Incorporating reversible sacrificial bonds in network polymers not only toughens these materials but also endows them with self‐recoverability. However, self‐recoverability is only realized for dispersed energy less than 10 MJ m−3. It remains a challenge to achieve simultaneous high stretchability, toughness, and recoverability. Here, inspired by the structure of mussel byssus cuticles, a new design strategy is proposed and demonstrated to improve both the toughness and self‐recoverability of elastomers by introducing a microphase‐separated structure with different physical crosslink densities. This structure can be achieved using a carefully designed comonomer sequence distribution of hydrogen bonding units in an ABA‐type triblock copolymer. The A blocks form hard domains with dense crosslinking that prevents macroscopic deformation, while the B blocks form a softer matrix with sparse and dynamic crosslinks that serve as sacrificial bonds. This elastomer exhibits high toughness (≈62 MJ m−3), self‐healing, and most notably, excellent self‐recovery (recovery against 650% elongation and 17 MPa tensile stress with a dissipated energy >27 MJ m−3 at room temperature). This combination of toughness, self‐healing, and self‐recovery expands the range of applications of these advanced dynamic materials.

In this paper, we first elucidate the significant seasonality in long‐term trends in the Asian monsoon on a monthly mean basis. Advanced monsoon onsets over the Bay of Bengal and the western Pacific were evident in recent decades. Increasing rainfall in May along 10°N reflected the advanced monsoon onset. Decreasing rainfall trends in June along 10°N were also detected. Because the rainfall trends in July and August showed less significance, the monsoon transition phase should be discussed in the context of climate change rather than boreal summer mean field. The advanced monsoon onset and weakening of the monsoon during early summer are most likely to be attributed to the heat contrast between the Asian landmass and the tropical Indian Ocean. The heating trend over the Asian landmass primarily contributes to the heat contrast variability with the persistent SST increase in the Indian Ocean throughout the season.

ObjectivesSeveral instruments for evaluating patient complexity have been developed from a biopsychosocial perspective. Although relationships between the results obtained by these instruments and the length of stay in hospital have been examined, many instruments are complicated and not easy to use. The Patient Centred Assessment Method (PCAM) is a candidate for practical use. This study aimed to test the validity and reliability of the PCAM and examine the correlations between length of hospital stay and PCAM scores in a regional secondary care hospital in Japan.DesignProspective cohort study.Participants and settingTwo hundred and one patients admitted to Ouji Coop Hospital between July 2014 and September 2014.Main predictorPCAM total score in initial phase of hospital admission.Main outcomeLength of stay in hospital.ResultsAmong 201 patients (Female/Male=98/103) with mean (SD) age of 77.4±11.9 years, the mean PCAM score was 25±7.3 and mean (SD) length of stay in hospital (LOS) 34.1±40.9 days. Using exploratory factor analysis to examine construct validity, PCAM evidently has a two-factor structure, comprising medicine-oriented and patient-oriented complexity. The Spearman rank correlation coefficient for evaluating criterion-based validity between PCAM and INTERMED was 0.90. For reliability, Cronbach’s alpha was 0.85. According to negative binomial regression analyses, PCAM scores are a statistically significant predictor (p<0.001) of LOS after adjusting for age, gender, Mini Nutritional Assessment Short-Form, Charlson Comorbidity Index, serum sodium concentration, total number of medications and whether public assistance was required. In another model, each factor in PCAM was independently correlated with length of stay in hospital after adjustment (medicine-oriented complexity: p=0.001, patient-oriented complexity: p=0.014).ConclusionPCAM is a reliable and valid measurement of patient complexity and PCAM scores have a significant correlation with hospital length of stay.

Mechanisms of Staphylococcus aureus resistance to fluoroquinolones were characterized. Subunit A and B proteins of DNA gyrase were partially purified from fluoroquinolone-susceptible strain SA113 and resistant isolate MS16405, which was 250-to 1,000-fold less susceptible to fluoroquinolones such as ciprofloxacin, norfloxacin, ofloxacin, temafloxacin, and sparfloxacin than SA113 was. The supercoiling activity of the gyrase from SA113 was inhibited by the fluoroquinolones, and the 50% inhibitory concentrations of the drugs correlated well with their MICs. In contrast, the gyrase from MS16405 was insensitive to inhibition of supercoiling by all of the quinolones tested, even at 800 ,ug/ml. Combinations of heterologous gyrase subunits showed that subunit A from MS16405 conferred fluoroquinolone resistance, suggesting that an alteration in gyrase subunit A is a cause of the fluoroquinolone resistance in MS16405. Uptake of hydrophilic fluoroquinolones such as ciprofloxacin and norfloxacin by MS16405 was significantly lower than that by SA113. Furthermore, this difference was abolished by the addition of an energy inhibitor, carbonyl cyanide m-chlorophenylhydrazone, suggesting that an alteration in an energy-dependent process, such as an active efflux of hydrophilic quinolones, may lead to decreased drug uptake and hence to increased resistance to fluoroquinolones in MS16405. These findings suggest that the fluoroquinolone resistance in MS16405 is due mainly to an alteration in subunit A of DNA gyrase and may also be associated with an alteration in the drug uptake process.

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In aged individuals needing long-term care, occlusal support is associated directly with dysphagia and indirectly with malnutrition and activities of daily living via dysphagia.

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ObjectivesThe primary objective of this study was to develop the Japanese version of the Patient Centred Assessment Method (PCAM) and its user guide. The secondary objective was to examine the validity and reliability in the primary care setting.DesignCross-sectional study.SettingThree family physician teaching clinics located in urban residential areas in Tokyo, Japan.ParticipantsPatients who were aged 20 years or older, and who had an appointment with physicians at the three participating clinics.Main outcome measuresPatient complexity measured by PCAM and complexity/burden level measured by a Visual Analogue Scale (VAS).ResultsAlthough confirmatory factor analysis using a model described in a previous study revealed that the indices did not meet the criteria for good fit, exploratory factor analysis revealed a new three-factor structure of ‘Personal well-being,’ ‘Social interaction’ and ‘Needs for care/service.’ Cronbach’s alpha of PCAM was 0.86. Spearman’s rank correlation coefficients between PCAM scores and VAS scores were 0.51 for complexity (p<0.001) and 0.41 for burden (p<0.001). There were 42 patients (14.3% of total patients) with PCAM scores greater than its mean of 16.5 but with complexity VAS scores less than its mean of 20.8.ConclusionsThe Japanese version of PCAM and its user guide were developed through Japanese translation and cultural adaptation by cognitive debriefing. PCAM is a valid and reliable tool to assess patient complexity in the primary care settings in Japan. Additionally, although the correlation between total PCAM scores and complexity/burden as assessed by VAS was moderate, PCAM can more precisely identify patient complexity than skilled physician’s intuition.