院外心停止蘇生後の体温管理療法における早期経腸栄養の効果と安全性

京都大学新制・課程博士博士(医学)甲第23068号医博第4695号新制||医||1049(附属図書館)京都大学大学院医学研究科医学専攻(主査)教授 石見 拓, 教授 大鶴 繁, 教授 福田 和彦学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDFA

Examining Treatment Decision-Making Among Patients With Axial Spondyloarthritis: Insights From a Conjoint Analysis Survey

OBJECTIVE: The number of therapies for axial spondyloarthritis (axSpA) is increasing. Thus, it has become more challenging for patients and physicians to navigate the risk-benefit profiles of the various treatment options. In this study, we used conjoint analysis-a form of trade-off analysis that elucidates how people make complex decisions by balancing competing factors-to examine patient decision-making surrounding medication options for axSpA. METHODS: We conducted an adaptive choice-based conjoint analysis survey for patients with axSpA to assess the relative importance of medication attributes (eg, chance of symptom improvement, risk of side effects, route of administration, etc) in their decision-making. We also performed logistic regression to explore whether patient demographics and disease characteristics predicted decision-making. RESULTS: Overall, 397 patients with axSpA completed the conjoint analysis survey. Patients prioritized medication efficacy (importance score 26.8%), cost (26.3%), and route of administration (13.9%) as most important in their decision-making. These were followed by risk of lymphoma (9.5%), dosing frequency (7.2%), risk of serious infection (6.0%), tolerability of side effects (5.3%), and clinic visit and laboratory test frequency (4.8%). In regression analyses, there were few significant associations between patients\u27 treatment preferences and sociodemographic and axSpA characteristics. CONCLUSIONS: Treatment decision-making in axSpA is highly individualized, and demographics and baseline disease characteristics are poor predictors of individual preferences. This calls for the development of online shared decision-making tools for patients and providers, with the goal of selecting a treatment that is consistent with patients\u27 preferences

Soil Organic Carbon Storage in Restored Salt Marshes in Huntington Beach, California

There is a growing interest in managing wetland restoration and conservation projects to maximize carbon sequestration. We measured soil organic carbon storage and methane flux from two southern California salt marshes which had been restored for 2 and 22 years. We hypothesized that organic carbon would accumulate following restoration and that methane flux would be negligible in both sites. While methane flux was minimal, soil organic carbon content was generally higher in the more recently restored site. Although there is a potential for carbon sequestration in salt marshes, tracking this process through time may be complicated by initial site conditions

Observation of tW production in the single-lepton channel in pp collisions at root s=13 TeV

A measurement of the cross section of the associated production of a single top quark and a W boson in final states with a muon or electron and jets in proton-proton collisions at root s = 13 TeV is presented. The data correspond to an integrated luminosity of 36 fb(-1) collected with the CMS detector at the CERN LHC in 2016. A boosted decision tree is used to separate the tW signal from the dominant t (t) over bar background, whilst the subleading W+jets and multijet backgrounds are constrained using data-based estimates. This result is the first observation of the tW process in final states containing a muon or electron and jets, with a significance exceeding 5 standard deviations. The cross section is determined to be 89 +/- 4 (stat) +/- 12 (syst) pb, consistent with the standard model.Peer reviewe

Shear Strength of Artificially Cemented Sands

In this study, a series of drained triaxial tests were performed in order to examine the effect of cementation on the shear behavior of granular soil. It was observed that the brittle nature and dilative tendency of granular soil is dominant under a low confining stress level, while high confining stress results in a contractive behavior despite the strong cementation bond. Based on experimental results, an idealized concept is suggested to define the shear strength of cemented sand in three distinctive zones: the cementation control zone with a constant cohesion intercept at a low confining stress level, the transition zone in which the cohesion intercept is gradually reduced after a breaking point, and the stress control zone with almost zero cohesion intercept due to breakage of cementation bonds at a high confining stress level. It was shown that the sitting pressures during cementation have little effect on the strength parameters of cemented sand, while the increase of gypsum content and relative density, and the decrease of particle size, result in an increase of the cohesion intercept and the breaking point. In addition, the prediction equations for the shear strength and cohesion intercept in the cementation control zone and the transition zone are suggested from the analytical and experimental interpretation

A Plausible Mechanism of Uracil Photohydration Involves an Unusual Intermediate

It is well-known that photolysis of pyrimidine nucleobases, such as uracil, in an aqueous environment results in the formation of hydrate as one of the main products. Although several hypotheses regarding photohydration have been proposed in the past, e.g., the zwitterionic and "hot" ground-state mechanisms, its detailed mechanism remains elusive. Here, theoretical nonadiabatic simulations of the uracil photodynamics reveal the formation of a highly energetic but kinetically stable intermediate that features a half-chair puckered pyrimidine ring and a strongly twisted intracyclic double bond. The existence and the kinetic stability of the intermediate are confirmed by a variety of computational chemistry methods. According to the simulations, the unusual intermediate is mainly formed almost immediately (∼50-200 fs) upon photoabsorption and survives long enough to engage in a hydration reaction with a neighboring water. A plausible mechanism of uracil photohydration is proposed on the basis of the modeling of nucleophilic insertion of water into the twisted double bond of the intermediate.11Nsciescopu

Dual Fluorescence of Octatetraene Hints at a Novel Type of Singlet-to-Singlet Thermally Activated Delayed Fluorescence Process

© Author(s)A novel type of singlet-to-singlet thermally activated delayed fluorescence (STS-TADF) from the optically bright 11Bu+ and dark 21Ag- states of octatetraene is proposed based on state-of-the-art ab initio simulations. The new phenomenon bears similarity with TADF, the key difference being that in the normal TADF the emissive state is repopulated from a nearby triplet, whereas in STS-TADF it occurs from a nearby dark singlet state (21Ag-). The nonadiabatic populations of the bright and dark singlet excited states are dynamically redistributed through a conical intersection mediated by an ultrafast skeleton C-C stretching vibration, establishing a steady state for a sufficiently long time to undergo radiative decay. The steady state manifests itself in the experimentally observed dual fluorescence. It is expected that the STS-TADF can be observed in other-conjugated chromophores as well.11Nsciescopu