A Study on Type Classification of Employees and Sales Support Analysis Based on Similarity of Sales-purchase Bayesian Network Structure

Since services contain human factors of service providers and receivers, the quality and the value of services are essentially difficult to define, especially because of the two service characteristics of ‘heterogeneity’ and ‘simultaneity’. On the other hand, because there are many opportunities to provide services that are suitable for individual customer in job categories where employees directly serve customers, providing services that make use of know-how of individual employees and companies is considered to be important. However, studies which propose the optimal service method in cases featuring heterogeneity and predict its effect are unsatisfactory, despite the fact that heterogeneity of employees and customers is found to exist. The aim of this paper is to propose a sales support analysis method which can suggest reinforcement on which product or service sales is effective, by comparing the sales characteristics of the employee’s type and the current state of each employee’s sales behavior, and considering employees’ sales abilities. We constructed each employee’s sales-purchase Bayesian network model based on nationwide sales data, and proposed employees’ classification method by their sales style. Then, we calculated the conditional purchase probability of each product by stochastic reasoning, based on the constructed Bayesian network model for each type and individual employees, and proposed a sales support analysis method that enables each employee to focus on products that have not yet improved the purchase probability as recommended products, based on the comparison between the characteristics of each type’s purchase probability and that of each employee of that type

Muscle atrophy in critically ill patients : a review of its cause, evaluation, and prevention

Critically ill patients exhibit prominent muscle atrophy, which occurs rapidly after ICU admission and leads to poor clinical outcomes. The extent of atrophy differs among muscles as follows: upper limb: 0.7%–2.4% per day, lower limb: 1.2%–3.0% per day, and diaphragm 1.1%–10.9% per day. This atrophy is caused by numerous risk factors such as inflammation, immobilization, nutrition, hyperglycemia, medication, and mechanical ventilation. Muscle atrophy should be monitored noninvasively by ultrasound at the bedside. Ultrasound can assess muscle mass in most patients, although physical assessment is limited to almost half of all critically ill patients due to impaired consciousness. Important strategies to prevent muscle atrophy are physical therapy and electrical muscular stimulation. Electrical muscular stimulation is especially effective for patients with limited physical therapy. Regarding diaphragm atrophy, mechanical ventilation should be adjusted to maintain spontaneous breathing and titrate inspiratory pressure. However, the sufficient timing and amount of nutritional intervention remain unclear. Further investigation is necessary to prevent muscle atrophy and improve long-term outcomes

Primary results of sedimetological research on the upper Jurassic to lower Cretaceous carbonate rocks in NW Zagros Mountains, Iran

The upper Jurassic-lower Cretaceous carbonate extensively distributed in Zagros Mountains (southern Iran) is correlated to hydrocarbon reservoir rocks, however has not been studied with sedimentological aspects. The studied section of about 1000 m thick exposed in Kuh-d-Yaghma (Aligdaz Province) mainly consists of shallow marine facies exhibiting sedimentary structures, such as paleosols, paleokarsts, biostromes, and stromatolites. The section was subdivided into nine units based on the results of observation of outcrops and thin sections. Depositional ages were estimated by fossil occurrences and strontium stable isotope. Units 1 and 2 represent subaerial-meteoric diagenetic structures (paleosols. paleokarsts, and banded cements) and dolomite of a mixed-water origin. Originally, the dolostone was highly-permeable coarse-grained sediment, in which dolomitization selectively subjected. These diagenetic processes may have been associated with global sea-level low or a regional tectonic event during Kimmeridgian, and formed lithified substrate, which is suitable for sedentary organisms. Unit 3 abundantly yields potential reef-building organisms, such as stromatoporoids, corals, and calcareous algae. However, the dominant constituents are broken uniserial branching stromatoporoids, their constructions should be regarded as biostromes and did not form reef framework. Fossil association and strontium isotopic ratio indicate that this unit was deposited in Tithonian. Units 4～7 are alternations of two deeper and two shallower facies. The deeper units (units 4 and 6) mainly consists of micritic limestone with biofacies characterized by ostracodes, bryozoans, and sponge spicules. The shallower units (units 5 and 7) represents stromatolites, oncoids, and ooids with rich assemblage of calcareous algae. Jurassic/Cretaceous boundary was placed in unit 5. First appearance of orbitolinid foraminifers at the base of unit 7 was interpreted to correspond to the base of Barremian. Units 8 and 9 consist of four upward-shallowing sequences. The base of each cycle consists of thinly bedded limestone containing brachiopod shell, and change into thickly bedded and massive limestone with shallow marine stromatolies and fauna, such as corals and rudists. Gradual decrease in thickness of the sequence indicates that the platform was in progradation due to accumulation of the carbonate deposits

High-flow nasal cannula on diaphragm

Background : Diaphragm dysfunction is a serious problem. However, a few management techniques exist for diaphragm dysfunction. Methods : Adult patients treated with high-flow nasal cannula (HFNC) in the intensive care unit were included in this study. The diaphragm function was evaluated using ultrasound measurement of thickening fraction before and after HFNC liberation. Normal diaphragm contraction was defined as thickening fraction ≥ 15% without HFNC, whereas decreased or paradoxical diaphragm contractions were 0%–15% or < 0%, respectively. Results : Forty patients were enrolled, and 16 (40%) had normal diaphragm contraction, whereas 19 (48%) or 5 (13%) had decreased or paradoxical diaphragm contractions, respectively. Thickening fraction increased after HFNC liberation (27.0% ± 25.7% vs. 38.8% ± 34.5%, p = 0.03 in HFNC vs. no HFNC) in patients without diaphragm dysfunction. In patients with decreased diaphragm contraction, thickening fraction did not change with or without HFNC (8.9% ± 11.7% vs. 6.7% ± 5.2%, p = 0.35), whereas paradoxical contraction decreased with HFNC (1.0% ± 10.2% vs. –10.3% ± 2.7%, p = 0.04) in patients with paradoxical diaphragm contraction. Conclusions : The work of breathing decreased with HFNC in patients without diaphragm dysfunction, but did not decrease in patients with decreased diaphragm contraction. Paradoxical diaphragm contraction decreased with HFNC

The Tantrāloka of Abhinavagupta : Annotated Translation of the 13th āhnika with the Commentary of Jayaratha (Part 1)

This article contains an annotated translation of a part of the 13th ahnika of the Tantrāloka of Abhinavagupta with the commentary of Jayaratha.The Tantrāloka,“Light on the Tantras”, is the most important work on Śaivism of Abhinavagupta, the great Kashmirian Philosopher of 10-11th Century.This work is conceived as a complete manual on the Non-dualistic Saivism, based on the Mālinīvijayottara-tantra.The structure of the Tantrāloka consists of the fourfold upāya (‘means\u27), which are anupāya, śupāyambhava-upāya, śākta-upāya and ānava-upāya.Apart from the first introductory chapter, Chapters 2 to 5 are consecrated to the anupāya, śambhava-upāya and śakta-upāya respectively.The rest of the work treats the ānava-upāya.Chapters 6 to 12 deal with the ānava-upāya for the advanced disciples who can practise without the help of the teacher (guru).Chap-ters from 15 onward, which can be considered as the second part of the Tantrāloka, treat the rituals which the guru bestows to disciples.The Chapter 13, which introduces this second part, describes the theoretical problems concerning the grace (anugraha) of the God Śiva.This divine grace becomes manifest in the descent of divine energy (śaktipāta).It is only through the śaktipāta that the liberation from the samsāra is possible.Various theories, beginning with the Sāmkhya, concerning the cause of bondage and liberation are refuted in the first part of this chapter and then the established theory of the non-dualistic Śaivism is given.Only the verses 1 to 52 are translated and annotated with the commentary of Jayaratha in this part 1

Effect of controlled ventilation on diaphragm

Background : Since diaphragm passivity induces oxidative stress that leads to rapid atrophy of diaphragm, we investigated the effect of controlled ventilation on diaphragm thickness during assist-control ventilation (ACV). Methods : Previously, we measured end-expiratory diaphragm thickness (Tdiee) of patients mechanically ventilated for more than 48 hours on days 1, 3, 5 and 7 after the start of ventilation. We retrospectively investigated the proportion of controlled ventilation during the initial 48-hour ACV (CV48%). Patients were classified according to CV48% : Low group, less than 25% ; High group, higher than 25%. Results : Of 56 patients under pressure-control ACV, Tdiee increased more than 10% in 6 patients (11%), unchanged in 8 patients (14%) and decreased more than 10% in 42 patients (75%). During the first week of ventilation, Tdiee decreased in both groups : Low (difference, -7.4% ; 95% confidence interval [CI], -10.1% to -4.6% ; p < 0.001) and High group (difference, -5.2% ; 95% CI, -8.5% to -2.0% ; p = 0.049). Maximum Tdiee variation from baseline did not differ between Low (-15.8% ; interquartile range [IQR], -22.3 to -1.5) and High group (-16.7% ; IQR, -22.6 to -11.1, p = 0.676). Conclusions : During ACV, maximum variation in Tdiee was not associated with proportion of controlled ventilation higher than 25%

Monitoring of muscle mass in critically ill patients : comparison of ultrasound and two bioelectrical impedance analysis devices

Background: Skeletal muscle atrophy commonly occurs in critically ill patients, and decreased muscle mass is associated with worse clinical outcomes. Muscle mass can be assessed using various tools, including ultrasound and bioelectrical impedance analysis (BIA). However, the effectiveness of muscle mass monitoring is unclear in critically ill patients. This study was conducted to compare ultrasound and BIA for the monitoring of muscle mass in critically ill patients. Methods: We recruited adult patients who were expected to undergo mechanical ventilation for > 48 h and to remain in the intensive care unit (ICU) for > 5 days. On days 1, 3, 5, 7, and 10, muscle mass was evaluated using an ultrasound and two BIA devices (Bioscan: Malton International, England; Physion: Nippon Shooter, Japan). The influence of fluid balance was also evaluated between each measurement day. Results: We analyzed 93 images in 21 patients. The age of the patients was 69 (interquartile range, IQR, 59–74) years, with 16 men and 5 women. The length of ICU stay was 11 days (IQR, 9–25 days). The muscle mass, monitored by ultrasound, decreased progressively by 9.2% (95% confidence interval (CI), 5.9–12.5%), 12.7% (95% CI, 9.3–16.1%), 18.2% (95% CI, 14.7–21.6%), and 21.8% (95% CI, 17.9–25.7%) on days 3, 5, 7, and 10 (p < 0.01), respectively, with no influence of fluid balance (r = 0.04, p = 0.74). The muscle mass did not decrease significantly in both the BIA devices (Bioscan, p = 0.14; Physion, p = 0.60), and an influence of fluid balance was observed (Bioscan, r = 0.37, p < 0.01; Physion, r = 0.51, p < 0.01). The muscle mass assessment at one point between ultrasound and BIA was moderately correlated (Bioscan, r = 0.51, p < 0.01; Physion, r = 0.37, p < 0.01), but the change of muscle mass in the same patient did not correlate between these two devices (Bioscan, r = − 0.05, p = 0.69; Physion, r = 0.23, p = 0.07). Conclusions: Ultrasound is suitable for sequential monitoring of muscle atrophy in critically ill patients. Monitoring by BIA should be carefully interpreted owing to the influence of fluid change

Urinary titin as a biomarker for muscle atrophy

Objective: Although skeletal muscle atrophy is common in critically ill patients, biomarkers associated with muscle atrophy have not been identified reliably. Titin is a spring-like protein found in muscles and has become a measurable biomarker for muscle breakdown. We hypothesized that urinary titin is useful for monitoring muscle atrophy in critically ill patients. Therefore, we investigated urinary titin level and its association with muscle atrophy in critically ill patients. Design: Two-center, prospective observational study Setting: Mixed medical/surgical intensive care unit (ICU) in Japan Patients: Nonsurgical adult patients who were expected to remain in ICU for >5 days Interventions: None Methods: Urine samples were collected on days 1, 2, 3, 5, and 7 of ICU admission. To assess muscle atrophy, rectus femoris cross-sectional area and diaphragm thickness were measured with ultrasound on days 1, 3, 5, and 7. Secondary outcomes included its relationship with ICU-acquired weakness (ICU-AW), ICU Mobility Scale (IMS), and ICU mortality. Measurements and Main Results: Fifty-six patients and 232 urinary titin measurements were included. Urinary titin (normal range: 1–3 pmol/mg Cr) was 27.9 (16.8–59.6), 47.6 (23.5–82.4), 46.6 (24.4–97.6), 38.4 (23.6–83.0), and 49.3 (27.4–92.6) pmol/mg Cr on days 1, 2, 3, 5, and 7, respectively. Cumulative urinary titin level was significantly associated with rectus femoris muscle atrophy on days 3–7 (p < 0.03), although urinary titin level was not associated with change in diaphragm thickness (p = 0.31–0.45). Furthermore, cumulative urinary titin level was associated with incidence of ICU-AW (p = 0.01) and ICU mortality (p = 0.02) but not with IMS (p = 0.18). Conclusions: In nonsurgical critically ill patients, urinary titin level increased 10–30 times compared with the normal level. The increased urinary titin level was associated with lower limb muscle atrophy, incidence of ICU-AW, and ICU mortality