反復的な督励が口頭指導下の心肺蘇生法に与える効果に関する無作為化シミュレーション研究

Background: Current guidelines emphasize the assistance of the emergency dispatcher in bystander cardiopulmonary resusitation (CPR). Its quality, however, has varied across cases. Objective: To determine the effect of repetitive coaching by dispatchers using verbal encouragement on the quality of lay-rescuer CPR. Methods: We conducted a dispatch-assisted CPR (DACPR) simulation study. Participants with no CPR training within the previous year were assigned randomly to 1 of 2 DACPR simulations. One was the No Coaching Group: callers were told to perform CPR and the dispatcher periodically confirmed that the caller was performing CPR. The second group was the Coaching Group: the dispatcher repetitively coached, encouraged, and counted aloud using a metronome. Participants performed CPR for 2 min under instruction from the study dispatcher. Parameters including chest compression depth, rate, and chest compression fraction were recorded by video camera and CPR manikin. Results: Forty-nine participants 20 to 50 years of age were recruited, and 48 completed the simulation (Coaching Group, n = 27; No Coaching Group, n = 21). The chest compression fraction was higher in the Coaching Group (99.4% vs. 93.0%, p = 0.005) and no participants interrupted chest compression more than 10 s in this group. When comparing the average depth of each 30-s period in each group, the depth increased over time in the Coaching Group (40.9 mm, 43.9 mm, 44.1 mm, and 42.8 mm), while it slightly decreased in the No Coaching Group (40.6 mm, 40.1 mm, 39.4 mm, and 39.8 mm). Conclusions: Repetitive verbal encouragements augmented chest compression depth with less-hands off time. Continuous coaching by dispatchers can optimize lay-rescuer CPR.博士（医学）・甲第852号・令和4年9月28日© 2022 Elsevier Inc.© 2022 The Author(s). Published by Elsevier Inc.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Implementation of a modified Nesterov's Accelerated quasi-Newton Method on Tensorflow

Recent studies incorporate Nesterov's accelerated gradient method for the acceleration of gradient based training. The Nesterov's Accelerated Quasi-Newton (NAQ) method has shown to drastically improve the convergence speed compared to the conventional quasi-Newton method. This paper implements NAQ for non-convex optimization on Tensorflow. Two modifications have been proposed to the original NAQ algorithm to ensure global convergence and eliminate linesearch. The performance of the proposed algorithm - mNAQ is evaluated on standard non-convex function approximation benchmark problems and microwave circuit modelling problems. The results show that the improved algorithm converges better and faster compared to first order optimizers such as AdaGrad, RMSProp, Adam, and the second order methods such as the quasi-Newton method.Comment: Paper published in 2018 17th IEEE International Conference on Machine Learning and Applications (ICMLA

Analyzing the Development of a Remote Debate Program Using Video Annotation through a Systems Approach

This study aims to apply a systems approach to analyze the development of an education system for remote asynchronous debates. Although several studies have applied a systems approach to various objects, they attempted to improve projects using the approach by intention. However, in our study, the use of a systems approach was an unintentional part of the process, with stakeholders not being explicitly aware of the concepts behind systems thinking. In the midst of the process, a variety of systems thinking methods were partially adopted, making the project more systemic; however, the project was not oriented to follow specific problem-solving techniques. An educational program and information system for education support with sufficient systemic properties was created with such a systems approach. We propose that working on a problem with significant underlying systemic properties may help one to naturally adopt a systems approach

A Stochastic Variance Reduced Nesterov's Accelerated Quasi-Newton Method

Recently algorithms incorporating second order curvature information have become popular in training neural networks. The Nesterov's Accelerated Quasi-Newton (NAQ) method has shown to effectively accelerate the BFGS quasi-Newton method by incorporating the momentum term and Nesterov's accelerated gradient vector. A stochastic version of NAQ method was proposed for training of large-scale problems. However, this method incurs high stochastic variance noise. This paper proposes a stochastic variance reduced Nesterov's Accelerated Quasi-Newton method in full (SVR-NAQ) and limited (SVRLNAQ) memory forms. The performance of the proposed method is evaluated in Tensorflow on four benchmark problems - two regression and two classification problems respectively. The results show improved performance compared to conventional methods.Comment: Accepted in ICMLA 201

交通外傷における救急隊の現場滞在時間に関連する要因とその地域差についての検討

Background: The outcome of road traffic injury (RTI) is determined by duration of prehospital time, patient’s demographics, and the type of injury and its mechanism. During the emergency medical service (EMS) prehospital time interval, on-scene time should be minimized for early treatment. This study aimed to examine the factors influencing on-scene EMS time among RTI patients. Methods: We evaluated 19,141 cases of traffic trauma recorded between April 2014 and March 2020 in the EMS database of the Nara Wide Area Fire Department and the prehospital database of the emergency Medical Alliance for Total Coordination of Healthcare (e-MATCH). To examine the association of the number of EMS phone calls until hospital acceptance, age ≥65 years, high-risk injury, vital signs, holiday, and nighttime (0:00–8:00) with on-scene time, a generalized linear mixed model with random effects for four study regions was conducted. Results: EMS phone calls were the biggest factor, accounting for 5.69 minutes per call, and high-risk injury accounted for an additional 2.78 minutes. Holiday, nighttime, and age ≥65 years were also associated with increased on-scene time, but there were no significant vital sign variables for on-scene time, except for the level of consciousness. Regional differences were also noted based on random effects, with a maximum difference of 2 minutes among regions. Conclusions: The number of EMS phone calls until hospital acceptance was the most significant influencing factor in reducing on-scene time, and high-risk injury accounted for up to an additional 2.78 minutes. Considering these factors, including regional differences, can help improve the regional EMS policies and outcomes of RTI patients.博士（医学）・甲第880号・令和5年3月15

外側環軸関節の関節症性変化のリスク増加に関連する要因; 後ろ向き研究

Purpose Atlantodens osteoarthritis and atlantoaxial osteoarthritis cause neck pain and suboccipital headaches. Currently, knowledge on the risk factors for atlantoaxial osteoarthritis is lacking. This study aimed to investigate the factors related to the increased risk of atlantoaxial osteoarthritis. Methods We analyzed computed tomography (CT) images of the upper cervical spine of 1266 adult trauma patients for whom upper cervical spine CT was performed at our hospital between 2014 and 2019. The degree of atlantoaxial osteoarthritis was quantified as none-to-mild (not having osteoarthritis) or moderateto- severe (having osteoarthritis). Risk factors associated with atlantoaxial osteoarthritis were identified using univariate and multivariable logistic regression analyses. Results The study group included 69.4% men, and the overall average age of the study population was 54.9 ± 20.4 years. The following factors were independently and significantly associated with atlantoaxial osteoarthritis in the multivariable logistic regression analysis: age in the sixth decade or older (odds ratio [OR], 20.5; 95% confidence interval [CI], 6.2‒67.2, p < 0.001), having calcific synovitis (OR, 4.9; 95% CI, 2.4‒9.9, p < 0.001), women sex (OR, 3.3; 95% CI, 1.9‒5.7, p = 0.002), and not having atlantodens osteoarthritis (OR, 2.1; 95% CI, 1.2‒3.8, p = 0.014). Conclusion In the multivariable logistic regression analysis, age in the sixth decade or older, calcification of the transverse ligament, being women, and not having atlantodens osteoarthritis were found to be significantly associated with atlantoaxial osteoarthritis. Delayed diagnosis and treatment can be avoided by focusing on these risk factors.博士（医学）・甲第873号・令和5年3月15

Coupled-Cluster Approach to Electron Correlations in the Two-Dimensional Hubbard Model

We have studied electron correlations in the doped two-dimensional (2D) Hubbard model by using the coupled-cluster method (CCM) to investigate whether or not the method can be applied to correct the independent particle approximations actually used in ab-initio band calculations. The double excitation version of the CCM, implemented using the approximate coupled pair (ACP) method, account for most of the correlation energies of the 2D Hubbard model in the weak ($U/t \simeq 1$) and the intermediate $U/t$ regions ($U/t \simeq 4$). The error is always less than 1% there. The ACP approximation gets less accurate for large $U/t$ ($U/t \simeq 8$) and/or near half-filling. Further incorporation of electron correlation effects is necessary in this region. The accuracy does not depend on the system size and the gap between the lowest unoccupied level and the highest occupied level due to the finite size effect. Hence, the CCM may be favorably applied to ab-initio band calculations on metals as well as semiconductors and insulators.Comment: RevTeX3.0, 4 pages, 4 figure