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The dispersal processes of anatomically modern humans in Asia during the late Middle to early Upper Paleolithic periods have been a focus of intensive research in recent years through interdisciplinary approaches including genetic, paleoanthropological, and archeological studies. However, sparse datasets, often only available from limited time-space contexts have not produced a satisfactory picture of the vast geographic extension of this continent. This study investigated how the chrono-spatial patterning of lithic technological records, which are widely available across Asia, might contribute to our better understanding of the population dynamics in this period. The study is based on a large database (PaleoAsiaDB) recently developed by the authors to accommodate the relevant datasets, including geographical coordinates of each site and available radiometric dates, for the Middle and Upper Paleolithic periods in Asia. Each of the 895 lithic assemblages was characterized in terms of the presence/absence of 24 lithic modes/submodes that were adapted from the work of John Shea to fit our research objective. The dataset was analyzed using exploratory statistical methods, including principal component analysis. The results revealed marked spatiotemporal patterns in technological variability from the late Middle to early Upper Paleolithic periods. Some can be interpreted as a result of modern human dispersal, whereas others are better explained from ecological and other perspectives rather than authorships. Although this study has obvious limitations due to its reliance on the information sourced from the literature, it provides a global synthesis of lithic variability in the crucial period of the dispersals of modern humans on a continental scale for the first time. The results serve as a guide to be tested with evidence from other research strategies, such as genetics and fossil studies.

Recently, several studies have presented quantitative data of lithic assemblages from Islands Southeast Asia (ISEA), based on technological and morphological analyses. While this has led to a better overall understanding of the nature of these assemblages, there is still lack of clarity about the relationship between manufacturing technology and usage. Accordingly, this study collected detailed data of lithic assemblages from Callao Cave in northern Luzon, Philippines. Multifaceted analyses including technological and morphological analysis and use-wear analysis were conducted to clarify the actual nature of lithic technology and tool use in relation to human behavior. Results of the technological and morphological analysis show that several core tools share same types of secondary reduction (retouch) with flake tools, while there are several retouched tools (flake tools and core tools) with several types of secondary reduction (retouch). In addition, there are no major differences between the sizes of the core tools and flake tools. Result of the use-wear analysis indicates that several retouched areas on both the core tools and flake tools were actually used. These stone-tool manufacturing and usage characteristics suggest that the hunter-gatherers who left the assemblages did not clearly distinguish between cores and flakes (or between core tools and flake tools), and did not treat lithic tools as single-function items. That is, it appears that secondary reduction was completed depending on the shapes, thicknesses, and angles of the edges of these lithic artifacts. The users/manufacturers thus placed emphasis on functional edges. It also seems that the core tools were used as both tools and objects for flake production. The characteristics of the assemblages in manufacturing and their usage suggest that lithic artifacts and lithic raw materials were used in Callao Cave efficiently and economically. Furthermore, in terms of their primary and secondary reduction processes, the assemblages from Callao Cave are considerably different from Upper Paleolithic assemblages found in the northern regions of Eurasia. This indicates that the characteristics of stone tool manufacturing and usage in Callao Cave reflect another strategy of early modern humans for using lithic raw material. However, these characteristics of the assemblages may most closely reflect the characteristics of the occupations and activities in the site. Accordingly, similar analyses, including technological and morphological analysis and use-wear analysis, need to be conducted on other lithic assemblages which are composed of many lithic artifacts in ISEA.

Aim Selecting optimal energy intake during diet therapy for older patients with diabetes mellitus is difficult because of the large differences in physical function and comorbid diseases. In Japan, although requirements for total energy intake are calculated by multiplying a person's standard bodyweight (BW) by the amount of physical activity, evidence supporting the application of this method among older people is limited. Therefore, we aimed to assess optimal energy intake by evaluating the relationship between energy intake and mortality in older patients. Methods We evaluated data from a 6-year prospective follow up of 756 older patients with diabetes mellitus, and the association between baseline nutrient intake and mortality. Total energy intake and nutrients were evaluated, and energy intake per actual BW was categorized into quartiles (Q). Cox regression analysis was used for statistical analyses. Energy intake per standard BW or age-related target BW was statistically analyzed using the same protocol. Results Analysis of energy intake per actual BW showed that hazard ratios for mortality was significantly higher in Q1 and Q4. Similar associations were found for energy intake per standard or target BW. Subgroup analysis showed that mortality rate was the lowest in Q2 in the young-old population and in Q3 in the old-old population. Conclusions A U-shaped relationship was observed between energy intake per BW and mortality in older patients with diabetes mellitus, which suggests that the optimal energy intake per actual or target BW should encompass a wide range to prevent malnutrition and excessive nutrition in these patients. Geriatr Gerontol Int 2020; 20: 59-65.

The aim of this study was to investigate the association between protein intake and mortality risk in patients with type 2 diabetes. We analyzed a pooled data of 2494 diabetic patients from two prospective longitudinal studies. Nutritional intake was assessed using a Food Frequency Questionnaire at baseline. Protein intake per body weight (kg) per day was categorized into quartile groups. Adjusted hazard ratios (HRs) and 95% confidence interval (CI) were calculated using Cox regression analysis. During the six-year follow-up, there were 152 incidents of all-cause mortality. The HR for mortality in the lowest quartile of protein intake per body weight compared with the highest quartile was 2.26 (95% CI: 1.34&ndash, 3.82, p = 0.002) after adjustment for covariates. Subgroup analyses revealed significant associations between low protein intake and mortality in patients aged over 75 years or under 65 years. After further adjustment of the total energy intake, a significant association between protein intake and mortality remained in patients aged &ge, 75 years, whereas the association was attenuated in those aged &lt, 65 years. Our results suggest that adequate protein intake is necessary in older diabetic patients over 75 years, whereas with diabetes, whereas whole optimal total energy intake is required in younger patients with type 2 diabetes.

Highlights • We examined links between medical claims and health check-up data for older adults. • Patients receiving pharmacotherapies were more likely to participate in health checkups. • Patients with intensive disease control were more likely to be aged ≥ 90 years. • Linking these databases can improve evaluations of diseases control in older adults., The Japanese government encourages older adults to participate in annual health checkups designed to detect lifestyle diseases such as hypertension, diabetes, and dyslipidemia. However, individuals who are already being treated for these diseases are unlikely to benefit from health checkup participation. This retrospective cohort study of older adults evaluated the associations of pharmacological treatments for these diseases with health checkup participation and identified the disease control factors among patients receiving treatments. Using medical claims data and health checkup data between September 2013 and August 2014 from 820,215 older adults aged ≥ 75 years residing in Tokyo, Japan, we examined the associations between pharmacological treatments and health checkup participation using binary logistic regression analysis. Next, patients receiving pharmacological treatments were categorized into intensive, moderate, or limited disease control based on their blood pressure, hemoglobin A1c levels, and lipid levels; multinomial logistic regression analyses were used to identify the disease control factors. The results showed that patients receiving pharmacological treatments were more likely (odds ratio: 1.374; P

This paper focuses on trapezoids, a weapon technology of the Initial Early Upper Paleolithic (the IEUP) in the Japanese Islands. A series of shooting and stabbing experiments using replicated trapezoids were conducted to evaluate weapon technology functions during the IEUP. The shooting and stabbing experiments were designed to investigate several factors, including impact velocity, weight of shafts, and hafting methods affecting the formation of impact fractures. Results of the shooting and stabbing experiments and comparisons between experimental specimens and archaeological specimens suggest that hunting weapons equipped with trapezoids had a mechanism of a cushion at their hafting parts or connected parts between shafts and fore-shafts. I was able to identify functional properties (i.e., lethality and strength) of obsidian trapezoids through experiments. Comparisons also indicate that specimens from the Doteue site contain several trapezoids broken by high impact. A characteristic fracture pattern on the broken specimens in both the archaeological specimens and the experimental specimens suggests that hunting weapons equipped with trapezoids were used with complex projectile technologies. Hunting weapons equipped with trapezoids were intended for specific functions. This research identifies complexity in producer decisions involving hunting tool production in the IEUP in the Japanese islands.

Aim Few reports have described the characteristics of hyperglycemic hyperosmolar syndrome (HHS) in the elderly. We investigated the background characteristics and clinical features of 14 elderly patients with HHS. Methods HHS was diagnosed based on a blood glucose level of >600 mg/dL and an effective plasma osmolality [2 (Na) + glu/18] of >320 mOsm/kg. For 14 cases of HHS, we investigated the medical and social backgrounds of the patients, their clinical findings, and the outcomes. Results The mean patient age was 83 years, and the mean body mass index was 17.8 kg/m2. Half had a history of either cerebral infarction or hip fracture. The mean duration of diabetes was 14 years, but 4 diabetes cases were newly diagnosed. There was a high prevalence of acute infection (79%) in HHS patients, especially urinary tract infection and pneumonia, with a seasonal peak in winter. Patients who had been treated with steroids, tube feeding, or both numbered 1, 2, and 1, respectively. Most HHS patients had a history of dementia. More than half of such patients were living alone or only with their spouse, and their activities of daily living showed marked deterioration. The mean blood glucose level, HbA1c, effective serum osmolality, and pH were 881 mg/dL, 10.3%, 353 mOsm/kg, and 7.39, respectively. One patient died during hospitalization, and 9 were discharged to nursing homes or other hospitals. The mean length of hospitalization was 55 days. In most cases, the insulin secretion capacity was preserved, and 9 patients were treatable with oral hypoglycemic agents alone. Conclusions Many cases of HHS in the elderly are associated with infection, a shortage of social support, cognitive impairment, or ADL decline. Although the survival rate in our series was high, the functional prognosis was impaired.

Because abnormal grain growth (AGG) degrades mechanical properties of industrial polycrystalline materials such as steel, understanding and controlling AGG are important. In this study, AGG of Al-Nb-microalloyed low-carbon steel was investigated at 1100°C using in-situ scanning electron microscopy-electron backscatter diffraction (SEM-EBSD). Owing to the pinning particles of AlN and Nb(C,N), fine austenite grains formed initially, and AGG appeared owing to the dissolution of the pinning particles at high temperatures. Relatively large grains invaded the surrounding smaller grains with a size ratio of approximately 0.3, resulting in AGG. We developed the in-situ observation method to investigate the AGG of the carburization process using a diffusion couple of high- and low-carbon steels. The carbon diffusion into the low-carbon steel from the high-carbon steel enhanced the grain growth of the low-carbon steel. Although the detailed mechanism is still unclear, we clearly showed that carburization can reduce the pinning force. When focusing on the misorientation of the grain boundary, grain boundaries with misorientation angles of 50–59° remained during AGG, which is explained by their lower mobility owing to their lower grain boundary energy. These results suggest that the difference in grain-boundary mobility can induce duplex grain growth with a bimodal distribution, resulting in AGG.

Aims Although evidence has accumulated that white matter hyperintensity (WMH) is associated with the deterioration of cognitive function and impairment of activities of daily living (ADL), the clinical relevance of WMH in elderly patients with diabetes mellitus is not still clear. The aim of this study was to examine whether WMH volume is associated with ADL and cognitive function and whether glucose control and glucose variability can affect WMH volume in these patients. Methods This cross-sectional study investigated the associations of WMH with cognitive function and instrumental ADL (IADL), as well as metabolic and vascular risk factors in a total of 178 elderly patients with diabetes. The study assessed WMH volumes and the functional status of cognition and IADL. WMH volumes were evaluated by obtaining axial T2-weighted and fluid-attenuated inversion recovery sequence images on brain magnetic resonance imaging and assessing the images using Software for Neuro-Image Processing in Experimental Research. Results We found a significant association between WMH volumes and Mini-Mental State Examination (MMSE) scores (p = 0.039) and between WMH and IADL status (p = 0.006). Furthermore, we found significant relations of large WMH volumes with a high glycoalbumin/glycohemoglobin ratio (GA/HbA1c) (p < 0.001). Large WMH volumes were also found to be associated with a low body mass index (p = 0.014) and a low diastolic blood pressure (p = 0.024), but not with HbA1c. Multiple regression analysis showed that high GA/HbA1c, which reflects high glucose variability, was a significant determining factor for large WMH volumes. We also found that GA/HbA1c was negatively associated with both MMSE (p = 0.036) and IADL (p < 0.001). Conclusions GA/HbA1c, which is a marker of glucose variability, was independently associated with WMH volumes, which could lead to the decline of cognition and IADL in elderly patients with diabetes mellitus.

The austenite (gamma) structure reversely transformed from martensite in Fe-0.55C mass% C alloy was investigated at high temperatures using in-situ an electron backscatter diffraction (EBSD) method. When the heating rate was varied, a rapidly heating produced fine gamma grains, in contrast, a slow heating induced coarse gamma grains having the same crystal orientations as those of the prior gamma grains; known as "gamma memory". The most likely mechanism for the gamma memory could be variant restrictions owing to cementite (theta). To investigate the effect of theta on the gamma memory, the sample was tempered at 700 degrees C for 24 h and theta was precipitated. The tempered sample exhibited the gamma memory irrespective of the heating rate. To clarify the origin of the gamma memory, we focused on the reversely transformed gamma formed adjacent to the theta and directly observed the orientation relationships (ORs) using the in-situ EBSD. A crystallographic analysis on the between neighboring ferrites (alpha), theta, and gamma revealed the existence of Kurdjumov-Sachs OR between gamma and two alpha (alpha 1 and alpha 2), Isaichev OR between alpha and theta, and Pitsch OR between theta and gamma. In the all possible combinations, the reversely transformed gamma satisfying the K-S OR for two alpha variants was limited to four variants. The theta variant satisfying the Isaichev OR for alpha 1 and alpha 2 was limited to one variant, which was close to one of the four variants by Pitsch OR, which suggests the gamma memory is due to these variant restrictions among alpha-theta-gamma.

This paper presents a case study about trapezoids from the initial Early Upper Paleolithic Period in the Japanese Islands. The use and the maintenance of trapezoids (or tools equipped with trapezoids) from Layer BBV of the Doteue site Loc. d and Loc. e in Shizuoka Prefecture are discussed through study of their breakage patterns. The results indicate that trapezoids were designed to be basally hafted and used as multifunctional tools for hunting and processing. The accumulation of discarded broken trapezoids by retooling at the site suggests repeated occupations of the site by planned hunting activities, proposed as an indication of modern human behavior of the initial Early Upper Paleolithic in the Japanese Islands.

This article explains lithic assemblage transitions during the Early Upper Palaeolithic (EUP) on the Musashino Upland by quantitative comparisons of lithic raw materials, core reduction (blade technology), and formal tool production. The results suggest that changes in aspects of lithic assemblage variability could be explained by changes in raw material utilization, not developments (sophistication of tool-making skills) in blade technology and methods of formal tool production. The results also indicate the possibility that the changes in lithic raw material would have been affected by changes in residential mobility and the foraging territorial scale of EUP hunter-gatherers, as well as the changes in organic raw material utilization in whole technological organization in various environmental settings during the EUP. Beside them, the characteristics of the lithic assemblages in Period I as the initial EUP assemblages in this region are different from general characteristics of Upper Palaeolithic assemblages (blade technology, standardized and formal flaked tools) in Eurasia. The nature of lithic raw material utilization, especially flaked tool use, in Period I assemblages looks extremely expedient. Therefore, the characteristics of initial EUP assemblages in this region represent that diversity in lithic raw material utilization and technological organization was present during the EUP.