Airway intervention in cases of acute epiglottitis

Airway intervention in cases of acute epiglottitis.Problem/objectives: In cases of acute epiglottitis, indications for airway intervention have not been established. In the present study, we reviewed patients with acute epiglottitis to identify clinical factors, which suggest airway intervention should be performed.

METHODOLOGY

Patients with acute epiglottitis admitted to The Jikei University Daisan Hospital (Tokyo) from 2004 to 2013 were identified. Patients' characteristics, histories, laryngoscopic findings and laboratory findings were reviewed and analysed.

RESULTS

Of the 83 patients (82 adults and one adolescent) in the sample, 16 (19%) underwent airway intervention and conservative treatment. The factors that were significantly more likely to have been present in patients who received airway intervention were odynophagia, drooling, hoarseness, muffled voice, dyspnoea, swelling of the posterior side of the epiglottis, less than 50% of the glottis area being visible with laryngoscopy, and a high white blood cell (WBC) count. The only factor that was shown by multiple logistic regression analysis to be distinctively predictive of airway intervention was "less than 50% of the glottis area being visible" (P = .000, odds ratio = 23.630, sensitivity = 86.6%, specificity = 78.6%, predictive accuracy = 85.2%).

CONCLUSIONS

When considering whether airway intervention should be performed in cases of acute epiglottitis, the most important clinical factor is the laryngoscopic finding that "less than 50% of the glottis area being visible." Other important clinical factors to consider are odynophagia, drooling, hoarseness, muffled voice, dyspnoea, swelling of the posterior side of the epiglottis and a high WBC count.

Structure determination of the rutile-TiO2(110)-(1 × 2) surface using total-reflection high-energy positron diffraction (TRHEPD)

Detailed structure of the rutile-TiO₂(110)-(1 × 2) has been determined using the newly developed technique of total-reflection high-energy positron diffraction (TRHEPD).

Photoelectron diffraction from laser-aligned molecules with X-ray free-electron laser pulses

We report on the measurement of deep inner-shell 2p X-ray photoelectron diffraction (XPD) patterns from laser-aligned I₂ molecules using X-ray free-electron laser (XFEL) pulses. The XPD patterns of the I₂ molecules, aligned parallel to the polarization vector of the XFEL, were well matched with our theoretical calculations. Further, we propose a criterion for applying our molecular-structure-determination methodology to the experimental XPD data. In turn, we have demonstrated that this approach is a significant step toward the time-resolved imaging of molecular structures.

New techniques for producing aesthetic, direct full-crown composite resin restorations for primary molars: a 24-month follow-up study of eight cases

AIM

Although the demand for aesthetic restoration of primary molars has increased, techniques for producing aesthetic, direct full-crown restorations using light-cured composite resin for primary molars and the associated clinical outcome are not well established. The aim of this study was to describe the use of new techniques to produce aesthetic, direct full-crown restorations using light-cured composite resin for primary molars. The authors evaluate the clinical outcomes of the restoration method and investigate whether this technique could be used as an alternative to conventional methods.

MATERIALS AND METHODS

Two new techniques, the resin block and the clear matrix, were studied by treating 8 teeth. The occlusal surface of stainless steel crowns was used for impression-taking to facilitate accurate reproduction of the anatomic structure, and the aesthetic restoration was obtained simply and consistently.

RESULTS

At the 24-month follow-up evaluation, these new direct techniques were completely satisfactory. Marginal discoloration was observed in one tooth treated with the clear matrix technique, and a small partial wear was observed in another tooth treated with the resin block.

CONCLUSION

The new techniques for restoration resulted in functional and aesthetic reproduction of occlusal morphology. Therefore, these techniques could be considered a practical alternative to conventional methods.

Stress tuning of the fundamental absorption edge of pure germanium waveguides

One-dimensional stress dependence on the fundamental absorption edge of pure germanium (Ge) waveguide has theoretically and experimentally been studied, considering built-in two-dimensional stress-tensile Ge grown on Si. Based on the results, we have designed Ge Franz-Keldysh (FK) electroabsorption (EA) modulators to work at 1550 nm. Application of one-dimensional [110] compressive stress above -350 MPa on a pure Ge [-110] waveguide should allow 1550 nm light transmission, unless otherwise a pure Ge modulator can only operate at 1600 nm or longer due to the built-in two-dimensional tensile stress in Ge. The prediction has experimentally been verified using a SiNx stressor film. This concludes that the presented stress-tuning approach of the pure Ge waveguides should expand the operation wavelength of Ge FK-EA modulators to C band. Since stress tuning can be locally done in the back-end-of-line of complementary metal oxide semiconductor (CMOS) process, the presented stress-tuning method should enable "field-programable" control of the operation wavelengths of the monolithically integrated Ge modulators in Si photonics platform.

Sources of organic matter in first flush runoff from urban roadways

This study aims to explore the influential sources of organic matter in first flush runoff from urban roadways by comparing organic carbon content and particle size distribution in road dust with those from discharge from vehicles during rainfall. Samples on first flush runoff and road dust were collected from urban roadways. In addition, vehicle drainage was assumed to flow from vehicles during rainfall events, so vehicle wash-off water was collected by spraying water onto the top and from the underside of vehicles to simulate accumulation during a vehicle run. In road dust, the organic carbon content in the <0.2 mm fraction was about twice that of the 0.2-2 mm fraction. The particle size distributions of both first flush runoff and vehicle wash-off water were similar, and particles <0.2 mm contributed to over 95% of the total volume. The dissolved organic carbon concentration in the vehicle wash-off water was considerably higher than that in the road dust/water mixture. The total organic carbon content in road dust was positively correlated with annual daily traffic. Therefore, vehicles were thought to strongly influence the nature of road dust.

Structure determination of two-dimensional atomic sheet of silicene using TRHEPD

This study reports determination of the atomic coordinates of a two-dimensional atomic sheet, silicene, by using total reflection high-energy positron diffraction (TRHEPD) [1]. TRHEPD method, formerly called as RHEPD, is a surface-sensitive tool owing to the total reflection of positrons. Since the sign of the potential energy for positrons in crystals is positive, opposite to that for the electrons, the positron beam at a grazing incidence are totally reflected at a crystal surface. The penetration depth of the positron beam in the total reflection region is estimated to be approximately a few Å, which corresponds to the thickness of 1-2 atomic layers. Thus, the positron beam selectively sees the topmost surface layer and hence the TRHEPD method is very useful for structure determinations of crystal surface and two-dimensional atomic sheet on the substrate. Silicene is a two-dimensional atomic sheet of silicon. Since the silicene has an intriguing property such as a Dirac cone like a graphene, it attracts increasing attention as a candidate for future devices. Recently, the synthesis of silicene on a Ag(111) surface was successfully performed [2]. Although the atomic coordinates of the silicene in this system was theoretically calculated, they were not confirmed experimentally. It is very important to experimentally determine the magnitude of the buckling in silicene and the spacing between the bottom of the silicene and the substrate because the dispersion of the Dirac cone is closely related to these structure parameters. We thus investigated the atomic positions of the silicene on the Ag(111) surface using the TRHEPD [3]. From the rocking curve analysis based on the dynamical diffraction theory of positrons (see figure), the existence of the buckling (0.83 Å) in silicene was verified experimentally. Moreover, the spacing between the silicene and the substrate was determined as 2.17 Å. The structural difference with the graphene will be also discussed.

A total reflection high-energy positron diffraction station at the KEK-SPF

A high-intensity mono-energetic positron beam generated by using a linear electron accelerator (linac) provides total reflection high-energy positron diffraction (TRHEPD) researches at Slow Positron Facility (SPF), KEK [1,2]. A pulsed 50-Hz electron beam generated with a dedicated linac (operated at 55 MeV, 0.6 kW) is injected on a Ta converter and causes fast positron-electron pair creation through bremsstrahlung. The positrons showering down on 25 μm-thick W foils, are moderated to thermal energy, and a fraction spontaneously comes out of the foils with an energy of 3 eV owing to the negative work function. The positron converter/moderator assembly is held at an electrostatic voltage of 15 kV for TRHEPD experiment. The emitted positrons are consequently accelerated to 15 keV as they enter the grounded beam-line and are guided by the magnetic field of about 0.015 T to the TRHEPD station. For diffraction experiments, positrons transported by the magnetic field have to be first released into a nonmagnetic region. Since the released positron beam has a large diameter, a brightness-enhancement unit is effectively used to achieve a small-diameter and highly-parallel beam with a sufficient flux. The linac-based positron beam gives about 60 times intensified diffraction pattern from a Si(111)-7x7 reconstructed surface compared to a previous result with a Na-22-based positron beam [3]. An improved signal-to-noise ratio in the obtained pattern due to the intensified beam allowed an observation of clear fractional-order spots in the higher Laue-zones, which had not been observed previously. The much intensified beam with the present system allows adjustment of the sample orientation without accumulating the positron signals. With the brightness enhanced beam, several remarkable results have been obtained efficiently by users of this facility. (Everybody is invited to use KEK Slow Positron Facility through approval of his/her research proposal.)

Surface sensitivity of total reflection high-energy positron diffraction

"Reflection high-energy positron diffraction (RHEPD) is the positron counterpart of reflection high-energy electron diffraction (RHEED). RHEPD was proposed in 1992 [1], and first demonstrated in 1998 [2]. Unlike the case of the electron, the potential energy of the positron inside a crystal is positive, and hence positrons incident on a crystal surface with a glancing angle smaller than a certain critical angle are totally reflected. This feature makes the positrons a tool extremely sensitive to the topmost layer of the crystal surface. Recent development of a brightness-enhanced intense positron beam at KEK [K. Wada, et al., J. Phys.: Conf. Ser. 443, 012082 (2013)] has made it possible to obtain clear RHEPD patterns. We rename the technique with a refined beam as ""total reflection high-energy positron diffraction (TRHEPD)"". Here we demonstrate that the TRHEPD pattern from the Si(111)-7x7 DAS surface taken with a glancing angle smaller than the critical angle for the total reflection is essentially determined only by the atoms exposed on the surface (adatoms and the atoms in the first surface layer) [3]. The technical details of the positron beam preparation [M. Maekawa, et al., to be published in Eur. Phys. J. D (2014)], results on the Pt/Ge(001) nano-wire surface[I. Mochizuki, et al., Phys. Rev. B 85, 245438 (2012)], TiO2(110)-1x2 surface, and silicene on Ag(111) surface [Y. Fukaya, et al., Phys. Rev. B 88 205413 (2013)] are also presented in this conference. "

TRHEPD rocking curve analyses of Pt/Ge(001) and TiO2(110) surfaces

Recently, we developed new total reflection high-energy positron diffraction (TRHEPD) apparatus [1] on a beam line of the linac-based intense positron beam of the Slow Positron Facility at KEK, Japan. The high intensity allows us to install a brightness-enhancement section, which to observation of clear positron diffraction patterns for crystal surfaces under total reflection condition. In this work, we investigated the atomic configuration of Pt-induced nanowires formed on a Ge(001) surface [2] using the apparatus. By means of the diffraction intensity analysis based on the dynamical diffraction theory, or TRHEPD rocking curve analysis, a previously proposed theoretical model [D. E. P. Vanpoucke et al., Phys. Rev. B 77, 241308(R) (2008)], composed of Ge dimers on the top layer and buried Pt arrays in the second and fourth layers, was confirmed to be the fundamental structure of the nanowire. We also investigated the atomic configuration of a rutile-TiO2(110) surface. It is well known that the structure of this surface transforms its periodicity from (1×1) to (1×2) by elevating the sample temperature above ~1100 K, whereas the detailed structure is yet to be revealed. There is a longstanding controversy between the structure models proposed by scanning tunneling microscopy, low energy electron diffraction, surface X-ray diffraction, first-principles calculation with density functional theory results, etc. To solve the problem, we have measured TRHEPD rocking curves and determined the atomic arrangements of the topmost crystal surface [3].

Exoplanet detection. A terrestrial planet in a ~1-AU orbit around one member of a ~15-AU binary

Using gravitational microlensing, we detected a cold terrestrial planet orbiting one member of a binary star system. The planet has low mass (twice Earth's) and lies projected at ~0.8 astronomical units (AU) from its host star, about the distance between Earth and the Sun. However, the planet's temperature is much lower, <60 Kelvin, because the host star is only 0.10 to 0.15 solar masses and therefore more than 400 times less luminous than the Sun. The host itself orbits a slightly more massive companion with projected separation of 10 to 15 AU. This detection is consistent with such systems being very common. Straightforward modification of current microlensing search strategies could increase sensitivity to planets in binary systems. With more detections, such binary-star planetary systems could constrain models of planet formation and evolution.

Spectroscopic Studies in InGaN Quantum Wells

Fundamental electronic modulations in strained wurtzite III-nitride, in particular InxGa1−xN, quantum wells (QWs) were treated to explore the reason why practical InGaN devices emit bright luminescences in spite of the large threading dislocation (TD) density. The emission mechanisms were shown to vary depending on the well thickness L and InN molar fraction x. The electric field across the QW plane, F, which is a sum of the fields due to spontaneous and piezoelectric polarization and the pn junction field, causes the redshift of the ground state resonance energy through the quantum confined Stark effect (QCSE). The absorption spectrum is modulated by QCSE, quantum-confined Franz-Keldysh effect (QCFK), and Franz-Keldysh (FK) effect from the barrires when, for the first approximation, potential drop across the well (FL) exceeds the valence band discontinuity, EV. Under large FL, holes are confined in the triangular potential well formed at one side of the well. This produces apparent Stokes-like shift in addition to the in-plane net Stokes shift on the absorption spectrum. The QCFK and FK further modulate the electronic structure of the wells with L greater than the three dimensional (3D) free exciton (FE) Bohr radius, aB. When FL exceeds EC, both electron (e) and hole (h) confined levels drop into the triangular potential wells at opposite sides of the wells, which reduces the wavefunction overlap. Doping of Si in the barriers partially screens the F resulting in a smaller Stokes-like shift, shorter recombination decay time, and higher emission efficiency. Finally, the use of InGaN was found to overcome the field-induced oscillator strength lowering due to the spontaneous and piezoelectric polarization. Effective in-plane localization of the QW excitons (confined excitons, or quantized excitons) in quantum disk (Q-disk) size potential minima, which are produced by nonrandom alloy potential fluctuation enhanced by the large bowing parameter and F, produces confined e-h pairs whose wavefunctions are still overlapped when L<aB. Their Coulomb interaction is more pronounced for FL<EV.

Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial

IMPORTANCE

No highly effective interventions to prevent delirium have been identified.

OBJECTIVE

To examine whether ramelteon, a melatonin agonist, is effective for the prevention of delirium.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter, rater-blinded, randomized placebo-controlled trial was performed in intensive care units and regular acute wards of 4 university hospitals and 1 general hospital. Eligible patients were 65 to 89 years old, newly admitted due to serious medical problems, and able to take medicine orally. Patients were excluded from the study if they had an expected stay or life expectancy of less than 48 hours.

INTERVENTIONS

Sixty-seven patients were randomly assigned using the sealed envelope method to receive ramelteon (8 mg/d; 33 patients) or placebo (34 patients) every night for 7 days.

MAIN OUTCOMES AND MEASURES

Incidence of delirium, as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition).

RESULTS

Ramelteon was associated with a lower risk of delirium (3% vs 32%; P = .003), with a relative risk of 0.09 (95% CI, 0.01-0.69). Even after risk factors were controlled for, ramelteon was still associated with a lower incidence of delirium (P = .01; odds ratio, 0.07 [95% CI, 0.008-0.54]). The Kaplan-Meier estimates of time to development of delirium were 6.94 (95% CI, 6.82-7.06) days for ramelteon and 5.74 (5.05-6.42) days for placebo. Comparison by log-rank test showed that the frequency of delirium was significantly lower in patients taking ramelteon than in those taking placebo (χ(2) = 9.83; P = .002).

CONCLUSIONS AND RELEVANCE

Ramelteon administered nightly to elderly patients admitted for acute care may provide protection against delirium. This finding supports a possible pathogenic role of melatonin neurotransmission in delirium.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry Identifier: UMIN000005591.