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Although it is reported that robot-assisted gait training (RAGT) with conventional physiotherapy for stroke patients increases the odds of walking independence at the end of the intervention, compared with conventional physiotherapy alone, it is not clear how long the benefit lasts or whether it is cost effective. This research aimed to clarify the duration of benefit of RAGT and its cost effectiveness.
Methods
A cost-utility analysis was conducted that compared RAGT plus conventional physiotherapy with conventional physiotherapy alone from a public healthcare payer’s perspective. The population comprised patients with subacute hemiplegic stroke who had a modified Rankin Scale of three to five (severe) and were treated in Japanese hospitals. The time horizon was half a year after admission to a convalescent hospital, since no additional benefit has been proved beyond that point. A decision tree model was used for the analysis. The effect of RAGT on walking independence and the durability of the benefit were estimated based on a literature review of randomized controlled trials (RCTs) and a meta-analysis. Costs and utility values were estimated from the literature.
Results
The literature review identified 14 RCTs. A meta-analysis of RCTs with more than two months’ follow-up after the intervention showed a significantly higher rate of independence in walking for the RAGT group at the end of follow-up (risk ratio 1.52, 95% confidence interval: 1.20, 1.93), whereas there was no significant difference between the groups more than three months after treatment. The incremental quality-adjusted life-years (QALYs) was 0.004 and the incremental cost was -USD287, indicating that RAGT with conventional physiotherapy was dominant. The incremental cost-effectiveness ratio was USD5,509 per QALY when it was assumed that the length of stay was not reduced by achieving early independence in walking.
Conclusions
The results showed excellent cost effectiveness for RAGT plus conventional physiotherapy in patients with subacute severe hemiplegic stroke in the Japanese setting when considering a reference value of USD34,000 (JPY5,000,000) per QALY in the cost-effectiveness evaluation. Although the incremental QALY gains were relatively small, cost savings could be expected from achieving early independence in walking.
Even without breaking or wind influence, ocean surface waves are observed to produce turbulence in the water, possibly influencing ocean surface dynamics and air–sea interactions. Based on the water-side free-surface simulations, recent studies suggest that such turbulence is produced through the interaction between the waves and the near-surface Eulerian current associated with the viscous attenuation of waves. To clarify the dynamical role of the air–water interface in the turbulence production, the attenuating interfacial gravity waves were simulated directly using a newly developed two-phase wave-resolving numerical model. The air–water coupling enhanced the wave energy dissipation through the formation of a strong shear at the air-side viscous boundary layer. This led to an enhancement of the wave-to-current momentum transfer and the formation of the down-wave Eulerian mean sheared current, which is favourable for the CL2 instability responsible for the production of Langmuir circulations. As a result, the water-side turbulence grew stronger compared with the corresponding free surface (water-only) wave-resolving simulation. The evolution of the wave-averaged field was well reproduced with the Craik–Leibovich equation with the upper boundary condition provided with the virtual wave stress based on linear theory. The wave energy dissipation by air–water coupling plays a significant role in the quantitative understanding of the wave-induced turbulence at the laboratory and field scales.
Children’s eating habits are established early in life and parents play a major role therein. Pregnancy is a teachable moment for the promotion of healthy eating because many women are concerned about their babies’ health and have frequent contact with healthcare providers. We aimed to investigate the association between diet quality during pregnancy and the offspring. A total of 691 sets of data on pregnant mothers and their 3-year-old offspring were obtained from the Seiiku Boshi cohort study. Dietary intake was assessed using a validated food frequency questionnaire for mothers in mid-to-late pregnancy and a validated diet history questionnaire for Japanese preschool children at the 36-month checkup. Diet quality was scored using the Japanese Food Guide Spinning Top. Maternal diet quality score was categorised into quartiles, and the association between offspring and maternal diet quality score, adjusted for socioeconomic factors, was assessed using multiple linear regression. The total offspring diet quality score showed a linear trend with the maternal diet quality score (the mean increments (confidential intervals) for each quartile were –0.12 (–1.32–1.08), 1.54 (0.34–2.73), and 1.22 (0.03–2.42)). In particular, offspring vegetable dishes scored higher in all quartiles of maternal vegetable dish scores than in the lowest quartile (0.69 (0.21–1.17), 0.97 (0.50–1.45), and 1.36 (0.88–1.83)). A high diet quality score during pregnancy was positively associated with that of offspring, suggesting the importance of nutritional education in pregnant women to improve their diet quality.
This study aimed to compare the differences in the intake of food groups and nutrients between Japanese adults who consumed the recommended daily vegetable intake (350 g/day) and those who did not. Dietary information was obtained from one-day dietary records collected from the 2016 National Health and Nutrition Survey, which was conducted in 46 prefectures in Japan. The participants aged ≥20 years (n = 21,606; 53.8% women) were classified into the < and ≥350 g/day groups. Inter-group differences for 17 food groups and 27 nutrients were assessed as percentages of consumers (food groups only) and energy-adjusted intake (units/MJ/d or % of total energy intake). Overall, 29% of participants consumed ≥350 g/day of vegetables. The ≥350 g/day group had a higher percentage of consumers and energy-adjusted intakes for all vegetable subgroups than the <350 g/day group. For other food groups, the ≥350 g/day group had higher percentages of consumers for all food groups, except for cereals, eggs, and condiments and seasonings, which showed no significant differences. However, the ≥350 g/day group had a significantly higher energy-adjusted intake for potatoes and other tubers, mushrooms, meats, and condiments and seasonings but a significantly lower value for cereals, eggs, savoury snacks and confectionaries, and beverages. The ≥350 g/day group had a significantly higher intake of almost all (25/27) nutrients, including sodium, than the <350 g/day group. Participants with vegetable intake ≥350 g/day might have a more favourable intake of food groups and nutrients; however, watching for salt intake is necessary when promoting vegetable intake.
Analysis of the chronological data and observation of a lagoonal sediment core reveal sand washover events between around 2.4 to 2.5 cal. ky BP in the Isumi River lowland. We conducted radiocarbon dating with AMS and constructed an age-depth model using the latest calibration curve and appropriate model routine. In the middle to lower part of the core, dark-gray sand layers are repeatedly deposited. Sand layers may exhibit an erosional surface at the base with fining upward grading. The overwash layers are composed of well-rounded sand with occasional gravel, indicative of transportation. overwash sediment characteristics are consistent with proximal marine deposits, suggesting an ocean origin (though riverine sediment is also similar in character). The age-depth model indicates very high sediment accumulation rates associated with overwash deposits. Based on the amount of accumulated sediment, relatively large-scale redeposition events occurred during this period but more information is needed to constrain the mechanism(s) causing the events. We also present a local reservoir age correction compatible with the Marine20 calibration curve.
This chapter offers an analysis of the challenges for governments and the private sector in cybersecurity governance from a systemic perspective. It first identifies the challenges that the liberal international order, characterised by political liberalism, economic openness, and international cooperation, has faced in the area of cybersecurity governance. It also observes that there have so far been no successful global efforts to harmonise rules or create a unified regime. This chapter then emphasises how the private sector’s essential role as innovators possessing technological expertise is unique to cybergovernance and explains how the interplay of different actors, both public and private, has practical meaning for states and actors.
We aim at developing a systematic method of separating omniscience principles by constructing Kripke models for intuitionistic predicate logic $\mathbf {IQC}$ and first-order arithmetic $\mathbf {HA}$ from a Kripke model for intuitionistic propositional logic $\mathbf {IPC}$. To this end, we introduce the notion of an extended frame, and show that each IPC-Kripke model generates an extended frame. By using the extended frame generated by an IPC-Kripke model, we give a separation theorem of a schema from a set of schemata in $\mathbf {IQC}$ and a separation theorem of a sentence from a set of schemata in $\mathbf {HA}$. We see several examples which give us separations among omniscience principles.
The consumption of various foods is internationally recommended in healthy diet although the association between dietary variety and incident dementia is unknown. We aimed to examine the association between dietary variety and the incidence of disabling dementia in older Japanese adults.
Design:
We conducted a prospective cohort study. Dietary variety was assessed based on the Dietary Variety Score (DVS). DVS was assessed by counting the number of ten food components (meat, fish/shellfish, eggs, milk, soyabean products, green/yellow vegetables, potatoes, fruit, seaweed and fats/oils) that were consumed almost daily using a FFQ. Participants were categorised into low (0–2 points), middle (3–4 points) and high (5–10 points) groups based on the DVS. Data on newly diagnosed disabling dementia were retrieved from the public long-term care insurance database. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95 % CI.
Setting:
Yabu cohort study, Japan.
Participants:
A total of 4972 community-dwelling adults aged 65 years or older.
Results:
During the median follow-up of 6·8 years, 884 participants were newly diagnosed with disabling dementia. After adjusting for confounders, the multivariable-adjusted HR for incident disabling dementia was 0·82 (95 % CI, 0·69, 0·97) for participants in the highest DVS category compared with those in the lowest DVS category (Pfor trend = 0·019).
Conclusions:
A higher dietary variety is associated with a reduced risk of disabling dementia in older Japanese adults. These results have potential implications for the development of effective public nutritional approaches to prevent dementia in older adults.
Edited by
Ornella Corazza, University of Hertfordshire and University of Trento, Italy,Artemisa Rocha Dores, Polytechnic Institute of Porto and University of Porto, Portugal
This chapter describes a study of addictive behaviours, including excessive exercising and the use of image- and performance-enhancing drugs (IPEDs), across 12 sports disciplines. Weightlifting and CrossFit were associated with a higher risk of excessive exercising and of using a wide range of IPEDs. Conversely, walking was associated with a lower tendency to exercise excessively, and with a lower rate of IPED use. These results may indicate that excessive exercising is linked to the risk of cross addiction with substance intake, particularly in disciplines that require high-intensity functional training. A more compassionate attitude towards oneself may help to prevent excessive exercising and use of IPEDs. Budo and yoga, which are both based on an integrated ‘mind–body’ approach, scored relatively high for self-compassion compared with other sports disciplines. The study findings may help to identify tailor-made ways to reduce the risk of addictive behaviours in each of these sports disciplines.
Recent ALMA observations detected protostellar outflows in 70-μm dark infrared dark clouds (IRDCs). These sources are candidates for the initial stages of high-mass star formation. We launched a new survey for free-free emission from outflow shocks using the Yamaguchi Interferometer (YI) at 8 GHz. We aim to catalog “proto-high-mass protostar” candidates that are still in the low to intermediate-mass phase. We selected starless-like clumps without any 70-μm point source from Traficante et al. (2015). We currently detected 82 sources from 167 clumps. 37 of them are fainter than 20 mJy (down to a few mJy). They tend to associate with colder and denser clumps that are suitable for star formation. This fact suggests that, at least, some of them trace star-formation activities. The highest-density clumps are, in fact, associated with several masers and molecular outflows. Furthermore, some of them have already shown a signature of ongoing cluster formation.
A new microsporidian disease of cultured rainbow trout Oncorhynchus mykiss has recently been confirmed in Japan, and the causative species was tentatively designated as Microsporidium sp. RBT-2021. Involvement of common prawn Palaemon paucidens in its transmission was suggested based on the previous feeding trials, although the microsporidian infection in P. paucidens was not confirmed. In this study, P. paucidens in Lake Biwa, Japan was investigated for microsporidian infection and 4 types of spores (types 1–4) were newly found. The nucleotide sequence of the small subunit ribosomal RNA gene was identical between type 1 and Microsporidium sp. RBT-2021, indicating they are conspecific. However, intriguingly, the spore morphology and the mode of development in fish and prawn were strikingly different. Morphological observations revealed type 1 in the prawn possesses characteristics of the genus Inodosporus Overstreet and Weidner, 1974, while Microsporidium sp. RBT-2021 in the trout exhibited the characteristics of the genus Kabatana Lom, Dyková and Tonguthai, 2000. In the phylogeny, type 1 was placed within a clade comprising Kabatana spp. and Inodosporus octosporus. Based on the morphological and molecular analyses, we describe Microsporidium sp. RBT-2021 as Inodosporus fujiokai n. sp. Together with the success of the previous prawn-feeding trials, this study strongly suggests I. fujiokai n. sp. has a multi-host life cycle utilizing fish and crustacean hosts and different modes of development in each host. Such polymorphic life cycle has barely been known among fish microsporidians. This study also suggests that the genus Kabatana is a junior synonym of the genus Inodosporus.
Eating frequency has been associated with nutrient intake and diet quality. The aim of this study was to examine the association between daily nutrient and food group intake and consumption of breakfast and/or snacks among young Japanese adults, as secondary analysis of the 2012 National Health and Nutrition Survey in Japan involved 1420 men and 1659 women aged 20–39 years. Dietary intake data were collected using a one-day semi-weighed household dietary record. Participants were classified into four groups based their breakfast and snack consumption, defined as the consumption of any food or beverage that contained energy based on participant-defined eating occasions; both breakfast and snack consumption (B+S+), breakfast consumption without snacking (B+S–), breakfast skipping and snack consumption (B–S+) and breakfast skipping without snacking (B–S–). The proportion of breakfast skippers among men and women was 11·8 % and 6·6 %, whereas that of snack consumers among men and women was 55·3 % and 68·2 %, respectively. Energy, Mg potassium (in both sexes), vitamin B2, Ca, (only men) and folate and dietary fibre (only women) intakes were higher among breakfast and snack consumers than in the B+S– group. The nutrient intake level of the B+S– group was similar to that of the B–S+ group, whereas the B–S– group had lower energy (both sexes), Cu, dietary fibre and potassium (only women) intakes than the B+S– group. Snack consumption could supplement nutrients that may not be adequately consumed by three meals among young Japanese adults.
Identifying trends in dietary salt sources is essential for effectively reducing salt/Na intake. This study aimed to examine the trends in dietary salt sources among Japanese adults using the 2007–2019 National Health and Nutrition Survey data collected from 95 581 adults aged ≥ 20 years. Dietary intake was estimated using the 1-d household-based dietary record. Foods reported as potential sources of salt intake in Japan and other countries were categorised into twenty-one groups. Salt intake for each food group was adjusted using the density method based on the energy intake. Trends in dietary salt intake based on food sources by sex and age groups (20–39 years, 40–59 years and ≥ 60 years) were analysed using the Joinpoint Regression Program. Salt intake for each age group in both men and women decreased from 2007 (5·3 g/1000 kcal–6·4 g/1000 kcal) to 2019 (4·9 g/1000 kcal–5·6 g/1000 kcal). The major dietary source of salt continued to be seasonings such as soya sauce and soyabean paste (approximately 70 %). Salt intake from seasonings decreased over time in adults aged ≥ 40 years but did not change in those aged 20–39 years. Additionally, a decreasing salt intake from unprocessed fish and shellfish and an increasing salt intake from unprocessed meat were observed across all age categories for both sexes. This study demonstrated that a strategy targeting different age groups may be needed to reduce salt consumption from seasonings among the Japanese population. Further studies on salt content in seasonings and continued monitoring of trends in dietary salt sources are required.
We systematically study conservation theorems on theories of semi-classical arithmetic, which lie in-between classical arithmetic $\mathsf {PA}$ and intuitionistic arithmetic $\mathsf {HA}$. Using a generalized negative translation, we first provide a structured proof of the fact that $\mathsf {PA}$ is $\Pi _{k+2}$-conservative over $\mathsf {HA} + {\Sigma _k}\text {-}\mathrm {LEM}$ where ${\Sigma _k}\text {-}\mathrm {LEM}$ is the axiom scheme of the law-of-excluded-middle restricted to formulas in $\Sigma _k$. In addition, we show that this conservation theorem is optimal in the sense that for any semi-classical arithmetic T, if $\mathsf {PA}$ is $\Pi _{k+2}$-conservative over T, then ${T}$ proves ${\Sigma _k}\text {-}\mathrm {LEM}$. In the same manner, we also characterize conservation theorems for other well-studied classes of formulas by fragments of classical axioms or rules. This reveals the entire structure of conservation theorems with respect to the arithmetical hierarchy of classical principles.
An increase in peripheral blood eosinophils in helminth infections is expected, and these cells are known to promote immunity against these parasites. However, studies have suggested that in some specific helminths, eosinophils may promote the needs and longevity of these parasites, and their role in these infections remains undefined, including in Toxocara canis infection. Thus, this study aimed to investigate the role of eosinophils in the context of larval migration of T. canis and the immunopathological aspects of infection. For this, we used wild-type mice and mice genetically deficient for the transcription factor GATA-binding factor 1 (GATA1−/−), infected with 1000 eggs of T. canis. At 0, 3, 14 and 63 days post-infection, parasite load, tissue cytokine production, leucocyte profile, bronchoalveolar lavage cells and histopathological analyses were carried out. Collectively, our results demonstrate that the presence of eosinophils mediates susceptibility to T. canis, inducing leucocytosis and the formation of granulomas, increasing the pulmonary and cerebral parasite load, and reducing the number of neutrophils, which may be necessary to control the infection.
American visceral leishmaniasis (VL) is a parasitic disease whose main domestic reservoir in the urban environment is dog and is considered one of the most important zoonoses in the context of public health. Serological tests are typically used for the diagnostic screening of the disease. This study aimed to analyse the performance of different methodologies used in the diagnosis of VL in dogs sampled from a recent transmission area. The sample consisted of 52 dogs separated into groups based on the absence and presence of clinical signs of VL. The following serological techniques were carried out: the DPP® rapid test (RT), the ALERE® RT and an RT and immunoenzymatic assay with a recently developed protein (rKDDR-plus). In addition, molecular techniques were carried out with conjunctival swabs, and bone marrow aspirate samples and parasitological samples were obtained directly from bone marrow aspirates. It was concluded that 27.4% of seronegative dogs were infected, but the serological tests, used as screening tests, showed unsatisfactory sensitivity results (average: 51.2%) for dogs without clinical signs. It was suggested that polymerase chain reaction with conjunctival swabbing be used as a screening test for dogs without clinical signs, as this is a non-invasive collection technique with high-sensitivity values.
Lacydonia Marion & Bobretsky, 1875 is the sole genus in the family Lacydoniidae Bergström, 1914. We herein describe the new species of Lacydonia shohoensis sp. nov. from 2042-m deep bottoms at Shoho Seamount of the Nishi-Shichito Ridge, the Northwest Pacific Ocean. It is most similar to L. anapaulae Rizzo et al., 2016 in having a depression on the median anterior region and lacking lateral lobes on the posterior margin of prostomium whereas it is distinguished by possessing pygidium dorsally pigmented with three reddish spots and non-pigmented pygidial lateral cirri equally elongated.
A future sustainable dietary pattern for Japanese is yet undefined. This study aimed to explore more sustainable Japanese diets that are nutritious, affordable and with low greenhouse gas emissions (GHGE) and particular emphasis on cultural acceptability. A newly developed data envelopment analysis (DEA) diet model was applied to 4-d dietary record data among 184 healthy Japanese men and 185 women volunteers aged 21–69 years. Alternative diets were calculated as the linear combinations of observed diets. Firstly, for each individual, four modelled diets were calculated that maximised cultural acceptability (i.e. minimise dietary change from observed diet), maximised nutritional quality assessed by the Nutrient-Rich Food Index (NRF), minimised monetary diet costs or minimised diet-related GHGE. The final modelled diet combined all four indicators. In the first four models, the largest improvement was obtained for each targeted indicator separately, while relatively small improvements or unwanted changes were observed for other indicator. When all indicators were aimed to optimise, the NRF score and diet-related GHGE were improved by 8–13 % with the lower monetary cost than observed diets, although the percentage improvement was a bit smaller than the separate models. The final modelled diets demanded increased intakes for whole grains, fruits, milk/cream/yogurt, legumes/nuts, and decreased intakes for red and processed meat, sugar/confectioneries, alcoholic and sweetened beverages, and seasonings in both sexes. In conclusion, more sustainable dietary patterns considering several indicators are possible for Japanese, while total improvement is moderate due to trade-offs between indicators and methodological limitation of DEA diet model.
A 4-day-old girl with Posterior fossa anomalies, Haemangiomas of the head and neck, Arterial, Cardiovascular, and Eye anomalies and ventral developmental defect syndrome comprising a facial haemangioma, aortic coarctation at the aortic arch, torturous aortic aneurysm distal to coarctation, and ductus arteriosus originating proximal to the coarctation is presented. The aortic arch was successfully reconstructed without cardiopulmonary bypass, and she is currently doing well after 4 years and 8 months.