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老健ハイツにおける薬剤費削減の取り組み
No full text要旨:介護老人保健施設では、薬剤費で大部分を占める医療費が、要介護度により定められた一定の入所費に包括される、いわゆる「まるめ」となっている。この医療費が、要介護度の上昇に伴う、複数科受診、高価な新薬の増加などにより、新田塚ハイツでは年々増加し、平成25年度には年間1,400万円にも達しており、県内の上位5番目となった。そこで、複数科･多剤投薬の適正化を定期処方に行い、①年間275万円以上の削減、②薬剤相互副作用発現率の高い6剤以上の投与数の削減を目的として、平成25年8月より薬剤費検討会を立ち上げた。その結果、1年間での削減額が約315万円、6剤以上の投薬者が26％から14％に減少し、目的が達成された。削減の影響により2名に一部復薬をしたが、他に問題はなかった。過剰でも過少でもない、適正な薬剤投薬とケアを目指して今後も努力すべきである
Prognostic Value of Dual-Time-Point 18F-FDG PET for Idiopathic Pulmonary Fibrosis
No full textThe aim of this prospective study was to clarify whether dual-time-point (18)F-FDG PET imaging results are useful to predict long-term survival of idiopathic pulmonary fibrosis (IPF) patients.
METHODS:
Fifty IPF patients underwent (18)F-FDG PET examinations at 2 time points: 60 min (early imaging) and 180 min (delayed imaging) after (18)F-FDG injection. The standardized uptake value (SUV) at each point and retention index value (RI-SUV) calculated from those were evaluated, and then the results were compared with overall and progression-free survival.
RESULTS:
A multivariate Cox proportional hazards model showed higher RI-SUV and higher extent of fibrosis score as independent predictors of shorter progression-free survival. The median progression-free survival for patients with negative RI-SUV was better than that for those with positive RI-SUV (27.9 vs. 13.3 mo, P = 0.0002). On the other hand, multivariate Cox analysis showed higher RI-SUV and lower forced vital capacity to be independent predictors of shorter overall survival. The 5-y survival rate for patients with negative RI-SUV was better than that for those with positive RI-SUV (76.8% vs. 14.3%, P = 0.00001). In addition, a univariate Cox model showed that positive RI-SUV as a binary variable was a significant indicator of mortality (hazard ratio, 7.31; 95% confidence interval, 2.64-20.3; P = 0.0001).
CONCLUSION:
Our results demonstrate that positive RI-SUV is strongly predictive of earlier deterioration of pulmonary function and higher mortality in patients with IPF
Sex Differences in the Default Mode Network with Regard to Autism Spectrum Traits : A Resting State fMRI Study
No full textAutism spectrum traits exist on a continuum and are more common in males than in females, but the basis for this sex difference is unclear. To this end, the present study draws on the extreme male brain theory, investigating the relationship between sex difference and the default mode network (DMN), both known to be associated with autism spectrum traits.
Resting-state functional magnetic resonance imaging (MRI) was carried out in 42 females (mean age +- standard deviation, 22.4 +- 4.2 years) and 43 males (mean age +- standard deviation, 23.8 +- 3.9 years) with typical development. Using a combination of different analyses (viz., independent component analysis (ICA), fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and seed-based analyses), we examined sex differences in the DMN and the relationship to autism spectrum traits as measured by autism-spectrum quotient (AQ) scores. We found significant differences between female and male subjects in DMN brain regions, with seed-based analysis revealing a significant negative correlation between default-mode resting state functional connectivity of the anterior medial prefrontal cortex seed (aMPFC) and AQ scores in males. However, there were no relationships between DMN sex differences and autism spectrum traits in females. Our findings may provide important insight into the skewed balance of functional connectivity in males compared to females that could serve as a potential biomarker of the degree of autism spectrum traits in line with the extreme male brain theory
携帯端末を活用したポインタ情報付きマルチスクリーン講義配信システム
No full text近年，プロジェクタとスクリーンを用いた講義が行われている．広い講義室において，講義室後方の受講者は，スクリーンの表示が認識しにくいという状況が発生する可能性がある．対策として複数のサブディスプレイを講義室に導入することが考えられるが，導入には高コストとなる．そこで，この論文では受講者が持つ携帯端末をディスプレイの代わりに使用してメインスクリーンと同じ表示を行うシステムを提案する．このシステムはメインスクリーン上のレーザーポインタを検出し，携帯端末の Web ブラウザにメインスクリーンのスライド画像と検出したレーザーポインタの座標を元にポインタカーソルを表示する．このシステムを用いることで，新たに複数のサブディスプレイを導入することなく，講義室後方の受講者も効果的な講義を受けることができる
Improvement of the fuzzy variables optimization technique for the pulmonary elastance estimation
No full textThe ventilation condition of artificial respiration should be set carefully, and the setting is expected to match individual pulmonary characteristic of each patient. However, we do not understand the pulmonary characteristic of the patient by the measurement of data. Therefore, the setting of the artificial respirator is decided by the experience and the intuition of the doctor. Purposes of this study are to develop a method to estimate the static P-V curve and the pulmonary elastance of the patient. The static P-V curve expresses the important feature of the lung, and this curve is a basis for deciding the air-way pressure limit value. In the previous works, we proposed the iterative fuzzy estimation method and the random optimization of the fuzzy variables. In this paper, a modified optimization algorithm is proposed. A numerical example is shown to illustrate the improvement in our modified algorithm
Experimental Study on Structural Performance of Precast Reinforced Concrete Core Wall with a Small Quantity of Horizontal Tied Rebars
No full textIn the core wall system in high-rise buildings, the four L-shaped core walls at the center effectively reduce seismic vibration. On the other hand, precast core walls are effective for construction because they can be built more quickly than cast-in-place core walls. In this study, a lateral loading test was conducted on a wall column simulating the corner and the area near the corner of an L-shaped core wall with a small quantity of horizontal tied rebars. The wall column was divided into precast columns, and horizontal tied rebars were concentrated at the second and third floor levels, and the mid height level of the first story. Based on the results of lateral loading tests, the structural performance of the wall column with a small quantity of horizontal tied rebars was clarified
Detection of PM2.5 Air Pollutions by Using MODIS Data (Part 1: Differences between the Detection of PM2.5 Air Pollutions and the Detection of Dust and Sandstorms)
No full textIn recent years, PM2.5 air pollution is a social and transboundary environmental issue with the rapid economic growth in many countries. As PM2.5 is small and includes various ingredients (e.g., sulfur oxide, nitrogen oxide, vitriol, nitrate salt, soot, etc.), the detection of PM2.5 air pollutions by using satellite data is difficult compared with the detection of dust and sandstorms (DSS). DSS can be detected by using AVI method and YDI method. AVI (Aerosol Vapor Index) is defined as AVI=T12-T11, where T12 and T11 are the brightness temperatures at 12μm and 11μm wave lengths, respectively. For MODIS data, T12 and T11 correspond to band32 and band31, respectively. YDI (Yellow Dust Index) is defined as YDI=(band4-band3)/(band4+band3). AVI and YDI methods detect PM2.5 air pollutions only a little. In this paper, we examine various RGB composite color images for detecting PM2.5 air pollutions by using MODIS data, i.e., {R, G, B = band4, band3, T11}, {R, G, B = band10, band9, T11}, {R, G, B = band9, band8, T11}, {R, G, B = AVI, band7-band1, T11}, {R, G, B = AVI, band10-band9, T11}, etc. A good method for the detection of PM2.5 air pollution is {R, G, B = band10, band9, T11}. In this composite color image, PM2.5 air pollutions are represented by light purple or pink color. This proposed method is applied to the detection of PM2.5 air pollutions in the wide area from China and India to Japan by using MODIS data on 12 January 2013, and AVI method is applied to DSS detection in the same area. By comparing the AVI image with the image by the proposed method, PM2.5 air pollutions can be distinguished from DSS. The proposed method is simpler than the method by Nagatani et al. (2013), and is useful to grasp the distribution of PM2.5 air pollutions in the wide area