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Renal ischemia-reperfusion (IR) injury is an inevitable complication in various clinical settings including kidney transplantation and major vascular surgeries. Renal IR injury is a major risk factor for acute kidney injury, which still remains a major clinical challenge without effective therapy. The main cause of renal IR injury is the massive production of reactive oxygen species (ROS) including hydrogen peroxide (H

Electrostatic interactions play a dominant role in charged materials systems. Understanding the complex correlation between macroscopic properties with microscopic structures is of critical importance to develop rational design strategies for advanced materials. But the complexity of this challenging task is augmented by interfaces present in the charged materials systems, such as electrode-electrolyte interfaces or biological membranes. Over the last decades, predictive molecular simulations that are founded in fundamental physics and optimized for charged interfacial systems have proven their value in providing molecular understanding of physicochemical properties and functional mechanisms for diverse materials. Novel design strategies utilizing predictive models have been suggested as promising route for the rational design of materials with tailored properties. Here, an overview of recent advances in the understanding of charged interfacial systems aided by predictive molecular simulations is presented. Focusing on three types of charged interfaces found in energy materials and biomacromolecules, how the molecular models characterize ion structure, charge transport, morphology relation to the environment, and the thermodynamics/kinetics of molecular binding at the interfaces is discussed. The critical analysis brings two prominent field of energy materials and biological science under common perspective, to stimulate crossover in both research field that have been largely separated.

During the last three decades, Japan has become one of the world's top countries for longevity, and the increase in average life expectancy is accompanied by a sharp rise in older population 65 years of age and above to ∼28%. This study aimed to examine the changes in major health-related measures, including a physical constitution, physical function, and functional capacity of community-dwelling Japanese older people in the last decade. From the data of 13 longitudinal cohort studies on aging conducted in Japan with a total of 13,441 older subjects, this study analyzed the changes in six indices that are related to health and functioning of the older people; height, weight, body mass index, walking speed, grip strength, and instrumental activity of daily living, between 2007 (±2 years) and 2017 (±2 years). Comparison of data for the two periods between subjects matched for age group and gender evidently showed better health status and a slower decline in most of the health-related measures in 2017 compared to a decade ago. The results of this study indicate that the phenomenon of “rejuvenation” is occurring among the new generation of Japanese older adults, and the importance of this older population as a social resource in the super-aged society should be reacknowledged.

Ascertaining progress in building age-friendly cities (AFCs) requires community diagnostic indicators. This study examines the relationship between social participation and happiness at the municipal level. The data from the Japan Gerontological Evaluation Study (JAGES) from 2013, 2016, and 2019, comprising 442,079 older people from 289 municipalities, are used. We also employ linear mixed-effects models to evaluate the association between social participation and happiness. In these models, we adjust for seven variables as potential confounders. This study reveals that the higher the social participation, except for neighborhood association, the higher the state of happiness (B = 0.14–0.30). Our study suggests that social participation is useful, as a community diagnostic indicator, for monitoring the progress of building AFCs, developing strategies, and creating evidence.

Shaping the wavefront of an incident wave to a complex scattering medium has demonstrated interesting possibilities, such as sub-diffraction wave focusing and light energy delivery enhancement. However, wavefront shaping has mainly been based on the control of transmitted waves that are inaccessible in most realistic applications. Here, we investigate the effect of maximizing the backscattered waves at a specific flight time on wave propagation dynamics and energy transport. We find both experimentally and numerically that the maximization at a short flight time focuses waves on the particles constituting the scattering medium, leading to the attenuation of the wave transport. On the contrary, maximization at a long flight time induces constructive wave interference inside the medium and thus enhances wave transport. We provide a theoretical model that explains this interesting transition behavior based on wave correlation. Our study provides a fundamental understanding of the effect of wave control on wave dynamics inside scattering medium.

Intending to obtain scientific evidence to use in developing indicators for evaluating the quality of home care, we surveyed doctors, nurses, and other home care professionals to determine the points they consider to be essential in evaluating home care. We investigated all 901 clinics registered to the National Association of Medical Institutions Supporting Home Care and a random sample of 600 Visiting Nurse Service stations registered to the National Association for Visiting Nurse Service in Japan. A total of 539 questionnaire responses were received (response rate: 35.9%). In this study, a factor analysis revealed four factors to be considered when evaluating the quality of home care: (1) patients’ and family members’ level of satisfaction, (2) home care process, (3) structure of home care, and (4) medical outcomes. The factor of the satisfaction of patients and family members identified in the present study was not considered in previous studies for evaluating the quality of care in Japan. Satisfaction is the point of difference in goals between hospital-based care and home care, and it requires different measurement indicators. Home care professionals expect to help relieve the physical and psychological burden felt by the patient and their family. Thus, on the evaluation indicators of quality of home care, their perspectives from the present study are valuable.

As the population ages, it is important to consider whether older adults tend to have healthier lives. This study examined temporal trends in cognitive function among community-dwelling Japanese older adults.The data source for this study was Integrated Longitudinal Studies on Aging in Japan (ILSA-J). We collected representative values for the Mini-Mental State Examination (MMSE) score obtained in 2010 and 2017; mean, standard deviation, and prevalence of ≤23 as cognitive impairment and ≥28 as intact cognitive function. Six cohorts (n=8,575) in 2010 and seven cohorts (n=6,089) in 2017 were included (age range 65-89). One-group meta-analyses were conducted to calculate pooled means of MMSE scores, the pooled prevalence of MMSE scores ≤23 and ≥28, and 95% confidence intervals (CIs).The mean MMSE score was higher in 2017 than in 2010 for all age groups in both men and women. The prevalence of MMSE ≤23 was lower in 2017 than in 2010 for all age groups for men and was lower in 2017 than in 2010 for all age groups other than for women aged 75-79 years. The prevalence of MMSE ≥28 was higher in 2017 than in 2010 for all age groups in both men and women. In addition, the pooled means of years of education was lower in 2010 than in 2017, which might be an explanatory factor.This study suggests that the cognitive function of community-dwelling Japanese older adults has improved in recent years. Future studies need to identify factors associated with the improvement.

This paper aims to explore three walking behaviors of older pedestrians that may increase their crash risks when crossing urban streets. Older and younger pedestrians' start-up delay in initiating a crossing and number of head turns during street crossing are observed at 30 pedestrian crossings in Seoul, South Korea, using video recorders. In addition, their estimation of the safe crossing distance to an approaching vehicle is collected in a survey. Our study shows that older pedestrians have a shorter start-up delay time than younger pedestrians, older pedestrians crossing streets turn their heads less frequently, and older pedestrians provide less reliable estimates about the distance of an approaching vehicle. Safety technologies, campaigns and environmental designs should target these behaviors to improve the safety of older pedestrians.

Significance We show the enhancement of ion transport properties for charged block copolymers comprising nonstoichiometric ionic liquids by stabilizing the cubic Frank–Kasper A15 phases. The ionic liquid cations predominantly present near the micellar interfaces to increase stabilization energies of the A15 structures if they have strong attractive electrostatic interactions with the charged polymer chains. Unprecedented reentrant phase transitions between lamellar and A15 structures occur through the electrostatic control of interfaces, resulting in radical changes in the conductivity by an order of magnitude. This study is one of the rare demonstrations of a low symmetry morphology to establish a prospective avenue for advanced polymer electrolytes having tailor-made interfaces. Our findings will have implications for energy storage and transfer devices., Recently, the interest in charged polymers has been rapidly growing due to their uses in energy storage and transfer devices. Yet, polymer electrolyte-based devices are not on the immediate horizon because of the low ionic conductivity. In the present study, we developed a methodology to enhance the ionic conductivity of charged block copolymers comprising ionic liquids through the electrostatic control of the interfacial layers. Unprecedented reentrant phase transitions between lamellar and A15 structures were seen, which cannot be explained by well-established thermodynamic factors. X-ray scattering experiments and molecular dynamics simulations revealed the formation of fascinating, thin ionic shell layers composed of ionic complexes. The ionic liquid cations of these complexes predominantly presented near the micellar interfaces if they had strong binding affinity with the charged polymer chains. Therefore, the interfacial properties and concentration fluctuations of the A15 structures were crucially dependent on the type of tethered acid groups in the polymers. Overall, the stabilization energies of the A15 structures were greater when enriched, attractive electrostatic interactions were present at the micellar interfaces. Contrary to the conventional wisdom that block copolymer interfaces act as “dead zone” to significantly deteriorate ion transport, this study establishes a prospective avenue for advanced polymer electrolyte having tailor-made interfaces.

The burden of missing incidents is not only on the person with dementia, but also on their family, neighbors, and community. The extent to which dementia-related wandering and missing incidents occur in the community has not been evaluated thoroughly in the published literature. Therefore, we evaluated the incidence of and risk factors for missing events due to wandering. We conducted a non-randomized prospective one-year follow-up cohort study based on symptom registration with missing events due to wandering as the endpoint. In the first consultation, 374 patients with dementia or mild cognitive impairment (MCI) and their caregivers who visited the National Center for Geriatrics and Gerontology in Japan were included. The incidence and recurrence rate of missing events were calculated. Participants were divided into (those with) dementia and (those with) MCI. Patients' basic and medical information was documented at baseline and after one year of follow-up. Furthermore, analysis of variance and logistic regression analysis were performed to clarify the risk factors associated with the missing event. Among the 236 patients with dementia enrolled, 65 (27·5%) had a previous missing event at baseline, and 28 had a missing event during the one-year follow-up period (recurrence rate of 43·1%). Of the 171 who did not have a previous missing event at baseline, 23 had a missing event during the one-year follow-up period (incidence rate of 13·5%). The scores of Mini-Mental State Examination (MMSE), Dementia Behavior Disturbance Scale (DBD), and Alzheimer's Disease Assessment Scale (ADAS) were statistically significant as the risk factors for the incidence of wandering leading to a missing event (p

On 11 March 2011, the great earthquake hit Japan, resulting in 15,895 deaths, 6156 serious injuries, and 2539 missing persons. This event affected the health and lives of older residents, and reports showed an increase in the number of people eligible for long-term care afterward. In this study, among the places affected by the 2011 Great East Japan Earthquake and tsunami, we focused on 15 municipalities, including designated municipalities based on the Special Act on Nuclear Evacuation in Fukushima Prefecture, and aimed to clarify the medium-term effects (six years post-disaster) on the long-term care certification rate and expenditure for provision of services. We used the Ministry of Health, Labour, and Welfare Monthly Status Report on Long-Term Care Insurance and the Ministry of Internal Affairs and Communications Population Register for 2011, 2014, and 2017. In 2011, we found no intergroup differences among the 15 Fukushima municipalities and other municipalities in either the long-term care certification rate or the per-person expenditure for use of services. In 2014, after the earthquake, the long-term care certification rate was 5.4% higher in the 15 Fukushima municipalities than in other municipalities for those aged 75 years or older. The rate of 2014&ndash, 2017 has not increased significantly, partly because of stability after the disaster and change in the population structure. Nevertheless, the long-term care certification rate in the 15 Fukushima municipalities is higher than that of the other two groups even after six years since the earthquake. Similarly, the per-person expenditure for use of services for one month was 11,800 yen higher in the 15 Fukushima municipalities than in other municipalities in 2014, and this trend continued into 2017. Strong, ongoing governmental support is needed, especially for those aged 75 or older, following a disaster.

We demonstrate selective pump focusing for highly isolated single-mode lasers in microdisk and microring cavities, and achieve lasing action from a microdisk cavity underneath a scattering medium. The spatial profile of the pumping light evolves by an iterative feedback process and is optimized to maximize the field overlap with a selected cavity mode. The high order of mode selectivity and high resolving power are obtained in a multimode cavity in the presence of significant modal overlaps. As a result of the adaptive optical pumping, we successfully achieve the efficient energy transfer to a microdisk underneath a random scattering medium and observe lasing action through the scattering medium. We believe that our selective pumping procedure will pave the way for the development of low-threshold, single-mode nanolasers embedded in various materials.

The efficient delivery of light energy is a prerequisite for non-invasive imaging and stimulating of target objects embedded deep within a scattering medium. However, injected waves experience random diffusion by multiple light scattering, and only a small fraction reaches the target object. Here we present a method to counteract wave diffusion and to focus multiplescattered waves to the deeply embedded target. To realize this, we experimentally inject light to the reflection eigenchannels of a specific flight time where most of the multiple-scattered waves have interacted with the target object and maximize the intensity of the returning multiple-scattered waves at the selected time. For targets that are too deep to be visible by optical imaging, we demonstrated a more than 10-fold enhancement in light energy delivery in comparison with ordinary wave diffusion cases. This work will lay a foundation for enhancing the working depth of imaging, sensing, and light stimulation.

Thick biological tissues give rise to not only the multiple scattering of incoming light waves, but also the aberrations of remaining signal waves. The challenge for existing optical microscopy methods to overcome both problems simultaneously has limited sub-micron spatial resolution imaging to shallow depths. Here we present an optical coherence imaging method that can identify aberrations of waves incident to and reflected from the samples separately, and eliminate such aberrations even in the presence of multiple light scattering. The proposed method records the time-gated complex-field maps of backscattered waves over various illumination channels, and performs a closed-loop optimization of signal waves for both forward and phase-conjugation processes. We demonstrated the enhancement of the Strehl ratio by more than 500 times, an order of magnitude or more improvement over conventional adaptive optics, and achieved a spatial resolution of 600 nm up to an imaging depth of seven scattering mean free paths., Optical imaging deep in biological tissue is difficult due to multiple scattering and specimen induced aberrations of both the incident and reflected light. Here, Kang et al. develop an adaptive closed-loop algorithm to correct tissue aberrations in the presence of multiple scattering for deep tissue imaging.

Ageing drivers experience a higher risk of intersection crashes because of their decrease in driving efficiency, including the decline in cognitive ability, head and neck flexibility, and visual acuity. Although several studies have been conducted to examine the factors associated with ageing driver crashes at intersections, little research has been conducted to examine the differences in the factors related to ageing drivers' turning paths and intersection geometric features. This study aims to improve the safety of ageing drivers at intersections by identifying the maneuvers that are risky for them and tracking their turning movements at selected intersections. We find that ageing drivers experience more crashes at intersections than younger drivers, especially crashes involving turning movements. Furthermore, ageing drivers experience more crashes at unchannelized intersections compared to channelized intersections. In addition, this study finds that ageing drivers exhibit greater and more inconsistent offsets during turning movements compared to those of younger drivers at both channelized and unchannelized intersections. Ageing drivers also tend to make relatively sharper or tighter turns than younger drivers. Hence, transportation engineers and road safety professionals should consider appropriate countermeasures to reduce the risks of crashes involving ageing drivers at intersections.

Objective To investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge. Design Retrospective, observational, propensity score (PS)–matched case-control study. Setting General hospitals. Participants Participants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no–self-exercise program groups. Intervention Self-exercise program participation. Main Outcome Measures At discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value − admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no–high efficiency), and mRS score. Results Patients were classified into a self-exercise program (n=780) or a no–self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no–high efficiency) of 2.2 (95% confidence ratio, 1.75–2.70). Conclusions SEPs may contribute to improving ADL.

We introduce the groupwise-pivotal referral (GPR) mechanism for auctions where buyers can participate only through referrals. Each buyer's type consists of a valuation and referable buyers. Unlike the second-price auction (SPA), the Vickrey-Clarke-Groves (VCG) mechanism provides referral incentives. However, VCG is not budget-feasible. In contrast, GPR is core-selecting, implying efficiency and budget feasibility. In GPR, bidders should refer truthfully and have no incentive to underbid. GPR is shill-proof and groupwise collusion-proof. Furthermore, GPR's ex-post revenue outperforms both VCG and SPA. We also study more general environments than auctions.

In auctions with externalities, the core can be empty, which is undesirable both in terms of stability and fairness. We show that the core is nonempty if the seller cannot deviate, as a counterpart of the result of the nonemptiness of the core when bidders cannot refuse to pay.

In the Delegated Proof-of-Stake (DPoS) blockchain, block producers (BP) are elected by stake-weighted vote. If the supermajority of BPs agree, they can fork the blockchain, i.e., can change the rule of the blockchain. Thus, preventing the centralization of votes is important. Some DPoS blockchains allow users to vote for multiple BPs. One may think that the takeover is more difficult (i.e., a larger stake is needed) if one user can vote for only one BP, or one may think that the number of votes allowed per account (VPA) does not matter, since it applies to everyone in the same way. This paper provides a game-theoretic foundation for an optimal VPA. We introduce the Governance Game and the takeover resistance coefficient (TRC), the minimum ratio of the attacker's stake to the defender's stake for a takeover. Solving the equilibrium of the governance game, we find the optimal VPA that minimizes the takeover risk (i.e., maximizes the TRC) and maximizes the voting flexibility. A smaller VPA requires an attacker to have a more stake for the takeover, but only up to a certain point. Our result implies that the "one vote per account" rule adopted by some major blockchains to mitigate centralization may not be necessary. In contrast, if less than half of BPs are needed for a fork, a smaller VPA requires a less stake.

In auctions with externalities, it is well-known that the core can be empty, which is undesirable both in terms of stability and fairness. Nevertheless, some auction outcome must be chosen. We separate deviations into two types: deviations by paying more and deviations by refusing to pay. In high-stakes auctions where bidders also care about their reputation, the latter are unlikely to occur, or else can be prevented by legal interventions. In contrast, the former is more undesirable in the sense that the seller and the bidders experience justified envy. We show that the core is nonempty if bidders cannot refuse to pay.

A strategy is truth-telling dominating (TTD) if it weakly (strictly, resp.) dominates truth-telling for all (some, resp.) strategy profiles of others. A strategy is iteratively TTD (i-TTD) if any iterate is TTD and payoff improving. We show that any mechanism only with undominated equilibria is not i-TTD manipulable. We also show that any TTD shill-bidding strategy is i-TTD. The Vickrey-Clarke-Groves (VCG) mechanism is not shill-proof, but neither the existence nor the nonexistence of TTD strategy had previously been known. We show both that VCG is TTD manipulable when externalities exist, but not TTD manipulable in package auctions without externalities.

Aim To examine whether the outcomes of fever treatment through home care differ from those through hospitalized care for older people who regularly receive home care in Japan. Methods A retrospective survey of medical record-based data for 679 older people who regularly received home care provided by a clinic in Japan. From these data, 61 fever cases (21 cases treated in the hospital and 40 treated at home and assigned to the hospitalized and home-care groups, respectively) were selected for analysis through a matching process. We compared the two groups in terms of mortality rate at 90 days after fever onset, and concerning changes in respective ranks for "Degree of Independent Living for the Elderly with Disability" and "Degree of Independent Living for the Elderly with Dementia" from immediately before fever onset to 90 days after fever onset. Results The mortality rate tended to be higher in the hospitalized group than in the home-care group (33% vs. 13%, respectively, P = 0.05). The hospitalized group also had a higher proportion of patients whose disability had worsened (43% vs. 23%, respectively, P = 0.16) and a significantly higher proportion of patients whose dementia had worsened (29% vs. 6%, respectively, P = 0.03). Conclusions Our findings suggest that home care is more effective than hospitalized care for treating fever in older people who regularly receive home care in Japan, as it leads to lower mortality and better maintenance of activities of daily living capabilities. Geriatr Gerontol Int 2020; 20: 482-487.

Hard shoulder running (HSR) has been increasingly used as a sustainable and viable way to increase road capacity. This study investigated the safety effect of HSR on freeways in South Korea using the empirical Bayes method. This study found an increase in the total number of crashes. In terms of crash severity, a higher proportion of crashes (25.3%) on 2(3)-lane sections were found to be serious (involving injuries and/or fatalities) compared to those on 4(5)-lane sections (3.6%). Also, a positive relationship was found between the length of the hard shoulder running and changes in crash frequencies. Thus, hard shoulder running on lengthy 2(3)-lane freeways should be avoided.

Background This study aimed to investigate whether care capacity for patients following stroke contributes to improved activities of daily living (ADL) at discharge from hospital based on the degree of stroke severity. Design Retrospective, observational, longitudinal study. Setting Acute phase hospitals. Participants From 2005 to 2011, 5006 patients with stroke at acute phase hospitals were registered in a database. There were 2501 individuals from 11 hospitals who met the following four criteria: (1) a pre-stroke modified Rankin Scale (mRS) score of 0–3; (2) admission to hospital within 7 days of suffering a stroke; (3) ischemic or hemorrhagic stroke; and (4) staying in hospital for 8–60 days. Main outcome measures The main outcome measure was the Functional Independence Measure (FIM, version 3.0) score at discharge. The FIM is an internationally used scale, which is used as an ADL outcome assessment scale for after rehabilitation. Results Among patients with stroke, those with care capacity had higher FIM scores at hospital discharge than did those without care capacity (unstandardized coefficient = 2.3, P = 0.015). Examination of this relationship by stroke severity showed that the FIM score at discharge was only significantly higher in patients who suffered from a moderate to severe stroke (unstandardized coefficient = 7.0, P = 0.040). No associations were observed in patients who suffered from minor, moderate, or severe stroke. Conclusions These results suggest that care capacity facilitates total recovery of the FIM, especially among patients who suffer from a moderate to severe stroke.

Objective: To determine whether early admission of patients with stroke into an inpatient rehabilitation facility (IRF) results in motor function improvement during hospitalization. Methods: Data were extracted from the Japan association of rehabilitation database for 2,760 patients admitted to IRFs at 28 centers. Early IRF admission was defined as 14 days from stroke onset to IRF admission. Variables surveyed were age; sex; stroke type; length of stay; period from stroke onset to IRF admission; motor functional independence measure (mFIM) and cognitive FIM at admission and discharge; and modified Rankin Scale score before onset, at admission, and at discharge. In addition, the difference between mFIM at admission and at discharge per day (ΔmFIM/day) was calculated by dividing by the length of stay. The average rehabilitation intensity per day was calculated as the total units of rehabilitation during hospitalization divided by the length of hospital stay. We defined intensive rehabilitation as rehabilitation conducted at the first quartile (>2.27 hour/day). Multiple regression analysis and instrumental variable analysis were performed to examine the association of early rehabilitation with activities of daily living (ADL) at discharge. Results: ΔmFIM/day was higher in early and intensive rehabilitation. The multiple regression analysis showed that significant improvements in ΔmFIM/day were observed for intensive rehabilitation (partial regression coefficient: 1.56; 95% confidence interval: 0.34-2.8), after controlling for various confounding variables. The instrumental variable analysis showed that ΔmFIM/day was associated with early IRF admission (partial regression coefficient: 0.1; 95% confidence interval: 0.05-0.14). Conclusion: Patients with stroke experience greater improvement in ADL if admitted to an IRF within 14 days after stroke onset.