Heatstroke predictions by machine learning, weather information, and an all-population registry for 12-hour heatstroke alerts.

This study aims to develop and validate prediction models for the number of all heatstroke cases, and heatstrokes of hospital admission and death cases per city per 12 h, using multiple weather information and a population-based database for heatstroke patients in 16 Japanese cities (corresponding to around a 10,000,000 population size). In the testing dataset, mean absolute percentage error of generalized linear models with wet bulb globe temperature as the only predictor and the optimal models, respectively, are 43.0% and 14.8% for spikes in the number of all heatstroke cases, and 37.7% and 10.6% for spikes in the number of heatstrokes of hospital admission and death cases. The optimal models predict the spikes in the number of heatstrokes well by machine learning methods including non-linear multivariable predictors and/or under-sampling and bagging. Here, we develop prediction models whose predictive performances are high enough to be implemented in public health settings.

[New use of pulse-oximeter as a prophylactic Stimulator to the wearer and a lifesaving tools for prevention of hypoxic mishaps].

Pulse-oximeter has been widely used for the clinical assessment of physical status of a patient and as an alarming tool of hypoxia to medical personnel at the bedside or in the observation center. However, it has never been used for direct stimulation of the wearer. We considered innovation of pulse-oximeter as a prophylactic alarm-oximeter for the wearer. If SPO2 goes down to unfavorable level, the alarm-oximeter starts to send signal through a control box to a stimulator, such as an electrical nerve stimulator, a cold thermal tip, or mechanical device like a vibrator or compressor. The dermal stimulator is usually fixed to the right or left wrist with a Velcro band. The control box is affixed to the wristband by using Velcro. The alarm may be sent to an earphone or speaker with a verbal command like "take a deep breath". Alarm-oximeter will be combined to an oxygen inhaler or mechanical ventilatory assist device, or a drug administration system through electric line or wireless transmitter to start or change its function before the arrival of medical personnel. It will prevent hypoxic mishaps during medical intervention or sleep apnea syndrome. It will be also applicable to stop snoring.

[A mask with a left side slit for passing a trunk of fiberscope and enabling respiratory support during fiberoptic manipulation].

During fiberscopic procedure through a nose or a mouth under local anesthesia, respiratory depression may develop after supplementation of intravenous anesthetics or sedatives. To cope with this problem, a mask was invented. The mask can be made by each user from a disposable anesthetic mask with a single layer elastic cushion (not a balloon type). The cylindrical ventilating port of the mask is cut off first. Then a new ventilating port is made at the right lateral side of the wall by drilling a window and inserting a tail of a slip joint taken from a tracheal tube. The left side wall including the elastic cushion area is cut straight. Along the inside of this slit, a long valve made by combining two different widths of surgical tape is fixed. At the upper end of this valve, a piece of rubber membrane is fixed as a floppy valve for the center hole. Finally the upper opening of the mask is covered with a piece of round rubber film as the outer-most valve. Toward the center of this valve, the slit of the left wall is extended. Both cut-ends of the cushion are approximated and fixed reversibly with a piece of surgical or Velcro tape to prevent opening of the slit by the positive pressure ventilation. When respiratory depression occurs during fiber optic procedure, the slit of the mask is opened to pass the trunk of fiber and the mask is advanced to the front of the face. The slit is firmly closed by fixing the cushion area. The respiratory port is connected to a bag-mask ventilator or an anesthesia machine, and then respiratory support is started.

Estimation of municipal solid waste generation and landfill area in Asian developing countries.

In developing Asian countries, the municipal cooperations are unable to handle the increasing amount of municipal solid waste, which into the uncollected waste being spread on roads and in other public areas leading to tremendous pollution and destruction of land and negative impact on human health. Generation of municipal solid waste increases with the rapid urbanization and accelerated economic development with in the rapidly growing advanced technological societies. The nature of municipal solid waste is a term usually applied to a heterogeneous collection group of waste produced in urban areas, the nature of which varies from region to region. The common problem faced by all developing Asian countries, is the disposal of municipal solid waste and availability of land fill site area. Present study explains the correlation analysis of among different factors of municipal solid waste and the objective is to assess the future municipal solid waste stream in Asian developing countries. The other goal of this study was to calculate the future land area that would be required for landfill site disposal in Asian developing countries.

Effect of underground urban structures on eutrophic coastal environment.

The NIES Integrated Catchment-based Eco-hydrology (NICE) model was expanded to include the density current and solute-transport process of groundwater in the Kanto Plain and to incorporate the effects of water table and tidal fluctuations around the eutrophic Tokyo Bay, Japan (NICE-SEA). The simulation reproduced excellently the observed values of river discharge and groundwater level in the catchment. The simulated groundwater level shows a minus value (below the sea level) around the Tokyo metropolitan area because of excessive withdrawal around the urban area in the past. The model shows that the underground urban structures, sewage pipes, seashore concrete dikes, and embankments have changed the hydrologic cycle in the catchment and the nutrient supply to Tokyo Bay. In particular, the groundwater flow is interrupted and the phase is delayed, resulting in an increase in the groundwater level, and a decrease of groundwater seepage into Tokyo Bay. Furthermore, we propose four types of political scenario for provisioning human ecosystem service (ES) sites to promote infiltration. The simulated result forecasts that the groundwater level increases predominantly at a maximum value exceeding 40 cm in a scenario for farmland and productive green areas and that the level recovers in some parts of the urban area. This phenomenon is related to the cut-off of groundwater flow by underground urban structures and the sewer leakage into the aquifer, which also influences the decrease of submarine groundwater discharge around the western side of Tokyo Bay.

[A suction bottle for post-anesthesia evaluation of the distribution of consumed carbon dioxide absorber granules in the canister].

Anesthetic methods, apparatus, and respiratory care patterns have changed greatly in the past several decades. New scrutiny must be applied to patterns of carbon dioxide absorber consumption in the canisters in anesthesia circuits. Fine examination may be performed by extracting absorber granules by suction to avoid jumbling the granules in the canister. However, a general surgical suction apparatus has too narrow suction tubes, a low flow volume and too large reservoir bottles. We constructed a reservoir bottle of 1.5 l to trap the granules. The bottle is closed with an easily removable lid penetrated by inlet (with a larger diameter) and outlet cannulas. A conventional heat and moisture exchange filter is affixed to the outlet to prevent contamination of the suction system by alkaline absorber dust. Suction may be applied by a vacuum cleaner with a higher flow rate. Traditional recommendation to use baffles along the inside wall of the canister to prevent "channeling of exhaled gases by the wall effect" may turn out to be misleading.

[Lever type push-pull device for ACD-CPR].

Prolonged use of the CardioPump can cause fatigue and may impair performing the ACD-CPR maneuver accurately. We applied a lever mechanism to lessen the fatigue. The fixed part of the lever consists of a 40 cm metal pipe, 2 cm in diameter, mounted vertically to a rectangular metal base plate (45 cm x 20 cm) placed under the patient when the device is used. The fulcrum of the lever is positioned at any height on the vertical tube. One end of the 65 cm lever was connected to a pin-joint hub at the fulcrum. The height of the fulcrum is adjusted for each patient according to the anterior-posterior dimension of the thorax. The Cardio-Pump is mounted in a frame which is movable along the shaft of the lever between the fulcrum and the handle at the operator end of the lever. ACD-CPR is performed by lowering and raising the handle. The range of motion is controlled for safety by observing the movement of the chest wall of the patient from the side. We were able to maintain ACD-CPR with this device for more than 30 minutes without significant fatigue.

[A portable sternal compressor for cardiac massage on a patient carried by a litter--Part 3: Applicability of the device tested by a recording manikin].

Effects of a portable sternal compressor developed by us was examined by 43 medical students (28 males and 15 females) and 9 anesthesia residents using a recording manikin. Compression over a depth of 3.5 to 5.0 cm was classified as adequate. First, the examinee held the device affixed in front of the chest with a belt hanged over the shoulder and pulled the other handle back and forth at a rate of 100 per minute. The male students could perform adequate compression in 92% of the total number of compression in the first one minute, while female students could in 65%. Though the anesthesia residents accomplished 99% of success rate in the first one minute, the rate fell to nearly 80% in the next minute and about 50% thereafter due to fatigue. When one handle was sustained on the floor with its fold-in stand and held between the knees of the examinee sitting on a chair, adequate compression was performed with the success rate of over 80% for 5 minutes. We conclude this device will be useful for cardiac massage on a patient either transported on a litter or lying on a soft bed.

Relationship between cardiac output and mixed venous-arterialPCO 2 gradient in sodium bicarbonate-treated dogs.

We examined the relationship between cardiac output (CO) and mixed venous-arterialPCO 2 gradient ([Formula: see text]) along with the other variables derived from arterial and/or mixed venous blood gases in sodium bicarbonate-treated dogs. Six dogs with low cardiac output following cardiopulmonary resuscitation were used. CO, blood gases, and hemoglobin measurements were repeated every 20-30 min after administration of sodium bicarbonate or normal saline. All measurements were performed after the confirmation of a steady state of CO2 elimination by end-tidal CO2 monitoring. Arteriovenous oxygen content difference ([Formula: see text]), mixed venous oxygen saturation ([Formula: see text]), and[Formula: see text] were highly correlated with CO. The correlation coefficients between[Formula: see text],[Formula: see text], and[Formula: see text] werer=-0.81 (P<0.001),r=0.70 (P<0.001), andr=-0.77 (P<0.001), respectively. The results suggest that, if[Formula: see text] is measured during the steady state, except for the period during the transient increase in CO2 elimination just after the administration of sodium bicarbonate,[Formula: see text] can be used as an index of systemic perfusion even after the administration of sodium bicarbonate.

Sedative and respiratory effects of intramuscular midazolam as a premedicant: Influence of gender.

We compared the sedative and respiratory effects of intramuscular midazolam in men and women in a randomized, single-blind trial. The patients (203 men and 195 women) received a single dose of midazolam (0.05, 0.075, 0.1, or 0.15 mg·kg-1) intramuscularly 45 min before arriving at the operating room. Assessments in the operating room included sedation level and respiratory status rated on an objective four-point scale. Men given 0.075, 0.1, or 0.15 mg·kg-1 of midazolam exhibited greater sedation than did women given comparable doses. Midazolam 0.15 mg·kg-1 depressed respiration more frequently in men than in women. Plasma concentrations of midazolam were determined in 10 men, and 10 women randomly selected from the patients who received 0.15 mg·kg-1 of midazolam. A higher plasma concentration of midazolam, associated with a higher degree of sedation and respiratory depression, was attained in men than in women. These findings suggest that the optimal dose per unit body weight of intramuscular midazolam as premedication should be lower in men than in women to prevent over-sedation and respiratory depression.

Effects of halothane and enflurane on epithelium-dependent contraction and ion transport of canine tracheal epithelium.

To gain insight into the cellular mechanisms involved in bronchodilation induced by inhalation anesthetics, we investigated whether halothane and enflurane can modulate functions of airway epithelium, such as epithelium-mediated bronchodilation and transepithelial transport. To measure the isometric tension of airways, paired rings of canine bronchi (4-6 mm OD), with and without the epithelium were mounted in Krebs-Ringer solution, gassed with 95% O2 and 5% CO2, and isometric tension was continuously recorded. To determine transepithelial transport, the posterior membranous portion of the trachea was mounted in Ussing-type chambers and the potential difference (PD), short-circuit current (SCC), and transepithelial resistance (R) were determined.Halothane and enflurane increased the contractile responses of the trachea to acetylcholine (ACh) in strips either with or without epithelium. However, this enhancement of the contractile responses by volatile agents was much larger with the epithelium than without. Furthermore, halothane tended to gradually increase and then decrease SCC of the trachea, but these changes were not statistically significant. These results indicate that halothane may modulate contractile response of the isolated trachea to ACh, but has no effect on ion transport by airway epithelium. The responsiveness of the trachea may be regulated independently of ion transport by airway epithelium.