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Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

Health 2017年第8期9卷 1159-1175页

作者： Nobuhiro Sato Kohei Akazawa Yuji Mitadera Tsubasa Suzuki Nahoko Ibe Yasuo hirose Department of Medical Informatics and Statistics Niigata University Graduate School of Medicine Niigata Japan Department of Emergency and Critical Care Medicine Niigata City General Hospital Niigata Japan Development Center of Medical Professionals for Next-Generation Niigata University Hospital Niigata Japan Patient and Family Support Center Niigata City General Hospital Niigata Japan

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

关键词： Older People Emergency Healthcare System Japan Long-Term Care Staffing Problems

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Structural Analysis of Thermally-Annealed Bulk Heterojunction Films Based on Sexithiophene and Fullerene

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Advances in Materials Physics and Chemistry 2014年第7期4卷 127-133页

作者： Yosei Shibata Takahiro Kono Takahiko Suzuki Yuzuru Narita Fumihiko hirose Yuji Yoshida Graduate School of Science and Engineering Yamagata University Yonezawa Japan Research Center for Photovoltaic Technologies National Institute of Advanced Industrial Science and Technology Tsukuba Japan

Recently, power conversion efficiencies of organic photovoltaics based on small molecules have been dramatically improved by means of the bulk heterojunction (BHJ) structure. Moreover, to optimize photovoltaic performance, thermal annealing treatments have often been used because of the simplicity of the process. However, the elucidation of effects of thermal annealing treatment on BHJ film structure based on small molecules is still not enough. Here, we report the results of structural analysis with synchrotron radiation of α-sexithiophene:fullerene BHJ films before and after thermal annealing treatment. In particular, the open-circuit voltage was increased to as high as 0.72 V;moreover, the BHJ films based on α-sexithiophene and fullerene were also clearly crystallized by the thermal annealing treatment. In this study, we found that the optimal crystal size existed in BHJ films for high-performance organic photovoltaics.

关键词： Organic Photovoltaics Oligothiophene Bulk Heterojunction Structure Thermal Anneal Morphological Control

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Static Analysis and Design of a Rolling Spherical Bearing

Static Analysis and Design of a Rolling Spherical Bearing

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第十一届IFTOMM世界大会

作者： Yukio Takeda Kazuki Ichikawa Hiroaki Funabashi Kazuya hirose Department of Mechanical Sciences and Engineering Tokyo Institute of Technology Tokyo 152-8552Japan Department of Mechanical Sciences and Engineering Tokyo Institute of Technology Tokyo 152-8552Japan Department of Mechanical Engineering Shibaura Institute of Technology Tokyo 108-8548Japan R＆D Division Hephaist Seiko Co. Ltd. Saitama 350-0833Japan

＜正＞A rolling spherical bearing （RSB） as an important machine element of in-parallel actuated mechanisms has been statically analyzed based on the Hertzian contact stress. The RSB is composed of a sun ball with a shaft, a socket and small planetary balls in a retainer. A fundamental equation to analyze static characteristics such as stiffness, load capacity and eccentricity of a RSB has been derived. Based on the equation, static stiffness and static load-carrying capacity have been investigated. Results of optimal design with respect to stiffness have been also shown and discussed.

关键词： Machine element Rolling spherical bearing Statics Hertzian contact theory Parallel mechanism Stiffness Static load-carrying capacity

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Quality of life in patients with chronic anal fissure after topical treatment with diltiazem

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World Journal of Gastrointestinal Surgery 2012年第11期4卷 251-255页

作者： Akira Tsunoda Yasuharu Kashiwagura Ken-ichi hirose Tadanori Sasaki Nobuyasu Kano Department of Surgery Kameda Medical CenterChiba 296-8602Japan Department of Pharmacy Services Kameda Medical CenterChiba 296-8602Japan

AIM: To assess the physical and mental health of fissure patients before and after topical treatment with diltiazem. METHODS: Consecutive patients were enrolled prospectively into the study. Quality of life was measured with the short-forum 36 health survey (SF-36) before and after 6-wk treatment with diltiazem. Patients scored symptoms of pain, bleeding, and irritation using numeral rating scales at the initial and follow-up visits. Fissure healing was assessed and side effects were noted. RESULTS: Fissures healed in 21 of 30 (70%) patients. There were significant reductions in the scores of pain, bleeding, and irritation after 1 wk of treatment, respectively. Four patients experienced perianal itching and one patient reported headache. When measured at baseline, pain and irritation showed a negative impact on two of the eight subscales on the SF-36, respectively (bodily pain and social functioning for pain; vitality and mental health for irritation). Repeating the SF-36 showed an improvement in bodily pain (P = 0.001). Patients whose fissures healed reported an improvement in bodily pain, health-perception, vitality, and mental health (P < 0.05). CONCLUSION: Successful treatment of chronic anal fissure with topical diltiazem leads to improvement in health-related quality of life.

关键词： Anal fissure Quality of life Diltiazem

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Role of Serum Cytokine Levels in Acute Respiratory Distress Syndrome Patients on Extracorporeal Membrane Oxygenation Support

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World Journal of Cardiovascular Surgery 2020年第1期10卷 1-10页

作者： Ena Gupta Kyle Carey Lydia McDermott Nicholas Cavarocchi Hitoshi hirose Michael Baram Division of Pulmonary and Critical Care Thomas Jefferson University Philadelphia PA USA Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia PA USA Division of Cardiothoracic Surgery Thomas Jefferson University Philadelphia PA USA

Background: Even with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome (ARDS), mortality remains high. Also, prognostication of patients with ARDS and ECMO is difficult. Cytokines are thought to be markers of inflammation in both ARDS and in ECMO, however, understanding is limited. We aimed to study the association of three serum cytokine levels with mortality in these patients with ARDS on ECMO. Methods: We performed a retrospective chart review of ARDS patients on ECMO between 2011 and 2017. Patients with serum TNF-α, IL-6 and IL-2 measured while on ECMO were included, with measurements recorded weekly up to a maximum of 4 measurements. A multivariable regression analysis was performed and generalizing estimating equations were used to analyze longitudinal trend of cytokines with mortality. Results: There were 47 patients with ARDS on ECMO, of which 31 (68.9%) survived at 30 days and 2 were lost to follow up. Initial IL-2 levels were found to be significantly higher among those who were alive compared to those who died at 30 days (2720 ± 2432 pg/ml vs. 1293 ± 693 pg/ml);p = 0.0460. At any given time, an increase in IL-2 was associated with a decrease in odds of death at 30 days (adjusted odds ratio 0.98, 95% confidence interval 0.97 - 0.99, p = 0.08). There was no significant difference in average or initial levels of TNF-α and IL-6 among those who were alive vs. those who died at 30 days. There was no association between either of these cytokine levels with death while on ECMO. Conclusions: Higher levels of cytokine IL-2 were associated with lower 30-day mortality. Further studies are needed to elucidate the pathobiology of cytokines while on ECMO and their use in predicting outcomes.

关键词： Serum Cytokines ECMO ARDS Mortality

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Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids

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World Journal of Gastroenterology 2017年第27期23卷 5034-5040页

作者： Kenichi Yoshikawa Reimi Kawashima Yuki hirose Keiko Shibata Takafumi Akasu Noriko Hagiwara Takeharu Yokota Nami Imai Akira Iwaku Go Kobayashi Hirohiko Kobayashi Akiyoshi Kinoshita Nao Fushiya Hiroyuki Kijima Kazuhiko Koike Masayuki Saruta Division of Gastroenterology and Hepatology Internal Medicinethe Jikei University Daisan Hospital Division of Gastroenterology and Hepatology Internal Medicinethe Jikei University School of Medicine

We are reporting a rare case of acute liver injury that developed after an internal hemorrhoid treatment with the aluminum potassium sulfate and tannic acid(ALTA) regimen. A 41-year-old man developed a fever and liver injury after undergoing internal hemorrhoid treatment with a submucosal injection of ALTA with lidocaine. The acute liver injury was classified clinically as hepatocellular and pathologically as cholestastic. We could not classify the mechanism of injury. High eosinophil and immunoglobulin E levels characterized the injury,and a drug lymphocyte stimulation test was negative on postoperative day 25. Fluid replacement for two weeks after hospitalization improved the liver injury. ALTA therapy involves injecting chemicals into the submucosa,from the rectum to the anus,and this is the first description of a case that developed a severe liver disorder after this treatment; hence,an analysis of future cases as they accumulate is desirable.

关键词： Aluminum potassium sulfate and tannic acid injection Aluminum potassium sulfate and tannic acid therapy Rectal submucosal injection Drug-induced lymphocyte stimulation test Drug-induced liver injury

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Surgical removal of a large mobile left ventricular thrombus via left atriotomy

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World Journal of Clinical Cases 2014年第2期2卷 32-35页

作者： Daizo Tanaka Shinya Unai James T Diehl Hitoshi hirose Division of Cardiothoracic Surgery Department of Surgery Thomas Jefferson University

Left ventricular(LV) thrombus is a life-threatening complication of severe LV dysfunction. Ventriculotomy has been a commonly performed procedure for LV thrombus; however, it often further decrease LV function after surgery. We present an alternative approach to thrombectomy in order to minimize the postoperative LV dysfunction. A 37-year-old female with a postpartum cardiomyopathy found to have poor LV function and a large left ventricular apical thrombus(3 cm × 3 cm) attached to the apex by a narrow stalk. Given her severe LV dysfunction, the LV thrombus was approached via left atriotomy under cardiopulmonary bypass. The LV thrombus was easily extracted with gentle traction via the mitral valve. Postoperatively, the patient was discharged home without any embolization event or inotropic support. LV thrombectomy via left atriotomy through the mitral valve could be an alternative option for the patients with poor LV function with a mobile LV thrombus.

关键词： Left ventricular thrombus Atriotomy Cardiomyopathy Surgical thrombectomy Pedunculated thrombus

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Arterial pulsation on a human patient simulator improved students’ pulse assessment

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Journal of Biomedical Science and Engineering 2012年第5期5卷 285-289页

作者： Akihiro Takeuchi Tomomi Kobayashi Minoru hirose Takashi Masuda Toshiro Sato Noriaki Ikeda Department of Medical Informatics School of Allied Health Sciences Kitasato University Sagamihara Japan Department of Medical Safety Engineering School of Allied Health Sciences Kitasato University Sagamihara Japan Department of Rehabilitation School of Allied Health Sciences Kitasato University Sagamihara Japan

Even with basic cardiovascular lectures, undergraduates do not usually experience the reality of palpation and, therefore, cannot integrate their physiological knowledge. We created a pulse training scenario of human patient simulators (HPS) to recognize and assess the normal and arrhythmic pulse of the radial artery. All 25 participants were recruited as volunteers to the study from the School of Allied Health Sciences, Kitasato University. Participants received training in radial palpation of arrhythmias on HPS. The test scenario included 10 arrhythmic pulses combined with normal pulses and weak pulses. The average examination scores significantly improved, from 23.8 ± 2.8 of the pretest to 72.9 ± 3.4 of the posttest (mean and SE, N = 25, p < 0.00001). A questionnaire and general written comments for the palpation training were positive. The palpation training improved the participants’ assessment of radial pulses.

关键词： Education Physiology Human Patient Simulator Arrhythmic Pulse Pulse Assessment

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Endoscopic submucosal dissection in a patient with esophageal adenoid cystic carcinoma

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World Journal of Gastroenterology 2017年第45期23卷 8097-8103页

作者： Kenichi Yoshikawa Akiyoshi Kinoshita Yuki hirose Keiko Shibata Takafumi Akasu Noriko Hagiwara Takeharu Yokota Nami Imai Akira Iwaku Go Kobayashi Hirohiko Kobayashi Nao Fushiya Hiroyuki Kijima Kazuhiko Koike Haruka Kaneyama Keiichi Ikeda Masayuki Saruta Division of Gastroenterology and Hepatology Internal MedicineJikei University Daisan Hospital Department of Endoscopy Jikei University Daisan Hospital Division of Gastroenterology and Hepatology Internal MedicineJikei University School of Medicine

We report the first use of endoscopic submucosal dissection(ESD) for the treatment of a patient with adenoid cystic carcinoma of the esophagus(EACC). An 82-year-old woman visited our hospital for evaluation of an esophageal submucosal tumor. Endoscopic examination showed a submucosal tumor in the middle third of the esophagus. The lesion partially stained with Lugol's solution,and narrow band imaging with magnification showed intrapapillary capillary loops with mild dilatation and a divergence of caliber in the center of the lesion. Endoscopic ultrasound imaging revealed a solid 8 mm × 4.2 mm tumor,primarily involving the second and third layers of the esophagus. A preoperative biopsy was non-diagnostic. ESD was performed to resect the lesion,an 8 mm submucosal tumor. Immunohistologically,tumor cells differentiating into ductal epithelium and myoepithelium were observed,and the tissue type was adenoid cystic carcinoma. There was no evidence of esophageal wall,vertical stump or horizontal margin invasion with p T1 b-SM2 staining(1800 μm from the muscularis mucosa). Further studies are needed to assess the use of ESD for the treatment of patients with EACC.

关键词： Adenoid cystic carcinoma of esophagus Endoscope Ultrasound Esophageal Tumor Endoscopic submucosal dissection

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Origin of enriched uranium contained in Japanese atmospheric deposits

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Natural Science 2012年第11期4卷 936-942页

作者： Yoshikazu Kikawada Kohei Oda Masao Nomura Teruyuki Honda Takao Oi Katsumi hirose Yasuhito Igarashi 1Department of Materials and Life Sciences Sophia University Tokyo Japan Atomic Energy Research Laboratory Tokyo City University Kawasaki Japan Department of Materials and Life Sciences Sophia University Tokyo Japan Meteorological Research Institute Tsukuba Japan Research Laboratory for Nuclear Reactors Tokyo Institute of Technology Tokyo Japan

The chemical compositions of atmospheric deposits collected in Fukuoka, Japan, in 1964 and 2000, which are known to have high 235U/238U uranium isotope ratio were determined. High uranium contents relative to that of continental crust were observed for the deposition samples in 1964 together with the high 235U/238U ratios, which indicated that the origin of uranium is fallout materials due to the large-scale 1961- 1962 nuclear explosions conducted by US and former USSR. The deposits in 2000 were mainly composed of dusts from the East Asia. This suggested that uranium with a high 235U/238U ratio in the deposits in 2000 has been transported as a component of mineral dust particles contaminated with nuclear debris from nuclear test sites from the East Asian deserts and arid regions by the prevailing wind.

关键词： Atmospheric Deposit Enriched Uranium Uranium Isotope Ratio Nuclear Test Anthropogenic Radionuclides

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