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We present a method for classification of the two distinct types of electrical activity that occur during an explosive volcanic eruption: vent discharges and lightning. Vent discharges occur at the onset of an explosion and create a distinctive radio frequency signature called continual radio frequency. Seconds to minutes after the onset of the eruption, lightning begins to occur throughout the eruption column. We use logistic regression to classify a radio frequency impulse as being part of either a lightning flash or a period of continual radio frequency. The classifier uses the number of peaks in the amplitude envelope from 1 ms windows before and after the impulsive very high frequency waveform, with an average accuracy of 97.9%. We propose that this method could be used in an algorithm to determine when explosive eruptions occurred by identification of the distinctive signatures of vent discharges and lightning. Plain Language Summary: We present a method for automated identification of two distinct types of electrical activity from explosive volcanic eruptions. Explosive eruptions produce lightning, just like thunderstorms. In addition, they also produce small (<4 m) spark‐like electrical discharges at the vent of a volcano, which are called vent discharges. These vent discharges occur for relatively long durations compared to the duration of a typical lightning flash (seconds vs. hundreds of milliseconds) and are thus easily distinguishable in very high frequency (30–300 MHz) electric field measurements. We use logistic regression to classify an electric field impulse as either being part of a lightning flash or a vent discharge. The classifier uses the number of peaks in the electric field signal in 1 ms time windows before and after an electric field impulse. The accuracy of the classifier is 97.9%. We explain that the classifier could be used on a low‐power lightning sensor to automatically identify that an explosive eruption had occurred. We discuss how this capability would enable a new era of volcanic lightning monitoring that would allow for new research into understanding the physical mechanisms of vent discharges to learn how they can be used during the response to an eruption. Key Points: We created a logistic regression model that classifies electrical activity as either vent discharges or lightning with an accuracy of 97.9%The logistic regression model uses the number of waveform peaks in 1 ms time windows preceding and succeeding an RF impulseThe model could be used to identify the characteristic pattern of electrical activity produced by explosive eruptions [ABSTRACT FROM AUTHOR]

Volcanic plumes from small and moderate eruptions represent a challenge in the study of plume morphology due to eruption source parameter uncertainties and atmospheric influence. Sakurajima volcano, Japan, features such activity and due to its continuous eruptions in the recent years provides an ideal natural laboratory. A data set of 896 eruptions between 2009 and 2016 with well‐constrained plume heights, estimated erupted mass, and associated atmospheric conditions has been compiled. Plume heights ranged between 1,500 and 5,000 m and mainly developed under stable atmospheric stratification and low background wind speeds. The eruptions presented in the database were used to drive FPLUME, a 1‐D integral volcanic plume model, to study the simulated plume morphology. FPLUME was seen to provide consistent results under stable atmospheric stratification. A method for the real‐time monitoring of erupted mass used in the Sakurajima observatory was seen to provide appropriate first guess estimates for the eruptions, showing agreement with analytical and simulated mass flow rate calculations. Volcanic plumes from Sakurajima show significant influence by the atmospheric environment. The plume scaling parameter (Π) was used to characterize the expected degree of plume bending with results correlating well against modeled plume angles. The vertical wind profile was seen to have a significant impact on the resolved plume. Wind shear characteristics were seen to have a mechanical effect on the plume, aiding or inhibiting bending. Finally, potential issues were identified in simulations under unstable atmospheric conditions as the model either failed to provide a solution or overestimated the plume height. Key Points: A database of 896 eruptions from Sakurajima with associated atmospheric profiles is presentedDifferent plume bending regimes are quantitatively evaluated using the FPLUME modelVertical wind shear mechanically affects plume morphology by aiding or inhibiting plume bending [ABSTRACT FROM AUTHOR]

Background: We have previously shown that the intraluminal concentration of NO in H. pylori -positive patients is significantly reduced compared to that in H. pylori -negative patients. Aim: The aim of this study was to evaluate the effect of H. pylori infection on gastric motor activity in relation to the level of NO and nitrite in the stomach in humans. Methods: Thirty-two H. pylori -negative and 32 H. pylori -positive patients with dyspepsia were studied. Gastric myoelectrical activity was recorded for 24 h using surface electrogastrography. Intraluminal gas and juice were endoscopically collected from the stomach to determine NO and nitrite and nitrate (NOx) levels using a chemiluminescence system. Results: The percentage of tachygastria in the morning preprandial state was significantly higher (P =0.005) in H. pylori -positive than -negative patients. In H. pylori -negative patients, there was a significant positive correlation between NO levels and the percentage of bradygastria (r =0.56, P =0.001) and a significant negative correlation between NOx levels and the percentage of normal electrical activity (r =- 0.57, P =0.001) in the preprandial state. Conclusions: Gastric motor activity is associated with NO and NOx levels in the gastric lumen. H. pylori infection may play a role in the pathogenesis of abnormal gastric myoelectrical activity. [ABSTRACT FROM AUTHOR]

- We have investigated the composition of plasma and urine in patients with recurrent calcium calculi treated with allopurinol alone, thiazide alone, and both agents together for more than 18 months, and compared the results with those of patients receiving no treatment. In patients treated with allopurinol, both plasma and urinary uric acid were decreased, and plasma parathyroid hormone (PTH) and urinary calcium were increased between 1 and 2 years after treatment. In patients treated with thiazide, plasma calcium was decreased 3 months after treatment but then increased gradually, although the pre-treatment level was not reached. Urinary calcium was decreased 3 months after treatment but returned to pre-treatment levels at 6 and 12 months. Plasma PTH was gradually increased. In patients treated with both allopurinol and thiazide, plasma and urinary uric acid, plasma potassium and urinary calcium were decreased during treatment. Plasma PTH increased gradually during treatment. In patients receiving no treatment, the composition of plasma and urine did not alter during follow-up. The reasons for the changes in urinary calcium and plasma PTH have been discussed. [ABSTRACT FROM AUTHOR]

IL-I receptor antagonist (IL-I ra) is a cytokine that competitively hinds the IL-I receptor to antagonize IL-I activity without any agonist function. Previous experiments indicated that the ratio of IL-I ra to IL-I α in the normal stratum corneum (SC) was much higher in the sun- exposed face than in the sun-protected area, upper arms. It was also reported by another laboratory that IL-Ira is increased in the lesional skin of psoriatic patients. This study was designed to measure the contents of IL-I α and IL-Ira in non-lesional and pathological SC obtained from inflammatory skin diseases including psoriasis and non-psoriatic dermatoses such as atopic dermatitis. The SC materials were obtained with a non-invasive tape-stripping method. Their soluble fractions were prepared and assayed for IL-I α and IL-Ira by enzyme-linked immunosorbent assays. As a result we confirmed the previous findings that the ratio of IL- I ra to IL-I α in the normal SC was much higher in the face than in the sun-protected sites, the trunk as well as extremities. Next, we found that IL-I α contents were significantly reduced in the SC samples obtained from inflammatory skin regardless of whether their IL-I ra contents increased or unchanged. Moreover, we noted that an increased ratio of IL- Ira to IL-I α in the SC was not specific to psoriasis. but was also found in other inflammatory skin diseases including atopic dermatitis. This ratio was found to become lower after successful treatment of these skin lesions with topical glucocorticoids. We conclude from these observations that the increased ratio of IL-Ira to IL-l α in the SC is a non-specific phenomenon that can occur in any inflammatory skin diseases regardless of the inflammatory pattern, probably reflecting a skin regulation process against various kinds of inflammation. [ABSTRACT FROM AUTHOR]

A numerical analysis and a water model study of the mold region of a billet continuous caster was performed with a novel injection concept using swirling flow in the pouring tube, to control the heat and mass transfer in the continuous casting mold. The following results were found: [ABSTRACT FROM AUTHOR]

Background The impact of chronic kidney disease (CKD) on the prognostic utility of cardiovascular biomarkers in high-risk patients remains unclear. Methods and Results We performed a multicenter, prospective cohort study of 3255 patients with suspected or known coronary artery disease (CAD) to investigate whether CKD modifies the prognostic utility of cardiovascular biomarkers. Serum levels of cardiovascular and renal biomarkers, including soluble fms-like tyrosine kinase-1 (sFlt-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin-I (hs-cTnI), cystatin C, and placental growth factor, were measured in 1301 CKD and 1954 patients without CKD. The urine albumin to creatinine ratio (UACR) was measured in patients with CKD. The primary outcome was 3-point MACE (3P-MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. The secondary outcomes were all-cause death, cardiovascular death, and 5P-MACE defined as a composite of 3P-MACE, heart failure hospitalization, and coronary/peripheral artery revascularization. After adjustment for clinical confounders, sFlt-1, NT-proBNP, and hs-cTnI, but not other biomarkers, were significantly associated with 3P-MACE, all-cause death, and cardiovascular death in the entire cohort and in patients without CKD. These associations were still significant in CKD only for NT-proBNP and hs-cTnI. NT-proBNP and hs-cTnI were also significantly associated with 5P-MACE in CKD. The UACR was not significantly associated with any outcomes in CKD. NT-proBNP and hs-cTnI added incremental prognostic information for all outcomes to the model with potential clinical confounders in CKD. Conclusions NT-proBNP and hs-cTnI were the most powerful prognostic biomarkers in patients with suspected or known CAD and concomitant CKD.

Background No studies have explored the association between newly diagnosed infections after admission and clinical outcomes in patients with acute heart failure. We aimed to explore the factors associated with newly diagnosed infection after admission for acute heart failure, and its association with in-hospital and post-discharge clinical outcomes. Methods and Results Among 4056 patients enrolled in the Kyoto Congestive Heart Failure registry, 2399 patients without any obvious infectious disease upon admission were analyzed. The major in-hospital and post-discharge outcome measures were all-cause deaths. There were 215 patients (9.0%) with newly diagnosed infections during hospitalization, and 2184 patients (91.0%) without infection during hospitalization. The factors independently associated with a newly diagnosed infection were age ≥80 years, acute coronary syndrome, non-ambulatory status, hyponatremia, anemia, intubation, and patients who were not on loop diuretics as outpatients. The newly diagnosed infection group was associated with a higher incidence of in-hospital mortality (16.3% and 3.2%, P <0.001) and excess adjusted risk of in-hospital mortality (odds ratio, 6.07 [95% CI, 3.61-10.19], P <0.001) compared with the non-infection group. The newly diagnosed infection group was also associated with a higher 1-year incidence of post-discharge mortality (19.3% in the newly diagnosed infection group and 13.6% in the non-infection group, P <0.001) and excess adjusted risk of post-discharge mortality (hazard ratio, 1.49 [95% CI, 1.08-2.07], P =0.02) compared with the non-infection group. Conclusions Elderly patients with multiple comorbidities were associated with the development of newly diagnosed infections after admission for acute heart failure. Newly diagnosed infections after admission were associated with higher in-hospital and post-discharge mortality in patients with acute heart failure. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT02334891.

Background Heart failure (HF) is a known risk factor for ischemic stroke, but data regarding ischemic stroke during hospitalization for acute decompensated HF (ADHF) are limited. Methods and Results We analyzed the data from a multicenter registry (Kyoto Congestive Heart Failure [KCHF] Registry) that enrolled 4056 consecutive patients with ADHF in Japan (mean age, 78 years; men, 2238 patients [55%]; acute coronary syndrome [ACS], 239 patients [5.9%]). We investigated the incidence and predictors of ischemic stroke during hospitalization for ADHF. During the hospitalization, 63 patients (1.6%) developed ischemic stroke. The median interval from admission to the onset of ischemic stroke was 7 [interquartile range: 2-14] days, and the most common underlying cause was cardioembolism (64%). Men (OR, 1.87; 95%CI, 1.11-3.24), ACS (OR, 2.31; 95%CI, 1.01-4.93), absence of prior HF hospitalization (OR, 2.21; 95%CI, 1.24-4.21), and high B-type natriuretic peptide (BNP)/N-terminal proBNP (NT-proBNP) levels (above the median) at admission (OR, 3.15; 95%CI, 1.84-5.60) were independently associated with ischemic stroke. In patients without ACS, the independent risk factors for ischemic stroke were fully consistent with those in the main analysis. Higher quartiles of BNP/NT-proBNP levels were significantly associated with higher incidence of ischemic stroke ( P for trend, <0.001). Patients with ischemic stroke showed higher in-hospital mortality, longer length of hospital stay, and poorer functional status at discharge. Conclusions During hospitalization for ADHF, 1.6% of the patients developed ischemic stroke. Men, ACS, absence of prior HF hospitalization, and high BNP/NT-proBNP levels at admission were independently associated with ischemic stroke.

Background No clinical studies have focused on the factors associated with discharge destination in patients with acute decompensated heart failure. Methods and Results Of 4056 consecutive patients hospitalized for acute decompensated heart failure in the KCHF (Kyoto Congestive Heart Failure) registry, we analyzed 3460 patients hospitalized from their homes and discharged alive. There were 3009 and 451 patients who were discharged to home and nonhome, respectively. We investigated the factors associated with nonhome discharge and compared the outcomes between home discharge and nonhome discharge. Factors independently and positively associated with nonhome discharge were age ≥80 years (odds ratio [OR],1.76; 95% CI,1.28-2.42), body mass index ≤22 kg/m 2 (OR,1.49; 95% CI,1.12-1.97), poor medication adherence (OR, 2.08; 95% CI,1.49-2.88), worsening heart failure (OR, 2.02; 95% CI, 1.46-2.82), stroke during hospitalization (OR, 3.74; 95% CI, 1.75-8.00), functional decline (OR, 12.24; 95% CI, 8.74-17.14), and length of hospital stay >16 days (OR, 4.14; 95% CI, 3.01-5.69), while those negatively associated were diabetes mellitus (OR, 0.69; 95% CI, 0.51-0.94), cohabitants (OR, 0.62; 95% CI, 0.46-0.85), and ambulatory state before admission (OR, 0.25; 95% CI, 0.18-0.36). The cumulative 1-year incidence of all-cause death was significantly higher in the nonhome discharge group than in the home discharge group. The nonhome discharge group compared with the nonhome discharge group was associated with a higher adjusted risk for all-cause death (hazard ratio, 1.66; P <0.001). Conclusions The discharge destination of patients with acute decompensated heart failure is influenced by factors such as prehospital social background, age, body mass index, low self-care ability, events during hospitalization (worsening heart failure, stroke, etc), functional decline, and length of hospital stay; moreover, the prognosis of nonhome discharge patients is worse than that of home discharge patients. Registration Information clinicaltrials.gov. Identifier: NCT02334891.

Background It remains unclear whether beta-blocker use at hospital admission is associated with better in-hospital outcomes in patients with acute decompensated heart failure. Methods and Results We evaluated the factors independently associated with beta-blocker use at admission, and the effect of beta-blocker use at admission on in-hospital mortality in 3817 patients with acute decompensated heart failure enrolled in the Kyoto Congestive Heart Failure registry. There were 1512 patients (39.7%) receiving, and 2305 patients (60.3%) not receiving beta-blockers at admission for the index acute decompensated heart failure hospitalization. Factors independently associated with beta-blocker use at admission were previous heart failure hospitalization, history of myocardial infarction, atrial fibrillation, cardiomyopathy, and estimated glomerular filtration rate <30 mL/min per 1.73 m 2 . Factors independently associated with no beta-blocker use were asthma, chronic obstructive pulmonary disease, lower body mass index, dementia, older age, and left ventricular ejection fraction <40%. Patients on beta-blockers had significantly lower in-hospital mortality rates (4.4% versus 7.6%, P <0.001). Even after adjusting for confounders, beta-blocker use at admission remained significantly associated with lower in-hospital mortality risk (odds ratio, 0.41; 95% CI, 0.27-0.60, P <0.001). Furthermore, beta-blocker use at admission was significantly associated with both lower cardiovascular mortality risk and lower noncardiovascular mortality risk. The association of beta-blocker use with lower in-hospital mortality risk was relatively more prominent in patients receiving high dose beta-blockers. The magnitude of the effect of beta-blocker use was greater in patients with previous heart failure hospitalization than in patients without ( P for interaction 0.04). Conclusions Beta-blocker use at admission was associated with lower in-hospital mortality in patients with acute decompensated heart failure. Registration URL: https://www.upload.umin.ac.jp/; Unique identifier: UMIN000015238.

Background Whether circulating growth differentiation factor 15 (GDF-15) levels differ according to smoking status and whether smoking modifies the relationship between GDF-15 and mortality in patients with coronary artery disease are unclear. Methods and Results Using data from a multicenter, prospective cohort of 2418 patients with suspected or known coronary artery disease, we assessed the association between smoking status and GDF-15 and the impact of smoking status on the association between GDF-15 and all-cause death. GDF-15 was measured in 955 never smokers, 1035 former smokers, and 428 current smokers enrolled in the ANOX Study (Development of Novel Biomarkers Related to Angiogenesis or Oxidative Stress to Predict Cardiovascular Events). Patients were followed up during 3 years. The age of the patients ranged from 19 to 94 years; 67.2% were men. Never smokers exhibited significantly lower levels of GDF-15 compared with former smokers and current smokers. Stepwise multiple linear regression analysis revealed that the log-transformed GDF-15 level was independently associated with both current smoking and former smoking. In the entire patient cohort, the GDF-15 level was significantly associated with all-cause death after adjusting for potential clinical confounders. This association was still significant in never smokers, former smokers, and current smokers. However, GDF-15 provided incremental prognostic information to the model with potential clinical confounders and the established cardiovascular biomarkers in never smokers, but not in current smokers or in former smokers. Conclusions Not only current, but also former smoking was independently associated with higher levels of GDF-15. The prognostic value of GDF-15 on mortality was most pronounced in never smokers among patients with suspected or known coronary artery disease.

Background VEGF-D (vascular endothelial growth factor D) and VEGF-C are secreted glycoproteins that can induce lymphangiogenesis and angiogenesis. They exhibit structural homology but have differential receptor binding and regulatory mechanisms. We recently demonstrated that the serum VEGF-C level is inversely and independently associated with all-cause mortality in patients with suspected or known coronary artery disease. We investigated whether VEGF-D had distinct relationships with mortality and cardiovascular events in those patients. Methods and Results We performed a multicenter, prospective cohort study of 2418 patients with suspected or known coronary artery disease undergoing elective coronary angiography. The serum level of VEGF-D was measured. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death and major adverse cardiovascular events defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. During the 3-year follow-up, 254 patients died from any cause, 88 died from cardiovascular disease, and 165 developed major adverse cardiovascular events. After adjustment for possible clinical confounders, cardiovascular biomarkers (N-terminal pro-B-type natriuretic peptide, cardiac troponin-I, and high-sensitivity C-reactive protein), and VEGF-C, the VEGF-D level was significantly associated with all-cause death and cardiovascular death but not with major adverse cardiovascular events.. Moreover, the addition of VEGF-D, either alone or in combination with VEGF-C, to the model with possible clinical confounders and cardiovascular biomarkers significantly improved the prediction of all-cause death but not that of cardiovascular death or major adverse cardiovascular events. Consistent results were observed within patients over 75 years old. Conclusions In patients with suspected or known coronary artery disease undergoing elective coronary angiography, an elevated VEGF-D value seems to independently predict all-cause mortality.

Background The lymphatic system has been suggested to play an important role in cholesterol metabolism and cardiovascular disease. However, the relationships of vascular endothelial growth factor-C ( VEGF -C), a central player in lymphangiogenesis, with mortality and cardiovascular events in patients with suspected or known coronary artery disease are unknown. Methods and Results We performed a multicenter, prospective cohort study of 2418 patients with suspected or known coronary artery disease undergoing elective coronary angiography. The primary predictor was serum levels of VEGF -C. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. During the 3-year follow-up, 254 patients died from any cause, 88 died from cardiovascular disease, and 165 developed major adverse cardiovascular events. After adjustment for established risk factors, VEGF -C levels were significantly and inversely associated with all-cause death (hazard ratio for 1- SD increase, 0.69; 95% confidence interval, 0.60-0.80) and cardiovascular death (hazard ratio, 0.67; 95% confidence interval, 0.53-0.87), but not with major adverse cardiovascular events (hazard ratio, 0.85; 95% confidence interval, 0.72-1.01). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF -C levels further improved the prediction of all-cause death, but not that of cardiovascular death or major adverse cardiovascular events. Consistent results were observed within 1717 patients with suspected coronary artery disease. Conclusions In patients with suspected or known coronary artery disease, a low VEGF -C value may independently predict all-cause mortality.

The Methamphetamine Treatment Project (MTP) offers the opportunity to examine co-occurring psychiatric conditions in a sample of 1016 methamphetamine users participating in a multisite outpatient treatment study between 1999-2001. Participants reported high levels of psychiatric symptoms, particularly depression and attempted suicide, but also anxiety and psychotic symptoms. They also reported high levels of problems controlling anger and violent behavior, with a correspondingly high frequency of assault and weapons charges. Findings continue to support the value of integrated treatment for co-occurring conditions, especially the importance of training counseling staff to handle psychotic symptoms when needed.

We interviewed 265 cocaine-experienced methadone patients about situations that occasioned their cocaine use and strategies they used to avoid cocaine use. Subjects identified an average of 15 situations that occasioned cocaine use. The three most frequently identified were having the drug present (86% of subjects), being offered the drug (85%) and having money available (83%). Subjects reporting fewer situations also reported longer periods of lifetime abstinence (p < 0.01). A principal components analysis extracted 10 groups of situations that were most frequently identified in combination. Subjects identified a median of seven strategies for avoiding cocaine use; however, there was large inter-subject variability. This variance was not accounted for by demographic variables, employment status or treatment experience. The three strategies identified most frequently were avoiding people and places (81%), thinking about what they could lose (76%) and leaving the situation (66%). The total number and type (reactive vs. proactive) of strategies identified by subjects had no relationship to cocaine abstinence, although four specific strategies (thinking about what could be lost, leaving the situation, moving to a new area and using a different drug) were positively correlated with cocaine abstinence. We discuss implications of these results for clinical practice.