Tokyo Metropolitan Area Research Articles

Abstract 4125719: Efficacy of Prodromal Symptom Assessment in Prognostic Stratification of Acute Myocarditis

Introduction: The outcomes of acute myocarditis are heterogeneous and can lead to clinically significant consequences. However, the patient characteristics associated with adverse outcomes at presentation are not fully understood. Objection: To investigate the association between the presence or absence of prodromal symptoms and in-hospital mortality in patients admitted with acute myocarditis. Methods: We analyzed multicenter data registry (Tokyo CCU Network Database, comprising 76 institutions in the Tokyo metropolitan area). The study included 261 cases with acute myocarditis from January 2017 to December 2020, among which 260 required hospitalization from the emergency department. Patients were grouped based on the presence or absence of prodromal symptoms prior to hospitalization. Prodromal symptoms include the following: (a) chest pain; (b) dyspnea; (c) fever; (d) ful-like symptoms; and (e) others.The primary outcome was in-hospital death. Results: Among the 261 patients with acute myocarditis, 187 patients (71.6%) exhibited prodromal symptoms, and 74 patients (28.3%) did not. The primary outcome occurred in 19 patients (25.6%) without prodromal symptoms and in 20 patients (10.6%) with prodromal symptoms (hazard ratio, 2.87; 95% CI, 1.34 to 6.13; P=0.004, Figure 1A). A multivariable-adjusted Cox regression analysis confirmed that the absence of prodromal symptoms was an independent predictor of poor prognosis, even after adjusting for age, sex and the history of diabetes and hypertension. Notably, this trend was pronounced among patients with Killip classes 2-4, revealing higher in-hospital mortality rate in the patients without prodromal symptoms compared to those with prodromal symptoms (48.6% vs 11.7%; P < 0.001, Figure 1B). Conclusions: This study demonstrates that the absence of prodromal symptoms in patients with acute myocarditis is an independent predictor of poor prognosis, especially for patients presented with Killip classes 2-4.

Fundamental study on ambient noise reduction for analysis of hitting sound of professional baseball players

In recent years, the sound of a hitting ball during a baseball game has focused attention on the American Major League Baseball and Japanese professional baseball. It is reported that information such as the direction and distance of a batted ball can be detected from the sound. The sounds of players hitting the ball are sometimes expressed using various onomatopoeic. In our previous study, we recorded the sound of a baseball hit during hitting practice for players of a university baseball team in the Tokyo metropolitan area in Japan. Relationships between the acoustic characteristics of the sound and the distance and direction of the ball were clarified. In this research, acoustic analysis of professional baseball players' batted ball sounds from Youtube and other videos is used to identify the acoustic features and characteristics of the batted ball. This paper describes the method and accuracy of noise removal around the hitting sound extracted from the video using a convolutional neural network with images.

Enhanced O3 concentration due to biogenic emissions during a hot summer in 2018 over the Tokyo metropolitan area, Japan

Abstract Photochemical ozone (O3) is an important chemical component in the atmosphere as an indicator of air pollution. Anthropogenic sources, such as domestic automobiles and industries, have been considered a main source of O3 especially in urban areas; however, recent emission regulations have led to declining trends in anthropogenic sources. Therefore, other sources, such as biogenic emissions, could be important in the near future. In addition, increasing temperatures caused by global warming will relate to increasing biogenic emissions. In this study, the role of biogenic volatile organic compounds (BVOC) on O3 concentration was focused. The target period was a hot summer in 2018 in Japan, and O3 concentration by simulating with and without biogenic emissions over the Tokyo metropolitan area was analyzed. The result clarified that around 20% (up to 63%) of O3 was produced from biogenic sources at high temperatures, even in the Tokyo metropolitan area. This study suggested that the biogenic sources should be paid attention to and taken into account in the regulation of anthropogenic emissions.

Feasibility of vehicle-to-grid (V2G) implementation in Japan: A regional analysis of the electricity supply and demand adjustment market

Vehicle-to-Grid (V2G) technology forms a critical bridge between electric vehicles (EVs) and renewable energy, playing a transformative role in the global shift towards a low-carbon future. Despite its promise, the impact of regional differences on V2G potential, particularly within specific application scenarios, remains largely unexplored. This study employs an agent-based modeling approach to evaluate V2G potential across Japan's 47 prefectures, with a focus on its integration into an energy reserve service business model. Our analysis reveals that EV ownership is the dominant factor influencing regional variability, with the Tokyo Metropolitan Area, Aichi, and Kanagawa emerging as top candidates for V2G deployment. Interestingly, when EV ownership is excluded from consideration, regions like Okinawa, Kagoshima, and Ibaraki show leadership in V2G potential. These findings highlight the existence of regional priorities for V2G application. Moreover, a ‘High Demand Disparity’ is observed in the power supply and demand adjustment market, where V2G systems are often either underutilized or overwhelmed, leaving many idle. The study underscores the need for region-specific strategies and the integration of diverse business models to fully capitalize on V2G's potential in various demand adjustment scenarios.

Allopurinol, Febuxostat, and Nonuse of Xanthine Oxidoreductase Inhibitor Treatment in Patients Receiving Hemodialysis: A Longitudinal Analysis

Rationale & ObjectiveAllopurinol and febuxostat, which are xanthine oxidoreductase inhibitors, have been widely used as uric acid-lowering medications. However, evidence regarding their cardiovascular effects in hemodialysis is insufficient. This study compared the effects of allopurinol and febuxostat on mortality and cardiovascular outcomes in patients receiving hemodialysis. Study DesignRetrospective observational cohort study. Setting & ParticipantsData of 6,791 patients who had no history of topiroxostat usage and underwent maintenance hemodialysis between March 2016 and March 2019 at Yokohama Daiichi Hospital, Zenjinkai, and its affiliated dialysis clinics in Japan’s Kanagawa and Tokyo metropolitan areas were collected. ExposureAllopurinol, febuxostat, and non-treatment. OutcomesAll-cause mortality, cardiovascular disease (CVD) events, heart failure (HF), acute myocardial infarction (AMI), and stroke. Analytical ApproachFor the main analyses, marginal structural Cox proportional hazards models were used to estimate hazard ratios (HRs) adjusted for time-varying confounding and selection bias due to censoring. ResultsAllopurinol and febuxostat showed significantly better survival than non-treatment for all-cause mortality (HR: 0.40, 95% confidence interval [CI]: 0.30–0.54; HR: 0.49, 95% CI: 0.38–0.63, respectively), without significant difference between allopurinol and febuxostat. Allopurinol showed significantly better survival than non-treatment, whereas febuxostat did not for CVD events (HR: 0.89, 95% CI: 0.84–0.95; HR: 1.01, 95% CI: 0.96–1.07, respectively), HF (HR: 0.71, 95% CI: 0.56–0.90; HR: 1.03, 95% CI: 0.87–1.21, respectively), and AMI (HR: 0.48, 95% CI: 0.25–0.91; HR: 0.76, 95% CI: 0.49–1.19, respectively). No comparisons showed significant results for stroke. LimitationsThe ratio of renal or intestinal excretion of uric acid and uremic toxins could not be elucidated, and we could not investigate gene polymorphism because of the large number of cases. ConclusionsAllopurinol and febuxostat improved survival for all-cause mortality. Allopurinol, and not febuxostat, reduced the risk of CVD events, HF, and AMI.

The 50-year spatial transition of suburban industrial parks and impacts on sustainable urbanization in the Tokyo metropolitan area

Suburban Industrial Parks (SIP) promote orderly industrial land agglomeration, contributing to sustainable land use transition. Previous studies mostly focused on socio-economic effectiveness and environmental strategies, while the multiscale spatial transition of SIPs and their roles in sustainable urbanization were not thoroughly examined. This study analyzes the temporal pattern of spatial features (TPSF) of SIPs in the Tokyo Metropolitan Area (TMA) using an original suburban industrial community (SIC) model that integrates SIP with its neighborhood. We investigated 110 SIPs established since 1959 across three investigation periods. The results reveal: 1) SIPs influence industrial land use in their neighborhood areas, mostly ranging from 500 to 2500 m. 2) SIPs’ effects on industrial land agglomerations vary over time, demonstrating three development phases: the first phase exhibits the strongest intensity of agglomeration; the second phase falls to the weak; and the third phase recovers a strong agglomeration. 3) Multiscale industrial agglomeration patterns show that 56 % of SIPs in the TMA contribute to orderly spatial transitions; 4) Main road networks facilitate industrial agglomeration. This study proposes the importance of adaptive land use management strategies for SIPs by development phases, and the SIC model could be an applicable tool for land use planning in metropolitan suburbs.

Urban exodus or suburbanisation? Medium-term COVID-19 pandemic impacts on internal migration in Japan

The COVID-19 pandemic has profoundly affected internal migration patterns worldwide. Most previous studies have reported on pandemic-induced changes in internal migration using data from 2020 and 2021. Therefore, little is known about the pandemic’s medium-term impact. To address this gap, this study investigated an annual series of migration patterns from 2019 to 2023 in Japan. At the municipal level, relationships between net migration rates and population density indicated that the urbanisation trend became weak in 2020, compared to that in 2019, and it was the weakest in 2021. The urbanisation degree became stronger in 2023, increasing to the level in 2020. Using annual inter-municipal migration flows, this study then investigated changes in migration flows to/from and within three major metropolitan areas (Tokyo, Nagoya, and Osaka). The changes in sizes of these flows and migration effectiveness index suggested that the pandemic had the largest impact in the Tokyo metropolitan area, among the three areas, and it stimulated intra-metropolitan migration as suburbanisation, rather than net out-migration as ‘urban exodus’, in Japan. The overall results indicated that the pandemic had the largest impact in 2021, which got smaller as the migration patterns recovered to the pre-pandemic ones in 2023.

Insights Into Urban Heat Island and Heat Waves Synergies Revealed by a Land‐Surface‐Physics‐Based Downscaling Method

AbstractResearchers have recently focused on the interplay of the urban heat island (UHI) effect and heat waves (HWs). However, the synergies of these two phenomena remains inconclusive at present. To address this gap, this study investigated UHIs and HWs synergies during the last 30 years in the Tokyo metropolitan area, through a unique and novel approach named Land‐Surface‐Physics‐Based Downscaling (LSP‐DS). LSP‐DS integrates the widely used Noah‐Multiparameterization (Noah‐MP) land‐surface model coupled with urban canopy‐process physics, aiming to conduct high‐resolution, long‐term urban‐specific simulations with much less computational resources. Our comprehensive analysis combining observation data and numerous LSP‐DS simulations confirms exacerbated UHIs during HWs. Specifically, HWs amplify the temperature differences between urban and rural environments, which is quantified by UHI intensity (UHII). During HWs, UHII increased more at night in inland areas and more during daytime in coastal areas. HWs present especially a heightened threat to coastal regions where daytime UHII increased by approximately 1°C during HWs. The Bowen ratio can explain the increase in the daytime UHII, and the daytime accumulated storage heat increase during HWs can explain the increase in nighttime UHII. Based on future projections of the increasing frequency of high temperatures, our findings highlight the impending heat‐related health challenges faced by urban residents.

Effects of artificial night lighting on a web-building spider species in urban green spaces

Urban green spaces are biological habitats that play an important role in maintaining urban biodiversity and are affected by artificial light at night (ALAN). Determining the effects of ALAN on predators in urban green spaces is important for promoting the maintenance and conservation of these functions of insect communities in urban green spaces. We investigated the effects of ALAN on a web-building spider species (Trichonephila clavata) in urban green spaces in the Tokyo metropolitan area, Japan. We used a GPS receiver to determine the positions of streetlights and spider webs and classified the webs into two groups: those within the reach of streetlights and those outside their range. We then measured the web distribution (web density), web size, female traits (femur length and body weight), and male presence. Web densities in the light conditions were higher and web sizes smaller than those of webs in the no light conditions. Female body weight and length were also significantly lower in the light conditions than in the no light conditions. However, female body condition and male abundance did not differ between the light and no light conditions. Our results showed that T. clavata maintains some degree of fitness in urban fragmented green spaces although their physical characteristics and behaviour are altered by ALAN. Therefore, we suggest that measures to improve the quality within green infrastructure are required to maintain the function of generalist predators such as web-building spiders in urban green spaces.

Application of the Ocean Health Index to assess ocean and coastal conditions of the Tokyo Metropolitan area

Ocean ecosystem services are fundamental to coastal economic development and climate regulation. The Tokyo Metropolitan Area (TMA) is one of the world’s most significant bay areas, with its economic development and residents relying on a healthy ocean and diverse marine ecosystem services. Post-World War II, the coastal zones of TMA have suffered from various human-induced stresses and impacts, jeopardizing the capacity of ocean ecosystem services and sustainable development. Although recent years have seen improvements in basic marine water quality, other ecosystem health issue, such as biodiversity, carbon storage, coastal protection are remain limited and require comprehensive enhancement. To better understand the current state of ocean health, promote more comprehensive ocean management decisions and plans, and support sustainable development in the region, it is essential to evaluate the ocean’s condition in the TMA and to assess future trends and risks. The Ocean Health Index (OHI) offers a comprehensive framework to evaluate global and regional ocean health conditions and their ecosystem services. This study applies the OHI to assess the ocean and coastal health of TMA, with indicators and reference points adjusted based on local conditions. From 2014 to 2019, the OHI assessment results indicate that TMA obtained an overall OHI score of 49 (out of 100), with goals ranging from 13 to 87. The environmental and social goals, such as Tourism and Recreation (87), Clean Water (67), Coastal Livelihoods and Economies (62), Sense of Place (62), and Artisanal Fishery Opportunity (51), are relatively high. In contrast, the ecological goals, such as Biodiversity (14), Carbon Storage (13), Coastal Protection (38), and Food Provision (24), are relatively low. This case study highlights strategies for improving ocean health conditions in TMA from both OHI goals and management structure perspectives. The methods and results provide a quantitative tool for regional marine and coastal management in TMA, aiding regional management organizations to establish quantifiable objectives for actions that were previously difficult to quantify. These results can indirectly promote the establishment of more comprehensive and holistic regional management organizations in TMA, which is currently fragmented, thereby effectively enhancing ocean health in TMA.

Urban dynamics and their implication on greenness trends: A 25-year retrospective study of the changing face of tokyo metropolitan area

Global metropolises and their needs for green space are rising due to demographic urbanization. Some phenomena contradicted to prevailing understanding have been observed in metropolises, such as the “sprawl shrinkage” associated with the increasing built-up area despite declining populations, and the positive relationship between population and greenness. To study these storylines, we conceptualized and mapped 5 urban dynamics by cross-referencing the“increase, stable, and decrease”of built-up area and population density based on threshold values of an introduced Normalized Difference Index (NDI). Furthermore, Kruskal-Wallis H Test was used to analyze the influence of different urban dynamic patterns on 3 greenness trends (greening, browning, and stable greenspace). From 1995 to 2021, Tokyo Metropolitan Area (TMA) gradually transited from intense urban expansion to a stabilization of built-up area and population density in the city center, declining urbanization in the peri-urban areas, and “sprawl shrinkage” in the far-outskirts. Moreover, compared to other urban dynamics, the pattern of built-up areas increases with a population density reduction of over 5% were conducive to maintaining NDVI values of 0.75 or higher. In the future, the ongoing demographic urbanization is highly likely to further exacerbate the phenomenon of urban-suburban disparity and intra-suburban differentiation. We propose that Asian metropolises should enhance regional cooperation and public-private partnerships to address potential regional ecological imbalances. Additionally, it is necessary to maximize the greenness within the given urban dynamics through figuring out the spatial impact mechanisms of urban development on greenness change from a long-term perspective.

Simulation of urban surface temperature and surface heat balance in the Tokyo metropolitan area

This study aimed to propose a method for simulating ground surface temperature and surface heat balance using thermal infrared remote sensing and an urban surface heat balance model and to conduct a simulation in the Tokyo metropolitan area. Previous studies have typically employed ground surface temperatures obtained through satellite remote sensing to analyze urban thermal environments. However, these studies were limited to using surface temperature data available only at the time of satellite passage. Therefore, in this study, we conducted a simulation for the Tokyo metropolitan area by integrating a one-dimensional heat balance model with ground surface temperatures observed by satellites. The novelty of this study lies in the utilization of parameters related to heat balance obtained through calculations of physical processes, as opposed to relying on empirical formulas or parameters. Consequently, realistic ground surface characteristics, including parameters such as evaporation efficiency and thermal inertia essential for the simulation, were derived by this combined method. Furthermore, diurnal variations in ground surface temperature distributions were accurately represented by using realistic surface temperature data based on satellite remote sensing, considering the effect of heat storage in urban areas—an aspect challenging to reproduce using conventional local meteorological models.

Evolution and controlling factors of natural levees during the past 4500 years derived from lowland archaeological ruins in central Kanto Plain, Japan

Lowland archaeological ruins are frequently used in conjunction with sediment cores to reconstruct geomorphological evolution on alluvial plains. Lowland ruins are, as a rule, heterogeneously distributed across alluvial plains and retain short chronological records when compared to sediment cores. Along the historic banks of the Tone River, in the central Kanto Plain, thorough surveying prior to major construction projects in the Tokyo metropolitan area uncovered a dense swath of lowland archaeological ruins. This study demonstrates the evolution of natural levees during the past 4.5 kyr by compiling data from uniformly distributed lowland archaeological ruins in the central Kanto Plain. The location and age of 774 lowland archaeological ruins and 101 radiocarbon dates from surficial fluvial sediments in 42 sediment cores were compiled and arranged chronologically. As a result, levees and river terraces aged < 4.5 ka were found to be contiguous with modern sedimentology in the Arakawa Lowland, while relatively young natural levees aged < 2.8 ka are contiguous with the present Nakagwa Lowland. The Tone River migrated from the Arakawa Lowland to the Nakagawa Lowland at ∼5 ka. Subsequently, sea levels lowered between 4 ka and 3 ka. Due to sea level lowering, a minor tributary of the Tone River partially eroded the alluvial plain, and relatively old geomorphology persisted in the Arakawa Lowland. In contrast, in the Nakagawa Lowland, the major tributary of the Tone River eroded the entire alluvial plain. Following sea-level rises up to 2 ka, natural levees aggraded and formed new surface sediments in the Nakagawa Lowland due to large sediment discharge from the major tributary of the Tone River. Natural levee evolution in the central Kanto Plain is influenced by both river migration and sea-level fluctuation.

From city center to suburbs: Developing a timeline-based TOD assessment model to explore the dynamic changes in station areas of Tokyo metropolitan area

Transit-Oriented Development (TOD) is regarded as a planning concept for urban sustainable development that has been increasingly embraced worldwide in recent years. However, scholars rarely assess the sustainability of Transit-Oriented Development (TOD) station areas over a period of time. This study, building upon the existing TOD assessment model based on node-place-ecology, introduces the concepts of “low-carbon cities” and a “timeline-based.” Focuses on whether the three dimensions of TOD station areas—node, place, and carbon—are dynamically balanced over time towards sustainable development. More specifically, this study starting from a micro-level perspective, takes the 70 stations on the Odakyu line as a clue, a railway that spans Tokyo and Kanagawa, aiming to develop a quantitative assessment model for sustainable TOD based on node-place-carbon, and to summarize the spatial dynamic changes of the 70 station areas in the Tokyo metropolitan area from 2011 to 2019 through the principles of sustainable development line (SDL) and K-means cluster analysis. The results indicate that after 8 years, the overall development of the station areas is moving towards sustainability, but there are still some station areas that deviate to some extent. And also, we observed that the trend of monopolization in the central station areas of the Tokyo metropolitan area is continuously strengthening. We believe that the sustainable assessment model developed in this study can provide constructive reference for the planning and design of cities, especially metropolitan areas, around the world.

Aluminum dynamics in nitrogen‐saturated Andisols in Tokyo

AbstractThe debate over whether forests around the Tokyo metropolitan area are nitrogen (N) saturation persists, as atmospheric N deposition in throughfall has decreased. This decrease is evidenced by a notable decline in samples collected in the 1990s (especially 1991–1992 and 1995). This decline can be attributed to a reduction in nitrogen oxide (NOx) emissions from automobiles. The acidity derived from N deposition can increase aluminum (Al) mobility. We conducted a monitoring study from September 2010 to December 2021 to elucidate the effects of decreased N deposition on Al concentrations and flux in a forested Andisol. Throughfall and soil‐percolated water samples were collected under stands of Japanese cedar and Japanese cypress in Hachioji, Tokyo (Field Museum Tamakyuryo). Major inorganic ions were determined by ion chromatography. Total Al concentrations were determined using atomic absorption spectrometry after concentration under acidic conditions. Aluminum and nitrate () concentrations were significantly correlated in the both Japanese cedar and Japanese cypress stands. In the case of the Japanese cedar stand, Al concentrations tended to decrease over time from November 2010 to May 2015. Based on stepwise multiple regression analysis, acid load associated with N transformation ([H+]load) was chosen as the sole factor affecting Al mobilization in the Japanese cedar stand. Decreased N deposition affects Al dynamics via a decrease in [H+]load.

Changes in Accelerometer-measured Physical Activity and Sedentary Behavior From Before to After COVID-19 Outbreak in Workers.

The novel coronavirus disease 2019 (COVID-19) pandemic may have reduced opportunities for engaging in physical activity (PA) and increased sedentary behavior (SB) among workers. However, most previous studies used self-reported assessments. This study aimed to examine the changes in accelerometer-measured PA and SB from before to after COVID-19 outbreak among Japanese workers. This 1-year longitudinal study used data from the annual health check-ups of workers who lived in the Tokyo metropolitan area. Baseline and follow-up data were collected from June to November of 2019 and June to November of 2020, respectively. Participants were asked to wear the accelerometer on their hip during awake hours for at least 10 days in both the surveys. Before the analysis, considering the difference in wearing time, time spent in PA and SB were converted to the percentage of wearing time. To investigate the changes in PA or SB from before to during COVID-19 outbreak, paired t-tests were performed. Of the 757 eligible participants, 536 were included in the analysis (70.8%). Participants' mean age was 53.3 years, 69.6% were female, and most were full-time employees. Time spent in PA decreased, regardless of weekdays or weekends, although changes on the weekends were not significant. Conversely, time spent in SB increased on both weekdays and weekends in 2020. These changes corresponded to approximately 10 minutes per day decrease in PA and increase in SB. Objectively measured PA decreased and SB increased by approximately 10 minutes per day after the COVID-19 outbreak among Japanese workers.

Effects of a dementia educational programme using virtual reality on nurses in an acute care hospital: A pre-post comparative study.

Poor awareness of dementia care by healthcare professionals affects the quality of care for people living with dementia in acute care settings. This study examined the effectiveness of a virtual reality-based educational programme for dementia for nurses working in acute care hospitals in Japan. A dementia education programme for nurses was designed. The programme comprised short movies, virtual reality videos based on the short movies, a lecture, discussions and role-playing based on the experimental learning model. Virtual reality video content was created to promote empathy for people living with dementia through a first-person experience of dementia. The educational programme involved nurses working in an acute care hospital in the Tokyo Metropolitan area. Before and after the programme, we employed structured questionnaires using validated instruments to assess participants' attitudes towards people living with dementia, their intentions of helping behaviour and their confidence in providing dementia care. Seventy-six nurses participated in and completed the pre- and post-tests. The mean age was 34.9 ± 9.2 years, and 90.8% of the participants were female. A paired t-test showed significant before-after improvement in the participants' attitudes towards people living with dementia (41.9 ± 5.1 vs. 44.5 ± 4.8), intentions of helping behaviour towards people living with dementia (10.8 ± 2.5 vs. 12.8 ± 2.1) and confidence in providing dementia care (25.9 ± 6.7 vs. 29.2 ± 6.0). The programme effectively improved nurses' attitudes towards people living with dementia and confidence in providing dementia care in acute care settings. Future research is important to explore the long-term effects of this programme and its effects on actual dementia care. The dementia education programme may promote person-centred care in acute hospitals. Future studies should consider the provision of more flexible programs so that nurses can more easily participate in them.

Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan

BackgroundTo assess the performance of pediatric extracorporeal membrane oxygenation (ECMO) centers, outcomes were compared between metropolitan and other areas. MethodsA retrospective cohort study was conducted at three regional centers on Kyushu Island and the largest center in the Tokyo metropolitan area of Japan. The clinical outcomes of patients of ≤15 years of age who received ECMO during 2010–2019 were investigated, targeting the survival and performance at discharge from intensive care units (ICUs), using medical charts. ResultsOne hundred and fifty-five patients were analyzed (regional, n = 70; metropolitan, n = 85). Survival rates at ICU discharge were similar between the two areas (64%). In regional centers, deterioration of Pediatric Cerebral Performance Category (PCPC) scores were more frequent (65.7% vs. 49.4%; p = 0.042), but survival rates and ΔPCPC scores (PCPC at ICU discharge–PCPC before admission) improved in the second half of the study period (p = 0.005 and p = 0.046, respectively). Veno-arterial ECMO (odds ratio [OR], 3.00; p < 0.03), extracorporeal cardiopulmonary resuscitation (OR, 8.98; p < 0.01), and absence of myocarditis (OR, 5.47; p < 0.01) were independent risk factors for deterioration of the PCPC score. A sub-analysis of patients with acute myocarditis (n = 51), the main indicator for ECMO, revealed a significantly higher proportion of cases with deteriorated PCPC scores in regional centers (51.9% vs. 25.0%; p = 0.049). ConclusionsThe survival rates of pediatric patients supported by ECMO in regional centers were similar to those in a metropolitan center. However, neurological outcomes must be improved, particularly in patients with acute myocarditis.

Effects of Aikido classes on mood in Japanese university students

This study examined the effects of a half-semester of aikido instruction on mood of Japanese university students using multidimensional indicators. In all, 23 female students (18.87 ± 0.76 years old) who attended weekly aikido classes (15 × 90 min for half of a semester) attending a private university in the Tokyo metropolitan area were included in the analysis. The Two-Dimensional Mood Scale (TDMS) was used to measure mood. The classes measured were the third (Period 1) and the fourteenth (Period 2). The TDMS was measured before (Time 1) and after (Time 2) each class. Each measurement took &lt;5 min to complete. A two-factor analysis of variance (period (2) × time (2)) was performed for the vitality level, stability level, pleasure level, and arousal level. The results showed that regardless of the length of the class, changes were seen in the scores of vitality level, pleasure level, and arousal level between before and after the class. Thus, aikido was shown to increase vitality and positively affected pleasant and aroused mood states after class. For stability level, only the period 2 group showed a change in post-class scores. In other words, the second half of the class showed an increase in calm and relaxed mood after class.

Heat-related mortality and ambulance transport after a power outage in the Tokyo metropolitan area.

Air conditioners can prevent heat-related illness and mortality, but the increased use of air conditioners may enhance susceptibility to heat-related illnesses during large-scale power failures. Here, we examined the risks of heat-related illness ambulance transport (HIAT) and mortality associated with typhoon-related electricity reduction (ER) in the summer months in the Tokyo metropolitan area. We conducted event study analyses to compare temperature-HIAT and mortality associations before and after the power outage (July to September 2019). To better understand the role of temperature during the power outage, we then examined whether the temperature-HIAT and mortality associations were modified by different power outage levels (0%, 10%, and 20% ER). We computed the ratios of relative risks to compare the risks associated with various ER values to the risks associated without ER. We analyzed the data of 14,912 HIAT cases and 74,064 deaths. Overall, 93,200 power outage cases were observed when the typhoon hit. Event study results showed that the incidence rate ratio was 2.01 (95% confidence interval [CI] = 1.42, 2.84) with effects enduring up to 6 days, and 1.11 (95% CI = 1.02, 1.22) for mortality on the first 3 days after the typhoon hit. Comparing 20% to 0% ER, the ratios of relative risks of heat exposure were 2.32 (95% CI = 1.41, 3.82) for HIAT and 0.95 (95% CI = 0.75, 1.22) for mortality. A 20% ER was associated with a two-fold greater risk of HIAT because of summer heat during the power outage, but there was little evidence for the association with all-cause mortality.