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Background Increasing evidence suggests that the impact of community-acquired pneumonia (CAP) extends beyond discharge from the hospital and the acute phase of illness. We sought to characterize mortality and hospital readmission across the adult age span and spectrum of comorbidities. Methods A retrospective cohort design and data from Optum’s de-identified Integrated Claims-Clinical dataset (2009-2018) were employed. Study population comprised all adults who, between 1.1.2013 and 12.31.2017, had ≥ 1 acute-care hospitalization for CAP; each qualifying CAP hospitalization separated by ≥ 365 days was included as a unique observation in analyses. Study outcomes included acute-care hospital readmission for any reason and death for any reason. Hospital readmission was ascertained during the 360-day period following discharge from the CAP hospitalization; death was ascertained during the CAP hospitalization as well as during the same 360-day period. Cumulative rates of mortality and readmission were summarized for all patients as well as subgroups defined on age and comorbidity profile (i.e., healthy, at-risk, high-risk). Results Study population totaled 37,006 patients who contributed 38,809 CAP hospitalizations; mean age was 71 years, 51% were female, and 88% had an at-risk (33%) or high-risk (55%) condition. Hospital readmission was 12.5% during the 30-day post-discharge period, and 42.3% during the 360-day post-discharge period. Mortality was 3.5% in hospital, 8.2% from admission to 30 days post-discharge, and 17.7% from admission to 360 days post-discharge. Mortality rates increased with age and severity of comorbidity profile; readmission rates were highest for persons aged 65-74 years and high-risk persons. Rates of readmission and mortality among adults hospitalized for CAP Conclusion All-cause mortality up to 1 year following hospital admission for CAP was substantial, and was associated with increasing age and worsening comorbidity profile. Both readmission and mortality were greater at all ages in high-risk and at-risk groups compared with their healthy counterparts. Strategies that prevent pneumonia and/or the pathophysiologic changes that follow CAP, especially among individuals with comorbid conditions, have the potential to reduce morbidity and mortality following CAP as well as healthcare costs associated with readmission. Disclosures Reiko Sato, PhD, Pfizer, Inc (Employee, Shareholder) Derek Weycker, PhD, Pfizer Inc. (Consultant, Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Melody Shaff, BA, Pfizer, Inc. (Consultant, Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Ahuva Hanau, BS, Pfizer, Inc. (Consultant, Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Alexander Lonshteyn, PhD, Pfizer, Inc. (Consultant, Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Stephen I. Pelton, MD, Merck vaccine (Consultant, Grant/Research Support)Pfizer (Consultant, Grant/Research Support)Sanofi Pasteur (Consultant, Other Financial or Material Support, DSMB)Seqirus Vaccine Ltd. (Consultant)

Background Mobility is a cornerstone of healthy aging. Pneumonia may impact mobility through damage to physiological systems as well as increased inflammation, which has been associated with reduced physical functioning. The objective of this study was to assess the impact of pneumonia on objectively measured physical functioning in a sample of older adults. Methods This was a post-hoc analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study provided by the National Institute on Aging’s AgingResearchBiobank. Participants with pre-existing mobility concerns aged 70-89 years were randomized to physical activity or health education interventions. Outcomes included the ability to complete a 400-meter walk and gait speed (meters/second, m/s) and were assessed every 6 months from baseline up to 42 months. New health events were assessed at each visit including overall pneumonia events and pneumonia hospitalizations. Repeated measures regression models evaluated the ability to walk 400-meters and gait speed as separate outcomes controlling for age, sex, race, education, past medical history, the occurrence of other health events, and a cumulative deficit frailty index. Results There were 1,635 LIFE Study participants with N=9,872 follow-up measures during the study period. Among these, 174 (10.6%) had a pneumonia event which included 96 hospitalization events. Those with pneumonia events during follow-up were mostly similar to those without pneumonia events at baseline, except for higher prevalence of past hospitalizations and respiratory problems. Any pneumonia event was associated with an adjusted mean gait speed of 0.67 (0.63-0.71) m/s vs. 0.70 (0.66-0.73) m/s in those without pneumonia and 0.60 (0.55-0.64) in those with pneumonia hospitalization. Similarly, pneumonia events were associated with 84% [odds ratio = 1.84 (1.45-2.23)] and pneumonia hospitalizations with 200% [odds ratio = 3.00 (2.48-3.52)] increases in the odds of not being able to walk 400-meters compared to those without pneumonia events. Conclusion Pneumonia-related health events were associated with subsequent reduced mobility measured by 400-meter walk tests and gait speed. Preventing pneumonia may be an important component of maintaining physical functioning in older adults. Disclosures Joshua Brown, PharmD, PhD, Pfizer, Inc (Consultant, Grant/Research Support) Reiko Sato, PhD, Pfizer, Inc (Employee, Shareholder) John Morley, MD, Pfizer, Inc (Consultant)

Background The risk of community-acquired pneumonia (CAP) increases with age and significantly impacts morbidity and mortality in the elderly population. The burden of illness and cost of preventing CAP has not been compared to other serious diseases. Methods This retrospective analysis used claims data from 2014 to 2015 and compared hospitalizations for CAP, myocardial infarction (MI), stroke, and osteoporotic fractures (OF) in adults aged ≥65 years enrolled in a Medicare Advantage insurance plan. Individuals who had not already been hospitalized for one of these conditions and did not have evidence of long-term care were included in the study. Hospitalizations for each condition were described by length of stay, readmissions, mortality, and total costs. Preventive measures included vaccinations for CAP and medications for MI, stroke, and OF. Results A total of 1,949,352 individuals were included in the cohort. In 2015, the rate of CAP-related hospitalizations was the highest at 846.7 per 100,000 person-years compared to 405 for MI, 278.9 for stroke, and 343.9 for OF. Vaccination costs for CAP were $40.2 million including $14.1 million for pneumococcal and $26.1 million for influenza vaccines. The cost of preventive medications for MI and stroke reached over $661 million and OF totaled $169 million. Conclusions Although CAP has a higher burden of hospitalization and total costs than MI, stroke, and OF in the elderly population, prevention efforts were disproportionately smaller for CAP. Prioritization of CAP prevention is needed to substantially reduce the burden of CAP.

Atrazine is still one of the most used agricultural pesticides worldwide and it has been recognized as a major contaminant of surface and ground water. The aims of this research were to isolate an endophytic microorganism from leaves of sugarcane, evaluate its ability to degrade atrazine, and investigate the formation of metabolites. By sequencing of the 16S rRNA gene, the endophytic isolate atz2 was identified as Streptomyces sp. The reduction in atrazine concentration by Streptomyces sp. atz2 was 98 % and UHPLC-MS/MS analyses showed the appearance of an unknown metabolite observed as m/z 311. Ecotoxicity tests with an aquatic organism, Daphnia similis, confirmed that this metabolite was nontoxic. This mechanism of detoxification of atrazine is different from the ones of other free-living microorganisms that inhabit the soil or rhizosphere. The results show new aspects of atrazine detoxification, highlighting a new role of endophytic bacteria in plants.

The Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects. We examined the cost-effectiveness of PCV13 vaccination in the Netherlands. Using a Markov-type model, incremental cost-effectiveness ratios (ICER) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective. Estimates of quality-adjusted life-years (QALYs), costs, vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospective studies. The base-case was PCV13 vaccination of adults aged 65–74 years compared to no vaccination, assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use. Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted. The ICER for base-case was €8650 per QALY (95% CI 5750–17 100). Vaccination of high-risk individuals aged 65–74 years was cost-saving and extension to medium-risk individuals aged 65–74 years yielded an ICER of €2900. Further extension to include medium- and high-risk individuals aged ≥18 years yielded an ICER of €3100. PCV13 vaccination is highly cost-effective in the Netherlands. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries., Vaccinating the elderly with 13-valent pneumococcal conjugate vaccine is highly cost-effective http://ow.ly/NVeui

Cobalt ferrite (CoFe2O4) and manganese substituted cobalt ferrite (Co0,25Mn0,75Fe2O4) were synthesized by coprecipitation and sol–gel methods. X-ray diffraction revealed that manganese ions slightly enlarged the crystal lattice with respect to pure cobalt ferrite. Magnetization, linear magnetostriction, and piezomagnetic coefficient values tended to decrease with the ion substitution. Linear magnetostriction dropped from a value of −111.5 ppm for cobalt ferrite to values of −22.6 and −30.6 ppm for the substituted samples obtained from coprecipitation and sol–gel, respectively. The sample prepared by sol–gel technique resulted in a higher magnetization, magnetostriction, and piezomagnetic coefficient than that synthesized by coprecipitation method.

Background Recent evidence demonstrates increased short-term risk of cardiac complications and respiratory failure among patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD), respectively, concurrent with an episode of community-acquired pneumonia (CAP). We evaluated patients with pre-existing HF or COPD, beginning 30 days after CAP diagnosis, to determine if CAP had a prolonged impact on their underlying comorbidity. Methods A retrospective matched-cohort design using US healthcare claims was employed. In each month of accrual, patients with HF or COPD who developed CAP (“CAP patients”) were matched (1:1, without replacement, on demographic and clinical profiles) to patients with HF or COPD who did not develop CAP (“comparison patients”). All patients were aged ≥40 years, and were pneumonia free during prior 1-year period. Exacerbation beginning 30 days after the CAP diagnosis and for the subsequent 1-year period were compared between CAP and comparison patients. Findings 38,010 (4·6%) HF patients and 48,703 (5·9%) COPD patients experienced a new CAP episode requiring hospitalization or outpatient care only, and were matched to comparison patients. In the HF subset, CAP patients were 47·2% more likely to experience an exacerbation vs patients without CAP (17·8% vs. 12·1%; p

Hysteresis loops and magnetostriction were measured on ring-shaped ${\rm Fe}_{85}{\rm Ga}_{15}$ samples. The samples were annealed at $T=980^{\circ}{\rm C}$ for 100 h and cooled from annealing temperature in two different ways: one was slowly cooled in an oven and the other one was quenched in cold water. X-ray diffraction results showed a strong texture in these samples, which is dependent on the cooling process. The anisotropy energy and magnetostriction of the samples were calculated based on these determined textures. These results agree qualitatively with magnetization and magnetostriction experiments and support the thermal history influence on the magnetostriction values.

To evaluate the feasibility of industrial biodiesel production, outdoor mass cultivation of the marine oleaginous diatom, Fistulifera sp. strain JPCC DA0580, was conducted in bench-scale photobioreactors (∼200 L, raceway- and column-types) and seasonal variation of biomass and oil content were monitored. Through three seasons (from spring to autumn), the microalgae showed steady growth and oil accumulation in both reactors in spite of fluctuating temperature and solar irradiation. When comparing the both reactors, the column-type bioreactor was better with regard to energy conversion efficiency compared to the raceway-type bioreactor. The areal oil productivity of 3.23 g/m(2)/day is comparable or even higher level as compared with the one from other oleaginous microalgae prepared in outdoor mass cultivation. Furthermore, repeated batch culture experiments resulted in success at least 5 cycles. Through the experimental period, little bacterial contamination was observed while protozoal contamination was a fatal issue. The microalgal cell was robust enough to be handled by an automated pump system in inoculation and harvesting processes, and cell adhesion to the bioreactor wall was not observed. These beneficial features could realize ease of oil production and system maintenance. These findings ensure promising innovation by means of outdoor mass cultivation with this strain toward biodiesel production.

The structural and magnetic properties of polycrystalline Fe100-xMnx alloys with x = 38, 42, 46, 50, and 55 atomic percent were investigated after a heat treatment and a cold rolling process. According to X-ray diffraction (XRD), all samples crystallize into a y -phase. For cold rolled alloys x = 38 and 42, XRD analysis using pole figures showed no texture formation whereas cold rolled alloys with x = 46 and 50 exhibited texture components {110} and with x = 55, {011} . Magnetization measurements clearly demonstrate an antiferromagnetic type of ordering. For both the as-cast as well as the cold rolled materials, magnetostriction measurements at room temperature gave nearly zero magnetostriction.

This study aims to discover the beliefs of non-native Japanese language teachers and to discuss the relationship between their beliefs and the following attributes: teaching experience, self-rated language ability, and motivation for teaching and learning Japanese. A questionnaire study was adapted and completed by 93 teachers in Indonesia. Factor analysis shows that subject knowledge, supportive attitudes, and classroom teaching skills are perceived as beliefs that define effective language teachers. Furthermore, the relationship between these beliefs and attributes of the teachers was compared. The results showed that subject knowledge and classroom teaching skills were related to teaching experience and Japanese speaking and listening abilities. On the other hand, all three factors were related to motivation for teaching and learning Japanese.

Background End-stage renal disease (ESRD) patients receiving dialysis are at particular risk for infection. We assessed the clinical and economic burden of pneumonia in a population of Medicare-enrolled ESRD patients with respect to incidence and case fatality rates, rates of all-cause and cardiovascular hospitalization, and costs. Methods Patients received dialysis between 01 January 2009 and 31 December 2011 and were enrolled in Medicare Parts A and B. Pneumonia episodes were identified from institutional and supplier claims. Patients were considered at-risk from first date of Medicare coverage and were censored upon transplant, withdrawal from dialysis, recovery of renal function, loss of Medicare benefits, or death. Linear mixed-effects models were used to assess hospitalization rates and costs over the 3 months prior to and 12 months following pneumonia episodes. Results The pneumonia incidence rate for the study period was 21.4 events/100 patient-years; the majority of episodes (90.1%) required inpatient treatment. The 30-day case fatality rate was 10.7%. Compared to month -3 prior to event, rates of all-cause and cardiovascular hospitalization were higher in the month of the pneumonia episode (IRR, 4.61 and 4.30). All-cause admission rates remained elevated through month 12; cardiovascular admission rates remained elevated through month 6. Mean per-patient per-month costs were $10,976 higher in the month of index episode compared to month -3, largely driven by increased inpatient costs, and remained elevated through end of 12-month follow-up. Conclusion Pneumonia episodes are frequent among ESRD patients and result in hospitalizations and greater overall costs to Medicare over the following year. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0412-6) contains supplementary material, which is available to authorized users.

Background Cancer microenvironment plays a vital role in cancer development and progression, and cancer-stromal interactions have been recognized as important targets for cancer therapy. However, identifying relevant and druggable cancer-stromal interactions is challenging due to the lack of quantitative methods to analyze whole cancer-stromal interactome. Results We present CASTIN (CAncer-STromal INteractome analysis), a novel framework for the evaluation of cancer-stromal interactome from RNA-Seq data using cancer xenograft models. For each ligand-receptor interaction which is derived from curated protein-protein interaction database, CASTIN summarizes gene expression profiles of cancer and stroma into three evaluation indices. These indices provide quantitative evaluation and comprehensive visualization of interactome, and thus enable to identify critical cancer-microenvironment interactions, which would be potential drug targets. We applied CASTIN to the dataset of pancreas ductal adenocarcinoma, and successfully characterized the individual cancer in terms of cancer-stromal relationships, and identified both well-known and less-characterized druggable interactions. Conclusions CASTIN provides comprehensive view of cancer-stromal interactome and is useful to identify critical interactions which may serve as potential drug targets in cancer-microenvironment. CASTIN is available at: http://github.com/tmd-gpat/CASTIN. Electronic supplementary material The online version of this article (doi:10.1186/s12864-016-3207-z) contains supplementary material, which is available to authorized users.

OBJECTIVE To estimate community-acquired pneumonia (CAP) incidence, turnover, episode length, inpatient length-of-stay, and cost burden. METHODS Using 2007 to 2010 employee demographic, payroll, and claims data, CAP episodes were identified in employees aged 18 to 64 years. Semiannual medical, drug, sick leave, short-term disability (STD), long-term disability, and workers' compensation costs and absence days were compared between employees with and without CAP (controls) using two-part regression modeling. RESULTS In a population of 250,000, the number of CAP episodes per 100,000 employees was 628. The incidence rate increased with age and comorbidity. CAP employees' turnover rate nearly doubled that of controls (P < 0.01). In every age and risk group, employees with CAP had significantly (P < 0.01) higher medical and drug costs than controls and double the STD costs and days (P < 0.05). CONCLUSIONS CAP and underlying comorbidity are associated with increased medical, pharmacy, and STD costs and employee turnover rates.

Background Community-acquired pneumonia (CAP) causes substantial clinical and economic burden. While several studies have reported the cost to treat CAP, there is little information on the cost to treat by age, risk profile, and hospitalization in US adults aged ≥50 years. Objective To quantify the cost, from a payer perspective, of treating CAP at the episode level, stratified by age, risk profile, and hospitalization. Methods A retrospective study of claims data from a large US health plan (1 January 2006–31 December 2008) was conducted. Patients aged ≥50 years having at least one medical claim with a primary diagnosis for pneumonia were identified. A CAP episode was defined as the period between the first and last pneumonia ICD-9 code with a chest X-ray claim. Episode-level variables included risk stratum based on presence of an immunocompromising/chronic condition, age group, number and length of inpatient and outpatient CAP episodes, and all-cause and CAP-related healthcare costs (adjusted to 2011 costs). Results Among the 27,659 study patients, 28,575 CAP episodes (20,454 outpatient; 8,121 inpatient) occurred. Mean age of patients with a CAP episode was 62.6. Low-risk patients accounted for 44.4 % of all CAP episodes. Mean CAP episode length was 31.8 days for an inpatient episode and 10.2 days for an outpatient episode. Mean all-cause total healthcare cost for an inpatient CAP episode ranged from $11,148 to $51,219 depending on risk stratum and age group. Mean outpatient episode-related costs were much lower than inpatient episode-related costs. Conclusions Cost to treat CAP requiring hospitalization is high regardless of age or the presence of underlying comorbidities. Given that almost half of the patients in this study did not have traditional risk factors for CAP, it is clear that better preventative strategies are needed. Electronic supplementary material The online version of this article (doi:10.1007/s40258-013-0026-0) contains supplementary material, which is available to authorized users.

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality in older adults, yet few studies have comprehensively measured the burden of CAP symptoms and their impact from the patient perspective. Our Web-survey used the newly developed CAP burden of illness questionnaire (CAP-BIQ) designed to assess the presence of key symptoms, comorbid conditions affected by CAP, psychosocial impacts, productivity, and CAP-associated physician visits in US adults aged 50 years and older. The CAP-BIQ was developed from semi-structured one-on-one interviews and finalized after cognitive debriefings with recently diagnosed CAP patients. The CAP-BIQ was then administered to 500 survey participants with a CAP diagnosis within the past 120 days confirmed by chest imaging recruited from a Web-based panel. Analyses of survey results were weighted for national representativeness, and were compared between relevant age, hospitalization status, and pneumonia-risk subgroups. The survey participants’ mean age was 62.4 years; 45 % were men; and 39.6 % were hospitalized due to CAP. On average, the surveys were completed 56.9 days after pneumonia diagnosis. Nearly all participants reported tiredness, cough, body aches, weakness, shortness of breath, wheezing, and a weak appetite at the time of diagnosis (99.0, 96.8, 96.9, 94.1, 89.1, 85.8, and 78.5 %, respectively). There was generally greater symptom prevalence at diagnosis in younger, nonhospitalized, or high-risk subgroups when compared to their respective older, hospitalized, or low-risk counterparts. Most participants reported at least one cough-related and weakness-related impact on their daily life and activities from CAP. Over three quarters of the respondents (77.4 %) needed assistance from a friend or family member during their bout with pneumonia and a majority of respondents (83.6 %) were satisfied with the care they received from their doctors across the course of their illness. This study systematically assessed CAP symptoms and their impacts using the CAP-BIQ, a questionnaire with established content validity. At CAP diagnosis, the range of patient-reported symptoms was broader than previous studies have reported. Additionally, the overwhelming need for caregiver assistance demonstrates the burden this illness places on older adults.

The objective of this study was to investigate the clinical features of suicide attempts in elderly patients (≥65 years) in Japan. We enrolled 546 patients who attempted suicide and were hospitalized for inpatient treatment. Characteristics were compared between the elderly and non-elderly patients. Compared with the non-elderly group, the incidence of mood disorders was significantly higher and the average length of stay in the intensive care unit and the duration of hospitalization were significantly longer in the elderly group. Elderly patients hospitalized for attempted suicide were more likely to have mood disorders than the non-elderly.

Carbohydrates are candidates for the basis of species-selective interaction of gametes during mammalian fertilization. In this study, we sought to clarify the roles of sugar residues in the species-selective, sperm–oocyte interaction in pigs and cattle. Acrosome-intact porcine and bovine sperm exhibited their strongest binding affinities for β-Gal and α-Man residues, respectively. Porcine-sperm specificity changed from β-Gal to α-Man after the acrosome reaction, while bovine-sperm specificity did not. Binding of acrosome-intact and acrosome-reacted sperm decreased after trypsinization, indicating that the carbohydrate-binding components are proteins. While immature oocytes bound homologous sperm preferentially to heterologous sperm, oocytes matured in vitro bound similar numbers of homologous and heterologous sperm. Lectin staining revealed the aggregation of α-Man residues on the outer surface of the porcine zona during maturation. In both species, zona-free, mature oocytes bound homologous sperm preferentially to heterologous sperm. The lectin-staining patterns of the zona pellucida and zona-free oocytes coincided with the carbohydrate-binding specificities of acrosome-intact and acrosome-reacted sperm, respectively, supporting the involvement of carbohydrates in gamete recognition in pigs and cattle. These results also indicate that sperm-zona pellucida and sperm–oolemma bindings are not strictly species-specific in pigs and cattle, and further suggest that sperm penetration into the zona and/or fusion with oolemma may be species-specific between pigs and cattle.

The objective of this study was to investigate the frequency and clinical features of suicide attempts in adults with autism spectrum disorders (ASDs).We enrolled 587 consecutive patients aged 18 or over who attempted suicide and were hospitalized for inpatient treatment. Psychiatric diagnoses, suicide attempt frequency and clinical features were compared between ASD and non-ASD patients.Forty-three (7.3%) of the 587 subjects who attempted suicide had ASDs. The incidence of patients with mood disorders was significantly lower (Fisher's Exact Test, P=.043) and that of those with an adjustment disorder was significantly higher (Fisher's Exact Test, P.001) in the ASD group than in the non-ASD group. The average length of stay at both the hospital and intensive care unit in the ASD group was longer than that in the non-ASD group (z=-2.031, P=.042; z=-2.322, P=.020, respectively).ASDs should always be a consideration when dealing with suicide attempts in adults at the emergency room.

Objective: This is an epidemiological survey that was conducted for 22 years to investigate the physical effects on inhabitants who had been exposed to cadmium (Cd) from processing of remnants discharged at the time of copper refinement. It was possible to obtain findings on physical effects 27 years after Cd exposure. Materials and Methods: Of the inhabitants who were 50 years old or younger in 1981 and who were living in the most contaminated area in the Kakehashi River basin, 68 (32 males and 36 females) who underwent all of the 5 screenings during the 22-year period were extracted as subjects. Early morning urine was collected for urinalysis, and Cd and ?2-MG concentrations were determined. Results: 27 years after cessation of Cd exposure, it was shown that urinary Cd concentrations were significantly decreased and urinary ?2-MG concentrations were significantly increased. Conclusion: Once exposed to Cd, it takes about 30 years for the Cd that remains in the body to decrease by half. Once renal tubular dysfunction occurs after Cd exposure, irreversible aggravation is inevitable.

Objective In order to assess the impact of educational content on students, this study investigated junior high school students' awareness of older adults' daily lives and the social resources available for older adults.Methods Participants were 967 second-year students at a public junior high school in S city. A complete enumeration survey was conducted using anonymous self-administered questionnaires. The survey items obtained information about participants' demographic characteristics, their perceptions of older adults' daily life, and their awareness of the social resources for older adults.Results Of the 555 returned questionnaires (57.4%), 490 (50.7%) valid responses were analyzed. A total of 158 participants (32.2%) lived with their grandparents, and 232 participants (47.3%) had some experience living with their grandparents, most of whom still lived independently. Further, 303 participants (61.8%) met their grandparents at least once or twice a week. The mean age of participants' grandparents was 72.2 years. The mean age that the participants regarded a person as "elderly" was 71.3 years. Participants' perceptions of older adults' daily lives included decreased physical ability due to aging, need and desire to stay in touch with family and/or friends, and enjoying hobbies and pleasurable activities. Participants who met their grandparents at least once or twice a week perceived elderly life as more cheerful compared to participants who met their grandparents once or twice a month or less. The participants were familiar with some social resources for older adults such as "administrative disaster-prevention wireless communication system," "transportation service by car," and "visiting nurse." Female participants were aware of significantly more social resources compared to male participants, as were participants who met their grandparents at least once or twice a week compared to those who met their grandparents once or twice a month or less.Conclusion Although participants were aware of the age-related physical changes, they were unaware of the difficulties associated with these changes in the daily lives of older adults. Gender and frequency of contact with grandparents may have contributed to junior high school students' awareness of social resources for older adults.

Background A 13-valent pneumococcal conjugate vaccine (PCV13) was recently developed for use in older adults, and may be effective not only against invasive pneumococcal disease (IPD) but also nonbacteremic pneumococcal pneumonia. The potential public health and economic impact of PCV13 in this population is unknown. Methods A microsimulation model depicting risk and costs of IPD and all-cause nonbacteremic pneumonia (NBP) in US adults aged ≥50 years ( n = 96.1 million), as well as expected impact of vaccination, was developed. Effectiveness of PPSV23 was based on published literature, and for all-cause NBP, was zero; effectiveness of PCV13 was based on PCV7 data in children, and for all-cause NBP, was varied across a reasonable range. Lifetime outcomes and costs were projected assuming: (1) use of PCV13 in all subjects at model entry, with and without periodic revaccination; and (2) use of PPSV23 per current ACIP recommendations. Results Use of PCV13 in all subjects at model entry without revaccination – in lieu of PPSV23 use per recommendations – reduced cases of IPD by 15,000 (95% CI 9000–21,000); cases of NBP by 1.2 million (0.9–1.5); total healthcare costs by $3.5 billion (1.9–5.2); and total societal costs by $7.4 billion (5.3–9.8). Use of PCV13 with revaccination every 5–10 years resulted in fewest cases of disease and lowest total costs. Findings were largely unchanged in sensitivity analyses. Conclusions Assuming that the effectiveness of PCV13 in adults is comparable to that observed for PCV7 in children and under reasonable assumptions regarding the underlying risks and costs of IPD and NBP, model projections suggest that routine use of PCV13 – in lieu of PPSV23 – would result in a greater reduction in the overall burden of pneumococcal disease in older US adults.

Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic syndrome (DRESS) is a severe systemic drug reaction known to be associated with lymphadenopathy. However, the pathological findings of lymphadenopathy in DIHS/DRESS are less defined. Here, we report a case of DIHS/DRESS using lymph node (LN) biopsy for the exclusive diagnosis of lymphoproliferative disorders.A 34-year-old Japanese woman was referred to us with generalized confluent erythema, involving mainly [...]

To evaluate the impact of clinical response on work stoppage or work absence among employed people with early RA.First-year data from the combination of MTX and etanercept trial was used. The analyses were restricted to the 205 patients working full or part time at baseline who answered questions on whether they stopped working or missed days from work in one or more of the four follow-up visits. Work stoppage referred to the first occurrence of subjects reporting stopping work. Work absence was defined as whether patients reported missed days from work. Clinical response and activity state considered included the ACR and European League against Rheumatism response criteria, 28-joint DAS (DAS-28) remission and the minimum clinically important difference of the HAQ score.After adjustment for baseline characteristics, ACR70 responders were 72% less likely to stop working and 55% less likely to miss work than ACR20 non-responders (P 0.05). Patients achieving DAS-28 remission were 54% less likely to stop work than those with DAS-28 3.2 (P 0.05). Moderate improvements did not appear to effect work stoppage or missed days after adjustments.Results suggest that achieving clinical remission or major improvement might be necessary to significantly impact work outcomes.

The objective of this study is to ensure the safety of nuclear reactors. A number of accidents caused by leaks from welded zones at pipe penetration points of the reactor vessel or in coolant pipes have been reported at sites around the world. One of the main causes of such leaks is welding residual stress. It is therefore very important to know the welding residual stress in order to maintain the safety of the plants, estimate plant life cycle and design an effective maintenance plan. In this study, the inherent strain method combined with Finite Element Method (FEM) is applied to measure the welding residual stress accurately.A mock-up for a welded joint at a coolant pipe of an actual nuclear reactor was manufactured for the study. The inherent strain method is used to measure the three-dimensional residual stress distribution. In this method, the inherent strains are unknowns. When the residual stresses have a complex three-dimensional distribution, the number of unknowns becomes very large. The inherent strain distribution is therefore expressed with an appropriate function, significantly decreasing the number of unknowns.10 kinds of inherent strain distribution functions are applied to estimate the residual stress distribution of the joint. Applicability of each function is diagnosed. Accuracy and reliability of analyzed results are judged from three points of view, that is, residuals, unbiased estimate of variance of errors and necessary conditions from welding mechanics. Most suitable function is selected, which brings most reliable result.The characteristics of the three-dimensional residual stress distribution are cleared. The circumferential stress and axial stress are important, related to stress corrosion cracking (SCC). The circumferential stress is estimated to be large tension near the outer surface of welding finish region. The large tensile axial stress is produced near the outer surface, widely in the circumferential direction. Near the inner surface where SCC may occur, both stresses are small tension or compression.

The aim of this study was to investigate the relationship between the clinical features of suicide attempts and the Great East Japan earthquake in Kanagawa. We enrolled 592 patients who attempted suicide and were hospitalized for inpatient treatment. Clinical features were compared between before the earthquake (A) and after the earthquake (B) groups. The number of suicide attempts increased from 286 to 306. The rate of increase in suicide attempts in men was the highest in the age group of 40-59 years. The frequency of joblessness, family psychiatric histories, precipitating event, and alcohol intake at suicide attempt was significantly higher in the B group than in the A group. The number of patients in serious condition in the B group was significantly higher than that in the A group. Other clinical features related to suicide in people who were indirectly affected by the earthquake disaster should be investigated to develop targeted prevention strategies. Language: en

BACKGROUND: The Belgian Superior Health Council (SHC) recently added a 13-valent pneumococcal conjugate vaccine (PCV13) to its recommendations for adult pneumococcal vaccination. This study addresses the policy question regarding whether a single dose of PCV13 should be reimbursed among Belgian adults aged 65-84 years with chronic comorbidities ("moderate-risk") or immunosuppression ("high-risk"). METHODS: A cohort model was developed to project lifetime risks, consequences, and costs of invasive pneumococcal disease (IPD) and pneumococcal community-acquired pneumonia (CAP). Parameter values were estimated using published literature and available databases, and were reviewed by Belgian experts. PCV13 effectiveness was assumed to be durable during the first 5 years following receipt, and to progressively decline thereafter with 15 years protection. The Belgian National Health Insurance perspective was employed. RESULTS: Use of PCV13 (vs. no vaccine) in moderate/high-risk persons aged 65-84 years (n = 861,467; 58% vaccination coverage) would be expected to prevent 527 cases of IPD, 1,744 cases of pneumococcal CAP and 176 pneumococcal-related deaths, and reduce medical care costs by €20.1 million. Vaccination costs, however, would increase by €36.9 million and thus total overall costs would increase by €16.8 million. Cost per QALY gained was €17,126. In probabilistic sensitivity analyses, use of PCV13 was cost-effective in 97% of 1,000 simulations. CONCLUSIONS: Reimbursement of PCV13 in moderate/high-risk Belgian adults aged 65-84 years would be cost-effective from the Belgian healthcare perspective. ispartof: PLOS ONE vol:13 issue:7 ispartof: location:United States status: published

We developed a model characterizing rates and costs of pneumococcal disease in the US to estimate the expected annual clinical and economic burden of this condition among older adults. Among the 91.5 million US adults aged >or=50 years, 29,500 cases of invasive pneumococcal disease, 502,600 cases of nonbacteremic pneumococcal pneumonia, and 25,400 pneumococcal-related deaths are estimated to occur yearly; annual direct and indirect costs are estimated to total $3.7 billion and $1.8 billion, respectively. Pneumococcal disease remains a substantial burden among older US adults, despite increased coverage with PPV23 and indirect benefits afforded by PCV7 vaccination of young children.

Patients with Down syndrome (DS) and a left-to-right shunt often develop early severe pulmonary hypertension (PH) and pulmonary vascular obstructive disease (PVOD); the pathophysiological mechanisms underlying the development of these complications are yet to be determined. To investigate the mechanisms, we evaluated the biosynthesis of thromboxane (TX) A(2) and prostacyclin (PGI(2)) in four groups of infants, cross-classified as shown below, by measuring the urinary excretion levels of 11-dehydro-TXB(2) and 2,3-dinor-6-keto-PGF(1alpha): DS infants with a left-to-right shunt and PH (D-PH, n = 18), DS infants without congenital heart defect (D-C, n = 8), non-DS infants with a left-to-right shunt and PH (ND-PH, n = 12), and non-DS infants without congenital heart defect (ND-C, n = 22). The urinary excretion ratios of 11-dehydro-TXB(2) to 2,3-dinor-6-keto-PGF(1alpha) in the D-PH, D-C, ND-PH, and ND-C groups were 7.69, 4.71, 2.10, and 2.27, respectively. The ratio of 11-dehydro-TXB(2) to 2,3-dinor-6-keto-PGF(1alpha) was higher in the presence of DS (P0.001), independently of the presence of PH (P = 0.297). The predominant biosynthesis of TXA(2) over PGI(2), leading to vasoconstriction, was observed in DS infants, irrespective of the presence/absence of PH. This imbalance in the biosynthesis of vasoactive eicosanoids may account for the rapid progression of PVOD in DS infants with a left-to-right shunt.

We have investigated structural and optical properties of TiO 2 thin films prepared by a conventional sol–gel method. X-ray diffraction and transmission electron microscopy demonstrate that the TiO 2 films are poly-crystallized and consist of anatase phase. The absorption spectra above the band-edge of the TiO 2 thin films exhibit the shoulder structures around 3.9 and 4.3 eV and the broad bands around 4.8 and 6.2 eV. Several absorption bands revealed by decomposing the absorption spectra can be assigned to the transitions from oxygen 2p to titanium 3d states in TiO 2 . Excitation spectra for a visible luminescence peaking at 2.23 eV exhibit a gradual increase with increasing energy from 8.0 eV, whose energy corresponds to the beginning of the transitions from oxygen 2p to titanium 4s and 4p states. The result gives the characteristics of the relaxation processes from titanium 4s and 4p to the relaxed excited states.

金沢大学大学院医学系研究科保健看護科学専攻, 金沢大学医薬保健研究域保健学系, The purpose of this study was to clarify the change and relationship of urinary cadmium (Cd) and β2-microglobulin (β2-MG) concentrations of inhabitants in Cd-polluted areas after soil restoration. The urinary Cd and β2-MG concentrations of 25 males and 28 females did not show a significant change, 22 years after the Cd-polluted soil was restored. Once exposed to Cd, it was found to remain in the body, 22 years after the Cd -polluted soil was restored. However, this did not influence renal tubular dysfunction in most of the younger generation compared with elders heavily exposed to Cd. © 2010 Springer Science+Business Media, LLC.

The Tn-antigen, GalNAcalpha-Ser/Thr, is a tumour-associated carbohydrate antigen that may provide a sensitive and specific marker for pre-clinical detection of carcinoma and a target for cancer therapies. We recently reported that MLS128 monoclonal antibody treatment significantly inhibited colon and breast cancer cell growth. On the basis of our observations, the present study aimed to produce human anti-Tn-antigen antibodies with specificity similar to that of MLS128 monoclonal antibody, which recognizes a structure of three consecutive Tn-antigens (Tn3). Six phage clones displaying human single-chain variable fragments (scFvs) were isolated from a newly constructed phage library by panning and screening with a synthetic Tn3-peptide. Deduced amino-acid sequences of six anti-Tn3 scFvs exhibited a high degree of homology. Of those, anti-Tn3 4E10 and 4G2 scFv proteins were successfully purified from phage-infected Escherichia coli to near homogeneity. Surface plasmon resonance analyses revealed a K(D) of purified scFv proteins for Tn3 on an order of 10(-7) M, which is high for carbohydrate-specific monovalent antibodies. Further analyses suggested that both scFv proteins also bind to Tn2 and cultured colon and breast cancer cells. These results demonstrated the potential for use of these scFvs in developing antibody therapeutics targeting colon and breast cancer.

In this paper, we report magnetostriction measurements and an investigation of structural properties on melt-spun ribbons of Fe85.7Al14.3, Fe81.3Al18.7, and Fe77.7Al22.3 ribbons produced at different wheel speeds. The bcc-disordered A2 structure is obtained for 14.3 and 18.7 at %Al whereas the alloy with 22.3 at %Al exhibits the DO3-type structure. With increasing Al concentration, the saturation magnetization decreases, whereas the average lattice constant, longitudinal, transverse, and volume magnetostriction increase. However for each alloy, the crystallite size, lattice constant, and magnetostriction vary randomly with wheel velocity. While the behavior of the longitudinal magnetostriction versus applied field is similar for all samples, the behavior of the transverse magnetostriction is strongly dependent on the wheel speed. These results indicate that the formed structural disorder and the stresses in the ribbons are different with wheel speed.

Longitudinal and transverse magnetostriction measurements were performed on polycrystalline Fe100- xTix alloys, for a large Ti concentration range, from x = 8.8 to 34.7 at.%. Our results showed that substituting Fe by Ti does not significantly enhance the magnetostriction. For all Ti concentrations in the magnetically saturated state, the longitudinal magnetostriction values vary from -2 ×10-6 to 6 × 10-6. On the other hand, Fe100-xTix alloys exhibit a large forced volume magnetostriction, which increases with increasing Ti-concentration. The magnetostriction behavior could be explained considering investigations of the hyteresis loops and the microstructure .

We report the effect of a short-time vacuum annealing (1073 K during 10 minutes) on structural phase transition temperatures and magneto-structural properties of as-quenched ribbons of the Heusler alloy Ni50.6Mn34.5In14.9. This alloy crystallizes in a single phase cubic B2-type austenite with a Curie point of TCA=284 K that with the lowering in temperature transforms into a martensite with TCM185 K. The direct and reverse martensitic phase transition temperatures were MS=257 K, Mf = 221 K, AS = 239 K, and Af = 266 K. After annealing austenite shows the highly ordered L21-type structure while the average chemical composition as well as the structural and magnetic transition temperatures were shifted to Ni50.2Mn34.3In15.5 and MS = 253 K, Mf = 238 K, AS = 257 K, Af = 265 K, ΔT = 13 K, TCA = 299 K and TCM207 K. In the annealed samples the magnetization changes associated to the magnetic and structural transitions are more abrupt and magnetization isotherms in both the austenitic and martensitic existence region show higher initial magnetic susceptibility and faster approach to saturation. Field-cooled hysteresis loops at 10 K were shifted along the negative H-axis for both samples, but a significant anomaly was evident on the left side of the hysteresis loop for as-quenched ribbons.

In order to investigate the effect of the quenching rate on the magnetostriction of Fe82.5Ga17.5 alloy, a set of ribbons was prepared by varying the wheel velocities from 7.5 up to 25 m/s. Additionally Fe85Al15, Fe81Al19 and Fe75Al25 ribbons were prepared under similar conditions. The microstructure shows generally columnar particles and (100) texture perpendicular to the surface of the ribbons. For Fe-Al ribbons, the lattice constant and magnetostriction (which shows volume magnetostriction effect for the higher Al concentrations) increase and saturation magnetization decreases with Al content. However, the average grains size and the lattice constants of Fe82.5Ga17.5 and Fe-Al alloys, show large fluctuations with the wheel velocity. For Fe82.5Ga17.5, ribbons the magnetostriction values and its character with applied field depend strongly on the quenching rate. The dependence of the longitudinal magnetostriction with wheel speed exhibits a maximum of about 116 ppm at 15 m/s, which is related to the higher degree of (100) texture.

Nanocrystalline YCo5 powders with high coercivity were prepared by mechanical milling and subsequent heat treatment at 820 °C for different annealing times, ta = 2.5, 3.0, 3.5 and 4.5 min, obtaining average crystallite sizes of  17, 19, 32 and 39 nm., respectively. The coercivity values were determined from the hysteresis loops measured at maxima fields of Hm = 5 and 20 T. The highest coercivity was obtained for the sample exhibiting  19 nm, where at room temperature and Hm = 5 T, the coercivity value is of 9.0 kOe. At 77 K and Hm = 5 T, the coercivity increase to 11.8 kOe and for Hm = 20 T, a higher value such as 13.1 kOe was found. The Ms/Mr ratio is enhanced to 0.62 indicating the occurrence of exchange interaction among nanocrystalline magnets.

A new system for measuring magnetic viscosity in bulk hard magnetic materials base on a pulsed field method is presented. After the magnetizing field pulse, the stray field of the sample, which is proportional to the magnetic moment, is measured with a compensated set of two Hall probes. The set of Hall probes is driven with an AC voltage source and the Hall voltage is detected using a lock-in amplifier. By this method the system is able to measure the time dependence of the magnetization (viscosity). The magnetic viscosity coefficient (S) is obtained through a linear fitting of the magnetization decay versus ln t. Two typical Nd-Fe-B samples were measured and good agreement with the results from the traditional viscosity experiment was obtained.