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

Study of the effect of mechanical impact parameters on an impact-mode piezoelectric ceramic power generator

This paper presents an analytical and experimental study on the effect of mechanical impact parameters on impact-mode piezoelectric ceramic power generators. The parameters are the velocity and mass. The method of analysis is based on a weight drop experiment. The results show that the peak of the instantaneous output voltage is proportional to the impact velocity, and for the output power, it is in a straight line relationship with the same parameter. For the same velocity of impact, the advantage of using heavy objects is clear because its momentum and the impact force are higher. However, an adjustment in the velocity of impact is found to be more effective for higher instantaneous output power than the mass. This finding is supported by the output power that is generated by a 4-g steel ball with a momentum of 4.34 gm/s, which is almost 300% higher than that of an 8-g steel ball for the same momentum. The frequency responses of a vibration-based impact-mode piezoelectric ceramic power generator also support the same conclusion

The Effect of the Parameters of a Vibration-Based Impact Mode Piezoelectric Power Generator

This study reports the effects of the parameters of a vibration-based impactmode piezoelectric power generator. First, an evaluation of the effects of the impact parameters, the mass, and the impact velocity is presented. It is found that the output voltage of the piezoelectric device in impactmode is directly proportional to the velocity,whereas the output power is equal to a quadratic function of the same variable. For the same impact momentum, the effect of the velocity in generating a higher peak output is dominant compared with the mass. Second, the vibration-based impact mode piezoelectric power generator is discussed. The experimental results show that a wider operating frequency bandwidth of the output power can be achieved with the preloading configuration. However, regardingmagnitude, due to the high velocity of impact, the configurationwith a gap between the tip and the piezoelectric device produces a higher output

Shape Effect of Piezoelectric Energy Harvester on Vibration Power Generation

Vibration energy harvesting is widely recognized as the useful technology for saving energy. The piezoelectric energy harvesting device is one of energy harvester and is used to operate certain types of MEMS devices. Various factors influence the energy regeneration efficiency of the lead zirconate titanate piezoelectric (PZT) devices in converting the mechanical vibration energy to the electrical energy. This paper presents the analytical and experimental evaluation of energy regeneration efficiency of PZT devices through impedance matching method and drop-weight experiments to different shape of PZT devices. The results show that the impedance matching method has increased the energy regeneration efficiency while triangular shape of PZT device produce a stable efficiency in the energy regeneration. Besides that, it becomes clear that the power, energy and subsequently efficiency of the triangular plate are higher than those of the rectangular plate under the condition of the matching impedance and the same PZT area

病床機能報告を用いた医療提供体制における地域性の検討

京都府立医科大学大学院生命基礎数理学京都府立医科大学大学院地域保健医療福祉行政システム学奈良県立医科大学地域医療学講座和歌山大学観光学部京都府立大学大学院生命環境科学研究科京都先端科学大学健康医療学部地域医療構想は、医療計画の一部として持続可能な社会保障制度の確立に重要な役割を担っている。現在、超高齢社会にも耐えうる医療提供体制の構築に向けて、地域の実情に合わせた病床機能分化の定量的な基準が検討されている。本報告は、病床機能報告データを用いて、全国の各都道府県および2 次医療圏の病床機能区分割合を算出し、空間パターン解析を実施した。その結果、都道府県別は、高度急性期と急性期の病床割合が、東日本において高い値の集積（ホットスポット）、西日本において低い値の集積（コールドスポット）が広範囲で統計的有意に認められた。一方で、2次医療圏別では広域なスポットの特徴はみられなかった。本結果は、病床機能区分割合の地域性があることを示し、地域医療提供体制の構築に有用な情報である

Factors associated with EMS on‑scene time and its regional difference in road traffic injuries: a population‑based observational study

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日© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.identifier:BMC emergency medicine Vol.22 No.1 Article No.160 (2022 Sep)identifier:1471227Xidentifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/4112identifier:BMC emergency medicine, 22(15): Article No.16

Additional file 1 of Factors associated with EMS on-scene time and its regional difference in road traffic injuries: a population-based observational study

Additional file 1