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The purpose of this survey was to assess the prevalence of genital and urinary tract symptoms among Japanese women with declining estrogen levels.A health-related questionnaire survey was conducted among women in their 40s or older to inquire about their genital, intercourse-related, and urinary symptoms and concern over their symptoms.Of the consecutive 10,000 respondents recruited, 4488 (44.9%) reported having symptoms: 3546 (79.0%) expressed concern over their symptoms. Furthermore, 2173 women (21.7%) had incontinence, 1999 (20.0%) had urinary frequency, 1648 (16.5%) had itching, and 1560 (15.6%) reported odor; these were followed by looseness, dryness, and burning. Of the 2518 (25.2%) sexually active women, 518 (20.6%) reported having dyspareunia and more reported having urinary symptoms than genital symptoms. Of the symptomatic respondents, 33.1% had genital symptoms alone, 28.4% had urinary symptoms alone, and 38.4% had both. More sexually active women had genital symptoms, while more sexually inactive women had urinary symptoms.Genital and urinary symptoms were shown to be common and coexist in a considerable proportion of the respondents, highlighting the pathology of genitourinary syndrome of menopause. Again, dyspareunia and lower urinary tract symptoms were shown to be quite common among postmenopausal women.

The newly developed low-cost micro-electro-mechanical system (MEMS)-based acceleration sensors exhibit sufficient accuracy and stability to monitor the shaking of structures caused by an earthquake. We have developed a practical shaking-monitoring system using MEMS-based acceleration sensors and a 920 MHz multi-hop radio communication method that offers reliable radio wave communication, even within buildings. In this system, the base clock of each sensor unit must be closely synchronized to the master clock to minimize acceleration-induced phase synchronization error. In the proposed system, this error can be limited to three milliseconds in a system of multiple sensor units.

Background: Thalamic volume measures have been linked to obsessive-compulsive disorder (OCD) in children and adolescents. However, it is unclear if alterations in thalamic volumes occur before or after symptom onset and if there is a relation to the presence of sub-clinical obsessive-compulsive symptoms (OCS). Here, we explore the relationship between OCS and the rate of thalamic volume change in a cohort of children and youth at high risk to develop a mental disorder. A secondary aim was to determine if there is a relationship between OCS and the individual's OCD polygenic risk score (OCD-PRS) and between the rate of thalamic volume change and the OCD-PRS.Methods: The sample included 378 children enrolled in the longitudinal Brazilian High-Risk Cohort for Mental Conditions. Participants were assessed for OCS and the symmetrized percent change (SPC) of thalamic volume across two time-points separated by 3 years, along with the OCD-PRS. Zero-altered negative binomial models were used to analyze the relationship between OCS and thalamic SPC. Multiple linear regressions were used to examine the relationship between thalamic SPC and OCD-PRS.Results: A significant relationship between OCS and the right thalamus SPC (p = 0.042) was found. There was no significant relationship between changes in thalamic volume SPC and OCD-PRS.Conclusions: The findings suggest that changes in the right thalamic volume over the course of 3 years in children may be associated to OCS. Future studies are needed to confirm these results and further characterize the specific nature of OCS symptoms associated with thalamic volumes.

This pre-specified analysis of DAPA-CKD assessed the impact of sodium-glucose cotransporter 2 inhibition on abrupt declines in kidney function in high-risk patients based on having chronic kidney disease (CKD) and substantial albuminuria. DAPA-CKD was a randomized, double-blind, placebo-controlled trial that had a median follow-up of 2.4 years. Adults with CKD (urinary albumin-to-creatinine ratio 200-5000 mg/g and estimated glomerular filtration rate 25-75 mL/min/1.73m2) were randomized to dapagliflozin 10 mg/day matched to placebo (2152 individuals each). An abrupt decline in kidney function was defined as a pre-specified endpoint of doubling of serum creatinine between two subsequent study visits. We also assessed a post-hoc analysis of investigator-reported acute kidney injury-related serious adverse events. Doubling of serum creatinine between two subsequent visits (median time-interval 100 days) occurred in 63 (2.9%) and 91 (4.2%) participants in the dapagliflozin and placebo groups, respectively (hazard ratio 0.68 [95% confidence interval 0.49, 0.94]). Accounting for the competing risk of mortality did not alter our findings. There was no heterogeneity in the effect of dapagliflozin on abrupt declines in kidney function based on baseline subgroups. Acute kidney injury-related serious adverse events were not significantly different and occurred in 52 (2.5%) and 69 (3.2%) participants in the dapagliflozin and placebo groups, respectively (0.77 [0.54, 1.10]). Thus, in patients with CKD and substantial albuminuria, dapagliflozin reduced the risk of abrupt declines in kidney function. HJLH and DC are co-primary authors. The DAPA-CKD Trial Committees and Investigators are listed in the Appendix.

For critically ill burn patients without a next of kin, the medical team is tasked with becoming the surrogate decision maker. This poses ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a next of kin affects treatment in burn patients. To evaluate this relationship, a retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care. Variables collected included age, gender, length of stay, total body surface area, course of treatment, and presence of a next of kin. In total, 67 patients met the inclusion criteria. Of these patients, 14 (21%) did not have a next of kin involved in medical decisions. Patients without a next of kin were significantly younger (P = .02), more likely to be homeless (P < .01), had higher total body surface area burns (P = .008), had shorter length of stay (P < .001), and were five times less likely to receive comfort care (P = .01). Differences in gender and ethnicity were not statistically significant. We report that patients without a next of kin present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care demonstrates a need for a cultural shift in burn care to prevent the suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present.

The global environment, including human society, should commit to harmonizing with Earth, and global material cycles play an important role in this regard. In this chapter, we clarify that materials are circulated via the low entropy of sunlight and this low entropy is transferred to maintain self-regulating activity through a material circulation cycle. This is an ideal state, in which the constancy and stability of Earth, including self-regulating systems, could be guaranteed. From the viewpoint of entropy, the ideal energy supply system must be based on the circulation of materials. When hydrogen is chosen as a secondary energy, the circulation of water, which is an oxidative state of hydrogen, may apply. From the viewpoint of entropy flow, a hydrogen-based energy system is the ideal energy system that mankind should pursue, as the circulation of materials is almost perfect and produced entropy can be discarded by heat. Green hydrogen, a clean energy carrier made by the application of renewable energies to water, is thus a key aspect for a clean energy system.

Introductions Digitization could be incorporated in rural areas of resource-poor countries because information gathered by nurses working on-site could be better used. Background For effective management of community health information, the usage and maintenance of digital records are important. Digitization of information provides essential information for informing health policy. Aim To develop a sustainable database to effectively collect and manage community health information and nursing practice. Methods This study used a mixed method design. Phase 1 involved the development of a database system through repeated systematic focus group discussions with community health nurses. Phase 2 involved a practical trial examination of the developed system with both objective and subjective evaluations. Results A nursing database system was developed with templates designed for the major health problems of communities. The templates were composed of multiple-choice items and a free-text field that allowed records to be more detailed than handwritten records and maintained in standardized formats. This enables accumulation of data that were less likely to be influenced by the variance of ability in each nurse. Discussion and conclusion A multifaceted evaluation of the database system suggested that it could improve the efficiency of information management and contribute to the improvement of nursing care quality through standardization of the recording pattern. Implications for nursing and health policy The nursing database will enable high-quality information storage that will potentially better inform health and healthcare policies as well as enable visualization of data concerning nursing care challenges and activities within the relevant communities. This information is essential for policy development and implementation in areas of human and fiscal resource allocations and meeting training/education needs.

Although most patients in the intensive care unit (ICU) receive antibiotics, little is known about patterns of antibiotic use in ICUs in Japan. The objective of this study was to evaluate the pattern of antibiotic use in ICUs. A nationwide one-day cross-sectional surveillance of antibiotic use in the ICU was conducted three times between January 2011 and December 2011. All patients aged at least16 years were included. Data from 52 ICUs and 1148 patients were reviewed. There were 1028 prescriptions for intravenous antibiotics. Of 1148 patients, 834 (73%) received at least one intravenous antibiotic, and 575 had at least one known site of infection. Respiratory and intra-abdominal infections were the two most common types. Of 1028 prescriptions, 331 (34%) were for surgical or medical prophylaxis. Excluding prophylaxis, carbapenems were the most commonly prescribed agent. Infectious disease consultations, pre- and post-prescription antimicrobial stewardship, and ICU-dedicated antibiograms were available in 44%, 52%, 77%, and 21% of the ICUs, respectively. In logistic regression analysis adjusting for patient characteristics, treatment in a university hospital (adjusted odds ratio, 1.72; 95% CI, 1.05–2.84; P = 0.033) and an open ICU (adjusted odds ratio, 2.30; 95% CI, 1.02–5.17; P = 0.044) were significantly associated with greater likelihood of carbapenem use. An increase in the number of closed ICUs and more intensive care specialists may reduce carbapenem use in Japanese ICUs. Large-scale epidemiological studies of antimicrobial resistance in the ICU are needed.

Introduction For critically ill burn patients without a next of kin (NOK), the medical team is tasked with becoming the surrogate decision maker. This poses difficult ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a NOK affects treatment in burn patients. This study is the first to evaluate this relationship. Methods A retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care from a single burn center from 2015 to 2019. Inclusion criteria were age ≥18 years and mortality within 4-weeks of admission. Exclusion criteria were death from dermatologic disease or trauma. Variables collected included age, gender, mechanism of injury, length of stay (LOS), total body surface area (TBSA), revised Baux score, and the presence of a NOK. Fisher’s Exact Test and Student’s t-test were used for analysis. Results In total, 67 patients met inclusion criteria. Of these patients, 14 (21%) did not have a NOK involved in medical decisions. Table 1 shows the means and odds ratio between the two groups. Patients without a NOK were younger (p < 0.05), more likely to be homeless (p < 0.01), had higher TBSA (p < 0.01), had shorter LOS (p < 0.01), and were 5 times less likely to receive comfort care (p < 0.05). Gender and ethnicity were not statistically significant. Conclusions Patients without a NOK present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care between the two groups demonstrates a need for a cultural shift in burn care to prevent suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present. Applicability of Research to Practice We report that the absence of a NOK has a significant impact leading to a decreased initiation of comfort care in critically ill burn patients. National protocols should be created to allow burn providers to act as a surrogate to prevent prolonged suffering.

Introduction The four main prognostic models used to determine risk of burn mortality are the revised Baux (rBaux), Belgian Outcome in Burn Injury (BOBI), Abbreviated Burn Severity Index (ABSI), and quick Sequential Organ Failure Assessment (qSOFA). These models fail to factor in medical comorbidities. The ASA PS (American Society of Anesthesiologists Physical Status) is a simple scale incorporating severity of traumatic injury with comorbidities, which strongly predicts mortality in surgical patients. The purpose of this study is to determine whether the ASA PS is an adequate adjunct to measure burn severity. Methods All adults admitted to an ABA verified burn center from January 2016 to April 2019 with TBSA ≥10% who underwent surgery were reviewed. Demographics (age, gender, TBSA, race, ASA PS), vital signs (GCS, blood pressure, respiratory rate), and outcome variables (length of stay [LOS], mechanical ventilation [MV] days, and complications) were evaluated. rBaux, BOBI, ABSI, and qSOFA scores were calculated. The primary outcome was in-hospital mortality. After descriptive statistical analysis, mortality associations of the models were assessed by determining odds ratios. Firth’s logistic regression and area under the receiver operator curves determined the predictive utility of the prognostic scores. Results Of the 183 patients who fit inclusion criteria, median age was 44 years (30–57), and the majority (70%) were male. Median TBSA was 20%, 65% (n=118) had full thickness burns, 14% (n=25) had inhalation injury, and mortality was 9% (n=17). rBaux score was the best predictor of mortality (AUC=.84), ICU LOS (R2=.04), and MV days (R2=.06). For every 10-point increase in rBaux score, there was a 1.7 times increase in mortality (OR=1.7, CI 1.4–2.3, p< .00). The predicted ICU LOS increases from 2.8 to 31.4 days for the lowest and highest rBaux score quartiles. Compared to rBaux scores of 30–53, patients with scores of 54–70 had 4 times more MV days (CI 1.5–11, p< .00). The ASA PS was slightly inferior to rBaux in predicting mortality (AUC=.72), although not statistically significant (p=0.1). As ASA PS score went from I/II to III, III to IV, and IV to V/VI; mortality increased by 2.8 (OR=2.8, CI 1.5–5.5, p< .00). Conclusions rBaux is the best predictor of mortality, ICU LOS, and MV days although ASA PS also predicts mortality. Future studies should determine the combined predictive ability of ASA PS and rBaux. Applicability of Research to Practice rBaux and ASA PS scores can be used to determine risk of mortality in burn patients.

This study aimed at developing communicative learning materials for teaching English as a foreign language to students of elementary teacher education study program of Flores University. The instruments used in this study were observation sheet, interview guide, scoring rubric, and questionnaire which were used to gather data during product’s development. This study used the research and development model proposed by Sugiyono (2009). The result shows that the developed communicative learning materials were relevant to the students’ needs. The learning materials which were designed in the form of a textbook were relevant to the students’ expertise and the developed materials which were used along with communicative activities were categorized as having good quality. The implementation of the communicative materials are effectively implemented in the classroom where the result of posttest mean score was 86 and pretest mean score was 75. The lecturers of English in this study program are suggested to use these present communicative learning materials and various activities in order to avoid the boredom of the students during teaching and learning process. The various activities used can help learners to enhance their English abilities in communication and the students’ improvements of English can be increased.

Background Chronic allograft dysfunction (CAD) is a main cause of graft failure in kidney transplantation. Methods We retrospectively analyzed 279 kidney transplant recipients who survived with a functioning graft for at least 2 years. CAD was defined as chronic graft deterioration, excluding other specific causes. We defined the pattern of decline in estimated glomerular filtration rate (eGFR), as follows: (1) “plateau” was defined as decline in eGFR ≤2 mL/min/1.73 m 2 /year; “long plateaus” were those lasting more than 5 years; (2) “rapid decline” was a decrease in eGFR ≥20 mL/min/1.73 m 2 /year. Patients diagnosed with CAD were categorized according to the occurrence of rapid decline and/or long plateau as follows: group 1, neither rapid decline nor long plateau; group 2, rapid decline only; group 3, long plateau only; and group 4, both rapid decline and long plateau. Results From a total of 81 graft losses, 51 (63%) failed because of CAD, with a median of 9.4 years. Sixteen patients belonged to group 1, 14 to group 2, 12 to group 3, and nine to group 4. Mean graft survival times in the four groups were 7.7 ± 1.1, 6.1 ± 3.1, 16.2 ± 2.5, and 10.8 ± 3.6 years, respectively ( P Conclusions The results indicate that this cohort of kidney transplant recipients who had CAD comprised subgroups with different clinical courses.

In this work, the development progress and status of Centimeter Level Augmentation Service (CLAS) in Japanese Quasi-Zenith Satellite System (QZSS) are described. Especially, essential points regarding user interface documents for CLAS called IS-QZSS-L6 are mentioned.

Excessive mechanical stress is thought to be a factor in the development of joint disorders through the expression of matrix metalloproteinases (MMPs) and related cytokines. Although studies revealed that mechanical stress on the synovium induces MMP expression, it is still not known which MMPs prolonged high level expression. The authors focused on MMP-3, which is one of the major factors in joint disorders such as rheumatism and temporomandibular joint disorders. They examined mRNA and protein levels of MMP-3, other MMPs and related cytokines after loading stress. Human synovial cells were seeded onto a collagen scaffold and different magnitudes of cyclic compressive load were applied for 1h. Time-dependent mRNA and protein levels for catabolic genes were examined after loading. mRNA expressions of MMP-1, MMP-3, MMP-9, IL-6, IL-8 and IL-1β increased after excessive compression. In particular, only mRNA of MMP-3 was up-regulated and maintained at a high level for 24h after excessive loading. The concentrations of MMP-3, IL-6 and IL-8 in culture media after loading increased with excessive compression. These results may account for the pathomechanism of MMP-3 induced by cyclic load on synovial cells in joint disorders.

We investigated the phase dynamics of long intrinsic Josephson junctions, which were fabricated on a narrow bridge structure of Bi2Sr2CaCu2Oy (Bi-2212) single crystals by using a focused ion-beam etching. We measured the probability distribution of the switching events from the zero-voltage state for two types of junction geometry. One is a junction where the bridge width (L1) is larger than the Josephson penetration depth, λJ, and the distance between two slits (L2) is comparable to λJ, while the other is a junction where L1 is comparable to λJ and L2 is larger than λJ. We found that a crossover temperature from the thermally activated regime to the macroscopic quantum tunneling regime was quite different between the two types of junction geometry. We discuss the observed behavior in terms of an edge effect in long Josephson junctions dependent on the junction geometry.

In this study, nonlinear behaviors in the time evolution of discharge current at atmospheric pressure are investigated from the viewpoints of chaos and fractals. When the electric field between two electrodes placed in atmospheric pressure increases and exceeds a certain value, the insulation breakdown of air and corona discharge occur. With the further increase in the electric field, the corona discharge gradually transforms into an arc discharge along with the increasing discharge current. It is found from the chaotic analysis results of the calculation of the largest Lyapunov exponents that the system sustains more chaos in the corona than the arc discharge, i.e.,the system is stabilized with the system changing from a corona to arc discharge. The correlation dimension of the time evolution of the discharge current saturates at a non-integer value at every discharge current, and 1/ｆ-type spectra are observed in the power spectrum, i.e., the system exhibits fractal properties. Published by AIP Publishing., Physics of Plasmas, 25(9), 92303; 2018

Introduction/Background The Quality of Life after Brain Injury (QOLIBRI; 37 items) is a disease specific subjective questionnaire of health-related quality of life (HRQoL) in persons after traumatic brain injury. We developed Japanese version of QOLIBRI; QOLIBRI-J and reported that it's test-retest reliability (ICC; 0.92, Cronbach α = 0.86) and validity (Correlations of SF-36) were excellent. The Questionnaires of QOLIBRI-J are based on subjective satisfaction, although those of another popular QOL instrument, Community Integration Questionnaire; CIQ is based on objective situations. We investigated between the relationship of QOLIBRI-J and CIQ of the persons with higher brain dysfunctions after TBI to show the differences of subjective and objective QOL. Material and method Subjects: 73 recruited community-dwelling Japanese with higher brain dysfunction after traumatic brain injury [61 male, 12 female: age 41.6 ± 14.3, Glasgow Outcome Scale-Extended; GOSE (3 to 8: median 5)]. Design The Correlations between QOLIBRI-J and CIQ were investigated in 73 subjects at the same time. They were also asked to fill the GOSE. The questionnaires were administered in one of three modes: by self-report (mail), self-report (participant presents at the clinic), and face-to-face interview. Results Distribution of GOS-E score were as follows, 3: lower severe disability (12.3%), 4: upper severe disability (27.4%), 5: lower moderate disability (27.4%), 6: upper moderate disability (16.4%), 7: lower good recovery (11.0%), 8: upper good recovery (5.5%). There was a low correlation between QOLIBRI-J total score and the CIQ total score (ρ=0.326 Spearman correlation coefficient). By the subscale analysis, the strongest correlation was found between QOLIBRI-J (Daily life/autonomy) and CIQ (social life). In contrast there was the weakest correlation between QOLIBRI (emotions) and CIQ (productive life). There was no correlation between the QOLIBRI and GOSE (ρ=0.21). Conclusion QOLIBRI-J had a mild correlation with CIQ. There were some differences between QOLIBI and CIQ. One of the reasons of this difference was thought to be the subjective emotional factor about taking a productive work.

This study describes an active flow control concept that uses counterflowing jets to significantly modify external flowfields and strongly disperse the shock waves of supersonic and hypersonic vehicles to reduce aerothermal loads and wave drag. The potential aerothermal and aerodynamic benefits of the concepts were investigated by conducting experiments on a 2.6%-scale Apollo capsule model in Mach 3.48 and 4.0 freestreams in a trisonic blowdown wind tunnel, as well as pretest computational fluid dynamics analyses of the flowfields, with and without counterflowing jets. The model employed three sonic and two supersonic (with design Mach numbers of 2.44 and 2.94) jet nozzles with exit diameters ranging from 0.25 to 0.5 in. The schlieren images were consistent with the pretest computational fluid dynamics predictions, showing a long penetration mode jet interaction at low jet flow rates of 0.05 and 0.1 Ib m /s, whereas a short penetration mode jet was revealed at higher flow rates. The long penetration mode jet appeared to be almost fully expanded and was unsteady, with the bow shock becoming so dispersed that it was no longer discernible. High-speed camera schlieren data revealed the bow shock to be dispersed into striations of compression waves, which suddenly coalesced to a weaker bow shock with a larger standoff distance as the flow rate reached a critical value. Heat transfer results showed a significant reduction in heat flux, even giving negative heat flux for some short penetration mode interactions, indicating that the flow wetting the model had a cooling effect, instead of heating, which could significantly impact thermal protection system requirements and design. The findings suggest that high-speed vehicle design and performance can benefit from the application ofcounterflowing jets as an active flow control.

High-damping materials are widely used in engineering fields. In order to increase the precision of vibration control to different levels, high-damping materials with high-rigidity are required. This study attempts to develop a new high-damping high-rigidity material using ductile ceramics based on the Al2TiO5–MgTi2O5 system, which has many continuous microcracks along the grain boundaries. Ductile ceramics have high internal friction (Q−1 = 0.01–0.037), but very low rigidity (

Ceramics are typically rigid and brittle. If this brittleness could be overcome, their application can be widely expanded. Itacolumite is known as a highly flexible unique rock in the sandstone group. The microstructure of itacolumite has many narrow gaps at the grain boundaries; these gaps allow a slight displacement of the particles, and the rock can plastically bend when stressed. The authors tried to develop highly ductile ceramics by mimicking itacolumite, which resulted in the Al 2 TiO 5 –MgTi 2 O 5 solid solution ceramics. These ceramics have a high ductility and good stress relaxation properties against flexure stress because there are many thin gaps along the grain boundaries formed by discontinuous grain growth during the sintering process and anisotropic thermal expansion during the cooling process. The ductility is caused by the integration of a slight displacement of the grains. This phenomenon was observed as a high-internal friction, reflecting the total friction of a high-grain boundary area.

To evaluate spinal arterial anatomy and identify risk factors for lower extremity weakness (LEW) following endovascular thoracoabdominal aortic aneurysm (TAAA) repair.A retrospective review was conducted of 37 patients (27 men; mean age 74.8+/-7.1 years, range 58-86) undergoing endovascular TAAA repair with branched stent-grafts at a single academic institution from July 2005 to December 2007. Data were collected on preoperative comorbidities, duration of operation, blood loss, type of anesthesia, extent of aortic coverage, blood pressure, cerebrospinal fluid (CSF) pressure and drainage, and postoperative development of LEW. Pre- and postoperative contrast-enhanced computed tomographic angiograms (CTA) in a 26-patient subset were analyzed to evaluate the number of patent intercostal and lumbar arteries before and after repair.All patients were neurologically intact at the end of the operation. Seven (19%) patients developed LEW postoperatively: 6 perioperatively and 1 after discharge. LEW was associated with postoperative hypotension, internal iliac artery (IIA) occlusion, and fewer patent segmental arteries on preoperative CTA. Lowest mean systolic blood pressure was90 mmHg in all 6 (100%) patients who developed LEW in hospital compared to 12 (44%) of the 27 patients who did not develop LEW (p = 0.02). Complete resolution of LEW (n = 4) followed prompt measures to raise blood pressure and lower CSF pressure. Persistent LEW (n = 3) was associated with sustained hypotension from sepsis, postoperative bleeding, and hemodialysis, respectively. Two (29%) of 7 patients with LEW either lost prograde flow to an IIA during repair or had bilaterally occluded IIAs preoperatively compared to 2 (7%) of 30 patients without LEW (p = 0.16). Comparison of pre- and postoperative CTAs showed no reduction in the mean number of patent segmental arteries in patients with or without LEW.Endovascular TAAA repair inevitably occludes direct inflow to lumbar and intercostal arteries. The distal segments of these arteries to the spine, however, are seen to remain patent through collaterals. Measures to preserve collateral pathways and increase perfusion pressure may help prevent or treat LEW.