cervical stab wounds, four (33.3%) required emergency surgery, and the rest were sutured on an out-patient basis. One patient had already been sutured on the field. All patients requiring emergency surgery had deep wounds, including those of the carotid vein, thyroid gland, nerves, and the trachea. Eight of the casualties were hospitalized at the study institution. Five of them were admitted to the intensive care unit. There were no deaths among the casualties transported to the hospitals.
Conclusion:
Regional core disaster medical hospitals must take on a central role, particularly in the case of local disasters. Horizontal communication and interactions should be reinforced by devising protocols and conducting joint training for effective inter-department collaborations on the field.
Maruhashi, T, Takeuchi, I, Hattori, J, Kataoka, Y, Asari, Y. The Tsukui (Japan) Yamayuri-en facility stabbing mass-casualty incident. Prehosp Disaster Med. 2019;34(2):203–208
We quantified an absolute imbalance of the medical risks and the support needs for children at each disaster-based hospital in Kanagawa immediately following the occurrence of a large earthquake by using the risk resource ratio (RRR) and need for medical resources (NMR).
Methods
The RRR and NMR of 33 disaster-based hospitals were estimated through dividing the estimated number of pediatric victims by the number of critically patients. We calculated the ratio of the NMR of each hospital.
Results
The total number of pediatric victims in Kanagawa was estimated at 8,391. The total number of vacant beds for pediatric victims was 352. The median RRR and NMR of the total number of pediatric victims were 27 and 224. The median RRR and NMR of the number of critically ill pediatric patients were 27 and 12.
Conclusions
The absolute imbalance of the RRR and NMR for children in Kanagawa was quantified. This suggests that we might embark on preparedness strategies for children in advance. (Disaster Med Public Health Preparedness. 2018;13:672–676)
Elastocaloric materials exhibit extraordinary cooling potential, but the repetition of cyclic mechanical loadings during long-term operation of cooling systems requires the refrigerant material to have long fatigue life. This article reviews the fundamental cause of fatigue from aspects of initiation and propagation of fatigue cracks in shape-memory alloys (SMAs) that are used as elastocaloric materials, and highlights recent advances in using compression to overcome fatigue by curtailing the generation of surfaces associated with crack propagation. Compression is identified as a key means to extend fatigue lifetime in engineering design of elastocaloric cooling drive mechanisms. We summarize the state-of-the-art performance of different SMAs as elastocaloric materials and discuss the influence of low cyclic strains and high resistance to transformation. We present integration of compression-based material assemblies into a cooling system prototype and optimization of the system efficiency using work recovery and related measures.
This work attempts to optimize past research results on lead zirconate titanate (PZT) using the fabrication processes at the U.S. Army Research Laboratory so as to achieve a high degree of {001} texture and improved piezoelectric properties. A comparative study was performed between Ti/Pt and TiO2/Pt bottom electrodes. The results indicate that the use of a highly oriented {100} rutile phase TiO2 led to highly textured {111} Pt which in turn improved both the PTO and PZT orientations. PZT (52/48) and (45/55) thin films with and without PTO seed layers were deposited and examined via x-ray diffraction (XRD) methods as a function of annealing temperature. The seed layer provides significant improvement in the {100} orientation generally, and in the {001} subset of planes specifically, while suppressing the {111} orientation of the PZT. Improvements in the Lotgering factor (f) were observed from an existing Ti/Pt/PZT process (f = 0.66) to samples using the PTO seed layer deposited onto the improved Pt electrodes, TiO2/Pt/PTO/PZT (f = 0.96).
We review our work on combinatorial search and investigation of morphotropic phase boundaries (MPBs) in chemically substituted BiFeO3 (BFO). Utilizing the thin-film composition spread technique, we discovered that rare-earth (RE = Sm, Gd, and Dy) substitution into the A-site of the BFO lattice results in a structural phase transition from the rhombohedral to the orthorhombic phase. At the structural boundary, both the piezoelectric coefficient and the dielectric constant are substantially enhanced. It is also found that the observed MPB behavior can be universally described by the average A-site ionic radius as a critical parameter, indicating that chemical pressure effect due to substitution is the primary cause for the MPB behavior in RE-substituted BFO. Our combinatorial investigations were further extended to the A- and B-site cosubstituted BFO in the pseudoternary composition spread of (Bi1−xSmx)(Fe1−yScy)O3. Clustering analysis of structural and ferroelectric property data of the fabricated pseudoternary composition spread reveals close correlations between the structural and ferroelectric properties. We show that the evolution in structural and ferroelectric properties is controlled solely by the A-site Sm substitution and not the B-site Sc substitution.
Three 100 nm-thick Mgx(TM)1-x (TM = Ni and Ti) composition spread thin films having compositional variation 0.4<x<0.95 and capped with a 5 nm-thick Pd layer were deposited in combinatorial electron-beam (e-beam) deposition chamber. Crystallinity of the films was characterized by scanning x-ray diffraction (XRD) and cross-sectional transmission electron microscopy (TEM). Hydrogen absorption and desorption of the films were monitored with an infrared (IR) camera that could image a full area of the films. The observed changes in IR intensity due to hydrogen absorption/desorption demonstrated sensitivity of the method to the differences in compostion, microstructure and type of TM.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
Abstract
In order to pursue device applications of magnetoelectric Cr2O3, we have fabricated epitaxial Cr2O3 thin films on (001), (110) and (101) oriented Nb doped TiO2 by pulsed laser deposition. The Cr2O3 films with different thicknesses (0.3 1 ¦Ìm) showed extremely smooth surfaces with rms roughness ¡Ö 0.3 nm (for 10 X 10 ¦Ìm2) as measured by AFM for all 3 different orientations. The films display robust insulating properties at room temperature with leakage current density of 8.9 X 10-6 A/cm2 at 10 kV/cm for 300 nm thick films. In order to investigate exchange bias, we fabricated bilayer films of Cr2O3/Co with all 3 orientations. The magnetic properties of the films were measured using SQUID and the magnetic optical Kerr effect (MOKE). From the Cr2O3/Co film grown on a (110) oriented TiO2, we clearly observe exchange bias of ¡Ö 13 Oe with a coercive field of 115 Oe upon cooling from 320 K to 30 K in a 1 T magnetic field. The microstructural properties of the bilayers and the effect of electric field on the exchange bias behavior were investigated using TEM, VSM and MOKE. Comparison of exchange bias with BiFeO3 and TbMnO3 multiferroic thin films will also be discussed. This work is supported by W. M. Keck Foundation, ONR grant No. N00014-01-1-0761, N00014-04-1-0085, and the NSF under grants DMR-00-94265 (CAREER), NSF DMR-00-0231291, NSF 0095166, NSF-MRSEC Award No. DMR-00-0520471. We acknowledge use of the Nanoscale Imaging, Spectroscopy, and Properties (NISP) Laboratory for TEM characterization.
High-throughput experimentation is effective in systematically producing large and diverse data sets. The marriage of combinatorial materials science and informatics is a natural one, and results are beginning to emerge from the integration of elements of materials informatics with data from combinatorial libraries. We discuss data management issues in high-throughput experimentation and highlight recent examples where data-mining tools are being implemented for extracting knowledge and predicting new compounds, with an emphasis on electronic materials.
Shape memory alloy (SMA) thin films are used as actuator materials in MEMS due to their unique properties. Binary thin films with a composition close to Ni50Ti50 are well-established materials, whereas ternaries like NiTiCu, NiTiPd, NiTiHf are less studied. Furthermore, new alloys are being developed which show a magnetic shape memory effect, e.g. Ni2MnGa. For the optimization of known, and the development of new, SMA thin films, a fast and reliable characterization technology is needed, which rapidly identifies the transformation temperatures (i.e. martensite and austenite start and finish temperatures) for a range of material compositions deposited on a whole wafer. In this paper, automated temperature-dependent resistance measurements are discussed as a means which yields the thermal hysteresis of the investigated thin films. Results of monitoring the uniformity of shape memory film depositions on the wafer level, as well as results on the use of this method as a tool for screening for new SMA films by characterization of materials libraries are reported.
We discuss visualization and data dependency issues related to managing sample characterization data from high-throughput experiments. We are developing software for on-line storage, sharing, and visualization of data from combinatorial or high-throughput experiments. The system is based on a centralized database and a Web interface that can be accessed from any networked computer. The greatest challenge facing us is the variety of data types and formats that such a system has to support so that data from many different sources, i.e. from synthesis and characterization instruments, could be combined. In order to minimize the software development effort, we have developed generalized extensible markup language (XML) schema for storing and processing experimental data. The use of a standard data format like XML, together with the relevant schema definitions can be used to implement storage, processing, visualization and other tools that are generic and thus greatly simplify the task of managing high-throughput experiments.
Giant magnetostrictive Fe-Pd and Fe-Ga thin films are expected as actuator/ sensor materials with high respective velocity and huge stress created by the magnetostriction. In order to develop magnetostrictive material induced by low magnetic field, we investigated bimorph-type magnetostrictive (positive magnetostriction / substrate / negative magnetostriction) thin films, that is, Fe-Pd(1, 3µm) or Fe-Ga(1, 3µm)/substlate /Ni(1, 3µm) by magnetron sputtering system. The substrate is Al(50µm) or kapton foil (125µm). Displacement of a upper part of these films was measured using an optical lever method. The displacement of the Fe70-Pd30(3µm )/ Al(50µm)/Ni(3µm)film ( length is 20 mm) was 280 μm under low DC magnetic field of 500 Oe and exhibits little hysteresis. These magnetostrictive properties are maintained under low alternating magnetic field. Moreover, the displacement of the film at the resonance frequency exhibits a peak and reached to 1.4 mm. The bimorph-type magnetostrictive thin film is useful for application in micro device as micro-pomp.
Caprella spp. (Crustacea: Amphipoda) inhabiting the Sargassum algal community in Otsuchi Bay near unpopulated areas of northern Japan, were collected from 1994 to 2001 and subjected to analysis of butyltin (BT) concentrations. The period from 1994 to 2001 corresponds to four to 11 years after legislation limiting the use of tributyltin (TBT) on small boats and aquaculture facilities was passed in Japan. Butyltin compounds including TBT, dibutyltin (DBT) and monobutyltin (MBT) were detected in all samples of Caprella spp., although the three BTs were not detected in seawater samples collected from the same area between 1997 and 1999. The concentration of total BTs (BTs=MBT+DBT+TBT) in Caprella spp. significantly decreased from 84 ng BTs/g wet wt in 1994 to 7·4 ng/g wet wt in 2001. The concentrations of BTs in Caprella spp., which have a high bioconcentration factor for TBT, are thought to reflect the average concentrations of BTs in the surrounding seawater in the previous few months. The half-life of BTs and TBT in Caprella spp. was 2·38 years and 2·07 years, respectively, which are less than half of that of TBT in seawater based on the national survey of The Ministry of the Environment, Japan. Illegal usage of TBT near the studied area may have decreased due to monitoring of BTs.