Delphi Method Consensus-Based Identification of Primary Trauma Care Skills Required for General Surgeons in Japan

Purpose General surgeons at regional hospitals should have the primary trauma care skills necessary to treat critically ill trauma patients to withstand transfer. This study was conducted to identify a consensus on primary trauma care skills for general surgeons. Methods An initial list of acute care surgical skills was compiled, and revised by six trauma experts (acute care surgeons); 33 skills were nominated for inclusion in the Delphi consensus survey. Participants (councilors of the Japanese Society for Acute Care Surgery) were presented with the list of 33 trauma care skills and were asked (using web-based software) to rate how strongly they agreed or disagreed (using a 5-point Likert scale) with the necessity of each skill for a general surgeon. The reliability of consensus was predefined as Cronbach’s α ≥ 0.8, and trauma care skills were considered as primarily required when rated 4 (agree) or 5 (strongly agree) by ≥ 80% participants. Results There were 117 trauma care specialists contacted to participate in the Delphi consensus survey panel. In the 1st round, 85 specialists participated (response rate: 72.6%). In the 2nd round, 66 specialists participated (response rate: 77.6%). Consensus was achieved after two rounds, reliability using Cronbach’s α was 0.94, and 34 items were identified as primary trauma care skills needed by general surgeons. Conclusion A consensus-based list of trauma care skills required by general surgeons was developed. This list can facilitate the development of a new trauma training course which has been optimized for general surgeons

Measurement of event-shape observables in Z→ℓ+ℓ− events in pp collisions at √ s=7 TeV with the ATLAS detector at the LHC

Event-shape observables measured using charged particles in inclusive $Z$-boson events are presented, using the electron and muon decay modes of the $Z$ bosons. The measurements are based on an integrated luminosity of $1.1 {\rm fb}^{-1}$ of proton--proton collisions recorded by the ATLAS detector at the LHC at a centre-of-mass energy $\sqrt{s}=7$ TeV. Charged-particle distributions, excluding the lepton--antilepton pair from the $Z$-boson decay, are measured in different ranges of transverse momentum of the $Z$ boson. Distributions include multiplicity, scalar sum of transverse momenta, beam thrust, transverse thrust, spherocity, and $\mathcal{F}$-parameter, which are in particular sensitive to properties of the underlying event at small values of the $Z$-boson transverse momentum. The Sherpa event generator shows larger deviations from the measured observables than Pythia8 and Herwig7. Typically, all three Monte Carlo generators provide predictions that are in better agreement with the data at high $Z$-boson transverse momenta than at low $Z$-boson transverse momenta and for the observables that are less sensitive to the number of charged particles in the event.Comment: 36 pages plus author list + cover page (54 pages total), 14 figures, 4 tables, submitted to EPJC, All figures including auxiliary figures are available at http://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2014-0

Effects of environmental factors on temporal variation in annual carbon dioxide and nitrous oxide emissions from an unfertilized bare field on Gray Lowland soil in Mikasa, Hokkaido, Japan

Soil is one of the important sources of atmospheric carbon dioxide (CO2) and nitrous oxide (N2O). Studies of CO2 and N2O emission from bare soil may explain the annual change of carbon (C) in soil organic matter (SOM) and help analyzing the N2O production from SOM. Therefore, CO2 and N2O emissions associated with the decomposition of SOM from bare soil are important factors for assessing the C budget and N2O emission in agricultural field. We conducted a study over seven years to assess the controlling factors of CO2 and N2O emissions from unplanted and unfertilized soil in Mikasa, Hokkaido, Japan. Carbon dioxide flux increased in the summer, and there were significant positive correlations between the CO2 flux and soil temperature in the first four years. However, apparent relationships between CO2 flux and WFPS, soil NH4 and NO3 concentrations were not observed. The slope of monthly CO2 emission against mean monthly temperature was positively correlated with monthly precipitation. These results suggest that the response of CO2 production to increase in soil temperature becomes more sensitive in wet soils. The average CO2 emission during the study period was 2.53 Mg C ha^[-1] year^[-1], and uncertainty of the annual CO2 emission was 24%. Annual precipitation explained the yearly variation (CO2 emission [Mg C ha^[-1] year^[-1]] = 0.0021 x annual precipitation [mm year^[-1]] -0.0499, R = 0.976, P < 0.001). Nitrous oxide flux increased from July to October, and was positively correlated with CO2 flux. Based on the ratio of N2O-N : NO-N of fluxes, N2O appeared to be the main product of denitrification. The average N2O emission in the study period was 4.88 kg N ha^[-1] year^[-1], and uncertainty of annual N2O emission was 58.5%. Strong relationships between the monthly emissions of CO2 and N2O suggest that N2O production by denitrification is strongly affected by SOM decomposition. Unlike the CO2 emission, the relationship between N2O emission and precipitation was not observed because of the multiple pathways of nitrification and denitrification for N2O production induced by SOM decomposition

Thermal Fatigue Properties of Ultrasonically Bonded Copper Joints

Thermal fatigue generally occurs in ultrasonically bonded copper joints in electronic devices as the bonding substrate is composed of plural materials, leading to differences in the coefficient of thermal expansion. In this study, we found that the thermal fatigue resistance of the ultrasonically bonded copper joints was influenced by the grain size and hardness of the bonding substrate through the evaluation of the thermal fatigue properties. Copper alloys C1020 and C1940 were used as substrate materials to investigate the influence of the initial properties of the bonding material on the thermal fatigue resistance. We evaluated the crack propagation due to thermal fatigue via thermal cycle tests. Microstructural observations of the region fractured because of thermal fatigue revealed that cracks resulting from thermal fatigue did not progress in the fine grain region formed at the bonded interface. It was inferred that grain boundaries were an obstacle to crack propagation. C1940 has higher hardness and finer grains than C1020, and showed a lower decreasing rate of the peel strength and bonding area after the thermal cycling test than C1020 joints. Thus, a hard copper material with fine grains is effective in suppressing thermal fatigue fracture of ultrasonically bonded copper joints

Three-year progression-free survival of a patient with concomitant mucinous adenocarcinoma of the colon with peritoneal dissemination and multiple myeloma who received lenalidomide: a case report

Abstract Background Concomitant multiple myeloma (MM) and other primary malignancies is rare. Therefore, the treatment outcomes of patients with these conditions have not been well discussed. Lenalidomide is an oral thalidomide analog drug used for MM. Recently, the antitumor effect of lenalidomide has been gaining attention, and lenalidomide has been applied for managing solid tumors. The current case showed the treatment course of a patient treated with lenalidomide for concomitant MM and colon cancer with peritoneal dissemination. Case presentation A 74-year-old female patient receiving treatment for MM was diagnosed with mucinous adenocarcinoma of the transverse colon. The patient was clinically diagnosed with stage IIIC T4aN2M0 disease. Subsequently, laparoscopic colectomy with lymph node dissection was planned. However, intraperitoneal observation revealed peritoneal dissemination that had sporadically and widely spread. Therefore, palliative partial colectomy was performed to prevent future hemorrhage or obstruction. The patient was discharged on the 10th postoperative day without postoperative complication. Based on the patient’s preference, lenalidomide was continually administered for MM without systemic chemotherapy. The patient survived for > 36 months without any signs of tumor progression. Conclusion The current case first showed the treatment course of concomitant MM and colon cancer. The antitumor effect of lenalidomide can possibly contribute to 3-year progression-free survival in patients with mucinous adenocarcinoma of the colon with peritoneal dissemination

Diatom Cells Grown and Baked on a Functionalized Mica Surface

We demonstrate the cultivation of diatom cells on a functionalized mica surface and the preparation of frustules on a mica surface by baking. Diatom cells were successfully grown on a mica surface treated with 3-aminopropyltriethoxysilane. After baking at 400˚C for 2 h, frustule structures without the organic components of the diatom cells were successfully observed by scanning electron microscopy and atomic force microscopy. Furthermore, the frustules deformed and became slender when a sample was baked at 800˚C for 2 h. Our method is effective for the direct characterization of frustule structures and physical properties without changing the configuration of the diatom cells grown on the mica surface