Objective: The aim of this study was to propose a method for preparing motion pictures to visualize the geometrical propagation of influenza infection.  The Greater Tokyo area (Kanto region) of Japan, which has a population of 43 million, was considered as a typical epidemic area for the 2012/2013 flu season.  Therefore, we collected data regarding the daily variations in the number of flu patients from 285 pharmacies located in the Kanto region during that time period.
Design and Methods: To visualize the information mined from these big data, a motion picture consisting of 90 frames ranging from December 12, 2012 to March 21, 2013 was created.  Each frame depicted the daily image of infection as a circle centered at the pharmacy location on the background map, and its radius was proportioned to patient number.  The time variations of the flu patients at the pharmacies appeared to be noisy, which would cause the flickering on a display screen.  We adopted data smoothing and a model time series of the Gaussian distribution curve to circumvent the above problem.
Result: The created motion picture indicated that the 2012/2013 flu season began near the central part of Toyo in December, 2012, spread towards the suburbs, and ended in March, 2013.
Conclusion: The method proposed in this study can be considered an efficient and intuitive way to communicate essential epidemiological information.

To re-examine the effectiveness of spa bathing for chronic pain. The comparison study was between spa bathing and usual hot baths, with 41 patients, 7 with rheumatoid arthritis, 11 with cerebrovascular hemiplegia, and 23 with vibration syndrome.
The patients bathed once a day for 10min, at 40°C and then once a day for six consecutive days for 10min. at 40°C
There was not much correlation between blood circulation and chronic pain: but spa bathing showed a significant longterm improvement in lessening pain than did hot bathing. The spa bathing in lessening was most efficacious 120min. and 180min. after bathing.

Objective: A perception survey of healthcare providers and pharmaceutical industries about the current package insert (PI) was conducted to evaluate whether its layout and issues such as the contents concerning drug-drug interactions are found appropriate.
Methods: A questionnaire was sent via the Internet to physicians of various subspecialties, or via the postal service to pharmacy-employed pharmacists and pharmaceutical industries.  It consisted of questions regarding the PI layout, the information contents on drug-drug interactions and other matters about PI revision.
Results: The survey showed that the PI is a major source of drug information for physicians (82.4%) and pharmacists (98.7%).  The layout (order of appearance of headings and information about drug interactions in a tabular format) of the current PI is widely accepted by physicians, pharmacists, and pharmaceutical industries.  There was, however, some degree of disagreement within these three groups in the perceptions about the presentation/contents of the several drug interactions, as well as about the timing for its updating.  Around 24% of physicians and 35% of pharmacists view that the content of drug interactions is insufficient, and that information about adverse drug reactions and drug interactions is not enough updated in the PIs.  On the other hand, near 86% of pharmaceutical industries were prone to wait for accumulation of enough data until revising the information in PIs.
Conclusions: Differences of perception were found between healthcare providers (i.e., PI users) and industries.  Our survey revealed that the basic layout of the current PI should be preserved, but there are issues such as the contents and updating of information regarding drug interactions and adverse drug interactions that may require modifications according to the healthcare providers’ point of view.

Worldwide, avian influenza H9N2 viruses of different lineages are the most widespread viruses in poultry. However, to date, cases in Russia have not been documented. In this study, we report the first detection of a G1-like H9N2 virus from poultry sampled at live-bird markets in Russia (Far East region) during the winter of 2018 (isolate A/chicken/Amur_Russia/17/2018). We assume there has been further circulation of the A/chicken/Amur_Russia/17/2018 H9N2 virus in the Russian Far East with possible distribution to other regions or countries in 2018–2019.
Animals ; Far East ; Genotype ; Influenza A Virus, H9N2 Subtype ; Influenza in Birds ; Poultry ; Russia

Worldwide, avian influenza H9N2 viruses of different lineages are the most widespread viruses in poultry. However, to date, cases in Russia have not been documented. In this study, we report the first detection of a G1-like H9N2 virus from poultry sampled at live-bird markets in Russia (Far East region) during the winter of 2018 (isolate A/chicken/Amur_Russia/17/2018). We assume there has been further circulation of the A/chicken/Amur_Russia/17/2018 H9N2 virus in the Russian Far East with possible distribution to other regions or countries in 2018–2019.

Objective: Providing emergency care to serious patients in rural areas remains challenging. Intentional transit practice involves transporting a serious patient to a nearby hospital while requesting the Helicopter Emergency Medical Services (HEMS). This study aims to evaluate its effectiveness on earlier primary medical interventions and the decision of the destination hospital.Patient and Methods: We conducted a single-center, retrospective observational study at a HEMS base hospital in a rural area of Japan. The study participants included patients who underwent the intentional transit practice between April 2012 and March 2019. We compared actual times to estimated times for each case treated with the HEMS alone (HEMS-alone model). Outcomes were the time from ambulance call to reaching the physician (physician reaching time), arrival at the final destination facility (destination hospital arrival time), and helicopter waiting time at the landing zone (helicopter waiting time). Subgroup analyses by region and an analysis of the relationship between diagnostic tests performed at the transit hospital and the type of destination facility were performed.Results: Eighty-seven patients were eligible for analysis. Compared to the HEMS-alone model, the intentional transit practice reduced the physician reaching time (median [interquartile] min) (26 [21–32] vs. 37 [29–47], P<0.0001) while increasing the destination hospital arrival time and the helicopter waiting time (71 [58–93] vs. 65 [59–80], P=0.03; 24 [18–34] vs. 19 [18–21], P<0.0001; respectively). Subgroup analysis showed a consistent result for physician reaching time but heterogeneity in the other time courses by region. Diagnostic tests were related to transportation to facilities other than the HEMS base hospital.Conclusion: The intentional transit practice is beneficial for providing primary care earlier than the HEMS alone and for transport to more specific facilities. However, it delays arrival at the destination facility and increases helicopter waiting time.

Objective: Early recognition of shock status by paramedics significantly affects patient prognosis; however, its accuracy remains unclear. This study assessed the diagnostic accuracy of paramedics in classifying shock and the characteristics of misdiagnoses.Materials and Methods: This multicenter prospective observational study compared the on-scene shock diagnoses of paramedics between July 2022 and June 2023 with those of physicians upon hospital arrival.Results: The overall diagnostic accuracy for shock revealed substantial agreement (k=0.64), whereas diagnosis by category ranged from slight to moderate agreement (k=0.11–0.51). Patients without systolic hypotension were more frequently missed during diagnosis.Conclusions: Enhanced clinical education is needed to improve the accuracy of shock diagnosis by paramedics.