Background The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.
Residential demand-side management (DSM) of electricity has been gaining attention as a way to reduce energy consumption at home and as a way of maximizing the utilization of fluctuating solar power generation. To promote the smooth introduction of DSM into homes, power usage trends according to the time of the day should be examined for individuals in relation to their lifestyles. The analyses of power usage trends can identify the types of home appliances that should be utilized differently in order to increase energy efficiency. Such analyses can also predict the individual behavioral changes that should result in home appliances being used in the time slots in which solar power is more conveniently available. The purpose of this research was to estimate and observe the amount of power saving potential for each daily time slot with respect to an individual’s particular attributes, and to derive the power saving potential of the whole country by accumulating these data on individuals. This was achieved by using the Survey on Time Use and Leisure Activities (STULA) and Energy-Saving Performance Catalog (ESPC) in Japan. According to the results of our estimation, a meaningful power saving potential is sufficient to address a power supply shortage after a disaster such as an earthquake. It is possible to save power by replacing existing home appliances with more energy efficient ones, by making environmentally conscious choices when using home appliances, and by discontinuing the use of home appliances during electricity shortages within the community as a whole. Using the estimated power saving potentials, we examined the effects of two DSMs: (1) adjusting the time for which home appliances are used; and (2) aggregating the power demand of households with different attributes. The results showed that these DSMs would contribute to a more stable power system operation. Future research might address the rapid penetration of community energy management systems and demand response systems.
This study evaluates the acceptability of home energy management systems (HEMS) in New York and Tokyo using a questionnaire survey. We investigated three basic functions of HEMS: money saving, automatic control, and environmental impact, and then quantified people’s propensity to accept each of these three functions by measuring their willingness to pay. Using the willingness to pay results, we estimated the demand probability under a given usage price for each of the three functions of home energy management systems and analyzed how socio-economic and demographic factors influence the demand probability. The demand probability related to a home energy management system function decreases as the usage price of the function increases. However, depending on people’s socio-economic characteristics, the rate of decrease in demand probability relative to the rate of increase in usage price varies. Among the three functions of home energy management systems, we found that the automatic control function showed the highest demand probability in New York and Tokyo, emphasizing the significance of an automatic control function. In New York, when the home energy management system has an automatic control function, its demand probability increases, which is further enhanced if people trust their utility company. In Tokyo, when a home energy management system has an environmental impact function, its demand probability increases at a given price. People in Tokyo have anxieties related to new technologies such as home energy management systems. Therefore, it is necessary to enhance their comprehension of a home energy management systems to address this anxiety.
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