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Transoral robotic surgery is frequently described, driven by the desire to offer a less morbid alternative to chemoradiation. However, the objective evaluation of post-operative function has rarely been reported. Therefore, high-resolution manometry was used in this study to evaluate the impact of changes in peri-operative swallowing function on pharyngeal pressure events.
Ten patients with various stages of oropharyngeal cancer underwent transoral surgery. High-resolution manometry and videofluoroscopic swallow studies were performed before surgery and two months afterwards. The following parameters were obtained: velopharyngeal and mesopharyngeal post-deglutitive upper oesophageal sphincter pressures, velo-meso-hypopharyngeal contractile integral, upper oesophageal sphincter relaxation pressure, and pharyngeal velocity.
There was no significant difference in pharyngeal pressure or contractile integral pre- versus post-operatively. However, pharyngeal velocity was significantly higher post-operatively than pre-operatively.
High-resolution manometry showed that transoral surgery in patients without pre-operative dysphagia preserved pharyngeal constriction. However, transoral surgery might produce scar formation in the pharynx, which could lead to narrowing of the pharynx.
To understand the lubrication-dominated permeation through a membrane, numerical simulations of permeation through a moving corrugated permeable membrane is carried out with a fully validated numerical method. Through comparisons between the numerical results and the results of an asymptotic analysis of permeate flux (under an infinitesimal permeability condition) using Reynolds lubrication equation, the effect of permeation on lubrication and its inverse effect (i.e., the dependence of permeation on lubrication) are discussed. The linear and non-linear dependences of the relaxation of the lubrication pressure due to membrane permeation are identified. The effect of the tangential component of the permeate flux is evaluated by a linear analysis, and the limitation of Reynolds-type lubrication is discussed.
Studies on community-acquired pneumonia (CAP) and pneumococcal pneumonia (PP) related to the 13-valent pneumococcal conjugate vaccine (PCV13) introduction in Asia are scarce. This study aimed to investigate the epidemiological and microbiological determinants of hospitalised CAP and PP after PCV13 was introduced in Japan. This observational hospital-based surveillance study included children aged ⩽15 years, admitted to hospitals in and around Chiba City, Japan. Participants had bacterial pneumonia based on a positive blood or sputum culture for bacterial pathogens. Serotype and antibiotic-susceptibility testing of Streptococcus pneumoniae and Haemophilus influenzae isolates from patients with bacterial pneumonia were assessed. The CAP hospitalisation rate per 1000 child-years was 17.7, 14.3 and 9.7 in children aged <5 years and 1.18, 2.64 and 0.69 in children aged 5–15 years in 2008, 2012 and 2018, respectively. There was a 45% and 41% reduction in CAP hospitalisation rates, between the pre-PCV7 and PCV13 periods, respectively. Significant reductions occurred in the proportion of CAP due to PP and PCV13 serotypes. Conversely, no change occurred in the proportion of CAP caused by H. influenzae. The incidence of hospitalised CAP in children aged ⩽15 years was significantly reduced after the introduction of PCV13 in Japan. Continuous surveillance is necessary to detect emerging PP serotypes.
Recently huge amount of dust Mdust ≃ 106−7M⊙ in galaxies at z = 7–8 has been discovered by ALMA observations. The suggested timescale of the dust production was a few–several×108 yr, while the stellar mass was several × 109M⊙. This amount of dust cannot be easily explained only by a supply from supernovae if we consider the dust destruction by reverse shocks. We propose that these values can be consistently explained if we take into account the grain growth in the interstellar medium (ISM). This scenario successfully reproduces the evolution of the dust mass, as well as the SFR, and stellar mass simultaneously. We conclude that even at such an early epoch of the Universe, the dust grain growth in the ISM plays a significant role in galaxies.
The spectral energy distribution (SED) model should treat the evolution of a galaxy from its birth. Dust in galaxies affects the formation and evolution of galaxies in various ways. For example, dust grains scatter and absorb stellar emitted ultraviolet (UV) photons and re-emit the radiation at infrared (IR) wavelengths. In this work, we construct a galaxy SED model based on our dust evolution model (Asano et al. 2013a,b, 2014) with a rigorous treatment of the chemical evolution. To reduce the computational cost, we adopt mega-grain approximation (MGA; (MGA; Inoue, 2005). MGA regards a high density dusty region as a huge size (10 pc) dust grain for calculating dust scattering. In this approximation, we can solve the radiative transfer easily and provide SEDs and attenuation curves of galaxies. This model can be used to fit any galaxy in the wavelength range of 10 nm-3 mm.
We present ALMA detection of the [O iii] 88 μm line and 850 μm dust continuum emission in a Y-dropout Lyman break galaxy, MACS0416_Y1. The [O iii] detection confirms the object with a spectroscopic redshift to be z = 8.3118±0.0003. The 850 μm continuum intensity (0.14 mJy) implies a large dust mass on the order of 4×106M⊙. The ultraviolet-to-far infrared spectral energy distribution modeling, where the [O iii] emissivity model is incorporated, suggests the presence of a young (τage ≍ 4 Myr), star-forming (SFR ≍ 60M⊙yr−1), and moderately metal-polluted (Z ≍ 0.2Z⊙) stellar component with a stellar mass of 3 × 108M⊙. An analytic dust mass evolution model with a single episode of star formation does not reproduce the metallicity and dust mass in ≍ 4 Myr, suggesting an underlying evolved stellar component as the origin of the dust mass.
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.
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.
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.
Adenosquamous carcinoma is a rare variant of semicircular canal that can affect various regions, including the head and neck. Adenosquamous carcinoma is characterised pathologically by the simultaneous presence of distinct areas of semicircular canal and adenocarcinoma, and usually takes an aggressive course with local recurrences, early lymph node metastases and distant disseminations.
We report a rare case of neck adenosquamous carcinoma of unknown primary origin, which was well-controlled by thorough resection without any other additional therapy.
We discuss the diagnosis and treatment of adenosquamous carcinoma along with a review of pertinent literature. We also consider the potential differential diagnosis of branchiogenic carcinoma.
Growth of GaN on Si(111) and Ge coated Si(111) using pulsed electron beam deposition (PED) process is reported. GaN was deposited on Si(111) and Ge/Si(111) at 600°C in an N2 environment without any surface pre-treatment such as pre-nitridation. X-ray diffraction confirmed that c-plane oriented GaN was grown. Photoluminescence showed near-band-edge emission, the intensity of which was improved with hydrogen passivation. Electrical characterization showed n-type conductivity with room temperature electron mobilities in the range of 300 cm2/V-sec.
We fabricated single-crystalline microspheres of wide-gap semiconductors with anisotropic crystal structures, such as ZnO and ZnSe, by laser ablation in superfluid helium and investigated their lasing properties. Whispering gallery mode lasing at their band edges in ultraviolet region was clearly observed under the optical excitation, reflecting their high sphericity and crystal quality.
We have investigated an influence of positive polarization charges generated at an interface between GaN barrier/p-AlGaN EB (Electron Blocking) layer in a blue-LED. Simulation results suggested that such polarization charges caused an electron overflow from QWs. The simulation results also indicated that sufficient acceptor doping at the interface could neutralize the positive polarization charges and suppress the electron overflow. We then demonstrated the electron overflow caused by the positive polarization charges and its suppression with sufficient Mg doping at the interface by monitoring emissions from an additional second QW inserted between the p-EB layer and the p-GaN layer. Finally we conclude that the contribution of the electron overflow is not significant for the efficiency droop in blue-LEDs.
We have studied photoluminescence (PL) from undoped GaN films grown by HVPE technique on sapphire. Several defect-related PL bands are observed in the low-temperature PL spectrum. The concentrations of the defects responsible for these PL bands are determined from the dependence of PL intensity on excitation intensity. The RL band with a maximum at 1.8 eV is often the dominant PL band in HVPE GaN. It is caused by an unknown defect with the concentration of up to ∼1017 cm-3. The concentrations of defects responsible for other defect-related PL bands rarely exceed 1015 cm-3.
Metal organic chemical vapor deposition, as well as material and basic device properties of nitride-based high electron mobility transistor structures on (111) silicon substrates varying in diameter from 4 to 8 inch were studied using in-situ and ex-situ characterization techniques. All substrates used for the growth of the nitride structures in this study were of SEMI standard thicknesses. The total thickness of the nitride structures was in the range of 1.5 – 5 µm. It is reported that nitride structures can be grown on 4, 6 and 8 inch diameter substrates with very similar post-growth wafer shape, material and device characteristics. It is also shown that their crystal quality, 2DEG transport properties and isolation blocking voltages can be improved by increasing nitride structure thickness while maintaining post-growth wafer bow and warp less than 50 µm. The maximum thickness of nitride structures that can be successfully grown on 8 inch diameter SEMI standard substrates seems to be limited to about 4.5 µm due to plastic deformation of Si. Blocking voltages of more than 700 V were achieved using 4.5 µm thick nitride-based high electron mobility transistor structures grown on 8 inch Si substrate.