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Abstract This paper presents a self‐triggered control approach with the view of risks for discrete‐time linear stochastic systems. More specifically, under the assumption that the first two moments of the disturbance distribution are known, the paper considers the problem of designing a control law that reduces the use of communication and power resources by aperiodically sampling the states and updating control inputs, while achieving a given performance goal at a risk below a specified level. This problem is approached by using the worst‐case Conditional Value‐at‐Risk as a measure of risk, to quantify the tail behavior of the stochastic systems, thus allowing us to suppress large losses. A numerical example is provided to illustrate the performance of the proposed approach.

An AB single case design was used to measure the effect of data-based feedback for 6 children in a listening and spoken language early intervention (EI) programme in Australia. Changes in the number of parent-child conversational turns following feedback were measured using an automated language environment analysis system. The perceived value and practicality of the feedback model were also investigated. A functional relationship was demonstrated between the intervention and an increase in the number of conversational turns for 4 of the children. Therapists were able to implement the model with high fidelity and perceived the intervention to be effective in changing parent behaviours. Parents reported the feedback helped them to improve their verbal interactions with their children. This study has provided preliminary evidence that supports the feasibility and the positive impact of data-based feedback in a listening and spoken language EI programme.

Abstract Background To evaluate whether urine laminin‐γ2 monomer (Ln‐γ2m) offers a useful biomarker for patients with non‐muscle‐invasive bladder cancer (NMIBC). Methods Participants comprised 297 patients, including 111 patients with NMIBC, 136 patients with benign genitourinary disease (BD) and 50 healthy donors (HD). Urine Ln‐γ2m was prospectively measured and accuracy was analyzed. Receiver operating characteristic (ROC) curves were determined and area under the ROC curve (AUC) was calculated for urine Ln‐γ2m, and compared to those of traditional urine tumor markers such as nuclear matrix protein 22 (NMP22), bladder tumor antigen (BTA) and cytology. The net benefits of combining urine markers were analyzed by decision curve analysis. Results Mean urine Ln‐γ2m was significantly higher in NMIBC than in BD or HD. The AUC for urine Ln‐γ2m was significantly higher than those for urine NMP22, BTA or cytology when comparing NMIBC with HD. In patients with low‐grade NMIBC, the AUC for urine Ln‐γ2m was higher than the AUCs for NMP22, BTA or cytology. A net benefit of combined examination using urine Ln‐γ2m/uCRN with NMP22 was demonstrated. Conclusion These results suggest urine Ln‐γ2m as a potentially useful biomarker for NMIBC, particularly in cases of low‐grade cancer.

Objective(s): In the treatment of castration-resistant prostate cancer (CRPC) with bone metastases, radium-223 dichloride (Ra-223) is the only bone-targeted drug that shows survival benefits. Completing six courses of Ra-223 treatment is thought to be associated with better patient survival, but this treatment has a relatively high rate of acute adverse events. Methods: This retrospective study included 85 patients from 12 institutions in Japan to investigate the clinical significance of the completion of Ra-223 treatment and acute adverse events in CRPC patients. Results: Six courses of Ra-223 treatment were completed in 65.9% of the patients. Grade 3 or higher acute adverse events were observed in 27.1% of patients. The prostate specific antigen and alkaline phosphatase declined at 26.9% and 87.9%, respectively. The overall survival rates at 12 and 24 months were 80.7% and 63.2%, respectively. Both completion of six courses of Ra-223 treatment and absence of grade 3 or higher acute adverse events were associated with longer overall survival. In univariate analysis, factors related to the history of treatment (five or more hormone therapy agents and cytotoxic chemotherapy) and hematological parameters (Prostate specific antigen (PSA) doubling time, alkaline phosphatase, hemoglobin, albumin, and serum calcium) were associated with completing six courses of Ra-223 treatment without experiencing grade 3 or higher acute adverse events. Multivariate analysis showed that a history of chemotherapy, PSA doubling time, hemoglobin, and serum calcium showed statistical significance. We built a predictive score by these four factors. Patients with lower scores showed higher rates of treatment success (p

Introduction: Magnetic resonance imaging (MRI) is widely used in orthopedics, but orthopedic surgeons, including spine surgeons, do not have detailed knowledge of MRI-related accidents. We, as orthopedic surgeons, investigated the details of medical accidents related to ferromagnetic objects brought into the MRI room using a national multicenter database. Methods: We conducted an exploratory analysis of accidents involving MRI ferromagnets based on the Japanese database of adverse medical occurrences. From a total of 104,659 accident reports over nine years, 172 involving the presence of ferromagnetic objects in the MRI room were extracted and analyzed. Results: The accident reports frequently involved children and the elderly. Nurses filed the highest number of reports (44.8%) by occupation, which was more than twice as many as physicians (19.8%). The most common ferromagnetic devices brought into the MRI rooms were pacemakers (n = 22). There were also large magnetic objects such as oxygen cylinders (n = 12) and IV stands (n = 7). In the field of orthopedics, ankle weights (n = 4), pedometers (n = 3), and artificial limbs (n = 2) were brought in. “Failure to check” was the most common cause of accidents (69%). Actual harm to patients occurred in 9% of cases, with no fatalities. Conclusions: Manuals and checklists should be developed and continuous education provided to prevent accidents involving magnetic objects brought into the MR scanner room. As orthopedic surgeons, including spine surgeons, we should be cautious with emergency, geriatric, and pediatric patients because their information and medical history may not be accurate. We should not overlook equipment commonly found in orthopedic practice such as ankle weights and pedometers.

Synthetic bone grafts are in high demand owing to increased age-related bone disorders in the global aging population. Here, we report fabrication of gear-shaped granules (G-GRNs) for rapid bone healing. G-GRNs possessed six protrusions and a hexagonal macropore in the granular center. These were composed of carbonate apatite, i.e., bone mineral, microspheres with ∼1-μm micropores in the spaces between the microspheres. G-GRNs formed new bone and blood vessels (both on the granular surface and within the macropores) 4 weeks after implantation in the rabbit femur defects. The formed bone structure was similar to that of cancellous bone. The bone percentage in the defect recovered to that in a normal rabbit femur at week-4 post-implantation, and the bone percentage remained constant for the following 8 weeks. Throughout the entire period, the bone percentage in the G-GRN-implanted group was ∼10% higher than that of the group implanted with conventional carbonate apatite granules. Furthermore, a portion of the G-GRNs resorbed at week-4, and resorption continued for the following 8 weeks. Thus, G-GRNs are involved in bone remodeling and are gradually replaced with new bone while maintaining a suitable bone level. These findings provide a basis for the design and fabrication of synthetic bone grafts for achieving rapid bone regeneration.

The aim of this study is to propose a new modified optimality criteria method for non-positive definiteness in multi-objective density-based topology optimization problems. Our proposed modified optimality criteria method is a density update method that was developed by incorporating the concept of Newton’s method into the conventional optimality criteria method. Topology optimization for strain energy minimization and von Mises stress minimization problems were performed separately, and actual experiments revealed the characteristics of each. Each optimization problem setting has its individual advantages: strain energy minimization is computationally stable, whereas von Mises stress minimization obtains a higher-strength structure. Therefore, in this study, to take advantage of both, we performed multi-objective optimization using the modified optimality criteria method. Since updating was not possible with the previously proposed modified optimality criteria method in multi-objective optimization problems, we propose incorporating mapping to enable it to be updated. As a numerical example problem, topology optimization was performed on the MBB beam model and gripper model for a robotic arm using the conventional optimality criteria method and our proposed mapping–based modified optimality criteria method to compare the update methods. Numerical example of the MBB beam model demonstrate that the mapping–based modified optimality criteria method is independent of the move-limit and can be updated. The mapping–based modified optimality criteria method also has a small number of arbitrary parameter settings that can cause problems for engineers because the weighting factor in the optimality criteria method is set in each element. Numerical example of the gripper model are used here to investigate the speed of updating the mapping–based modified optimality criteria method and guidelines for setting the appropriate weight coefficients of performance function to create a design.

Objectives To assess whether acoustic stimulations relieve venipuncture pain and determine which stimulation is the most effective type.Design Systematic review and network meta-analysis.Data sources PubMed, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov and the International Clinical Trials Registry Platform databases were systematically searched in September 2023.Study selection Randomised controlled trials evaluating the efficacy of acoustic stimulations on patients undergoing venipuncture were eligible. Acoustic stimulations were classified into seven categories: five types of acoustic stimulations (music medicine (researcher selected), music medicine (patient selected), music therapy, sounds with linguistic meaning and sounds without linguistic meaning) and two controls (only wearing headphones and no treatment).Primary and secondary outcome measures Primary outcomes included self-reported pain intensity assessed during venipuncture and treatment cost, and secondary outcomes were self-reported mental distress and adverse events.Results Of 6406 citations, this network meta-analysis included 27 studies including 3416 participants; the mean age was 31.5 years, and 57% were men. Among the five types of acoustic stimulations, only musical interventions, such as music medicine (patient selected) (standardised mean difference (SMD) −0.44 (95% CI: −0.84 to –0.03); low confidence), music medicine (researcher selected) (SMD −0.76 (95% CI: −1.10 to –0.42); low confidence) and music therapy (SMD −0.79 (95% CI: −1.44 to –0.14); low confidence), were associated with improved pain relief during venipuncture compared with no treatment. No significant differences existed between the types of acoustic stimulations. Free-of-charge acoustic stimulations were provided to patients, and no specific adverse events were reported. In many studies, the risk of bias was rated high because of the difficulty of blinding the intervention to the participants and the self-reported pain outcome.Conclusions Music interventions were associated with reduced venipuncture pain. Comparisons between types of acoustic stimulations revealed no significant differences. Therefore, music intervention could be a safe and inexpensive pain relief method for venipuncture.PROSPERO registration number CRD42022303852.

In this study, the oxidation of As(III) was examined in a fixed-bed flow reactor filled with a SiO2-supported Pt catalyst, and the reaction kinetics were analyzed. The results of the experiments with different concentrations of As(III) at small W/F suggest that the reaction follows the Langmuir-Hinshelwood (L-H) mechanism. However, at large W/F, the kinetic equations different from the L-H equation were obtained because the O2 supply to the catalyst surface was rate-limiting. It was also demonstrated using this reactor that As(III) of an equivalent concentration as the mine effluent was almost completely oxidized to As(V) with only dissolved O2.

Introduction: This study aimed to identify immune mediators, including cytokines, chemokines, and growth factors, in the plasma for predicting treatment efficacy and immune-related adverse events (irAEs) in advanced urothelial carcinoma (aUC) treated with immune checkpoint inhibitors (ICIs).Methods: We enrolled 57 patients with aUC who were treated with the anti-programmed cell death protein 1 (PD-1) antibody pembrolizumab after the failure of platinum-based chemotherapy between February 2018 and December 2020. Plasma levels of 73 soluble immune mediators were measured before and 6 weeks after initiating pembrolizumab therapy. The association of estimated soluble immune mediators with clinical outcomes, including overall survival (OS), progression-free survival (PFS), anti-tumor responses, and irAEs, were statistically evaluated.Results: In the multivariate analysis, levels of 18 factors at baseline and 12 factors during treatment were significantly associated with OS. Regarding PFS, baseline levels of 17 factors were significantly associated with PFS. Higher levels of interleukin (IL)-6, IL-8, soluble tumor necrosis factor receptor 1 (sTNF-R1), and IL-12 (p40), both at baseline and post-treatment, were significantly associated with worse OS. Conversely, low IL-6 and high TWEAK levels at baseline were associated with irAEs. Among identified factors, interferon (IFN) γ and IL-12 (p40) were repeatedly identified; high baseline levels of these factors were risk factors for worse OS and PFS, as well as progressive disease. Notably, using correlation and principal component analysis, factors significantly associated with clinical outcomes were broadly classified into three groups exhibiting similar expression patterns.Discussion: Measuring plasma levels of soluble immune mediators, such as IL-6, IL-8, sTNF-R1, IFNγ, and IL-12 (p40), could be recommended for predicting prognosis and irAEs in ICI-treated patients with aUC.

We performed whole genome sequencing (WGS) of 15 Palyam serogroup virus (PALV) strains isolated from cattle or Culicoides biting midges in Japan from 1984 to 2018. We found that the PALV strains consisted of Chuzan (Kasba) virus (CHUV), D‘Aguilar virus (DAGV), Bunyip Creek virus, and another PALV, Marrakai virus (MARV). The Japanese MARV strains isolated in 1997 were closely related to Australian PALV strains isolated in 1968–1976 in genome segments 2 and 10, but they were most closely related to other Japanese PALV strains in the other genome segments. Our data suggest that the Japanese MARV strains were reassortant viruses between Asian and Australian PALVs. In addition to the WGS, we developed a real-time reverse-transcription polymerase chain reaction assay that can broadly detect PALV and specifically detect CHUV and DAGV, utilizing the data obtained by the WGS in this study. We detected the DAGV gene in bovine stillborn fetuses and congenitally abnormal calves in 2019 using the newly developed assay. To our knowledge, this is the first report of isolation of MARV outside of Australia and the first report of detection of PALV in bovine fetuses or calves with congenital abnormality outside of Africa.