Zero-determinant strategies are memory-one strategies in repeated　games which unilaterally enforce linear relations between expected payoffs of　players. Recently, the concept of zero-determinant strategies was extended　to　the class of memory-n strategies with n _ 1, which enables more compli-cated control of payoffs by one player. However, what we can do by　memory-n　zero-determinant strategies is still not clear. Here, we show that memory-n　zero-determinant strategies in repeated games can be used to control condi-tional expectations of payoffs. Equivalently, they can be used to control ex-pected payoffs in biased ensembles, where a history of action pro_les with large　value of bias function is more weighted. Controlling conditional expectations　of payoffs is useful for strengthening zero-determinant strategies, because play-ers can choose conditions in such a way that only unfavorable action pro_les　to one player are contained in the conditions. We provide several examples　of memory-n zero-determinant strategies in the repeated prisoner's dilemma　game. We also explain that a deformed version of zero-determinant strategies　is easily extended to the memory-n case.

Zero-determinant strategies are a class of memory-one strategies in repeated games which unilaterally enforce linear relationships between payoffs. It has long been unclear for what stage games zero-determinant strategies exist. We provide a necessary and sufficient condition for the existence of zero-determinant strategies. This condition can be interpreted as the existence of two different actions which unilaterally adjust the total value of a linear combination of payoffs. A relation between the class of stage games where zero-determinant strategies exist and other class of stage games is also provided.

The quadratic unconstrained binary optimization (QUBO) problem is categorized as an NP-hard combinatorial optimization problem. The variable neighborhood search (VNS) algorithm is one of the leading algorithms used to solve QUBO problems. As neighborhood structure change is the central concept in the VNS algorithm, the design of the neighborhood structure is crucial. This paper presents a modified VNS algorithm called "B-VNS", which can be used to solve QUBO problems. A binomial trial was used to construct the neighborhood structure, and this was used with the aim of reducing computation time. The B-VNS and VNS algorithms were tested on standard QUBO problems from Glover and Beasley, on standard max-cut problems from Helmberg-Rendl, and on those proposed by Burer, Monteiro, and Zhang. Finally, Mann-Whitney tests were conducted using α = 0.05, to statistically compare the performance of the two algorithms. It was shown that the B-VNS and VNS algorithms are able to provide good solutions, but the B-VNS algorithm runs substantially faster. Furthermore, the B-VNS algorithm performed the best in all of the max-cut problems, regardless of problem size, and it performed the best in QUBO problems, with sizes less than 500. The results suggest that the use of binomial distribution, to construct the neighborhood structure, has the potential for further development.

Wireless power transfer (WPT) systems have attracted considerable attention in relation to providing a reliable and convenient power supply. Among the challenges in this area are maintaining the performance of the WPT system with the presence of a human body and minimizing the induced physical quantities in the human body. This study proposes a magnetic resonant coupling WPT (MRC-WPT) system that utilizes a resonator with a grounded loop to mitigate its interaction with a human body and achieve a high-efficiency power transfer at a short range. Our proposed system is based on a grounded loop to reduce the leakage of the electric field, resulting in less interaction with the human body. As a result, a transmission efficiency higher than 70% is achieved at a transmission distance of approximately 25 cm. Under the maximum-efficiency conditions of the WPT system, the use of a resonator with a grounded loop reduces the induced electric field, the peak spatial-average specific absorption rate (psSAR), and the whole-body averaged SAR by 43.6%, 69.7%, and 65.6%, respectively. The maximum permissible input power values for the proposed WPT systems are 40 and 33.5 kW, as prescribed in the International Commission of Non-Ionizing Radiation Protection (ICNIRP) guidelines to comply with the limits for local and whole-body average SAR.

The power transmission effi ciency of a resonatorcoupled wireless power transfer (RC-WPT) system with some angular misalignments is examined in this paper. In addition to conventional single-spiral resonators, the dual-spiral resonators which we have proposed are used in the RC-WPT system. It was confi rmed that the power transmission effi ciency of the RC-WPT system decreased with the increment of angular misalignments. However, it was shown that the decayed power transmission efficiency due to the angular misalignments could be recovered by adding the appropriate axial displac ements between transmitting (Tx) and receiving (Rx) units.

A 38-year-old woman was referred to our hospital with a complaint of left buttock pain. Contrast-enhanced computed tomography and magnetic resonance imaging showed a 7cm smooth mass on the anterior sacrum adjacent to the small intestine and mesentery. The mass was suspected to be a gastrointestinal stromal tumor of the small intestine;however, a definitive diagnosis from radiological and clinical findings was impossible. Laparoscopic visualization revealed that there was no lesion in the small intestine;the mass situated in the retroperitoneally, in contact with the anterior sacrum around the aortic bifurcation. With a diagnosis of retroperitoneal tumor, laparoscopic resection was performed simultaneously. An incision was made in sigmoid mesentery, and the tumor was detached and resected preserving the anterior fascia of the hypogastric nerve. Intraoperatively the surface of the tumor was confirmed to be smooth, and there was no infiltration around the tumor, which facilitated handling and manipulation of the tumor for resection. The patient was discharged without any complications and the pathological diagnosis was benign schwannoma. Anterior sacral retroperitoneal schwannomas are rare and difficult to diagnose preoperatively. In this case, successfully management was achieved via simultaneous laparoscopic observation and resection.

A 52-year-old-man visited hospital with right lower abdominal pain. We diagnosed acute appendicitis and intraperitoneal abscess. We decided to perform interval appendectomy and started antibacterial treatment. Antibacterial treatment was successful and the patient was discharged. Laparoscopic appendectomy was performed six month later. Only thickening of appendix mucosa was found in the specimen, but postoperative pathological diagnosis revealed goblet cell adenocarcinoma(GCA)of appendix. There was a risk factor associated with invasion depth T4, we performed ileocecal resection(D3)one month after the first surgery. The postoperative pathological examination result was pT4aN0M0 pStageⅡ.Recurrence has not been observed 18 months later. This case was an appendiceal GCA which was accidentally found in a specimen after interval appendectomy and treated by additional surgery. Infrequently, there are some reports of acute appendicitis associated with appendiceal tumor. In clinical practice, it is difficult to perform interval appendectomy for all appendicitis cases after conservative treatment, but it is suggested that for complicated appendicitis, we should perform interval appendectomy in consideration of age, ADL, and social background.

Abdominal incisional hernia is a frequent complication of open abdominal surgery. We herein report a rare case in which the left lateral segment of the liver prolapsed as the contents of an abdominal incisional hernia.The patient was a woman in her 80s whose chief complaint was abdominal protrusions. She had undergone abdominal surgery for gallstones 30 years ago. Computed tomography revealed abdominal incisional hernias in the upper abdomen, from which the left lateral segment of the liver and the transverse colon had prolapsed. Laparoscopic hernia repair surgery was performed under general anesthesia. The intraoperative findings showed the adhesion of the round ligament of the liver to the abdominal wall and transverse mesocolon. The prolapsed left lateral segment of the liver appeared as if being pulled upward by the round ligament of the liver and the poor formation of the triangle ligament. Two hernia orifices were repaired using two meshes. Recently, laparoscopic hernia repair surgery is increasing. Laparoscopic hernia repair surgery is useful to observe the abdominal cavity, details of hernia orifice and content, and the check of repair’s completion.

We have developed ACTce‑CCM̶ Analysis and Coordination Tools of Clinical Ethics in Critical Care Medicine. The preparation process was carried out in four stages:construct setting and prototype creation, application of prototype version to fictitious cases, clarification of the construct based on focus group interviews, and a fact-finding survey on ethical issues and ethical adjustment. The completed version of ACTce-CCM consists of information organization and assessment frameworks, problem analysis and integration, problem lists, goals, care practices, and ethical adjustment. There are six frameworks for information organization and assessment:pathology and treatment, QOL and QOD, patient intention, family psychosocial situation, medical team situation, and the surrounding situation. The problem lists include those related to the patient, the family, and the medical staff. Goals include those of the medical team and the expected outcomes for the patient/family. Care practices and ethical adjustment consist of three aspects: direct patient care, direct family care, and medical team adjustment.

This study aimed to clarify outcome of the public health nursing practice conducted under the influence of COVID-19. A self-administered anonymous questionnaire survey was performed for 4th grader students at University from 2018 through 2020. The investigation items consisted of basic attributes, impression of public health nurse activity, learning motivation and learning target items. We compared shortened clinical practice and online practice enforced in 2020 and before. For 217 effective answers,＂A public health nurse was involved in practice sufficiently＂ was significantly low. In top learning achievement scores of 2020 included many of the items from the the learning target＂Process of public health nursing activity＂ and ＂Role and function of public health center and municipalities. In 2018 and 2019, learning achievement degrees were over 80% in 94.3% of 53 items while on the other hand it was only 32.1% in 2020. Learning achievement degrees were less than 60% in no items in 2018 and 2019 while it was 15.1% in 2020. For the techniques of health service and health practice for which the learning achievement degree were low in 2020, it is necessary to support students so that they can acquire them as a public health nursing practice ability.

To realize a stable and efficient wireless power transfer (WPT) system that can be used in any environment, it is necessary to inspect the influence of environmental interference along the power transmission path of the WPT system. In this paper, attempts have been made to reduce the influence of the medium with a dielectric and conductive loss on the WPT system using spiral resonators for resonator-coupled type wireless power transfer (RC-WPT) system. An important element of the RC-WPT system is the resonators because they improve resonant characteristics by changing the shape or combination of spiral resonators to confine the electric field that mainly causes electrical loss in the system as much as possible inside the resonator. We proposed a novel dual-spiral resonator as a candidate and compared the basic characteristics of the RC-WPT system with conventional single-spiral and dual-spiral resonators. The parametric values of the spiral resonators, such as the quality factors and the coupling coefficients between resonators with and without a lossy medium in the power transmission path, were examined. For the lossy mediums, pure water or tap water filled with acryl bases was used. The maximum transmission efficiency of the RC-WPT system was then observed by tuning the matching condition of the system. Following that, the transmission efficiency of the system with and without lossy medium was investigated. These inspections revealed that the performance of the RC-WPT system with the lossy medium using the modified shape spiral resonator, which is the dual-spiral resonator proposed in our laboratory, outperformed the system using the conventional single-spiral resonator.

We report the case of a 48-year-old woman with relapsed B-lineage acute lymphoblastic leukemia(B-ALL)following cord blood transplantation, in which leukemic cell CD22 antigens became negative after a single administration of inotuzumab ozogamicin(InO).At relapse, a major part of leukemic cells expressed CD19 and CD22 antigens, however some leukemic cells were negative for CD22. As treatment with blinatumomab proved ineffective, InO therapy was subsequently initiated