With the recent development of neonatal medicine, the number of children with medical complexities (CMCs) is increasing. Outdoor activities are important for their psychosocial development, and the principles of accessibility should be addressed. We report the experience of 2 CMCs' high-altitude mountaineering with the necessary support. The participants were a 3-y-old girl with cerebral palsy, symptomatic epilepsy, and a ventriculoperitoneal shunt (Child A) and a 6-y-old girl who underwent bilateral Glenn operations at 11 mo for hypoplastic left heart syndrome (Child B). The support staff consisted of 4 doctors, 1 nurse, 5 nonmedical staff , 3 members from a mountaineering association, and 2 people from an oxygen company. The climbing schedule was 2 days. On the first day, we took a bus to a hut at an altitude of 2450 m and stayed overnight to acclimatize to the altitude. On the second day, we took the beginner's route, which took 3 h to climb 500 m, and our team made an attempt on the summit. During the attempt, Child B panicked. Although her lung sounds did not raise suspicions of pulmonary edema, we decided to leave the mountain with her because her transcutaneous oxygen saturation decreased. Child A had no apparent health problems and made it to the summit. Although CMCs' alpine climbing requires careful planning and staffing considering the risk of high-altitude sickness, our case suggests the feasibility of such activities with CMCs as part of accessibility.

The coronavirus disease (COVID-19) pandemic has raised concerns about the impact of delayed health check-ups and cancer screenings on cancer diagnosis and treatment. This study aimed to investigate the awareness of cancer patients on future screening measures during the pandemic in rural Japan. An anonymized open-data survey was undertaken in Fukui Prefecture, a rural region of Japan, in 2021. Participants were asked about their cancer screening history, screening frequency during the pandemic, and reasons for not undergoing screening. Among the 1262 respondents, the proportion of patients who underwent cancer screening in 2020 during the pandemic was similar to the proportion who underwent regular (annual or biannual) screening in 2019 before the pandemic. Of those who underwent regular screening, 82% still underwent screening in 2020, while only 21% of those who had irregular screenings. The number of respondents who believed they were healthy and did not require screening increased over time, possibly due to restrictions on going out and refraining from activities during the pandemic. This study in rural Japan found that regular cancer screening prior to the pandemic was associated with a more positive attitude toward screening during the pandemic. Raising awareness about the importance of cancer screening and encouraging participation is crucial for promoting positive attitudes in the future. The findings highlight the need for continued efforts to ensure access to screening services during the pandemic and future public health emergencies.

Background There is concern that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants may have higher infectivity and virulence than does the original strain. We compared disease severity between patients infected with conventional strains of SARS-CoV-2 and those infected with the alpha variant. Methods The study included patients with SARS-CoV-2 infection confirmed in Fukui Prefecture between March 12, 2020, and May 12, 2021. They were grouped into 4 phases based on fluctuations in the number of notifications. Data analysis was performed using EZR version 1.41 and BellCurve for Excel version 3.20. Results The analysis included 963 patients with SARS-CoV-2 infection, 346 of whom were infected with the alpha variant. In stratified analyses, patients infected with the alpha variant did not differ significantly from patients infected with conventional strains in terms of disease severity or mortality. Among individuals with SARS-CoV-2 infection, risk factors for pneumonia included infection with the alpha variant, older age, and male sex. Conclusions Infection with the alpha variant was associated with a higher frequency of pneumonia, but not with increased disease severity or mortality.

This study introduces a novel and simple way to suppress the self-absorption effect in laser-induced breakdown spectroscopy (LIBS) by utilizing a defocusing laser irradiation technique. For this purpose, a Nd:YAG laser with a wavelength of 1,064 nm and repetition rate of 10 Hz with energy in the range of 10 mJ–50 mJ was used. The laser irradiation was focused by using a 150-mm-focal-length plano-convex lens onto the sample surface under defocusing of approximately –6 mm. Potassium chloride (KCl) and sodium chloride (NaCl) pellet samples were used to demonstrate this achievement. When the defocus position is adjusted to –6 mm for KCl and NaCl samples, the self-reversal in the emission lines of K I 766.4 nm, K I 769.9 nm, Na I 588.9 nm, and Na I 589.5 nm vanish. Meanwhile, the FWHM values of K I 766.4 and K I 769.9 nm are 0.29 nm and 0.23 nm, respectively, during –6 mm defocus laser irradiation, as opposed to 1.24 nm and 0.86 nm under tight focus laser irradiation. Additionally, this work demonstrates that, when the laser energy is changed between 10 and 50 mJ, no self-reversal occurs in the emission lines when –6 mm defocus laser irradiation is applied. Finally, a linear calibration curve was generated using KCl at a high concentration ranging between K concentrations from 16.6% to 29%. It should be noted that, even at such high K concentrations, the calibration curve is still linear. This means that self-absorption is almost negligible. This simple change in defocus laser irradiation will undoubtedly contribute to the suppression of the self-absorption phenomenon, which disrupts LIBS analytical results.

Farmed anguillid eels are frequently stocked into natural fresh waters to enhance eel resources, but little is known about what happens to these eels or their interactions with wild eels after stocking. A recent study observed a depressed survival and growth rate of farmed Japanese eels when they were reared with wild eels, which indicated that wild eels might interfere with the survival and growth of farmed-and-stocked eels through intraspecific competition. To contribute to improving eel stocking efficiency, the growth of farmed-and-stocked Japanese eels was compared among four rivers with different wild eel densities using mark-and-recapture studies. Based on the 2-year recapture survey after stocking, it was found that the density of the farmed-and-stocked eels was not significantly different among rivers. The daily growth rates of farmed-and-stocked eels in the rivers with lower wild eel density were significantly higher than those of the eels stocked into the rivers with higher wild eel density. The farmed-and-stocked eels moved significantly greater distances downstream than wild eels that showed sedentary behaviour. This and previous studies indicate that significant questions remain about the effectiveness of stocking farmed eels into water bodies where naturally recruited wild eels are present.

Abstract This study introduces a novel and extremely simple way for suppressing the self-absorption effect in laser-induced breakdown spectroscopy (LIBS) by utilizing a defocusing laser irradiation technique. It is claimed that defocusing laser irradiation produces more uniform laser plasma due to lower fluence than tight focus laser irradiation, hence greatly lowering the effect of self-absorption in the laser plasma. KCl and NaCl pellet samples were used to demonstrate this achievement. When the defocus position is adjusted to – 6 mm for KCl and NaCl samples, the self-reversal emission lines K I 766.4 nm, K I 769.9 nm, Na I 588.9 nm, and Na I 589.5 nm vanish. Meanwhile, the FWHM values of K I 766.4 and K I 769.9 nm are 0.29 nm and 0.23 nm, respectively, during -6 mm defocus laser irradiation, as opposed to 1.24 nm and 0.86 nm, under tight focus laser irradiation. Additionally, this work demonstrates that when the laser energy is changed in between 10 to 50 mJ, no self-reversal emission occurs when -6 mm defocus laser irradiation is applied. Finally, a linear calibration curve is generated using KCl at a high concentration ranging between K concentration from 16.6–29%. This simple change of defocus laser irradiation will undoubtedly contribute to the suppression of the self-absorption phenomenon, which disrupts LIBS analytical results.

End-of-life advance care planning (ACP) has become increasingly important in home care setting. In facilitating ACP discussion in home care setting, accurate understanding of patients' survival would be beneficial because it would facilitate healthcare professionals to individualize ACP discussion. However, little is known about survival outcome of home care patients. This study aimed to clarify the outcome of patients and identify factors to better predict the survival outcome of home care patients with the focus on patients' primary diseases.We conducted a retrospective analysis using data from 277 patients managed at a home care clinic in Japan and first treated in 2017 or 2018. Data regarding sociodemographic and clinical characteristics, and clinical outcome on December 31, 2019 were extracted. Using Kaplan-Meier product-limit method, we estimated the overall 30 days, 90 days, 1 year, and 3 year survival probabilities among the entire patients and their differences according to their primary disease. We also evaluated whether outcomes differed based on the primary disease or other factors using the hazard ratio and Cox proportional hazards regression.The overall survival probability was 82.5% at 30 days, 67.8% at 90 days, 52.7% at 1 year, and 39.1% at 3 years. The survival rates at 30 days, 90 days, 1 year, and 3 years were 64.6%, 33.4%, 9.5%, and 4.1% among cancer patients; 91.9%, 86.4%, 78.1%, and 47.0% among dementia patients; and 91.9%, 86.4%, 78.1%, and 47.0% among patients with other nervous and cerebrovascular diseases, respectively. Cox proportional hazard regression clarified that cancer patients (hazard ratio 6.53 [95% CI 4.16-10.28]) and older adults (hazard ratio 1.01 [95% CI 1.00-1.02]) were significantly more likely to die than dementia patients and young patients, respectively.Primary disease had a significant influence on the prediction of survival time and could be a useful indicator to individualize ACP in home care setting.

Little is known about how emergency transfers take place and what outcomes they lead to in the patients who receive home care in Japan. We aimed to assess outcomes of emergency transfers and factors associated with such outcomes in the Japanese home care setting.A retrospective analysis of patient data from a home care clinic in Fukui, Japan, included all patients who experienced emergency transfers which were reported to the clinic during 2018 and 2019. We collected data on patients' sociodemographic and clinical characteristics, as well as the transfer process and its outcome, using patient charts and other administrative records. We first analyzed the overall outcome and then evaluated whether transfer outcomes would differ according to by whom and from where the emergency medical service (EMS) was called, by univariate and multivariate analyses.We considered 63 patients who experienced emergency transfers during the study period. Of the total, 10 (15.9%) returned to their residences without being admitted or being dead on arrival. Although only 2.6% (1/39) of patients whose transfers were determined by health care professionals (HCPs) returned home without being admitted, a direct return was observed for 37.5% (9/24) of patients whose transfer was determined by those other than HCPs (odds ratio of direct return to residences 22.80, 95% confidence interval 2.65-195.87). There was no other variable which was significantly associated with the outcomes after the emergency transfers, although all the patients who have no available caregivers resulted in hospitalization.In this preliminary analysis in the Japanese home care setting, only a small proportion of patients returned to their residences without being admitted following emergency transfers. Patients whose EMS transfer was requested by an HCP usually resulted in an admission to the clinic, whereas transfers requested by non-HCPs frequently did not.

BackgroundThe “no flow” interval is the time from out-of-hospital cardiac arrest (OHCA) to cardiopulmonary resuscitation (CPR). Its prognostic value is important to define for prehospital resuscitation decisions, post-resuscitation care and prognostication, and extracorporeal cardiopulmonary resuscitation (ECPR) candidacy assessment. MethodsWe examined bystander-witnessed OHCAs without bystander CPR from two Resuscitation Outcomes Consortium datasets. We used modified Poisson regression to model the relationship between the no-flow interval (9-1-1 call to professional resuscitation) and favourable neurological outcome (Modified Rankin Score ≤ 3) at hospital discharge. Furthermore, we identified the no-flow interval beyond which no patients had a favourable outcome. We analysed a subgroup to simulate ECPR-treated patients (witnessed arrest, age < 65, non-asystole initial rhythm, and >30 min until return of circulation). ResultsOf 43,593 cases, we included 7299; 616 (8.4%) had favourable neurological outcomes. Increasing no-flow interval was inversely associated with favourable neurological outcomes (adjusted relative risk 0.87, 95% CI 0.85–0.90); the adjusted probability of a favourable neurological outcome decreased by 13% (95% CI 10–15%) per minute. No patients (0/7299, 0%; 1-sided 97.5% CI 0–0.051%) had both a no-flow interval >20 min and a favourable neurological outcome. In the hypothetical ECPR group, 0/152 (0%; 1-sided 97.5% CI 0–2.4%) had both a no-flow interval >10 min and a favourable neurological outcome. ConclusionsThe probability of a favourable neurological outcome in OHCA decreases by 13% for every additional minute of no-flow time until high-quality CPR, with the possibility of favourable outcomes up to 20 min.

Carbon detection is usually difficult to carry out with high sensitivity and minimally destructive effect. While the conventional laser induced breakdown spectroscopy (LIBS) method operated with atmospheric ambient air is well known as a powerful and versatile analytical tool, it suffers nevertheless from the low sensitivity of C detection when measured in both atmospheric and low pressure ambient air with the more adverse effect found in the former case. This was shown to have its origin in the serious time mismatching effect between the formation of the shock wave plasma by the ablated major host elements and the premature fast passage of the much lighter ablated C atom. However, this study shows the result of high sensitivity C analysis of stone samples using LIBS technique with relatively low laser pulse energy of 60 mJ and low pressure He ambient gas without showing visible surface damage. The helium gas provides the additional delayed excitation by the He metastable excited states through the Penning-like ionization process. The C emission intensities measured from the jasper and black stone in 2.6 kPa He ambient gas are in general significantly higher than those measured in 0.5 kPa ambient air. The enhancement is shown to increase reaching an 8 fold enhancement with increased laser energy up to 60 mJ before undesirable surface damage is created. A further measurement of C emission using pelletized KBr mixtures with various CaCO3 concentrations reveals a straight calibration line of rather large slope with extrapolated zero intercept and estimated detection limit of around 0.6 ppm, demonstrating its potential application for highly sensitive quantitative analysis of C with minimal destructive effect.