Interdisciplinary class for high school students on the climate environment around Japan and "seasonal feeling" expressed in the school songs with attention to the asymmetric seasonal march from autumn to the next spring

This study is a part of the activity to develop an interdisciplinary lesson plan for high school students on the climate environment around Japan and the "seasonal feeling". This time, we focused our attention to the asymmetric seasonal march from autumn to the next spring as proposed by Kato et al. (2013). Comparison of the climate between early winter and early spring was made in the class not only on that around the Japan but also on the relation to the larger-scale systems such as the Siberian air mass, including the brief data analysis. The students also compared the detailed "seasonal feeling" between the two seasons expressed in the school songs and the Japanese classic poems called "Wa-Ka". This paper reports the contents and results of this joint activity at the two high schools

The significance of nanoparticle shape in chirality transfer to a surrounding nematic liquid crystal reporter medium

This perspective reports on recent progress toward the development of an approach to a priori predict - both chirality "strength" and efficacy of chirality transfer from a chiral nanoshape solute to an achiral nematic environment

Interdisciplinary Class on the Climate Environment around the Japan Islands in Association with the Seasonal Feeling (with Attention to the Transition Stage from Autumn to Winter)

The complicated seasonal variations are found in East Asia influenced by the Asian monsoon, resulting in the variety of “seasonal feeling”. For example, although the air temperature around the Japan Islands is still rather higher from November to early December than in the midwinter, the wintertime weather pattern often appears then due to the development of the Siberian high. In the Hokuriku District, the Japan Sea side of the central Japan, the shallow convective rainfall called the “Shi-gu-re” frequently occurs associated with the air mass transformation process over the Japan Sea in the cold air outbreak situation from the continent. It is also well known that the “Shi-gu-re” is often used for expression of the “seasonal feeling” in the Japanese classical literature. Thus the present study tried to develop an interdisciplinary class on the climate environment around the Japan Islands in association with the “seasonal feeling”, with attention to the transition stage from autumn to winter. The present paper will discuss on the joint activity of meteorology with the Japanese classical literature, the music and the art, for the class at the Faculty of Education, Okayama University, and that at the Okayama-Ichinomiya High School

Tokyo Guidelines 2018 management bundles for acute cholangitis and cholecystitis

Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: . Related clinical questions and references are also include

Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also include

Delphi consensus on bile duct injuries during laparoscopic cholecystectomy:An evolutionary cul-de-sac or the birth pangs of a new technical framework?

Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce. Surgeons from Japan, Korea, Taiwan, and the USA, etc. (n=614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when 80% of overall responses were 4 or 5. Response rates for the first- and second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: (1) Effective retraction of the gallbladder, (2) Always obtaining critical view of safety, and (3) Avoiding excessive use of electrocautery/clipping as vital procedures; and (4) Calot's triangle area and (5) Critical view of safety as important landmarks. For (6) Impacted gallstone and (7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated. A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BD