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The impact of pre- versus post-arrest emergency calls from care facilities on out-of-hospital cardiac arrest (OHCA) outcomes remains unclear. This study examined how call timing and time of day influence bystander cardiopulmonary resuscitation (BCPR) and 1-month survival. We conducted a nationwide retrospective cohort study from 2017 to 2022. We analyzed 27,222 witnessed OHCAs of presumed cardiac origin in adults aged ≥ 65 years in care facilities. Pre-arrest calls were defined as cases in which the witnessed time occurred after the EMS call time; post-arrest calls were those in which the witnessed time was the same as or earlier than the call time. The primary outcome was 1-month survival and the secondary was BCPR rate. Propensity score matching and logistic regression were used for survival analysis. Of all cases, 10,789 (39.6%) were preceded by pre-arrest calls. BCPR was less frequent in pre-arrest than post-arrest cases (43.3% vs. 84.4%; p  < 0.01). Survival was highest during daytime (8.0%) and lowest at night (3.3%). Nighttime occurrence (adjusted odds ratio = 0.45, confidence interval = 0.40–0.51) and pre-arrest calls (0.78, 0.68–0.89) independently predicted lower survival. Early EMS activation alone is insufficient. Continuous dispatcher guidance and improved night-shift preparedness in care facilities may enhance OHCA outcomes.

Current navigation systems use multi-sensor data to improve the localization accuracy, but often without certitude on the quality of those measurements in certain situations. The context detection will enable us to build an adaptive navigation system to improve the precision and the robustness of its localization solution by anticipating possible degradation in sensor signal quality (GNSS in urban canyons for instance or camera-based navigation in a non-textured environment). That is why context detection is considered the future of navigation systems. Thus, it is important firstly to define this concept of context for navigation and to find a way to extract it from available information. This paper overviews existing GNSS and on-board vision-based solutions of environmental context detection. This review shows that most of the state-of-the art research works focus on only one type of data. It confirms that the main perspective of this problem is to combine different indicators from multiple sensors.

To investigate the 2-year healing rate of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) treated initially with intravitreal ranibizumab (IVR) and later combined with other treatment as needed, and the characteristics of refractory cases. 130 patients (130 eyes) with BRVO-ME who received IVR initially were studied. Anti-vascular endothelial growth factor drug was additionally administered when ME relapsed or persisted. Photocoagulation was performed when the non-perfusion area (NPA) was ≥5 disc diameter (DD), and/or when ME relapsed due to microaneurysm. Patients were classified into a healed group [ME resolved in <2 years or mild ME remained without best-corrected visual acuity (BCVA) loss for ≥6 months] or refractory group (ME persisted for ≥2 years). 110 eyes were classified into the healed group, and 20 eyes into the refractory group. The healed group and refractory group had, respectively, mean follow-up periods of 21.2 and 37.4 months, and frequencies of NPA ≥5 DD of 55.5 and 25.0% (p = 0.015). In the healed group, mean BCVA (logMAR) improved significantly compared to baseline in all the periods until 24 months after treatment initiation and at the last visit (p<0.001). In the refractory group, mean BCVA improved significantly compared to baseline until 12 months after treatment initiation (p<0.05 for all periods), but was not significantly different at 18 or 24 months or at the last visit. In patients with BRVO-ME treated initially with IVR and later given additional treatments as needed, the healing rate was 84.6%. In eyes that healed within 2 years, BCVA improved relative to baseline throughout 24 months and at the last visit. In refractory eyes, BCVA improved only until 12 months, and thereafter deteriorated to baseline level at the last examination.

Key messageSevere insect defoliation induced non-lignified tracheids and thin-walled latewood tracheids in the defoliation year in Larix kaempferi. These anomalous tracheids had heterogenous lignin deposition of S2 layer.Severe insect defoliation induces the formation of light ring consisted of thin-walled latewood tracheids in larch trees, which would affect wood quality. However, the identity of the secondary wall layers affected by insect defoliation remains unclear. The aim of this study is to clarify the effects of insect defoliation on the formation of secondary cell walls of tracheids in Larix kaempferi with focus on the defoliation timing. We observed by light microscopy and transmission electron microscopy (TEM) the secondary cell walls of tracheids produced in a defoliation year in L. kaempferi trees on which needles were attacked in July (gypsy moth, GM samples) or August (larch sawfly, LS samples). Light microscopy observations revealed that GM samples produced non-lignified tracheids in the transition zone between earlywood and latewood, as well as thin-walled latewood tracheids, and non-lignified tracheids were observed near the cambial zone in LS samples following defoliation for two consecutive years. TEM observations revealed that the tracheids in both samples had anomalous layers in secondary walls such as thin S2 layers with heterogeneous lignin deposition. The production of non-lignified tracheids corresponded to defoliation date in both samples, unlike changes in the layer composition of anomalous tracheids. Our study suggests that changes in wood structure depend on the date of insect defoliation and that insect defoliation affects the formation of secondary cell walls of tracheids, presumably in response to inadequate photosynthate supply as a result of defoliation.

Studies of the usefulness of transverse right ventricular (RV) shortening are limited. We retrospectively analyzed the CMR images of 67 patients (age: 50.8 ± 19.0 years; men: 53.7%; Control: n = 20, Overloaded RV (atrial septal defect): n = 15, Constricted RV (pericarditis): n = 17, Degenerated RV (arrhythmogenic right ventricular cardiomyopathy): n = 15) (all enrolled consecutively for each disease) in a single center. We defined RV longitudinal (fractional longitudinal change: FLC) and transverse (fractional transverse change: FTC) contraction parameters. We assessed the FTC/FLC (T/L) ratio on four-chamber cine CMR views and compared the four groups regarding the fractional parameters. FTC had a stronger correlation (R 2  = 0.650; p  < 0.001) with RV ejection fraction than that with FLC (R 2  = 0.211; p  < 0.001) in the linear regression analysis. Both FLC and FTC were significantly lower in the Degenerated RV and Constricted RV groups compared with those in the Control and Overloaded RV groups. The T/L ratio was significantly lower in the Degenerated RV group ( p  = 0.008), while the Overloaded RV ( p  = 0.986) and Constricted RV ( p  = 0.582) groups had preserved T/L ratios, compared with the Control group. Transverse shortening contributes to RV function more significantly compared with longitudinal contraction. Impaired T/L ratios may reflect RV myocardial degeneration. RV fractional parameters may help precisely understand RV dysfunction.

The utilization of electric vehicles (EV) and their used batteries in supporting small-scale energy management systems were studied. Both theoretical study and practical demonstration were performed to measure the feasibility of the developed system. Each five EVs and used EV batteries were used along with 20 kW photovoltaic (PV) panels as a renewable energy source. The main objective of the developed system is performing a peak-load shifting by utilizing EVs, used EV batteries and PV panels. The planning of load leveling was performed 24 h ahead for each 30 min period. The studies showed that the application of EVs and used EV batteries in supporting certain small-scale energy management systems is feasible. In addition, some findings during the demonstration test were listed and analyzed for the purpose of further system development and deployment.

Despite concerns raised on the inequality in healthcare provision in Japan, little is known about the factors that hinder candidates’ application to medical schools. A nationwide cross-sectional survey was conducted to identify the impact of economic factors and living place on students’ choice of and preparation for medical school. The survey was administered to high school teachers with career advisory roles, as they support and likely influence students’ choice and decision on this matter. Responses totaling 1,094 were obtained from 1,746 high schools across Japan. The ratio of high schools with two or more students enrolled in medical schools every year is higher in private schools, those with high tuition, and those located in big cities. Approximately 66.8% of the respondents agreed that \"It is difficult for students in economically disadvantaged families to enroll in medical schools;\" 42.0% agreed that \"Some students gave up on aspiring to enter medical schools because they could not afford it,\" and 61.2% agreed that \"Students living in urban areas are more likely to enroll in medical schools.\" When asked about the percentage of students attending prep school among those aspiring for a medical career, significantly more respondents from private versus public high schools answered \"80% or more.\" When asked about the percentage of parents who are doctors or dentists among students aspiring for a medical career, significantly more respondents from private versus public high schools answered \"50% or more.” The results suggest that students from lower-income families and those living in rural areas are more likely to be disadvantaged when choosing a medical career (because of financial difficulties) than those who live in urban areas and come from wealthier families. The results imply that economic and geographical divides in medical admission are reflected in high school teachers’ perception of and support provided to students.

What qualities and abilities are appropriate for a person who plans to become a doctor? To answer this question, it is meaningful to understand the opinions of the general public, since they are important stakeholders in the training of doctors. As part of a national door-to-door questionnaire survey, participants were asked about 16 qualities and abilities they considered suitable for becoming a doctor. Of the 1200 people interviewed, 1190 responded. The ratio of affirmative answers was the highest (92.2%) for the “Accurately judges situations” element, followed by “Cares about others’ feelings” (87.4%), “Understands the reality of medical care and welfare” (87.2%), and “Resistant to mental stress” (86.2%). “High academic ability”, which is currently the most important factor in the actual selection of students, ranked ninth among the sixteen elements (71.8%). Aside from academic ability, the general public places importance on other factors in selecting students for admission to medical schools. This study provides a valuable reference for medical schools regarding admission policies and applicant selection processes.

To elucidate changes in the defensive traits of tree seedlings under global environmental changes, we evaluated foliar defensive traits of the seedlings of successional trees, such as beech, oak, and magnolia grown in a natural-light phytotron. Potted seedlings were grown under the combination of two CO2 concentrations (360 vs. 720 ppm) and two nitrogen (N) treatments (4 vs. 15 kg N ha−1 yr−1) for two growing seasons using quantitative chemical analyses and anatomical method. We hypothesized that the effects of CO2 and N depend on the successional type, with late successional species providing greater defense of their leaves against herbivores, as this species exhibits determinate growth. Beech, a late successional species, responded the most to both elevated CO2 concentration (eCO2) and high N treatment. eCO2 and low N supply enhanced the defensive traits, such as the high leaf mass per area (LMA), high carbon to N ratio (C/N ratio), and increase in the concentrations of total phenolic and condensed tannin in agreement with the carbon–nutrient balance (CNB) hypothesis. High N supply decreased the C/N ratio due to the high N uptake in beech leaves. Oak, a mid–late successional species, exhibited different responses from beech: eCO2 enhanced the LMA, C/N ratio, and concentration of total phenolics of oak leaves, but only condensed tannin increased under high N supply. Magnolia did not respond to all treatments. No interactive effects were observed between CO2 and N supply in all species, except for the concentration of total phenolics in oak. Although the amounts of phenolic compounds in beech and oak varied under eCO2 and high N treatments, the distribution of these compounds did not change. Our results indicate that the changes in the defensive traits of forest tree species under eCO2 with N loading are related to the successional type.

Purpose . To investigate the dropout rate of anti‐vascular endothelial growth factor (VEGF) treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and identify the characteristics of dropout cases. Methods . We studied 235 eyes of 235 treatment‐naïve BRVO‐ME patients receiving intravitreal injection of ranibizumab. Additional intravitreal anti‐VEGF drug was given when ME relapsed or persisted, and photocoagulation was performed as needed. Adherence until treatment completion was defined as disappearance of ME within 2 years after the first injection without recurrence for more than 6 months or mild ME remaining but no visual deterioration for more than 6 months without additional anti‐VEGF drug. In patients with ME recurrence, those who were followed for more than 2 years were considered adherence, and those followed for less than 2 years were considered dropout. The clinical course and background of the two groups were compared. Results . 179 patients (76.2%) adhered to treatment and 56 patients (23.8%) dropped out. Mean follow‐up periods in adherence and dropout groups were 23.4 and 7.1 months, respectively. There were no significant differences between the two groups in demographic and baseline factors of age, gender ratio, distance from home to hospital, visual acuity, and foveal thickness (FT). At the last follow‐up, visual acuity was significantly poorer in the dropout group than in the adherence group (0.23 vs. 0.11 logMAR, p = 0.003), and FT was significantly greater in the dropout group than in the adherence group (316 vs. 273  µ m, p = 0.002). Reasons for dropout included patient declining further treatment in 12.5%, progression of dementia in 8.9%, others, and unknown in 64.3%. Conclusion . The clinical outcome of patients who dropped out of anti‐VEGF therapy for BRVO‐ME was worse compared to patients who adhered to therapy, and the reasons for discontinuation varied.