In this paper we report the first close, high-resolution observations of downward-directed terrestrial gamma-ray flashes (TGFs) detected by the large-area Telescope Array cosmic ray observatory, ...obtained in conjunction with broadband VHF interferometer and fast electric field change measurements of the parent discharge. The results show that the TGFs occur during strong initial breakdown pulses (IBPs) in the first few milliseconds of negative cloud-to-ground and low-altitude intracloud flashes, and that the IBPs are produced by a newly-identified streamer-based discharge process called fast negative breakdown. The observations indicate the relativistic runaway electron avalanches (RREAs) responsible for producing the TGFs are initiated by embedded spark-like transient conducting events (TCEs) within the fast streamer system, and potentially also by individual fast streamers themselves. The TCEs are inferred to be the cause of impulsive sub-pulses that are characteristic features of classic IBP sferics. Additional development of the avalanches would be facilitated by the enhanced electric field ahead of the advancing front of the fast negative breakdown. In addition to showing the nature of IBPs and their enigmatic sub-pulses, the observations also provide a possible explanation for the unsolved question of how the streamer to leader transition occurs during the initial negative breakdown, namely as a result of strong currents flowing in the final stage of successive IBPs, extending backward through both the IBP itself and the negative streamer breakdown preceding the IBP.
Motivated by the detection of a significant dipole structure in the arrival directions of ultrahigh-energy cosmic rays above 8 EeV reported by the Pierre Auger Observatory (Auger), we search for a ...large-scale anisotropy using data collected with the surface detector array of the Telescope Array Experiment (TA). With 11 years of TA data, a dipole structure in a projection of the right ascension is fitted with an amplitude of 3.3+- 1.9% and a phase of 131 +- 33 degrees. The corresponding 99% confidence-level upper limit on the amplitude is 7.3%. At the current level of statistics, the fitted result is compatible with both an isotropic distribution and the dipole structure reported by Auger.
Evidence for a large-scale supergalactic cosmic ray multiplet (arrival directions correlated with energy) structure is reported for ultra-high energy cosmic ray (UHECR) energies above 10\(^{19}\) eV ...using seven years of data from the Telescope Array (TA) surface detector and updated to 10 years. Previous energy-position correlation studies have made assumptions regarding magnetic field shapes and strength, and UHECR composition. Here the assumption tested is that, since the supergalactic plane is a fit to the average matter density of the local Large Scale Structure (LSS), UHECR sources and intervening extragalactic magnetic fields are correlated with this plane. This supergalactic deflection hypothesis is tested by the entire field-of-view (FOV) behavior of the strength of intermediate-scale energy-angle correlations. These multiplets are measured in spherical cap section bins (wedges) of the FOV to account for coherent and random magnetic fields. The structure found is consistent with supergalactic deflection, the previously published energy spectrum anisotropy results of TA (the hotspot and coldspot), and toy-model simulations of a supergalactic magnetic sheet. The seven year data post-trial significance of this supergalactic structure of multiplets appearing by chance, on an isotropic sky, is found by Monte Carlo simulation to be 4.2\(\sigma\). The ten years of data post-trial significance is 4.1\(\sigma\). Furthermore, the starburst galaxy M82 is shown to be a possible source of the TA Hotspot, and an estimate of the supergalactic magnetic field using UHECR measurements is presented.
Ultra high energy cosmic rays provide the highest known energy source in the universe to measure proton cross sections. Though conditions for collecting such data are less controlled than an ...accelerator environment, current generation cosmic ray observatories have large enough exposures to collect significant statistics for a reliable measurement for energies above what can be attained in the lab. Cosmic ray measurements of cross section use atmospheric calorimetry to measure depth of air shower maximum (\(X_{\mathrm{max}}\)), which is related to the primary particle's energy and mass. The tail of the \(X_{\mathrm{max}}\) distribution is assumed to be dominated by showers generated by protons, allowing measurement of the inelastic proton-air cross section. In this work the proton-air inelastic cross section measurement, \(\sigma^{\mathrm{inel}}_{\mathrm{p-air}}\), using data observed by Telescope Array's Black Rock Mesa and Long Ridge fluorescence detectors and surface detector array in hybrid mode is presented. \(\sigma^{\mathrm{inel}}_{\mathrm{p-air}}\) is observed to be \(520.1 \pm 35.8\)Stat. \(^{+25.0}_{-40}\)Sys.~mb at \(\sqrt{s} = 73\) TeV. The total proton-proton cross section is subsequently inferred from Glauber formalism and is found to be \(\sigma^{\mathrm{tot}}_{\mathrm{pp}} = 139.4 ^{+23.4}_{-21.3}\) Stat.\( ^{+15.0}_{-24.0}\)Sys.~mb.
Improvement in the control of delayed chemotherapy-induced nausea and vomiting (CINV) is needed. There is limited information on antiemetic prophylaxis for patients undergoing low-emetic-risk ...chemotherapy (LEC), and the optimal antiemetic treatment is not well understood. Therefore, we analyzed the risk factors for delayed CINV to aid in the development of individualized treatments.
This prospective multicenter study was conducted in 13 hospitals and included patients with solid cancers undergoing LEC. A total of 222 patients were enrolled between September 2013 and November 2014. The participants completed a daily diary for 5 days after the commencement of the first cycle of LEC to describe the daily incidence of CINV (yes/no). Furthermore, the participants described the severity of nausea and the amount of food intake with the help of VAS.
Two hundred and ten patients provided their data that were analyzed using multivariate logistic regression to examine the risk factors for delayed CINV. History of CINV, Eastern Cooperative Oncology Group performance status score ≥1, acute CINV, and single-day antiemetic prophylaxis were identified as independent risk factors for delayed CINV.
The current use of antiemetic prophylaxis according to the recommended guideline appears to effectively control delayed CINV in patients undergoing LEC. Therefore, patients with the abovementioned risk factors should be carefully observed, and their treatment should be adjusted according to their symptoms. The use of multiple-day dexamethasone may be beneficial for those patients who develop acute CINV, especially when it is accompanied by anorexia.
Active smoking is a risk factor for occupational injury, whereas its association with passive smoking is unknown. To evaluate the contribution of active and passive smoking to non-fatal occupational ...injury in manufacturing sectors, 2302 randomly selected workers aged 16–83 years working in 244 small- and medium-scale enterprises in Yashio city, Japan, were surveyed by means of a self-administered questionnaire. Smoking history, exposure to passive smoking, and occupational injury were evaluated by self-report. Exposure levels to passive smoking were assessed separately at work and at home as never, occasional, or regular exposure. Overall, 61.4% of men and 22.3% of women were current smokers. Among never smokers, 62.2% of men and 68.6% of women reported exposure to passive smoking either at work or home. Prevalence of occupational injuries was 36.2% for never, 43.3% for former, and 41.2% for current smokers among men and 19.7% for never, 22.2% for former, and 25.2% for current smokers among women. Among never smoking men, odds ratios (ORs) of occupational injury were 2.11 when regularly exposed to passive smoking at work or at home (
p=0.025), 2.27 at work (
p=0.015), and 3.08 at home (
p=0.106), in comparison to never smoking men who were never exposed to passive smoking either at work or at home (referent group). These associations were attenuated to be non-significant, after controlling for potential confounders. Never smoking men with occasional exposure to passive smoking were not significant ORs (1.11–1.19). In contrast, current and former smoking men had significant increases in adjusted ORs (1.57–2.00). In women exposed to smoking there was a non-significant increase in occupational injury. The present study indicates an expected increase in the risk of, occupational injury for current and former smoking men and suggests that exposure to passive smoking is a possible risk factor for never smoking men.
A cross-sectional study evaluated the contribution of daily sleep habits to occupational injuries. A self-administered questionnaire solicited answers about sleep, symptoms of depression, ...occupational injury, demographics, presence of diseases and lifestyle factors from 2,903 workers between the ages of 16-83 (mean 45) yr in small and medium-scale enterprises. Eight sleep habits were queried and dichotomized: 1) less or more than 6 hr of daily sleep, 2) taking more or less than 30 min to fall asleep (Difficulty initiating sleep; DIS), 3) awakening during sleep more or less than 3 times/wk (Difficulty maintaining sleep; DMS), 4) early morning awakening more or less than 3 times/wk (EMA), 5) definitely/somewhat difficulty waking up or not, 6) sleeping very poorly/not so well at night or not, 7) definitely/somewhat insufficient nightly sleep or not, and 8) difficulty in breathing during sleep more than once/week or less. Occupational injury was assessed by asking subjects ‘Have you ever been injured during your work, including minor scratches and cuts (Yes/No)?’ Both sleep and injury were assessed over the previous one year period. One-third of workers answered that they had experienced injury. Workers with sleep features of DIS, sleeping poorly at night, insufficient sleep, and insomnia had a significantly higher prevalence for injury after adjusting for multiple confounders. The findings suggest that poor nocturnal sleep habits are associated with self-reported occupational injury.
The purpose of this study was to assess the incidence, features, and pathogenesis of microscopic injuries to the cardiac conduction system caused by cardiopulmonary resuscitation.
: Prospective ...study.
Autopsy unit of the university.
Victims who had been transferred to the emergency room due to cardiac arrest arising from nontraumatic cause plus age-matched control patients.
None.
The cardiac conduction system of 80 hearts without gross injury from patients who had received cardiopulmonary resuscitation due to nontraumatic causes was examined. Of these 80 patients, seven (9%) showed fresh injuries, including a lesion that had gone unreported in the previous literature. Localized hemorrhage without inflammatory reaction was evident in six of these patients. Three of the six patients showed hemorrhage in the sinoatrial node, whereas the other three patients showed hemorrhage in the atrioventricular conduction system. The remaining one patient showed localized dissection of the atrioventricular node artery with the appearance of red blood cells in the false lumen. There was no significant difference with regard to age, gender, cause of cardiopulmonary arrest, whether victim had received electrical shock treatment, whether victim had received anticoagulants, and the duration of cardiopulmonary resuscitation between the seven patients with fresh injuries and the other 73 patients. Fracture of the sternum or rib was found in only one of the seven patients but in 14 of the 73 patients. No pathologic lesions were found in the 30 control patients who did not receive cardiopulmonary resuscitation.
It can be presumed that injuries to the conduction system do occur in limited regions during cardiopulmonary resuscitation. Minute differences in the location of the cardiac silhouette or cardiac conduction system also need to be considered, rather than just the severity of force to the anterior chest, when determining the pathogenesis of these injuries.
A 75-year-old woman presented with intracranial B-cell lymphoma associated with Behcet’s disease manifesting as headache and dizziness. She had been treated with prednisolone for 17 years, and ...colchicine for 4 years under a diagnosis of incomplete Behcet’s disease. Computed tomography revealed a 4-cm high density mass surrounded with diffuse edema in the right frontal lobe. Surgery removed a discolored red mass together with hematoma. The histological diagnosis was B-cell type malignant lymphoma. Malignant lymphoma is rarely associated with Behcet’s disease, as only 10 cases have been reported.
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