Cholesterol and breast cancer risk: a cohort study using health insurance claims and health checkup databases.

PURPOSE: This study aimed to investigate the association between serum cholesterol and triglyceride levels and breast cancer risk in Japanese women. METHODS: We retrospectively evaluated the association between the levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs) and the incidence of breast cancer in a cohort study by using the health insurance claims and health checkup data from a database provided by JMDC Inc. We included 956,390 women who were insured between April 2008 and June 2019, identified breast cancer cases by using validated definitions, and estimated the risk of breast cancer by using multivariable Cox proportional hazards regression models adjusted for potential confounders. RESULTS: During the 2,832,277 person-years observation period (median 2.4 years), 6284 participants were diagnosed with breast cancer. There was marginally significant association between LDL-C and breast cancer risk when comparing the highest and lowest quintiles and at the clinical cutoff values for diagnosing hyperlipidemia. HDL-C was not associated with breast cancer. However, when stratified by age groups (< 50 and ≥ 50), HDL-C was inversely associated with breast cancer risk in women over 50 years old. TG was not associated with breast cancer risk. CONCLUSION: In this population, there was a modest association of LDL-C at the clinical cutoff values for diagnosing hyperlipidemia (140 mg/mL), and there were no associations of HDL-C and TG with breast cancer risk.

Characteristics and outcomes of pediatric out-of-hospital cardiac arrest by scholastic age category.

OBJECTIVES: There is a paucity of data examining nationwide population-based incidences and outcomes of pediatric out-of-hospital cardiac arrest. The objective of this study is to describe the detailed characteristics of pediatric out-of-hospital cardiac arrest by scholastic age category and to evaluate the impact of bystander cardiopulmonary resuscitation and public access-automated external defibrillators on the 1-month survival and favorable neurological status of pediatric out-of-hospital cardiac arrest patients. DESIGN: A nationwide, population-based, observational study. SETTING: Nationwide emergency medical system in Japan. PATIENTS: Out-of-hospital cardiac arrest patients aged ≤ 18 yr. MEASUREMENTS AND MAIN RESULTS: We identified 7,624 pediatric out-of-hospital cardiac arrest patients (≤ 18 yr old) from a nationwide population-based out-of-hospital cardiac arrest database in Japan from 2005 to 2008 and stratified them into five categories by scholastic age. The overall rates of 1-month survival and favorable neurological outcomes were 11.0% and 5.1%, respectively. Bystander cardiopulmonary resuscitation resulted in a significant improvement in both 1-month survival (odds ratio 2.81; 95% confidence interval 2.30-3.44) and favorable neurological outcomes (odds ratio 4.55; 95% confidence interval 3.35-6.18). Performing public access-automated external defibrillators had a significant effect on the 1-month survival rate (odds ratio 3.51; 95% confidence interval 1.81-6.81) and favorable neurological outcomes (odds ratio 5.13; 95% confidence interval 2.64-9.96). CONCLUSIONS: This study demonstrated that bystander cardiopulmonary resuscitation and public access-automated external defibrillators had a significant impact on the outcomes of pediatric out-of-hospital cardiac arrest. The improved survival associated with bystander cardiopulmonary resuscitation and public access-automated external defibrillators are clinically important and are of major public health importance for school-aged out-of-hospital cardiac arrest patients.

Comparison of neurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: a nationwide, population-based, observational study.

BACKGROUND: The effect of prehospital use of supraglottic airway devices as an alternative to tracheal intubation on long-term outcomes of patients with out-of-hospital cardiac arrest is unclear. STUDY OBJECTIVES: We compared the neurological outcomes of patients who underwent supraglottic airway device insertion with those who underwent tracheal intubation. METHODS: We conducted a nationwide population-based observational study using a national database containing all out-of-hospital cardiac arrest cases in Japan over a 3-year period (2005-2007). The rates of neurologically favorable 1-month survival (primary outcome) and of 1-month survival and return of spontaneous circulation before hospital arrival (secondary outcomes) were examined. Multiple logistic regression analyses were performed to adjust for potential confounders. Advanced airway devices were used in 138,248 of 318,141 patients, including an endotracheal tube (ETT) in 16,054 patients (12%), a laryngeal mask airway (LMA) in 34,125 patients (25%), and an esophageal obturator airway (EOA) in 88,069 patients (63%). RESULTS: The overall rate of neurologically favorable 1-month survival was 1.03% (1426/137,880). The rates of neurologically favorable 1-month survival were 1.14% (183/16,028) in the ETT group, 0.98% (333/34,059) in the LMA group, and 1.04% (910/87,793) in the EOA group. Compared with the ETT group, the rates were significantly lower in the LMA group (adjusted odds ratio 0.77, 95% confidence interval [CI] 0.64-0.94) and EOA group (adjusted odds ratio 0.81, 95% CI 0.68-0.96). CONCLUSIONS: Prehospital use of supraglottic airway devices was associated with slightly, but significantly, poorer neurological outcomes compared with tracheal intubation, but neurological outcomes remained poor overall.

Factors Associated With Impeding the Reintegration of Incest Survivors: A Qualitative Study in Selected Safe Homes in Nepal.

BACKGROUND: Incest is a globally prevalent phenomenon and is defined as sexual relations between closely related family members. Despite being a criminal offense irrespective to the gender and age incest is a prevalent issue in Nepal. Incest survivors are sheltered in safe homes for specific periods and reintegrated into their families following their healing. This research aims to explore the challenges and issues involved in the reintegration of incest survivors and investigate how the interconnected perceptions of families and individuals relate to the incest survivors' successful reintegration. METHODS: This qualitative study was conducted in three districts of Nepal. Fourteen incest survivors, five service providers from safe homes, and 22 community members were purposefully and theoretically selected. Semi-structured interviews were carried out to collect the study data, which were subsequently coded and analyzed using a grounded theory approach. RESULTS: The results indicate the importance of the reintegration of incest survivors, as staying in a safe home may not offer a long-term solution for these individuals. However, reintegration is challenging without acceptance and support from the survivors' families and communities, the survivors' readiness to reintegrate, and agreement from the survivors' safe homes. Factors found to influence the unsuccessful reintegration of survivors included family fragmentation, socio-economic status, family resistance, the survivor-perpetrator relationship, survivors' interests, fears, and the possibility of repeated incidents, harmful social norms and cultural practices, community intervention, and negative perceptions. CONCLUSION: This study found that factors associated with impeding the reintegration of incest survivors are found in survivors, their families, and their communities. Creating harmonious family systems, providing education on gender equality, empowering women to fight against all sorts of abuse, and governmental assurances on the implementation of legal aid, human rights, ratified conventions on child rights and women's rights may help prevention of incest, and address the reintegration challenges of incest victims.

Two- and Three-Dimensional Modeling and Simulations of Grain Growth Behavior in Dual-Phase Steel Using Monte Carlo and Machine Learning.

Dual-phase (DP) steel has been widely used in automotive steel plates with a balance of excellent strength and ductility. Grain refinement in DP steel is important to improve the properties further; however, the factors affecting grain growth need to be well understood. The remaining problem is that acquiring data through experiments is still time-consuming and difficult to evaluate quantitatively. With the development of materials informatics in recent years, material development time and costs are expected to be significantly reduced through experimentation, simulation, and machine learning. In this study, grain growth behavior in DP steel was studied using two-dimensional (2D) and three-dimensional (3D) Monte Carlo modeling and simulation to estimate the effect of some key parameters. Grain growth can be suppressed when the grain boundary energy is greater than the phase boundary energy. When the volume fractions of the matrix and the second phase were equal, the suppression of grain growth became obvious. The long-distance diffuse frequency can promote grain growth significantly. The simulation results allow us to better understand the factors affecting grain growth behavior in DP steel. Machine learning was performed to conduct a sensitivity analysis of the affecting parameters and estimate the magnitude of each parameter's effects on grain growth in the model. Combining MC simulation and machine learning will provide one promising research strategy to gain deeper insights into grain growth behaviors in metallic materials and accelerate the research process.

Evaluation of Austenite-Ferrite Phase Transformation in Carbon Steel Using Bayesian Optimized Cellular Automaton Simulation.

Austenite-ferrite phase transformation is a crucial metallurgical tool to tailor the properties of steels required for particular applications. Extensive simulation and modeling studies have been conducted to evaluate the phase transformation behaviors; however, some fundamental physical parameters still need to be optimized for better understanding. In this study, the austenite-ferrite phase transformation was evaluated in carbon steels with three carbon concentrations during isothermal annealing at various temperatures using a developed cellular automaton simulation model combined with Bayesian optimization. The simulation results show that the incubation period for nucleation is an essential factor that needs to be considered during austenite-ferrite phase transformation simulation. The incubation period constant is mainly affected by carbon concentration and the optimized values have been obtained as 10-24, 10-19, and 10-21 corresponding to carbon concentrations of 0.2 wt%, 0.35 wt%, and 0.5 wt%, respectively. The average ferrite grain size after phase transformation completion could decrease with the decreasing initial austenite grain size. Some other parameters were also analyzed in detail. The developed cellular automaton simulation model combined with Bayesian optimization in this study could conduct an in-depth exploration of critical and optimal parameters and provide deeper insights into understanding the fundamental physical characteristics during austenite-ferrite phase transformation.

Big-Volume SliceGAN for Improving a Synthetic 3D Microstructure Image of Additive-Manufactured TYPE 316L Steel.

A modified SliceGAN architecture was proposed to generate a high-quality synthetic three-dimensional (3D) microstructure image of TYPE 316L material manufactured through additive methods. The quality of the resulting 3D image was evaluated using an auto-correlation function, and it was discovered that maintaining a high resolution while doubling the training image size was crucial in creating a more realistic synthetic 3D image. To meet this requirement, modified 3D image generator and critic architecture was developed within the SliceGAN framework.

Novel Algorithm for the Estimation of Cancer Incidence Using Claims Data in Japan: A Feasibility Study.

PURPOSE: We developed algorithms to identify patients with newly diagnosed cancer from a Japanese claims database to identify the patients with newly diagnosed cancer of the sample population, which were compared with the nationwide cancer incidence in Japan to assess the validity of the novel algorithms. METHODS: We developed two algorithms to identify patients with stomach, lung, colorectal, breast, and cervical cancers: diagnosis only (algorithm 1), and combining diagnosis, treatments, and medicines (algorithm 2). Patients with newly diagnosed cancer were identified from an anonymized commercial claims database (JMDC Claims Database) in 2017 with two inclusions/exclusion criteria: selecting all patients with cancer (extract 1) and excluding patients who had received cancer treatments in 2015 or 2016 (extract 2). We estimated the cancer incidence of the five cancer sites and compared it with the Japan National Cancer Registry incidence (calculated standardized incidence ratio with 95% CIs). RESULTS: The number of patients with newly diagnosed cancer ranged from 219 to 17,840 by the sites, algorithms, and exclusion criteria. Standardized incidence ratios were significantly higher in the JMDC Claims Database than in the national registry data for extract 1 and algorithm 1, extract 1 and algorithm 2, and extract 2 and algorithm 1. In extract 2 and algorithm 2, colorectal cancer in male and stomach, lung, and cervical cancers in females showed similar cancer incidence in the JMDC and national registry data. CONCLUSION: The novel algorithms are effective for extracting information about patients with cancer from claims data by using the combined information on diagnosis, procedures, and medicines (algorithm 2), with 2-year cancer-treatment history as an exclusion criterion (extract 2).

Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest.

OBJECTIVE: Most previous studies of pediatric out-of-hospital cardiac arrest have typically examined relatively small datasets from small study regions. Although several studies have reported the impact on adult out-of-hospital cardiac arrest, little information is available on the impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest. We set out to examine the impact of cardiopulmonary resuscitation instruction by telephone dispatcher on the outcomes of pediatric out-of-hospital cardiac arrest. DESIGN: Population-based, observational study. SETTING: Japan-wide population-based setting. PATIENTS: We identified 1,780 pediatric out-of-hospital cardiac arrest patients (67.8% male) with witnessed collapse from a nationwide, population-based, out-of-hospital cardiac arrest database. INTERVENTION: None. MEASUREMENT AND MAIN RESULTS: We assessed the impact of telephone dispatcher assistance on the outcomes of 1-month survival rates and favorable neurologic status among the groups. The overall rate of bystander-performed chest compression and mouth-to-mouth ventilation among the witnessed pediatric out-of-hospital cardiac arrests were 39.5% and 25.6%, respectively. Telephone dispatcher assistance was offered in 28.4% of the witnessed pediatric out-of-hospital cardiac arrest cases and resulted in a significant increase in both chest compression (adjusted odds ratio 6.04; 95% confidence interval 4.72-7.72) and mouth-to-mouth ventilation (adjusted odds ratio 3.10; 95% confidence interval 2.44-3.95), and a significant improvement in 1-month survival rate (adjusted odds ratio 1.46; 95% confidence interval 1.05-2.03), but no significant effect on favorable neurologic outcomes at 1 month (adjusted odds ratio 1.15; 95% confidence interval 0.70-1.88). Potential confounding factors included age categories, sex, bystander type, cause of cardiac arrest, bystander cardiopulmonary resuscitation, and attempted defibrillation. CONCLUSIONS: Telephone dispatcher assistance could significantly increase bystander cardiopulmonary resuscitation among witnessed pediatric out-of-hospital cardiac arrests. Although there was only a small, nonsignificant effect on the improvement in favorable neurologic outcome at 1 month, the improved survival associated with telephone dispatcher assistance in pediatric out-of-hospital cardiac arrest is clinically important, and is of major public health importance. In cases where cardiac arrest was uncertain from the bystander's replies during the call to emergency medical services, telephone dispatcher assistance was not offered, which could affect the adjusted odds ratio of the present study.

Monophasic versus biphasic defibrillation for pediatric out-of-hospital cardiac arrest patients: a nationwide population-based study in Japan.

INTRODUCTION: Conventional monophasic defibrillators for out-of-hospital cardiac-arrest patients have been replaced with biphasic defibrillators. However, the advantage of biphasic over monophasic defibrillation for pediatric out-of-hospital cardiac-arrest patients remains unknown. This study aimed to compare the survival outcomes of pediatric out-of-hospital cardiac-arrest patients who underwent monophasic defibrillation with those who underwent biphasic defibrillation. METHODS: This prospective, nationwide, population-based observational study included pediatric out-of-hospital cardiac-arrest patients from January 1, 2005, to December 31, 2009. The primary outcome measure was survival at 1 month with minimal neurologic impairment. The secondary outcome measures were survival at 1 month and the return of spontaneous circulation before hospital arrival. Multivariable logistic regression analysis was performed to identify the independent association between defibrillator type (monophasic or biphasic) and outcomes. RESULTS: Among 5,628 pediatric out-of-hospital cardiac-arrest patients (1 through 17 years old), 430 who received defibrillation shock with monophasic or biphasic defibrillator were analyzed. The number of patients who received defibrillation shock with monophasic defibrillator was 127 (30%), and 303 (70%) received defibrillation shock with biphasic defibrillator. The survival rates at 1 month with minimal neurologic impairment were 17.5% and 24.4%, the survival rates at 1 month were 32.3% and 35.6%, and the rates of return of spontaneous circulation before hospital arrival were 24.4% and 27.4% in the monophasic and biphasic defibrillator groups, respectively. Hierarchic logistic regression analyses by using generalized estimation equations found no significant difference between the two groups in terms of 1-month survival with minimal neurologic impairment (odds ratio (OR), 1.57; 95% confidence interval (CI), 0.87 to 2.83; P = 0.14) and 1-month survival (OR, 1.38; 95% CI, 0.87 to 2.18; P = 0.17). CONCLUSIONS: The present nationwide population-based observational study could not confirm an advantage of biphasic over monophasic defibrillators for pediatric OHCA patients.

Effect of Cold-Rolling Directions on Recrystallization Texture Evolution of Pure Iron.

The influence of cold-rolling directions on the recrystallization texture evolution of pure iron was examined. As-received pure iron sheets were cold-rolled under two different conditions (specimens A and B). Specimen A was cold-rolled in the vertical direction against the cold-rolling direction of the as-received sheet. Specimen B was cold-rolled in the vertical direction against the cold-rolling direction of the as-received sheet, and then in the cold-rolling direction of the as-received sheet. Cold-rolled specimens were heated to each desired temperature before being quenched in water to room temperature (298 ± 2 K). Both cold-rolled specimens showed the development of γ-fiber and {100}<011> orientation. Additionally, γ-fiber formed comparatively more in cold-rolled specimen A, while α-fiber developed comparatively more in cold-rolled specimen B. Strain distribution in cold-rolled specimen A was presumably inhomogeneous, whereas that in cold-rolled specimen B was rather uniform at the macro-scale. The formation of γ-fiber was confirmed in annealed specimen A. In annealed specimen B, however, the recrystallization texture tended to be random, and the formation of α-fiber was observed. Furthermore, the formation of Goss orientation in both annealed specimens was established. Recrystallized ferrite grains with Goss orientation nucleated in high strain regions of cold-rolled specimen. These findings show that by devising the cold-rolling direction, it is possible to discover new types of recrystallization textures.

Development of gamma-ray-induced positron age-momentum correlation measurement.

In conventional positron annihilation spectroscopy using radioisotopes, source contributions are unavoidable since positrons annihilate in the material covering the radioisotopes. Part of the positrons annihilate within the radioisotopes even when radioisotopes are deposited directly on a sample. Gamma-ray-induced positron annihilation spectroscopy makes it possible to measure only the spectra of a sample without source contributions since positrons are directly generated inside the sample from the gamma rays by pair production and annihilate inside the same sample. In this study, a new positron age-momentum correlation measurement system using ultrashort pulsed gamma rays is developed. The gamma rays with an energy of 6.6 MeV are generated by the inverse Thomson scattering of laser photons by high-energy electrons and are irradiated to the sample. The laser pulse can fully control the timing of gamma-ray generation. This characteristic and the use of a digital oscilloscope with a 12-bit vertical resolution enable us to develop a simple measurement system. Time-resolved momentum distributions for stainless steel with no defects and deformed interstitial free steel show the explicit differences reflecting the type of defect; for BaF2 single crystals, the results have been interpreted by considering the formation of positronium.

Collapse-to-emergency medical service cardiopulmonary resuscitation interval and outcomes of out-of-hospital cardiopulmonary arrest: a nationwide observational study.

INTRODUCTION: The relationship between collapse to emergency medical service (EMS) cardiopulmonary resuscitation (CPR) interval and outcome has been well documented. However, most studies have only analyzed cases of cardiac origin and Vf (ventricular fibrillation)/pulseless VT (ventricular tachycardia). We sought to examine all causes of cardiac arrest and analyze the relationship between collapse-to-EMS CPR interval and outcome in a nationwide sample using an out-of-hospital cardiac arrest (OHCA) registry. METHODS: This was a retrospective observational study based on a nationwide OHCA patient registry in Japan between 2005 and 2008 (n = 431,968). We included cases where collapse was witnessed by a bystander and where collapse and intervention time were recorded (n = 109,350). Data were collected based on the Utstein template. One-month survival and neurologically favorable one-month survival were used as outcome measures. Logarithmic regression and logistic regression were used to examine the relation between outcomes and collapse-to-EMS CPR interval. RESULTS: Among collapse-to-EMS CPR intervals between 3 and 30 minutes, the logarithmic regression equation for the relationship with one-month survival was y = -0.059 ln(x) + 0.21, while that for the relationship with neurologically favorable one-month survival was y = -0.041 ln(x) + 0.13. After adjusting for potential confounders in the logistic regression analysis for all intervals, longer collapse-to-EMS CPR intervals were associated with lower rates of one-month survival (odds ratio (OR) 0.93, 95% confidence interval (CI): 0.93 to 0.93) and neurologically favorable one-month survival (OR 0.89, 95% CI 0.89 to 0.90). CONCLUSIONS: Improving the emergency medical system and CPR in cases of OHCA is important for improving the outcomes of OHCA.

Population density, call-response interval, and survival of out-of-hospital cardiac arrest.

BACKGROUND: Little is known about the effects of geographic variation on outcomes of out-of-hospital cardiac arrest (OHCA). The present study investigated the relationship between population density, time between emergency call and ambulance arrival, and survival of OHCA, using the All-Japan Utstein-style registry database, coupled with geographic information system (GIS) data. METHODS: We examined data from 101,287 bystander-witnessed OHCA patients who received emergency medical services (EMS) through 4,729 ambulatory centers in Japan between 2005 and 2007. Latitudes and longitudes of each center were determined with address-match geocoding, and linked with the Population Census data using GIS. The endpoints were 1-month survival and neurologically favorable 1-month survival defined as Glasgow-Pittsburgh cerebral performance categories 1 or 2. RESULTS: Overall 1-month survival was 7.8%. Neurologically favorable 1-month survival was 3.6%. In very low-density (<250/km(2)) and very high-density (≥10,000/km(2)) areas, the mean call-response intervals were 9.3 and 6.2 minutes, 1-month survival rates were 5.4% and 9.1%, and neurologically favorable 1-month survival rates were 2.7% and 4.3%, respectively. After adjustment for age, sex, cause of arrest, first aid by bystander and the proportion of neighborhood elderly people ≥65 yrs, patients in very high-density areas had a significantly higher survival rate (odds ratio (OR), 1.64; 95% confidence interval (CI), 1.44 - 1.87; p < 0.001) and neurologically favorable 1-month survival rate (OR, 1.47; 95%CI, 1.22 - 1.77; p < 0.001) compared with those in very low-density areas. CONCLUSION: Living in a low-density area was associated with an independent risk of delay in ambulance response, and a low survival rate in cases of OHCA. Distribution of EMS centers according to population size may lead to inequality in health outcomes between urban and rural areas.

Immediate defibrillation or defibrillation after cardiopulmonary resuscitation.

OBJECTIVES: This study aimed to determine whether short cardiopulmonary resuscitation (CPR) by emergency medical services before defibrillation (CPR first) has a better outcome than immediate defibrillation followed by CPR (shock first) in patients with ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT) out-of-hospital cardiac arrest. METHODS: We analyzed a national database between 2006 and 2008, and included patients aged 18 years or more who had witnessed cardiac arrests and whose first recorded rhythm was VF/pulseless VT. Those study subjects were divided into five groups in accordance with the CPR/defibrillation intervention sequence. Each group was subdivided into call-to-response intervals of <5 minutes and ≥ 5 minutes. We identified 267 patients in the shock-first group and 6,407 patients in the CPR-first group. One-month survival and neurologically favorable one-month survival rates were used for outcome measures. The association of intervention type on outcomes (one-month survival or neurologically favorable one-month survival) was analyzed using multivariate logistic regression analyses by adjusting potential confounding factors such as survey year, gender, age (years), bystander CPR, intubation, and call-to-response interval (min). RESULTS: The overall one-month survival rate was 26.2% (3,125/11,941) and the neurologically favorable one-month survival rate was 16.6% (1,983/11,934). The CPR-first group had a one-month survival rate of 27.8% (1,780/6,407) and a neurologically favorable one-month survival rate of 17.8% (1,140/6,404), and the shock-first group had survival rates of 24.7% (66/267) and 18.4% (49/267), respectively. There were no significant differences in one-month survival and neurologically favorable one-month survival in these two primary comparison groups (odds ratio [95% confidence interval], 0.85 [0.64-1.13] and 1.04 [0.76-1.42], respectively). Logistic regression analysis showed that neither CPR first nor shock first was associated with the rate of one-month survival or neurologically favorable one-month survival, after adjusting for potential confounders. CONCLUSIONS: In our study, CPR prior to attempted defibrillation did not present a better outcome compared with shock first as measured by either one-month survival or neurologically favorable one-month survival, after adjusting for potential confounders. Further studies are required to determine whether CPR first has an advantage over shock first.

Additional medical costs associated with ventilator-associated pneumonia in an intensive care unit in Japan.

BACKGROUND: Additional health care costs associated with ventilator-associated pneumonia (VAP) vary widely per country; none of which have been explored in Japan. Thus, we aimed to examine the economic and clinical effects of VAP in Japan. METHODS: This was a retrospective matched case-control study of 22 patients with VAP who were treated in the intensive care unit of Yokohama Rosai Hospital between January 2012 and December 2018. Twenty-two matched controls were selected based on 5 variables (ie, sex, age, diagnosis and surgical procedure, underlying disease with or without advanced malignant tumor, and best motor response). The additional health care costs incurred owing to VAP were calculated from the difference between the mean costs of VAP and control cases. RESULTS: VAP incurred an additional cost of approximately United States Dollars (USD) 34,884 per case. The length of hospitalization itself was the major factor contributing to additional medical costs, generating a difference of 9,824 USD. DISCUSSION: VAP not only worsens patient outcomes but also generates significant additional medical costs. Patients who had developed VAP required more medical resources such as the performance of a tracheostomy. CONCLUSIONS: VAP incurs a higher mean total hospital medical cost. Thus, appropriate infection control strategies should be implemented.

Three-Dimensional Analysis of Ferrite Grains Recrystallized in Low-Carbon Steel during Annealing.

We performed a three-dimensional (3D) analysis of ferrite grains recrystallized in low-carbon steel during annealing. Cold-rolled specimens were heated to 723 K and held for various periods. The 3D morphology of ferrite grains recrystallized during the annealing process was investigated. The progress of recovery in low-carbon steel was more inhibited than that in pure iron. However, ferrite recrystallization in low-carbon steel was more rapid than that in pure iron. The Avrami exponent was inconsistent with the 3D morphology of the recrystallized ferrite grains in pure iron but consistent with that of the grains in low-carbon steel. Thus, the Avrami exponent depends on the recovery and recrystallization behaviors. Furthermore, the recrystallized ferrite grain growth was virtually 2D. Three types of recrystallized ferrite grains were observed: recrystallized ferrite grains elongated along the transverse or rolling direction; plate-shaped recrystallized ferrite grains grown in the transverse and rolling directions; fine and equiaxed recrystallized ferrite grains. These results suggest that the recrystallized ferrite grains did not grow in the normal direction. Thus, we concluded that the 3D morphology of recrystallized ferrite grains depends on the kinetics of recrystallization and the initial microstructure before recrystallization.

Quantitative Analysis of the Recovery Process in Pure Iron Using X-ray Diffraction Line Profile Analysis.

We conducted quantitative analysis of the recovery process during pure iron annealing using the modified Williamson-Hall and Warren-Averbach methods. We prepared four types of specimens with different dislocation substructures. By increasing the annealing temperature, we confirmed a decrease in dislocation density. In particular, screw-dislocation density substantially decreased in the early stage of the recovery process, while edge-dislocation density gradually decreased as annealing temperature increased. Moreover, changes in hardness during the recovery process mainly depended on edge-dislocation density. Increases in annealing temperature weakly affected the dislocation arrangement parameter and crystallite size. Recovery-process modeling demonstrated that the decrease in screw-dislocation density during the recovery process was mainly dominated by glide and/or cross-slip with dislocation core diffusion. In contrast, the decrease in edge-dislocation density during the recovery process was governed by a climbing motion with both dislocation core diffusion and lattice self-diffusion. From the above results, we succeeded in quantitatively distinguishing between edge- and screw-dislocation density during the recovery process, which are difficult to distinguish using transmission electron microscope and electron backscatter diffraction.

Collaborative effects of bystander-initiated cardiopulmonary resuscitation and prehospital advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a nationwide population-based observational study.

INTRODUCTION: There are inconsistent data about the effectiveness of prehospital physician-staffed advanced cardiac life support (ACLS) on the outcomes of out-of-hospital cardiac arrest (OHCA). Furthermore, the relative importance of bystander-initiated cardiopulmonary resuscitation (BCPR) and ACLS and the effectiveness of their combination have not been clearly demonstrated. METHODS: Using a prospective, nationwide, population-based registry of all OHCA patients in Japan, we enrolled 95,072 patients whose arrests were witnessed by bystanders and 23,127 patients witnessed by emergency medical service providers between 2005 and 2007. We divided the bystander-witnessed arrest patients into Group A (ACLS by emergency life-saving technicians without BCPR), Group B (ACLS by emergency life-saving technicians with BCPR), Group C (ACLS by physicians without BCPR) and Group D (ACLS by physicians with BCPR). The outcome data included 1-month survival and neurological outcomes determined by the cerebral performance category. RESULTS: Among the 95,072 bystander-witnessed arrest patients, 7,722 (8.1%) were alive at 1 month, including 2,754 (2.9%) with good performance and 3,171 (3.3%) with vegetative status or worse. BCPR occurred in 42% of bystander-witnessed arrests. In comparison with Group A, the rates of good-performance survival were significantly higher in Group B (odds ratio (OR), 2.23; 95% confidence interval, 2.05 to 2.42; P < 0.01) and Group D (OR, 2.80; 95% confidence interval, 2.28 to 3.43; P < 0.01), while no significant difference was seen for Group C (OR, 1.18; 95% confidence interval, 0.86 to 1.61; P = 0.32). The occurrence of vegetative status or worse at 1 month was highest in Group C (OR, 1.92; 95% confidence interval, 1.55 to 2.37; P < 0.01). CONCLUSIONS: In this registry-based study, BCPR significantly improved the survival of OHCA with good cerebral outcome. The groups with BCPR and ACLS by physicians had the best outcomes. However, receiving ACLS by physicians without preceding BCPR significantly increased the number of patients with neurologically unfavorable outcomes.

Consumer reactions to risk information on bovine spongiform encephalopathy in Japan.

OBJECTIVES: To investigate the impact of information on foodborne disease on consumers, we quantified consumers' anxiety, purchasing behaviors, and willingness-to-pay (WTP) in response to the reading of newspaper articles published in 2001 that documented the first cow in Japan to be infected with bovine spongiform encephalopathy (BSE). METHODS: An online questionnaire survey of 993 females aged 20-59 years was conducted in 2007. The participants were randomly selected from the general population via the Internet and were divided into three groups. Each group was assigned a different number of BSE-related articles to read, namely, two, four, and six articles, respectively. Each participant described her personal level of anxiety, underlying reasons for her anxiety, and changes in purchasing behavior after reading the articles. The respondents who wanted to buy guaranteed-safe beef were asked to state their maximal WTP. RESULTS: The level of anxiety was significantly lower and distrust of the relevant administration significantly greater in the group asked to read six articles than in the other groups. The WTP value for guaranteed beef was approximately 1.3-fold higher than the regular purchase price, with significant differences between groups. In the 'six-article' group, the ratio between WTP and the regular purchase price was significantly less than that in the 'four-article' group. CONCLUSIONS: These findings suggest that the anxiety of consumers can be reduced if they receive an appropriate amount of published information. WTP may be linked to the contents of the articles.