We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Let M be a closed oriented 3-manifold equipped with an Euler structure e and an acyclic representation of its fundamental group. We define a twisted self-linking homology class of the diagonal of the two-point configuration space of M with respect to e. This twisted self-linking homology class appears as an obstruction in the Chern–Simons perturbation theory. When the representation is the maximal free abelian representation $\rho_0$, we prove that our self-linking class is a properly defined “logarithmic derivative” of the Reidemeister–Turaev torsion of $(M,\rho_0,e)$ equipped with the given Euler structure.
Although B vitamins have been shown to play beneficial roles in bone health, the effects of vitamin B1 in humans are still unclear. This study aimed to investigate the effects of vitamin B1 supplementation on middle-aged and older adults. This single-armed trial study included community-dwelling adults in Japan and used a pre- and post-test design. The participants were given 28.0 mg of vitamin B1 supplementation per day for 1 month in addition to their daily usual diet. The effect of this treatment on bone turnover markers and metabolism was evaluated at baseline and after 1 month. Forty-two participants were enrolled (mean age, 58.6 ± 10.4 years; 36 women). The vitamin B1 levels in whole blood increased significantly from baseline after vitamin B1 supplementation. The level of serum tartrate-resistant acid phosphatase 5b (TRACP 5b), a bone resorption marker, reduced significantly (378 ± 135 vs. 335 ± 120 mU/dL, p < 0.001), while the level of N-terminal propeptide of type I procollagen (P1NP), a marker specific to bone formation, did not change. Moreover, the serum phosphorus and parathyroid hormone (PTH) concentrations did not change, whereas the corrected serum calcium concentrations increased and vitamin D concentrations decreased. The serum TRACP 5b levels decreased after vitamin B1 supplementation in the middle-aged and older adults. Further definitive trials are needed to determine the efficacy of vitamin B1 in improving bone health.
The clean energy transition is complicated by material constraints that threaten national security. Idealized proposals for a rapid decarbonization via a greatly accelerated diffusion of solar, wind, battery and other technologies entails massive amounts of critical raw materials (CRM). These CRM include copper, aluminum, cobalt, lithium, graphite, rare earths, and other minerals and metals. In the international debate, CRM are also referred to as “critical minerals,” “critical strategic minerals,” “battery minerals,” “energy transition metals,” and various other terms. The International Energy Agency (IEA) aggressively supports decarbonization, but also warns that zero-carbon scenarios imply that the energy sector's overall demand for CRM could sextuple by 2040. Japan aims for net-zero greenhouse gas (GHG) emissions by 2050, and India's net-zero target is two decades later. But like all countries, their CRM supply chains are at present unable to satisfy ambitious goals for deploying solar, wind, battery storage, power transmission, and green hydrogen. Multilateral cooperation is imperative to address the growing challenges of CRM, especially their price volatility, security of supply, and Environment, Social, and Governance (ESG) issues. Building a sustainable and diversified global supply chain is crucial to building security in clean energy. One step in this direction was seen in September 2021, when Japan, India and other members of the Quadrilateral Security Dialogue, or QUAD, signed an agreement for cooperation in procuring rare earths. This paper discusses potential additional cooperation between India and Japan, for bolstering both countries' CRM supply security.
We examine three tools that can enhance coordination success in a repeated multiple-choice coordination game. Gradualism means that the game starts as an easy coordination problem and moves gradually to a more difficult one. The Endogenous Ascending mechanism implies that a gradual increase in the upper bound of coordination occurs only if coordination with the Pareto superior equilibrium in a stage game is attained. The Endogenous Descending mechanism requires that when the game’s participants fail to coordinate, the level of the next coordination game be adjusted such that the game becomes simpler. We show that gradualism may not always work, but in such instances, its effect can be reinforced by endogeneity. Our laboratory experiment provides evidence that a mechanism that combines three tools, herein termed the “Gradualism with Endogenous Ascending and Descending (GEAD)” mechanism, works well. We discuss how the GEAD mechanism can be applied to real-life situations that suffer from coordination failure.
Using longitudinal data on teams and quality competition results, this study examines the impact of team and task familiarity on brewing excellence in the Japanese sake industry from 1956 to 2018. Sake production involves teamwork at every stage, but while some teams work together long term, others experience high turnover. The study highlights two factors: team familiarity, the collective experience of working together, and task familiarity, the individual experience of the task. High familiarity can strengthen team bonds and improve teamwork, but it can also limit the inflow of new knowledge and thus hinder innovation. This study uses data from national quality competitions and brewer lists, and considers the Great East Japan Earthquake of 2011 as an external shock to address endogeneity and estimate the causal relationship between familiarity and competition outcomes. The empirical results show that increases in both team and task familiarity are negatively associated with quality superiority.
This study focused on exploring the relationship between antimicrobial use indicators, including the modified antibiotic heterogeneity index (mAHI), and the carbapenem susceptibility in Pseudomonas aeruginosa.
Design:
Survey-based observational study conducted across multiple facilities.
Setting:
Public community hospital institutions.
Methods:
This survey was conducted in 15 community hospitals in Japan. Indicators, such as the defined daily doses (DDDs), days of therapy (DOTs), antibiotic heterogeneity index (AHI), and mAHI, were analyzed for P. aeruginosa carbapenem susceptibility using Spearman’s rank correlation. The predictive accuracies of the AHI and mAHI for carbapenem susceptibility were compared using DeLong’s test for the 2 correlated receiver operating characteristic curves.
Results:
No significant correlations were observed between DDDs or DOTs and carbapenem susceptibility. However, a significant correlation was observed between carbapenem susceptibility and the mAHI (r = 0.261, P = .02), which also demonstrated a higher predictive accuracy for high susceptibility rates than that of the AHI (area under the curve: 0.75 vs 0.58, p < .01). The optimal mAHI cutoff value for predicting 90% susceptibility was 0.765, with a sensitivity of 67.7% and specificity of 76.5%.
Conclusions:
The mAHI may be a better predictor of carbapenem susceptibility than other commonly used indicators. This study underscores the utility of the mAHI as an effective indicator of antimicrobial usage patterns for managing carbapenem susceptibility in P. aeruginosa. Incorporating the mAHI into antimicrobial stewardship programs could enhance the effectiveness of antimicrobial interventions across diverse healthcare settings.
Health technology assessment (HTA), by investigating clinical, economic, and social consequences of technologies in a country, enhances health system equity and sustainability. In low- and middle-income countries (LMICs), economic constraints and inadequate access to specialized human resources present challenges. Therefore, strategies to optimize resource allocation in the health sector are necessary.
Methods
A literature review was carried out, with studies that directly identified barriers or facilitators for the use of artificial intelligence (AI) in HTA being considered eligible. The texts were analyzed from the perspective of LMIC. The searches were carried out on 8 August 2023 using the following databases: MEDLINE via PubMed, Web of Science, and Google Scholar. The selection was performed in two stages: (i) screening by title and abstract and (ii) evaluation of the eligibility criteria in full text.
Results
After conducting the search, five studies were selected for narrative synthesis. Evidence of the potential benefits of using AI in HTA in low- and middle-income countries includes rationalization of resources; reduction of the burden on health systems and minimization of human workload; efficiency in data analysis, including clinical data; prediction of economic impact; and support for managerial decision-making. However, important challenges were also raised, such as the deficiency of local infrastructure; the training and education of professionals; the lack of ethical regulation; and the organizational and political considerations of these countries.
Conclusions
There are few studies in the literature that provide scientific support on the use of AI in HTA decision-making in LMIC. The evidence points to increasing the efficiency and rationality of resources, enhancing the results arising from HTA. With this, it is expected to expand access to health technologies and enable more sustainable health systems.
Giant coronary artery aneurysms and myocardial fibrosis after Kawasaki disease may lead to devastating cardiovascular outcomes. We characterised the vascular and myocardial outcomes in five selected Kawasaki disease patients with a history of giant coronary artery aneurysms that completely regressed.
Methods:
Five patients were selected who had giant coronary artery aneurysm in early childhood that regressed when studied 12–33 years after Kawasaki disease onset. Coronary arteries were imaged by coronary CT angiography, and coronary artery calcium volume scores were determined. We used endocardial strain measurements from CT imaging to assess myocardial regional wall function. Calprotectin and galectin-3 (gal-3) as biomarkers of inflammation and myocardial fibrosis were measured by enzyme-linked immunosorbent assay.
Results:
The five selected patients with regressed giant coronary artery aneurysms had calcium scores of zero, normal levels of calprotectin and gal-3, and normal appearance of the coronary arteries by coronary computed tomography angiography. CT strain demonstrated normal peak systolic and diastolic strain patterns in four of five patients. In one patient with a myocardial infarction at the time of Kawasaki disease diagnosis at the age of 10 months, CT strain showed altered global longitudinal strain, reduced segmental peak strain, and reduced diastolic relaxation patterns in multiple left ventricle segments.
Conclusions:
These patients illustrate that regression of giant aneurysms after Kawasaki disease is possible with no detectable calcium, normal biomarkers of inflammation and fibrosis, and normal myocardial function. Individuals with regressed giant coronary artery aneurysm still require longitudinal surveillance to assess the durability of this favourable outcome.
Ticks prefer specific feeding sites on a host that are influenced by host–tick and tick–tick interactions. This study focused on the spatiotemporal distribution of ticks in Hokkaido sika deer, an important tick host in Hokkaido, Japan. Tick sampling was performed on the sika deer in the Shiretoko National Park between June and October 2022. Ticks were collected from 9 different body parts of the deer to compare their attachment site preferences. Interspecific and intraspecific relationships among ticks were examined using co-occurrence analysis. The collected ticks were nymphal and adult stages of 4 species: Ixodes ovatus, Ixodes persulcatus, Haemaphysalis japonica and Haemaphysalis megaspinosa. Seasonal variations in tick burden were observed, with I. persulcatus and I. ovatus peaking in June and declining towards October; H. japonica showing low numbers in July and August and increasing from September; and H. megaspinosa appearing from September onwards with little variation. Attachment site preferences varied among species, with a significant preference for the pinna in I. ovatus and I. persulcatus. Haemaphysalis japonica was mainly found on the body and legs between June and August, and shifted to the pinna from September. Haemaphysalis megaspinosa showed a general preference for areas other than the legs. Co-occurrence analysis revealed positive, negative and random co-occurrence patterns among the tick species. Ticks of the same genus and species exhibited positive co-occurrence patterns; I. ovatus showed negative co-occurrence patterns with Haemaphysalis spp. This study revealed the unique attachment site preferences and distinct seasonal distributions of tick species in the Hokkaido sika deer.
Coping styles can be improved by dyadic palliative care interventions and may alleviate patients’ and family caregivers’ distress. Moreover, family caregivers’ preloss resilience protects against depression after bereavement. This study aimed to determine the types of coping styles can be encouraged to increase resilience.
Methods
A self-reported questionnaire survey was administered to family caregivers at the 4 palliative care units, and their resilience was assessed using the Connor–Davidson Resilience Scale (CD-RISC) and their coping styles were assessed using the Brief Coping Orientation to Problem Experienced, as well as their background characteristics.
Results
Among 291 caregivers with a mean CD-RISC score of 56.2 (standard deviation: 16.13), internal locus of control, educational level, and history of psychotropic drug use were associated with resilience. After adjusting for the aforementioned factors, more frequent use of positive coping styles such as active coping (Spearman’s ρ = 0.29), acceptance (ρ = 0.29), positive reframing (ρ = 0.29), planning (ρ = 0.24), and humor (ρ = 0.18), was found to be associated with higher resilience. On the contrary, more frequent use of negative coping styles such as behavioral disengagement (ρ = −0.38), self-blame (ρ = −0.27), and denial (ρ = −0.14) was found to be associated with less resilience.
Significance of results
By assessing internal locus of control, educational level, and history of psychotropic medication use of family caregivers, as factors associated with their respective resilience, may help identify less resilient family caregivers who are at risk for developing major depression after bereavement. In addition, coping skill-based educational interventions targeting patients and their family caregivers that focus on specific coping styles associated with resilience may increase family caregivers’ resilience, resulting in less emotional distress and a lower risk of major depression after bereavement.
Healthcare-associated infections (HAIs) pose significant challenges to healthcare systems worldwide. Epidemiological data are essential for effective HAI control; however, comprehensive information on HAIs in Japanese hospitals is limited. This study aimed to provide an overview of HAIs in Japanese hospitals.
Methods:
A multicenter point-prevalence survey (PPS) was conducted in 27 hospitals across the Aichi Prefecture between February and July 2020. This study encompassed diverse hospital types, including community, university, and specialized hospitals. Information on the demographic data of the patients, underlying conditions, devices, HAIs, and causative organisms was collected.
Results:
A total of 10,199 patients (male: 5,460) were included in this study. The median age of the patients was 73 (interquartile range [IQR]: 56–82) years, and the median length of hospital stay was 10 (IQR: 4–22) days. HAIs were present in 6.6% of patients, with pneumonia (1.83%), urinary tract infection (1.09%), and surgical site infection (SSI) (0.87%) being the most common. The prevalence of device-associated HAIs was 0.91%. Staphylococcus aureus (17.3%), Escherichia coli (17.1%), and Klebsiella pneumoniae (7.2%) were the primary pathogens in 433 organisms; 29.6% of the Enterobacterales identified showed resistance to third-generation cephalosporins. Pneumonia was the most prevalent HAI in small-to-large hospitals (1.69%–2.34%) and SSI, in extra-large hospitals (over 800 beds, 1.37%).
Conclusions:
This study offers vital insights into the epidemiology of HAIs in hospitals in Japan. These findings underscore the need for national-level PPSs to capture broader epidemiological trends, particularly regarding healthcare challenges post-COVID-19.
Although the relationship between dyslipidaemia (DL) and coronary artery disease (CAD) or between trace minerals intake and CAD is well known separately, the exact nature of this relationship remains unknown. We hypothesize that the relationship between trace mineral intake and CAD may differ depending on whether or not the individual has DL. The present study analysed the relationships among trace mineral intake, DL, and CAD in middle-aged and older adults living in Shika town, Ishikawa prefecture, Japan. This study included 895 residents following the exclusion of those with genetic risk carriers for familial hypercholesterolemia. Trace mineral intake was evaluated using the brief-type self-administered diet history questionnaire. Interactions were observed between DL and CAD with zinc (p = 0.004), copper (p = 0.010), and manganese intake (p < 0.001) in a two-way analysis of covariance adjusted for covariates such as sex, age, body mass index, and current smokers and drinkers. Multiple logistic regression analysis showed that zinc (odds ratio (OR): 0.752; 95% confidence interval (CI): 0.606, 0.934; p = 0.010), copper (OR: 0.175; 95% CI: 0.042, 0.726; p = 0.016), and manganese (OR: 0.494; 95% CI: 0.291, 0.839; p = 0.009) were significant independent variables for CAD in the dyslipidaemic group. The present results suggest that DL with a low trace mineral intake is associated with CAD. Further longitudinal studies are required to confirm this relationship.
We report a case of dilated cardiomyopathy-like hypertensive cardiomyopathy (HTN-CM) with polycystic kidney disease without family history when a 3-month-old boy developed bacteraemia secondary to a urinary tract infection. He was later confirmed as having autosomal recessive inheritance due to the proven PKHD1 gene mutation. The treatment consisted mainly of antihypertensive and anti-heart failure therapies and he was discharged on the 131st day. To prevent the development of heart failure in patients with HTN-CM due to autosomal recessive polycystic kidney disease (ARPKD), it is important to improve the fetal diagnosis rate of ARPKD, detect hypertension early, and strictly control the blood pressure after birth.
This study aimed to investigate the contamination status of hospital sinks with carbapenemase-producing Enterobacterales (CPE), the efficacy of daily cleaning with sodium hypochlorite, and the relationships between CPEs isolated from contaminated sinks and patients.
Design:
Pre/postintervention surveys of the CPE-contaminated sinks.
Setting:
Hospital wards including pediatric intensive care unit in a children’s hospital.
Participants:
Consenting CPE-colonized patients admitted between November 2018 and June 2021 in our hospital.
Methods:
Environmental culture of 180 sinks from nine wards in our hospital was performed three times with an interval of 2 years (2019, 2021, 2023). Molecular typing of the isolated strains from the sinks and patients was performed. After the first surveillance culture, we initiated daily disinfection of the sinks using sodium hypochlorite.
Results:
Before the intervention, we detected 30 CPE-positive sinks in 2019. After the intervention with sodium hypochlorite, we observed a substantial decline in the number of sinks contaminated with CPE; 13 in 2021 and 6 in 2023. However, the intervention did not significantly reduce the number of CPE-contaminated sinks used for the disposal of nutrition-rich substances. The CPE isolates from the patients and those from the sinks of the wards or floors where they were admitted tended to have similar pulse-field gel electrophoresis patterns.
Conclusion:
Contaminated sinks could be reservoirs of disseminating CPE to the patients. Daily disinfection of sinks with sodium hypochlorite may be effective in eliminating CPE, although the effect could be weaker in sinks with a greater risk of contact with nutrition-rich substances.
A high-speed solenoid-type pulsed valve is applied to a water-fuelled magnetron sputtering thruster, which can lead a compact and neutralizer-free electric propulsion device by generating a thrust due to the ejection of the sputtered target material, in order to minimize the size of the gas feeding system. The pulsed valve is opened for approximately 5 msec and the gaseous water is introduced into the source via a gas line connected to the source. A dc high voltage is firstly applied between the cathode and the anode; then the discharge is sustained for the period in which a gas pressure enough for the discharge is maintained and a change in the discharge mode is observed during the discharge pulse. To investigate the impact of the mode change on the thrust generation, a temporally resolved measurement of the force is equivalently performed by installing a pulsed voltage power supply and by changing the pulse width of the discharge voltage. The results show the temporal reduction of the thrust-to-power ratio during a pulsed discharge due to the nonlinear correlation between ion energy and sputtering yield. It is suggested that the use of a pulsed valve would be useful for downsizing of the electric propulsion system, while an optimization to properly control the gas flow rate is needed for further development.
We introduce the notion of completed $F$-crystals on the absolute prismatic site of a smooth $p$-adic formal scheme. We define a functor from the category of completed prismatic $F$-crystals to that of crystalline étale $\mathbf {Z}_p$-local systems on the generic fiber of the formal scheme and show that it gives an equivalence of categories. This generalizes the work of Bhatt and Scholze, which treats the case of a mixed characteristic complete discrete valuation ring with perfect residue field.
This paper reports a complete secondary analysis of Jeon and Yamashita’s (2022) systematic review to build the second language (L2) model of the simple view of reading (SVR). The same meta-analytic methodologies were maintained, with the exception of applying meta-analytic structural equation modeling (MASEM). This study successfully replicated some of the aggregated correlations but not others, owing to (a) the recoding of the original raw data to recreate a dataset and (b) the motivated change in sample selection from a longitudinal study for MASEM. The MASEM results extended previous findings that L2 comprehension skills contribute more to L2 reading comprehension than L2 decoding skills, and together explain a large amount of variance in L2 reading comprehension. The SVR model with metalinguistic skills showed their contribution to L2 decoding and comprehension skills, but no direct impact on L2 reading comprehension, supporting the parsimonious structure of SVR in L2.
Previous research on the changes in resting-state functional connectivity (rsFC) in anorexia nervosa (AN) has been limited by an insufficient sample size, which reduced the reliability of the results and made it difficult to set the whole brain as regions of interest (ROIs).
Methods
We analyzed functional magnetic resonance imaging data from 114 female AN patients and 135 healthy controls (HC) and obtained self-reported psychological scales, including eating disorder examination questionnaire 6.0. One hundred sixty-four cortical, subcortical, cerebellar, and network parcellation regions were considered as ROIs. We calculated the ROI-to-ROI rsFCs and performed group comparisons.
Results
Compared to HC, AN patients showed 12 stronger rsFCs mainly in regions containing dorsolateral prefrontal cortex (DLPFC), and 33 weaker rsFCs primarily in regions containing cerebellum, within temporal lobe, between posterior fusiform cortex and lateral part of visual network, and between anterior cingulate cortex (ACC) and thalamus (p < 0.01, false discovery rate [FDR] correction). Comparisons between AN subtypes showed that there were stronger rsFCs between right lingual gyrus and right supracalcarine cortex and between left temporal occipital fusiform cortex and medial part of visual network in the restricting type compared to the binge/purging type (p < 0.01, FDR correction).
Conclusion
Stronger rsFCs in regions containing mainly DLPFC, and weaker rsFCs in regions containing primarily cerebellum, within temporal lobe, between posterior fusiform cortex and lateral part of visual network, and between ACC and thalamus, may represent categorical diagnostic markers discriminating AN patients from HC.
It is uncertain whether dietary intake of mushrooms rich in dietary fibre and several antioxidants is associated with a lower risk of dementia. We sought to examine prospectively the association between mushroom intake and the risk of disabling dementia. We performed a prospective study involving 3750 people aged 40 to 64 years residing in three communities who participated in an annual cardiovascular risk survey from 1985 to 1999. Cases of incident disabling dementia were surveyed from 1999 to 2020. We calculated the hazard ratios (HR) and 95 % CI for incident total dementia according to mushroom intake among participants with or without a history of stroke. During a mean 16·0 years’ follow-up in 3739 eligible participants, 670 people developed disabling dementia. For women, mushroom intake was inversely associated with the risk of total dementia and the association was confined to dementia without a history of stroke. The multivariable HR (95 % CI) for total dementia in women were 0·81 (0·62, 1·06) for mushroom intake of 0·1–14·9 g/d and 0·56 (0·42, 0·75) for mushroom intake above 15·0 g/d (Pfor trend = 0·003) compared with no intake. The corresponding HR (95 % CI) for dementia without a history of stroke were 0·66 (0·47, 0·93) and 0·55 (0·38, 0·79) (Pfor trend = 0·01). In men, no associations were observed between mushroom intake and the risk of disabling dementia. Among Japanese women, dietary mushroom intake was associated with a lower risk of disabling dementia.
The central parsec of AGN is a key region for the launching of winds, and near-infrared interferometry is a unique tool for its study. With GRAVITY at the VLT interferometer, we can now spatially resolve not just the hot dust continuum on milliarcsecond ‘torus’ scales through imaging but also the broad-line region (BLR) on microarcsecond scales through spectro-astrometry. We have mapped the kinematics of the BLR in seven nearby AGN, measured sizes of the hot dust for seventeen AGN, and reconstructed dust images for two AGN. BLR kinematics has allowed us to measure the BLR size and supermassive black hole mass independent of reverberation mapping. The ongoing GRAVITY+ upgrade will greatly enhance the sensitivity and sky coverage of GRAVITY, and first results demonstrate its power for AGN science at z∼2 and beyond.