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This study aimed to examine the long-term effects of the 2011 Japan earthquake and tsunami on the incidence of fatal and nonfatal myocardial infarction (MI). In the present study, the incidence of 2 types of cardiac events was comprehensively recorded. The study area was divided into 2 zones based on the severity of tsunami damage, which was determined by the percentage of the inundated area within the residential area (

This study investigated the long-term impact of the 2011 Japan earthquake and tsunami on the incidence of acute decompensated heart failure (HF) in the disaster area. This was a population-based study using comprehensive registration for all hospitals within the study area. The standardized incidence ratio (SIR) and 95% confidence interval (CI) for new onset of HF during the disaster year (2011) and postdisaster years (2012 to 2014) were determined. When SIR were compared between the low- and high-impact areas, as defined by the extent of tsunami inundation in residential areas, SIR showed a significant increase in high-impact areas in 2011 (1.67, 95% CI 1.45 to 1.88) and tended to return to baseline in 2012, the first postdisaster year (1.25, 95% CI 1.06 to 1.43). The rate again increased in 2013 (1.38, 95% CI 1.18 to 1.57) and 2014 (1.55, 95% CI 1.35 to 1.75). In low-impact areas, no such increase was apparent during either the disaster year or the postdisaster years. Mean postdisaster period SIR for municipalities significantly correlated with the percentage of tsunami flooding in residential areas (r = 0.52, p

Gang bonding process using TCB (thermo-compression bonder) has been developed in recent years as one of the methods to mount advanced packages fast [1, 2]. In the gang bonding process, we can improve the throughput considerably by post-bonding multi pre-bonded chips at a time. However, when a conventional elastic film was used to reduce the variance of bonding load to each chip, we found that the position shift of the chips occurred by deformation of the film especially in narrow pitch chip bonding. In addition, it is difficult to supply enough heat for the solder joint, because the elastic film generally has low thermal conductivity and low heat resistance. In particular, heat capacity necessary for solder fusion is insufficient in the case of chip on wafer (CoW) using Si substrate. In this presentation, we will report about novel gang bonding head (GBH) that is able to reduce the position shift and has both of high thermal conductivity and low elasticity.

For improvement of the productivity and the cost reduction, FOWLP (fan-out wafer level package) or FOPLP (fan-out panel level package) process using large-sized substrate has been actively developed in recent years. Above all, we will report about the novel TCB (thermal compression bonding) equipment which is even applicable to a 3D-IC stacking process and a fine pitch FOWLP or FOPLP of RDL-first process using large-sized substrate. We made the prototype which was applicable to CoW of 12 inch wafer and evaluated it. The prototype includes a high rigid fixed stage which is designed to the same size as the bonding head, and a substrate handling mechanism which lifts a substrate from the stage and transfers it to other prescribed position every one bonding cycle. By using this equipment, it is possible to thermally press a chip on even large-sized substrate without causing deterioration in bonding accuracy resulting from stage distortion. Also, it does not need to manage UTOS (Underfill time on stage), when the equipment is used for "2 step bonding process" which can improve the throughput of TCB. In this presentation, we will report about the investigation result of the heat influence on adjacent chip and about the temperature difference in the 3D-IC stacking process by using the prototype. In addition, we will present a novel multi-layer collecting bonding process which is applicable to a large-sized substrate effectively, and report about the result of the evaluation of solder connection of the TSV TEG chip.

As one of the methods to stack the 3D-IC fast, the collective bonding process using TCB (thermo-compression bonder) attracts attention [1-3]. In the collective bonding process, we can improve the throughput considerably by postbonding the multilayered pre-bonded chips at a time. However, when the number of the stacked chips increased, we found that the temperature difference between the upper layer and lower layer became large and the good solder connection was not obtained in all the layer in conventional TCB. Therefore, we reported that the collective bonding could be realized by using the heat insulation stage which can prevent an outflow of the heat from the bonding head [1]. By using the heat insulation stage, we could reduce the temperature difference to less than 10oC for four layers, but it was necessary to reduce temperature difference more, depending on the kind of NCF. Besides, it was difficult to reduce difference of temperature when, for example, the number of the stacked chips increased more than eight layers. In this presentation, we report about new collective bonding process that is able to reduce the temperature difference by using high temperature backup stage. We could enable the high temperature process of the stage by using the wafer-handling mechanism which lifts a substrate from the stage every one bonding cycle.

Background The aim of this study was to evaluate the temporal impact of the 2011 Japan earthquake and tsunami on the incidence of sudden cardiac and unexpected death ( SCUD ). Methods and Results We surveyed the impact of the disaster on the incidence and clinical characteristics of SCUD in Iwate. To perform complete identification of SCUD for 8 weeks before and 40 weeks after the disaster, medical records and death certificates relevant to SCUD were surveyed in the study area. Compared with the previous year's rate, the incidence (per 10 000 person‐year) of SCUD for the initial 4 weeks after the disaster (acute phase) was double (33.5 vs 18.9), and thereafter the rate returned to the previous level. Significant relationships were found between weekly numbers of SCUD and seismic activity (intensity, r =0.43; P r =0.46; P SIR ) of SCUD in the acute phase was significantly increased compared with that of previous years (1.71, 95% CI 1.33 to 2.16). Increased SIR s were predominantly found in female subjects (1.73, 95% CI 1.22 to 2.37), the elderly (1.73, 95% CI 1.29 to 2.27), and residents living in the tsunami‐stricken area (1.83, 95% CI 1.33 to 2.46). In addition, SIR s for weekdays (1.71, 95% CI 1.28 to 2.24) and nights‐mornings (2.09, 95% CI 1.48 to 2.86) were amplified. Conclusions The present results suggest that the magnitude of a disaster, related stress, and population aging may cause a temporary increase in the incidence of SCUD with amplification of ordinary weekly and circadian variations.

On March 11, 2011, a huge tsunami attacked the northeastern coast of Japan after a magnitude 9 earthquake. No reports have investigated the impact of tsunamis on the incidence of cardiovascular disease, especially heart failure (HF). We investigated the number and clinical characteristics of hospitalized patients with acute decompensated HF (ADHF) in the east coast of Iwate hit by the tsunami (tsunami area) for a 12-week period around the disaster. For comparison with previous years, numbers of ADHF were surveyed in the corresponding area in 2009 and 2010. In addition, to elucidate the impact of the tsunami, a similar study was performed in a remote area where the tsunami had minimal effect (control area). After the disaster, the number of patients with ADHF in the tsunami area was significantly increased compared to the predisaster period (relative risk 1.97, 95% confidence interval 1.50 to 2.59). The peak was found 3 to 4 weeks after the disaster. In contrast, in the control area, no significant change in ADHF events was observed (relative risk 1.29, 95% confidence interval 0.94 to 1.78). There was a significant correlation between changes in the number of ADHF admissions and percent tsunami flood area (r = 0.73, p

In this study, we monitored changes in the mixed venous blood oxygen saturation (Sv-O2) level of 45 patients with acute myocardial infarction and compared these results to the traditional parameters. The Sv-O2 level was found to correlate well with the clinical course of patients and their hemodynamic conditions. The mean Sv-O2 level of the group having congestive heart failure (53.3 +/- 8.4%) was found to be statistically lower than those without (69.8 +/- 5.6). Furthermore, patients whose Sv-O2 level was lower than 60% were found to be at greater risk for heart failure and a very high mortality rate. Patients were classified into four subsets according to Forrester's hemodynamic classification; their Sv-O2 levels were 70.7 +/- 4.1% (I: 23 cases), 54.7 +/- 6.9% (II: 8 cases), 55.8 +/- 9.4% (III: 10 cases), and 47.0 +/- 8.0 (IV: 4 cases), respectively. A severe relationship between pulmonary capillary wedge pressure and Sv-O2 having a correlation coefficient of r = -0.64 was observed, and a logarithmic curvilinear relation between cardiac index approximately Sv-O2, stroke volume index approximately Sv-O2 and left ventricular stroke work index approximately Sv-O2 was also evident. When the decrease in the Sv-O2 level was more than 5%, it always showed a significant decrease in the cardiac index. This study suggested tht continuous monitoring of the Sv-O2 level revealed simultaneous changes in the hemodynamic state, which lead to the assistance and aid for treating patients with critical conditions of acute myocardial infarction. In such circumstances, it was noted that the Sv-O2 level should be maintained above 60% in order to stabilize the hemodynamic state.

The neck uptake ratio of 99mTcO4- was measured using a gamma camera and pinhole collimator. The patient was sit 2 m apart from the collimator surface and radioactivity was counted 20 minutes after injection. The whole body count with lead shield (Cc) and without shield (Cd), and natural background count (CBG) were measured. As the shield was utilized the B filter for conventional thyroidal 131I uptake test (lead plate of 1.3 cmx10 cmx10 cm) and it was placed over the anterior neck to cover the thyroid gland at the measurement of (Cc). Then 99mTcO4- neck uptake ratio was calculated as following: (formula: see text) The mean values were 5.3%, 4.5%, 3.1%, 11.2% and 20.7% in the group of euthyroid, hypothyroid, subacute thyroiditis, hyperthyroid state with chronic thyroiditis and Graves' disease, respectively. This method is very convenient and simple to perform following scintigraphy of the thyroid gland with pinhole collimator.

Long-term Effects of the 2011 Japan Earthquake and Tsunami on the Incidence of Heart Failure: A Community-based Study MOTOYUKI NAKAMURA, FUMITAKA TANAKA, HIROSHI ENDOF, MIKIO KAWAKAMI, TATSUYA MATSUMOTO, OSAMU NISHIYAMA, TOSHIYUKI ONODA Internal Medicine, Iwate Medical Univ, Cardiology, Iwate Ofunato Hospital, Internal Medicine, Iwate Kamaishi Hospital, Cardiology, Iwate Kuji Hospital, Cardiology, Iwate Ninohe Hospital, Preventive Medicine, Iwate Medical Univ