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Background: Non-motor symptoms in myasthenia gravis (MG) are rarely confirmed. Although there are some small cohort studies, a large-systemic survey has not yet been performed. Methods: We investigated the incidence and clinical characteristics of patients with MG who had taste disorders and alopecia using data of 1710 patients with MG enrolled in the Japan MG Registry 2021. Results: Among them, 104 (6.1%) out of 1692 patients and 138 (8.2%) out of 1688 patients had histories of taste disorders and alopecia, respectively. Among the patients with MG, taste disorders were significantly more common in women, those with severe symptoms, refractory MG, or thymoma-associated MG, and were less common in those with ocular MG. The taste disorders often occurred after the onset of MG and often responded to MG treatments. Alopecia was more common in MG patients with a history of bulbar palsy and thymoma, and it often occurred before the onset of MG and sometimes responded to MG treatments. Multivariate logistic regression analysis revealed taste disturbance was associated with worst quantitative MG score and thymoma-associated MG; and alopecia was associated with thymoma-associated MG. Conclusion: Clinicians should be aware of the non-motor symptoms in MG, especially in patients with severe myasthenic symptoms and thymoma-associated MG. [ABSTRACT FROM AUTHOR]

Background: Living in rural areas is a major contributor of health inequity. Tackling health inequity is important for primary care physicians. Therefore, it is important to compare the quality of primary care between rural and urban areas. To the best of our knowledge, this is the first study to examine the association between rurality and patient experience (PX) in Japan using validated measures. Methods: This cross-sectional study was conducted using online surveys. Participants were selected using a stratified random sample based on sex and age. The Japanese version of the Person-Centered Primary Care Measure (PCPCM) was used as an indicator of PX. We used the Rurality Index for Japan (RIJ) to measure rurality. Furthermore, we used multivariate linear regression analysis to examine the relationship between the RIJ and PCPCM after adjusting for confounders. Results: Of the 1112 eligible participants, 800 responded to the survey (response rate:71.9%). The mean PCPCM scores were 2.46 (standard deviation: 0.73) and median RIJ was 15 (interquartile range: 6–33). The crude and adjusted coefficients of rurality were − 0.02 (− 0.006–0.001, p = 0.114) and − 0.02 (− 0.005–0.001), respectively, demonstrating that rurality was not significantly associated with the total PCPCM score. Subgroup analyses were similar to the main analyses. Conclusion: We found that PX in primary care did not differ by rurality in the general Japanese population. [ABSTRACT FROM AUTHOR]

Background: The shortage and aging of surgeons in regional surgical care has been remarkable, and the importance of surgical education for young surgeons in the region is only increasing. However, there are very few reports about regional surgical education. This study aimed to clarify the current status and issues regarding surgical education in regional surgical care and to examine the ideal way to provide surgical education in the region. Methods: Two questionnaire surveys were carried out. (1) "Survey on the awareness regarding the education of young surgeons" was conducted by mail in institutions where surgeons worked. (2) "Survey on the current status of surgical education for young surgeons" was conducted via the Internet with surgeons under 40 years old and mentors at the same facility. Results: There were 175 respondents to survey (1), among whom 131 (75%) surgeons were interested in educating young surgeons, and 112 (64%) were actively participating in this educating. Regarding the best evaluation methods for mentors who are educating young surgeons, the most frequent answer was "I don't know (51%)". The number of respondents in survey (2) was 87, including 27 (31%) young surgeons and 60 (69%) mentors. Although there was no difference between young surgeons and mentors in the level of satisfaction with the current status of young surgeons, 37% of young surgeons in urban areas were dissatisfied with their current status, compared to 0% in the regional area (p < 0.05). Conclusions: Although surgeons did not have confidence in their own education, the level of satisfaction among young surgeons was high even in those providing regional surgical care. Development of an evaluation system for surgical education is necessary for young surgeons to receive more effective surgical education in the region. [ABSTRACT FROM AUTHOR]

Background: The workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors. Methods: An anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis. Results: One hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice. Conclusions: Through a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research. [ABSTRACT FROM AUTHOR]

Introduction: Alternative Food Networks (AFNs) are important sources of community-driven sustainable food production and consumption. It is apparent that despite the existing environmentally friendly ways of producing food, such networks are not yet multiplying at a rate which could help tackle climate change and biodiversity loss. This study is set in Sado island, Japan, which has become well known for its farming practices protecting the crested ibis, as well as its GIAHS status, but which also has an AFN beyond these accreditations. It investigates the challenges and opportunities of Sado's AFN to find ways to help it thrive, and give potential pointers for developing new AFN's. Methods: In this research I use a mix of experiential sensory ethnography, socially-engaged art and interviews to understand the challenges and opportunities of an AFN in Sado island, Japan. A range of Sado's AFN actors were engaged to provide a more holistic picture. Results: Young and new entrant farmers, food processors and retailers in Sado expressed the need for their work to be fun as well as in coexistence with nature, using innovative practices and models to make this a reality. AFN actors also revealed a great capacity to undertake numerous food and culture related events, for the purpose of community, throughout the year. Despite this, there are gaps in capacity, and a lingering negative image of farming and rural areas as difficult places to live. These factors are stemming the ability for new AFNs to begin and existing ones to thrive. Discussion: Giving farming a fun, empowering and positive image whilst creating greater networking capacity could strengthen this AFN and help create new ones in other ruralities. Further, better acknowledging the importance of the culture and arts through which people connect to nature could form a greater source of pride and motivation to stay in rural areas. [ABSTRACT FROM AUTHOR]

While previous reports have established the anti-inflammatory effects of hangeshashinto, the intracellular signal transduction pathways involved have yet to be elucidated. We aim to employ an experimental system using oral cancer cells to assess the impact of hangeshashinto on intracellular signal transduction pathways in response to stimulation by Porphyromonas gingivalis pathogen-associated molecular patterns (PAMP). Hangeshashinto demonstrated the ability to inhibit the production of interleukin (IL)-6 and IL-8 induced by P. gingivalis PAMP. Furthermore, hangeshashinto suppressed the activation of the IL-6 promoter stimulated by PAMP. Hangeshashinto, like Toll-like receptor (TLR) signaling inhibitors (resatorvid and C29) and an immunosuppressant (dexamethasone), exhibited the ability to suppress TLR-mediated activation of the transcription factor nuclear factor-κB (NF-κB) in response to PAMP stimulation. This study suggests that the anti-inflammatory effects of hangeshashinto may be attributed to the inhibition of TLR signal transduction pathways including NF-κB activation, thereby suppressing NF-κB-dependent gene expression. [ABSTRACT FROM AUTHOR]

Background: Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. Methods: This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. Results: Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. Conclusions: The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals. [ABSTRACT FROM AUTHOR]

Simple Summary: Surgery is the most effective treatment for early-stage lung cancer, but it poses a heavy physical burden. Accordingly, understanding the perioperative daily life conditions of patients is important to maintain their health status and to provide appropriate treatment. We performed a prospective study to examine the socioclinical factors associated with the physical quality of life of patients who underwent surgery for lung cancer at Shonan Kamakura General Hospital, Kanagawa, Japan. In the preoperative setting, living alone and lower performance status were independently associated with worse physical quality of life. In the postoperative setting at 6 months, later smoking cessation, lower performance status, living alone, and higher comorbid burden were independently associated with worse physical quality of life. In order to maintain quality of life and provide enough treatment, perioperative management should include taking care of the patient's physical condition, lifestyle, smoking, and comorbid status. Surgery is the most effective treatment for early-stage lung cancer; however, it poses a higher physical burden than other treatment options. Therefore, understanding the perioperative course of patients is important. Using the Short Form Health Survey 36, we prospectively measured the physical quality of life of patients who underwent anatomical pulmonary resection for non-small cell lung cancer at Shonan Kamakura General Hospital, Kanagawa, Japan (n = 87). In the preoperative setting, patients who had lower performance status and lived alone had significantly worse physical quality of life scores on multivariate analysis (regression coefficient (95% confidence interval), −9.37 (−13.43–−5.32) and −10.22 (−13.74–−7.40), respectively, p < 0.0001 for both). At 6 months postoperatively, patients who stopped smoking within 1 year preoperatively (stopped smoking within 1 year vs. remote or never smokers, 41.0 ± 10.5 vs. 48.6 ± 7.2, p = 0.002), had lower performance status (0 vs. 1–2, 49.3 ± 6.6 vs. 38.6 ± 9.6, p < 0.0001), lived alone (living alone vs. living with somebody, 41.6 ± 9.7 vs. 48.1 ± 7.9, p = 0.021), and had higher comorbid burden (Charlson comorbidity index <3 vs. ≥3, 48.2 ± 6.9 vs. 39.1 ± 14.7, p = 0.003) had significantly worse physical quality of life scores on univariate analysis. More recent smoking (regression coefficient (95% confidence interval), −4.90 (−8.78–1.0), p = 0.014), lower performance status (8.90 (5.10–12.70), p < 0.0001), living alone (5.76 (1.39–10.13), p = 0.01), and higher comorbid burden (−6.94 (−11.78–−2.10), p = 0.006) were significant independent predictors of worse postoperative physical quality of life on multivariate analysis. Therefore, patients with these conditions might need additional support to maintain their physical condition after anatomical lung cancer surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: While stereotactic body radiation therapy (SBRT) has become increasingly used for the treatment of non-metastatic prostate cancer since its insurance coverage in Japan in 2016, optimal dose fractionation remains undetermined. This study was a phase 1 dose escalation trial of SBRT, aiming to assess the maximum tolerated dose (MTD) of SBRT using five fractions. Patients were planned to receive SBRT at doses of 42.5, 45, or 47.5 Gy, with toxicity as the primary endpoint. No dose-limiting toxicities were observed at 42.5 Gy, and one patient experienced a grade 4 rectal perforation at 45 Gy, leading to the determination of 42.5 Gy as the MTD. There were no deaths or biochemical recurrences during the follow-up period. This study underscores the need for further trials to ascertain the optimal SBRT dose fractionation, balancing efficacy and safety for non-metastatic prostate cancer treatment. The purpose of this study was to determine the maximum tolerated dose (MTD) for stereotactic body radiation therapy (SBRT) in the treatment of non-metastatic prostate cancer. This study was a phase 1 dose escalation trial conducted in Japan. Patients with histologically proven prostate cancer without lymph nodes or distant metastases were enrolled. The prescribed doses were 42.5, 45, or 47.5 Gy in five fractions. Dose-limiting toxicity (DLT) was defined as grade (G) 3+ gastrointestinal or genitourinary toxicity within 180 days after SBRT completion, and a 6 plus 6 design was used as the method of dose escalation. A total of 16 patients were enrolled, with 6 in the 42.5 Gy group and 10 in the 45 Gy group. No DLT was observed in the 42.5 Gy group. In the 45 Gy group, one patient experienced G3 rectal hemorrhage, and another had G4 rectal perforation, leading to the determination of 42.5 Gy as the MTD. None of the patients experienced biochemical recurrence or death during the follow-up period. We concluded that SBRT for non-metastatic prostate cancer at 42.5 Gy in five fractions could be safely performed, but a total dose of 45 Gy increased severe toxicity. [ABSTRACT FROM AUTHOR]

Lung cancer (LC) is currently the leading cause of cancer deaths in Japan. Early detection through lung cancer screening (LCS) is important for reducing mortality. Therefore, exploring the factors affecting willingness to undergo LCS, particularly among young people, is important. This study aimed to elucidate the inclination toward LCS and its determining factors among Japanese university students. This cross-sectional study, involving 10,969 Japanese university students, was conducted in April 2023. A Pearson's chi-square test and a binomial logistic regression analysis were used to analyze factors related to the dependent variable, willingness to undergo LCS in the future. Out of the 6779 participants (61.8%) involved in this study, 6504 (95.9%) provided valid responses, and 4609 (70.9%) expressed a willingness to undergo LCS in the future. Analysis revealed current smoking as a barrier to future willingness to undergo LCS. Other barriers included postponing the age of screening, anxiety about the screening content, and concerns about the possibility of having cancer after screening. Addressing barriers, such as current smoking and anxiety about screening, that prevent young people from undergoing LCS in the future is crucial. Therefore, universities should provide opportunities to educate students about LCS and explore various educational methods. [ABSTRACT FROM AUTHOR]

Monitoring and predicting fault slip behaviors in subduction zones is essential for understanding earthquake cycles and assessing future earthquake potential. We developed a data assimilation method for fault slip monitoring and the short-term prediction of slow slip events, and applied to the 2010 Bungo Channel slow slip event in southwest Japan. The observed geodetic data were quantitatively explained using a physics-based model with data assimilation. We investigated short-term predictability by assimilating observation data within limited periods. Without prior constraints on fault slip style, observations solely during slip acceleration predicted the occurrence of a fast slip; however, the inclusion of slip deceleration data successfully predicted a slow transient slip. With prior constraints to exclude unstable slip, the assimilation of data after slow slip event occurrence also predicted a slow transient slip. This study provides a tool using data assimilation for fault slip monitoring and prediction based on real observation data. [ABSTRACT FROM AUTHOR]

Background: Premenstrual syndrome (PMS) is prevalent among women of reproductive age, but most do not seek medical advice. We hypothesized that building PMS awareness could promote medical help-seeking for PMS and thus reduce menstrual symptoms and improve work productivity. Methods: In January 2020, women aged between 25 and 44 years, having paid work, and not currently consulting with an obstetrics and gynecology doctor (n = 3090) responded to the Menstrual Distress Questionnaire (MDQ), the Premenstrual Symptoms screening tool, and the World Health Organisation Health and Work Performance Questionnaire. In addition, they received checklist-based online education for PMS. Of 3090 participants, 2487 (80.5%) participated in a follow-up survey in September 2020. We conducted multiple logistic regression analyses and text analyses to explore factors that encouraged and discouraged medical help-seeking. We also evaluated changes in menstrual symptoms and work productivity, using generalized estimating equations with interactions between the severity of PMS, help-seeking, and time. Results: During the follow-up period, 4.9% of the participants (121/2487) sought medical help. Those having high annual income (adjusted odds ratio [aOR] = 2.07, 95% confidence interval [CI]: 1.21–3.53) and moderate-to-severe PMS (aOR = 2.27, 95% CI: 1.49–3.46) were more likely to have sought medical help. Those who did not seek medical help despite their moderate-to-severe PMS reported normalization of their symptoms (36%), time constraints (33%), and other reasons for not seeking medical help. Participants with moderate-to-severe PMS who had sought medical help showed a significant improvement of − 8.44 points (95% CI: − 14.73 to − 2.15 points) in intermenstrual MDQ scores during the follow-up period. However, there were no significant improvements in premenstrual and menstrual MDQ scores or absolute presenteeism. Conclusion: Medical help-seeking alleviated intermenstrual symptoms in women with moderate-to-severe PMS, but only a small proportion of them sought medical help after PMS education. Further research should be conducted to benefit the majority of women who are reluctant to seek medical help, including the provision of self-care information. Trial registration: UMIN Clinical Trials Registry number: UMIN000038917. [ABSTRACT FROM AUTHOR]

Spatiotemporal changes in catches and transition of fishing grounds have been observed in various coastal fishery resources in Japanese waters in recent years. Are these changes part of cyclical fluctuations on a centennial timescale? Are these changes situations that have never been observed prior to this? Are common factors included in the long-term fluctuations among coastal fisheries resources? A total of 12 important Japanese coastal fisheries resources including fishes, shells, invertebrates, and algae were analyzed using fisheries statistics on the geographical center of catch compiled since 1894. The time series of the geographical center of catch showed a cyclical fluctuation trend over time rather than changing monotonically. The geographic center of catch in recent years (2019-2021) was located at the northeastern margin of the distribution, compared to its location since the end of the 19th century for many fishery resources. For coastal fishery resources, the situation in terms of fluctuations in the geographical center of catch is more extreme than in the past 100 years. The results of the dynamic factor analysis suggested that the state of these resources may be affected by the global ocean environment and other factors including human activities. Examining how fisheries have responded to past cyclical fluctuations may provide insight into adapting to the current rapid changes caused by climate change. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) risk is influenced by socioeconomic status-related parameters, particularly occupation. We investigated occupational gaps in CHD risk and how the introduction of remote work moderated the observed occupational differences in CHD risk during the coronavirus disease 2019 pandemic in Japan. Data from a web-based, nationwide cohort study, comprising 17,640 workers (aged 20–65 years) with baseline data from December 2020, were analyzed. Participants were grouped by occupation as upper-level nonmanual workers (managers/professionals) and others (reference group). The primary outcome was CHD (angina pectoris/myocardial infarction) onset retrospectively confirmed at the 1-year follow-up survey. Upper-level nonmanual workers exhibited a higher CHD incidence than others (2.3% vs. 1.7%). This association was pronounced in the younger (20–49 years) population, with a significant CHD risk (adjusted risk ratio = 1.88). Upper-level nonmanual workers exhibited nearly 15% higher remote work prevalence, with a significant remote work-related CHD risk (adjusted risk ratio = 1.92). The mediating effects of remote work explained an overall disparity of 32% among the younger population. Occupational gaps in CHD incidence in Japan differ from those in Western countries, where upper-level nonmanual workers have lower cardiovascular risk. In Japan, remote work can mediate CHD risk in the younger population of upper-level nonmanual workers. [ABSTRACT FROM AUTHOR]

Recently, patients with out-of-hospital cardiac arrest (OHCA) refractory to conventional resuscitation have started undergoing extracorporeal cardiopulmonary resuscitation (ECPR). However, the mortality rate of these patients remains high. This study aimed to clarify whether a center ECPR volume was associated with the survival rates of adult patients with OHCA resuscitated using ECPR. This was a secondary analysis of a retrospective multicenter registry study, the SAVE-J II study, involving 36 participating institutions in Japan. Centers were divided into three groups according to the tertiles of the annual average number of patients undergoing ECPR: high-volume (≥ 21 sessions per year), medium-volume (11–20 sessions per year), or low-volume (< 11 sessions per year). The primary outcome was survival rate at the time of discharge. Patient characteristics and outcomes were compared among the three groups. Moreover, a multivariable-adjusted logistic regression model was applied to study the impact of center ECPR volume. A total of 1740 patients were included in this study. The center ECPR volume was strongly associated with survival rate at the time of discharge; furthermore, survival rate was best in high-volume compared with medium- and low-volume centers (33.4%, 24.1%, and 26.8%, respectively; P = 0.001). After adjusting for patient characteristics, undergoing ECPR at high-volume centers was associated with an increased likelihood of survival compared to middle- (adjusted odds ratio 0.657; P = 0.003) and low-volume centers (adjusted odds ratio 0.983; P = 0.006). The annual number of ECPR sessions was associated with favorable survival rates and lower complication rates of the ECPR procedure. Clinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/ctr%5fe/ctr%5fview.cgi?recptno=R000041577 (unique identifier: UMIN000036490). [ABSTRACT FROM AUTHOR]

Flood mitigation efforts (flood fighting), including raising awareness among local residents, have been crucial in Japan to reduce damage during flood events. In this study, interviews were conducted with three flood fighting management bodies on the Yodo and Yamato Rivers, which still have strong flood fighting corps, and field investigations were performed focusing on the actual operation of flood fighting warehouses, which serve as infrastructure bases for flood fighting. Targets included the flood fighting affairs associations on the left and right banks for the Yodo River and that on the right bank for the Yamato River. The survey results showed that with the progress of flood control measures and river improvement, opportunities to conduct actual flood fighting work during floods decreased in all cases in recent years, but flood fighting techniques and knowledge were passed on through exercises and drills. In addition, the flood fighting warehouses were well managed and maintained their functions as material and equipment storage places and as waiting and meeting places for flood fighting corps members. Considering the intensification of external flood forces due to future extreme weather changes, it was deemed that the role of the flood fighting corps is expected to increase in importance, and it was judged that preparations were being made to respond to this trend. On the other hand, there were some challenges in terms of securing a sufficient number of members due to the shortage resulting from the aging of the corps members and maintaining warehouses from a budgetary standpoint. [ABSTRACT FROM AUTHOR]

Background: The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview. Methods: This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient. Results: Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity. Conclusions: Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students. [ABSTRACT FROM AUTHOR]

The physical properties of seafloor massive sulfides are crucial for interpreting sub-seafloor images from geophysical surveys, shedding light on the evolution of seafloor mineral deposits. While some studies have explored the relationship between electrical properties and the volume of conductive minerals in rocks from seafloor massive sulfide deposits, they primarily focused on artificial samples, leaving the characteristics of natural samples less understood. Moreover, there has been no comprehensive study detailing the general characteristics of electrical properties, particularly chargeability and relaxation time, in relation to the volumetric fraction of sulfides in rocks from massive sulfide mounds in typical hydrothermal areas. In this study, we employed complex conductivity measurements, elemental concentration analysis, and mineral content identification on to rock samples from the active hydrothermal zones of the Okinawa Trough in Japan. The complex conductivity observed was remarkably high, with a pronounced imaginary component and a broad frequency range. This is attributed to induced polarization extending beyond our measurement range. The rock samples were rich in conductive sulfide minerals such as pyrite, chalcopyrite, and galena. Using the Cole–Cole rock physics model, we established a correlation between rock chargeability and relaxation time coefficient with the volume fraction of conductive sulfide minerals, which deviated from previous findings. The intensity of induced polarization was notably higher than anticipated in earlier studies using artificial samples. Furthermore, we observed a distinct positive correlation between the coefficient of relaxation time and the increase in sulfide volume, likely due to the geometric characteristics of the sulfide minerals. Our findings suggest that rocks in massive sulfide mounds may generally construct sulfide clusters that lengthen the conductive path of the electrical carrier. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, depression and suicide rates increased worldwide, and in Japan. Presumably, an increase of neuroticism-related personality traits mediates the relation linking the COVID-19 pandemic with depression and suicide. This study examined COVID-19 pandemic effects on dysfunctional attitudes, cognitive vulnerability to depression, in healthy participants. Methods: The study used Dysfunctional Attitude Scale (DAS) -24 data of three subscales (i.e., achievement, dependency, and self-control) obtained from 270 Japanese medical students during October 2017 – June 2022. Participants were divided into two groups: those for whom DAS-24 was assessed before the pandemic (phase 1 group, October 2017 – March 2020, n = 178) and those for whom DAS-24 was assessed during the pandemic (phase 2 group, April 2020 – June 2022, n = 92). Results: Total DAS-24 scores of the phase 2 group were significantly (p = 0.047) lower than those of the phase 1 group. Scores of the dependency subscale for the phase 2 group were significantly (p = 0.002) lower than those for the phase 1 group, but no significant difference was found in the scores of the achievement and self-control subscales. Conclusions: These findings suggest that a decrease in DAS-24 scores, particularly of the dependency subscale, occurred during the COVID-19 pandemic. Possible mechanisms underlying these results are 1) individuals became less preoccupied with receiving evaluation, 2) individuals realized that self-cognition depending on the approval of others is unimportant, and 3) high levels of dysfunctional attitude were maladaptive for obtaining affective benefits via social interactions during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background and Objectives: Androgen deprivation therapy (ADT) for prostate cancer has greatly improved treatment outcomes. As patient survival rates have increased, reports of decreased bone density and increased bone fractures as side effects of ADT have emerged. The prevalence of osteoporosis in Japanese men was 4.6%. The purpose of this study was to evaluate the effect of osteoporosis treatment in prostate cancer patients who underwent ADT in Japan. Materials and Methods: The subjects were 33 male patients who had undergone ADT for prostate cancer, who were noted to have decreased bone density. Mean age was 76.2 ± 7.7 years (64–87). Medications included vitamin D in one case, bisphosphonates (BP) in 27 cases, and denosumab in five cases. The evaluation method examined the rate of change in bone mineral density (BMD) before osteoporosis treatment and 1 year after. For comparison, a group without osteoporosis treatment intervention (n = 33) was selected, and matched for prostate cancer treatment and age. The rate of change in trabecular bone score (TBS) was also calculated. Results: The percentage changes in BMD before and 1 year after treatment were as follows: lumbar spine, 7.1 ± 5.8% in the treatment group versus −3.9 ± 4.1% in the no treatment group; femoral neck, 5.5 ± 6.2% in the treatment group versus −0.9 ± 3.9% in the no treatment group; total femur, 6.6 ± 6.4% in the treatment group versus the no treatment group which was −1.7 ± 3.2%. In all cases, there was a clear significant difference (p < 0.01). The percent change in TBS was further calculated in the same manner. There was no significant difference between the two groups: +1.7 ± 3.8% in the treated group versus +0.3 ± 4.1% in the untreated group. Conclusions: Osteoporosis treatment in Japanese patients with prostate cancer on ADT therapy was found to significantly increase BMD compared to the untreated group. BP and denosumab were found to be very effective in increasing BMD. [ABSTRACT FROM AUTHOR]

Background: Little information is available on the association between gender nonconformity during adolescence and subsequent mental health. While the distress related to gender nonconformity may be socially produced rather than attributed to individual-level factors, further research is needed to better understand the role of psychosocial factors in this context. Method: We analyzed data from the Tokyo Teen Cohort, obtained through random sampling of adolescents born between 2002 and 2004. We used inverse probability weighting to examine the association of gender nonconformity at ages 12 and 14 as a time-varying variable with subsequent mental health at age 16, while accounting for time-fixed and time-varying confounders. Furthermore, we used a weighting approach to investigate the mediating role of modifiable psychosocial factors in this association, addressing exposure-mediator and mediator–mediator interactions. Results: A total of 3171 participants were analyzed. Persistent gender nonconforming behavior at ages 12 and 14 was associated with subsequent depression (β = 2.02, 95% confidence interval [CI] 0.85 to 3.19) and psychotic experiences (β = 0.33, 95% CI 0.14 to 0.52) at age 16. The results remained robust in sensitivity analyses. Approximately 30% of the association between gender nonconformity and depression was consistently mediated by a set of psychosocial factors, namely loneliness, bullying victimization, and relationships with mother, father, and friends. Conclusions: Persistent gender nonconformity during adolescence is associated with subsequent mental health. Psychosocial factors play a vital mediating role in this association, highlighting the essential need for social intervention and change to reduce stigmatization and ameliorate mental health challenges. [ABSTRACT FROM AUTHOR]

Objective: A Mediterranean dietary pattern, sleeping habits, physical activity, and lifestyle appear to affect reproductive health. There are few reports about whether fertility-specific quality of life (QOL) is linked to infertility treatment outcomes. The aim of this study is to investigate when lifestyle factors and fertility-specific QOL are comprehensively considered, which factors influence assisted reproductive technology (ART) outcomes. Methods: This prospective cohort includes 291 women undergoing a first ART treatment at multiple centers in Japan and was designed to evaluate the influence of diet, physical activity, sleeping pattern, computer use duration, and fertility-specific quality of life tool (FertiQoL) score on ART treatment outcomes using a questionnaire. The primary endpoint was the good-quality blastocyst rate per oocyte retrieval and the secondary endpoints were a positive pregnancy test and gestational sac (GS) detection. Results: The good-quality blastocyst rate per oocyte retrieval tended to be negatively associated with frequent fish consumption. After all embryo transfer (ET) cycles, a positive pregnancy test tended to be positively associated with longer sleep and longer computer use (OR = 1.6, 95% CI = 0.9-2.7 and OR = 1.7, CI = 1.0-2.8, respectively) and negatively associated with a smoking partner (OR = 0.6, CI = 0.3-1.0). GS detection was positively and significantly associated with frequent olive oil intake and longer computer use (OR = 1.7, CI = 1.0-3.0 and OR = 1.7, CI = 1.0-3.0, respectively). After ET cycles with a single blastocyst, a positive pregnancy test was positively and significantly associated with longer computer use (OR = 2.0, CI = 1.1-3.7), while GS detection was significantly more likely in women with longer computer use (OR = 2.1, CI = 1.1-3.8) and tended to be more likely in women with a higher FertiQoL Total scaled treatment score (OR = 1.8, CI = 1.0-3.3). p < 0.05 was considered statistically significant and 0.05 ≤ p <0.01 as tendency. Conclusions: Olive oil may be an important factor in dietary habits. Fertility-specific QOL and smoking cessation guidance for partners are important for infertile couples. [ABSTRACT FROM AUTHOR]

In the era of globalization, the international community has witnessed a rapid increase in the number of low-skilled workers migrating from developing countries to industrial countries. However, there remain competing approaches to the governance of lowskilled labor migration; that is, the economic theory and the rights-based approach. By utilizing the labor migration between Vietnam and Japan under the Technical Intern Training Program (TITP), this article reveals the limitations of these two approaches in governing the migration of low-skilled workers. Moreover, through examining the Memorandum of Cooperation on the Technical Intern Training Program signed by the Vietnamese and Japanese governments in 2017 and its contribution to the TITP, this article suggests that to regulate labor migration properly, it is essential to uphold the rights-based approach and consider labor migration as a transnational issue that should be addressed at the international level; that is, through the bilateral or multilateral instruments. [ABSTRACT FROM AUTHOR]

Objective: Multisystem proteinopathy (MSP) is an inherited disorder in which protein aggregates with TAR DNA‐binding protein of 43 kDa form in multiple organs. Mutations in VCP, HNRNPA2B1, HNRNPA1, SQSTM1, MATR3, and ANXA11 are causative for MSP. This study aimed to conduct a nationwide epidemiological survey based on the diagnostic criteria established by the Japan MSP study group. Methods: We conducted a nationwide epidemiological survey by administering primary and secondary questionnaires among 6235 specialists of the Japanese Society of Neurology. Results: In the primary survey, 47 patients with MSP were identified. In the secondary survey of 27 patients, inclusion body myopathy was the most common initial symptom (74.1%), followed by motor neuron disease (11.1%), frontotemporal dementia (FTD, 7.4%), and Paget's disease of bone (PDB, 7.4%), with no cases of parkinsonism. Inclusion body myopathy occurred most frequently during the entire course of the disease (81.5%), followed by motor neuron disease (25.9%), PDB (18.5%), FTD (14.8%), and parkinsonism (3.7%). Laboratory findings showed a high frequency of elevated serum creatine kinase levels and abnormalities on needle electromyography, muscle histology, brain magnetic resonance imaging, and perfusion single‐photon emission computed tomography. Interpretation: The low frequency of FTD and PDB may suggest that FTD and PDB may be widely underdiagnosed and undertreated in clinical practice. [ABSTRACT FROM AUTHOR]

Following recent advancements in medical laboratory technology, the analysis of high-resolution renal pathological images has become increasingly important in the diagnosis and prognosis prediction of chronic nephritis. In particular, deep learning has been widely applied to computer-aided diagnosis, with an increasing number of models being used for the analysis of renal pathological images. The diversity of renal pathological images and the imbalance between data acquisition and annotation have placed a significant burden on pathologists trying to perform reliable and timely analysis. Transfer learning based on contrastive pretraining is emerging as a viable solution to this dilemma. By incorporating unlabeled positive pretraining images and a small number of labeled target images, a transfer learning model is proposed for high-accuracy renal pathological image classification tasks. The pretraining dataset used in this study includes 5000 mouse kidney pathological images from the Open TG-GATEs pathological image dataset (produced by the Toxicogenomics Informatics Project of the National Institutes of Biomedical Innovation, Health, and Nutrition in Japan). The transfer training dataset comprises 313 human immunoglobulin A (IgA) chronic nephritis images collected at Fukushima Medical University Hospital. The self-supervised contrastive learning algorithm "Bootstrap Your Own Latent" was adopted for pretraining a residual-network (ResNet)-50 backbone network to extract glomerulus feature expressions from the mouse kidney pathological images. The self-supervised pretrained weights were then used for transfer training on the labeled images of human IgA chronic nephritis pathology, culminating in a binary classification model for supervised learning. In four cross-validation experiments, the proposed model achieved an average classification accuracy of 92.2%, surpassing the 86.8% accuracy of the original RenNet-50 model. In conclusion, this approach successfully applied transfer learning through mouse renal pathological images to achieve high classification performance with human IgA renal pathological images. [ABSTRACT FROM AUTHOR]

(1) Background: This systematic review presents an overview of psychological interventions in suicide published between 2013 and 2023 in Spain and Japan, sparked by Spain's alarming recent increase in suicide rates and the potential exemplar of Japan's reduction efforts. (2) Methods: Following the PRISMA checklist, the databases Web of Science, Scopus, PubMed, and PsycInfo were searched using the terms [("suicide" OR "suicidal behavior" OR "suicidal attempt" OR "suicidal thought" OR "suicidal intention") AND ("prevention" OR "intervention" OR "psychosocial treatment" OR "Dialectical Behavior Therapy" OR "Cognitive Therapy" OR "psychotherap*")] AND [("Spain" OR "Spanish") OR ("Japan" OR "Japanese")]. We included articles published in peer-reviewed academic journals, written in English, Spanish, and Japanese between 2013 and 2023 that presented, designed, implemented, or assessed psychological interventions focused on suicidal behavior. (3) Results: 46 studies were included, concerning prevention, treatment, and training interventions. The risk of bias was low in both Spanish and Japanese studies, despite the lack of randomization of the samples. We identified common characteristics, such as psychoeducation and coping skills. Assertive case management was only highlighted in Japan, making an emphasis on active patient involvement in his/her care plan. (4) Conclusions: The findings will help professionals to incorporate into their interventions broader, more comprehensive approaches to consider more interpersonal components. [ABSTRACT FROM AUTHOR]

Older adult patients account for 70% of all hospitalized patients in Japan, and intermediate care based on patient-centered care (PCC) that ensures continuity and quality of care at the interface between home services and acute care services and restores patient's independence and confidence is necessary for them to continue living independently. At present, no concept of intermediate care is established in Japan, and the implementation of PCC has been delayed. Thus, in this study, a Japanese version of the intermediate care evaluation index (patient-reported experience measure (PREM)) was created on the basis of the original PREM developed in the UK, and data in wards with intermediate care functions in Japan were collected to confirm internal consistency and validity from 2020 to 2022. The Japanese version of PREM was found to have a factor structure with two potential factors. Given the clear correlation with the shared decision-making evaluation index, which is the pinnacle of PCC, the theoretical validity of the Japanese version of PREM, which is based on PCC as a theoretical basis, was confirmed. [ABSTRACT FROM AUTHOR]

Exercise training integrating physical and cognitive activities is gaining attention because of its potential benefits for brain health. This study focuses on exercise training using a dart game called Wellness Darts. Wellness Darts is a sport involving throwing darts and walking to pull them out of the board, memorizing the score, and subtracting this from the total score, thus requiring the simultaneous performance of two tasks: exercise and calculation. This is expected to maintain and improve cognitive function, and whether this continual darts training affects brain function is of great interest. Before conducting the longitudinal study revealing its effect on brain function, we aimed to cross-sectionally confirm the difference in hemispheric lateralization between expert and non-expert players. Functional near-infrared spectroscopy (fNIRS) was used to measure brain activity for three groups: an expert older group who practiced darts continually, a non-expert older control group, and a non-expert younger control group. Their brain activity patterns were quantified by the lateralization index (LI) and compared between groups. The results showed that the younger and the expert older groups had significantly higher LI values than the non-expert older group, and there was no difference between the expert older and the younger groups. Our results suggest that the Wellness Darts game possibly promotes hemispheric lateralization. [ABSTRACT FROM AUTHOR]

The reverse-yield factor (RF) database was developed for qualitatively and quantitatively disaggregating Japanese composite foods into raw primary commodity (RPC) ingredients. Representative equations for four types (dried, salted, fermented and mixed foods) were developed to calculate RFs using the food content and composition data for composite foods listed in the Standard Tables of Food Composition in Japan—2020—(STFCJ), published by the Ministry of Education, Culture, Sports, Science and Technology of Japan. Out of 1150 composite foods identified in the STFCJ, RFs for 54 dried, 41 salted, 40 fermented and 818 mixed foods were obtained. RFs for 197 mixed foods could not be calculated because these foods were produced from ingredients with no specified information and/or through complex processing. The content and composition of Japanese composite foods would be interpreted representatively by RFs in the developed database. [ABSTRACT FROM AUTHOR]

Simple Summary: The clinical course of classic Hodgkin lymphoma arising in immune deficiency/dysregulation (CHL-IDD) differs from that of CHL arising in immunocompetent cases and typically exhibits aggressive clinical behaviors. This study investigated the genetic aberration of 9p24.1 and protein expression of PD-L1 and also analyzed the clinicopathological association of these genetic lesions in CHL-IDD. Our findings showed that PD-L1 expression and 9p24.1 copy number alterations were observed in all patients analyzed in this study. Though it is recognized that an increase in 9p24.1 copy number alteration is associated with a more aggressive clinical course in immunocompetent CHL patients, we identified a subset of the 9p24.1 copy gain group, which had less 9p24.1 copy number alteration than the amplification group, exhibited more extensive extranodal lesions and had higher clinical stages in CHL-IDD cases. This finding speculates the presence of a genetically distinct subgroup within CHL-IDD patients, which may explain certain characteristic features. A subset of patients with rheumatoid arthritis receiving methotrexate develop immune deficiencies and dysregulation-associated lymphoproliferative disorders. Patients with these disorders often exhibit spontaneous regression after MTX withdrawal; however, chemotherapeutic intervention is frequently required in patients with classic Hodgkin lymphoma arising in immune deficiency/dysregulation. In this study, we examined PD-L1 expression levels and 9p24.1 copy number alterations in 27 patients with classic Hodgkin lymphoma arising from immune deficiency/dysregulation. All patients demonstrated PD-L1 protein expression and harbored 9p24.1 copy number alterations on the tumor cells. When comparing clinicopathological data and associations with 9p24.1 copy number features, the copy gain group showed a significantly higher incidence of extranodal lesions and clinical stages than the amplification group. Notably, all cases in the amplification group had latency type II, while 6/8 (75%) in the copy gain group had latency type II, and 2/8 (25%) had latency type I. Thus, a subset of the copy-gain group demonstrated more extensive extranodal lesions and higher clinical stages. This finding speculates the presence of a genetically distinct subgroup within the group of patients who develop immune deficiencies and dysregulation-associated lymphoproliferative disorders, which may explain certain characteristic features. [ABSTRACT FROM AUTHOR]

To reduce CO2 emissions in the residential and transportation sectors, distributed energy technologies, such as photovoltaic power generation (PV), stationary storage batteries (SBs), battery electric vehicles (BEVs), and vehicle-to-home (V2H) systems, are expected to be introduced. The objective of this study was to analyze the impact of the installed capacity of PV and SB, the type of vehicle, and their combination on the economic and environmental performance of the total energy consumption of residences and vehicles. Thus, this study developed a model to optimize the technological configuration of residential energy systems, including various vehicle types and driving patterns. The simulation results showed that it is more economically and environmentally efficient to install a BEV and a V2H system in households with longer parking times at the residence and to install an SB in addition to these technologies in households with shorter parking times at the residence. Furthermore, comparing a gasoline vehicle and an SB, the most economical combination, with a BEV and a V2H system and with a BEV, a V2H system, and an SB, estimated the carbon tax rate necessary for cost equivalence. The result indicated that the carbon tax rate needs to be increased from its current level. [ABSTRACT FROM AUTHOR]

The Seto Inland Sea (SIS) is the largest semienclosed coastal sea in Japan and has three connections with the outer seas. When a typhoon approached the SIS in September 2011, spatial variations of sea level elevation were observed across the SIS. Additionally, an unusual sea level rise (abnormal surge) occurred in Hiroshima Bay approximately 8 days after the typhoon passed, with the Itsukushima Shrine in the bay flooded by the surge. To understand themechanismof the abnormal surge in the bay and the relationship between sea level variations and circulation in the SIS, we investigated the 2011 event by applying a high-resolution numerical ocean circulationmodel using SCHISMwith bias correction for sea surface heights (SSHs) at the open boundary. The overall easterly throughflow due to the west-high eastlow SSH pattern in the SIS and temporary SSH disturbances due to typhoons were well reproduced in the model results. Among the three connections, the Bungo Channel mainly determined the overall net flux into the SIS and contributed significantly to sea level variations within the SIS. Additionally, the Kii Channel played more crucial roles in shaping the circulation and local sea level variations. The Kanmon Strait exhibited minor impacts. The abnormal tide in Hiroshima Bay was mainly attributed to seawater flux input from the outer seas, in conjunction with the subtidal internal seiche with the bay. The results will help us to further understand the physical processes of the ocean and establish evidence-based safety plans for reducing natural hazard damage. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to determine the extent to which consumers perceive food-related information to be tied to the intrinsic characteristics of food, particularly safety. Design/methodology/approach: The authors examined Japanese consumers' preferences regarding domestic or foreign perishables, as well as how they interpret origin information, focusing on their perceptions of safety using descriptive analysis and binary logistic regression analysis. Findings: The results indicated that a high proportion of Japanese consumers considered domestic foods to be safer; in particular, people affected by food safety information obtained through personal communication, books and magazines tended to choose domestically produced perishables rather than imported ones. Originality/value: The belief that domestic foods are safer than imported ones was highly universal among Japanese consumers, although this belief is not necessarily grounded in scientific evidence. When considering strategies to improve consumers' information literacy, factors that have fostered this belief must be discussed. For consumers to make logical food choices, both food businesses and consumers require scientific and informational literacy and policy support. [ABSTRACT FROM AUTHOR]

This study investigates the neutralizing activity against the XBB1.5 variant and the ancestral strain in a population post-bivalent vaccination using a pseudo virus assay validated with authentic virus assay. While bivalent booster vaccination and past infections enhanced neutralization against the XBB 1.5 strain, individuals with comorbidities showed reduced responses. The study suggests the need for continuous vaccine updates to address emerging SARS-CoV-2 variants and highlights the importance of monitoring real-world immune responses. [ABSTRACT FROM AUTHOR]

Tooth loss is prevalent in older adults and associated with functional capacity decline. Studies on the susceptibility of some individuals to the effects of tooth loss are lacking. This study aimed to investigate the heterogeneity of the association between tooth loss and higher-level functional capacity in older Japanese individuals employing a machine learning approach. This is a prospective cohort study using the data of adults aged ≥65 y in Japan (N = 16,553). Higher-level functional capacity, comprising instrumental independence, intellectual activity, and social role, was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The scale ranged from 0 (lowest function) to 13 (highest function). Doubly robust targeted maximum likelihood estimation was used to estimate the population-average association between tooth loss (having <20 natural teeth) and TMIG-IC total score after 6 y. The heterogeneity of the association was evaluated by estimating conditional average treatment effects (CATEs) using the causal forest algorithm. The result showed that tooth loss was statistically significantly associated with lower TMIG-IC total scores (population-average effect: −0.14; 95% confidence interval, −0.18 to −0.09). The causal forest analysis revealed the heterogeneous associations between tooth loss and lower TMIG-IC total score after 6 y (median of estimated CATEs = −0.13; interquartile range = 0.12). The high-impact subgroup (i.e., individuals with estimated CATEs of the bottom 10%) were significantly more likely to be older and male, had a lower socioeconomic status, did not have a partner, and had poor health conditions compared with the low-impact subgroup (i.e., individuals with estimated CATEs of the top 10%). This study found that heterogeneity exists in the association between tooth loss and lower scores on functional capacity. Implementing tooth loss prevention policy and clinical measures, especially among vulnerable subpopulations significantly affected by tooth loss, may reduce its burden more effectively. [ABSTRACT FROM AUTHOR]

Pain is a global health problem that leads to sedentary behavior and tends to cause negative emotion. In contrast, exercise is widely recommended for a health promotion, while pain often worsens with physical activity. Although exercise therapy is often prescribed to people with pain, the mechanisms of exercise effect on pain remains unclear. In this study, we tried to identify a universal association factor between regular exercise and pain intensity utilizing a cross-sectional web-based survey involving 52,353 adult participants from a large national study conducted in Japan. Using principal component analysis, we uncovered a mediation model of exercise effect on pain through psychological components. Analyses were performed in half of the population with pain (n = 20,330) and validated in the other half (n = 20,330), and showed that high-frequency exercise had a significant association with reduction in pain intensity. We also found Negative Affect and Vigor, two psychological components, are fully associating the exercise effect on pain (indirect effect = − 0.032, p < 0.001; association proportion = 0.99) with a dose-dependent response corresponding to the frequency of exercise. These findings were successfully validated (indirect effect of high-frequency exercise = − 0.028, p < 0.001; association proportion = 0.85). Moreover, these findings were also identified in subpopulation analyses of people with low back, neck, knee pain, and the tendency of the exercise effect on pain was increased with older people. In conclusion, the effect of exercise on pain is associated with psychological components and these association effects increased in parallel with the frequency of exercise habit regardless pain location. [ABSTRACT FROM AUTHOR]

Universities were the only educational institutions that restricted in-person lectures during the prolonged coronavirus disease 2019 (COVID-19) pandemic. This study is the first attempt to estimate the effects of restricting in-person lectures on containing the spread of COVID-19. Our investigation was conducted on Japanese universities since their various lecture styles are suitable for our analysis. A multiple-event study negative binomial regression model was employed, and the results showed that restricting the ratio of in-person lectures had limited effects on decreasing COVID-19 infections among university students. For example, if universities restrict almost all in-person lecture from a rate of over half of in-person lectures, the number of student infections would decline by 5.5 per 10,000 students between seven weeks before and after the change. Other lecture style changes had even smaller differences. In addition, we estimated the effect of the start of long breaks on the number of infections and found that they lead to a relatively higher level of infections regardless of lecture styles at the end of semesters. This implies that students are more likely to be infected outside than in class. [ABSTRACT FROM AUTHOR]

Tsunamis resulting from earthquakes can cause extensive damage, including infrastructure destruction, injuries, and fatalities. To address these risks, numerous tsunami evacuation simulations have been conducted to assess evacuation strategies and identify issues, particularly in Japan, where the Nankai Trough earthquake is anticipated, affecting underground malls in urban areas. Our previous research primarily focused on evacuating from underground to the surface, neglecting surface evacuation. Therefore, this study extended the previous study to include horizontal evacuation following the exit from the underground mall to ground level. It also considered the impact of pedestrian road crossings as interactions with vehicular traffic within the simulation to enhance realism and verify the evacuation risk. The study also explores scenarios where evacuation guide stairs are unavailable, comparing the effectiveness of alternative staircases in the evacuation plan. Results indicate that while using alternative staircases temporarily increases the number of evacuees reaching the surface, road crossings on evacuation routes become significant bottlenecks, leading to surface congestion and delayed evacuations. This raises doubts about the effectiveness of alternative staircases and highlights the need to consider alternative evacuation routes as a secondary plan. Additionally, the study reveals that reduced pedestrian flow at road crossings can significantly impact on evacuation times. Ultimately, this study demonstrated that achieving a short evacuation time from underground malls to the ground level might not always yield the best evacuation plan. It underscored the importance of considering aboveground factors in evacuation planning to ensure safety in the event of a tsunami caused by an earthquake. [ABSTRACT FROM AUTHOR]

In tourist facilities, managing ticket sales can reduce congestion imbalances. This study reports on the results of a pilot experiment conducted at Kaiyukan in Osaka, one of the largest aquariums in Japan. The experiment utilized pre-sale ticket data for controlling admission time intervals, smoothing the number of admissions through dynamic pricing, and predicting visitor numbers. The study reviewed the effectiveness of each of these approaches to alleviate congestion inside Kaiyukan. We then report on a method to predict the number of visitors from the pre-sale conditions of Kaiyukan admission tickets. It was found that setting entry times to 15-minute intervals was most operationally advantageous for the Kaiyukan. Moreover, the behavioral effects induced by variable pricing were more effective when prices were changed based on time slots rather than on a daily basis. Compared to the Holt–Winters' method, we were able to maintain stable prediction accuracy even during consecutive holidays and long school vacation seasons. [ABSTRACT FROM AUTHOR]

The mechanisms underlying stabilization of soil organic matter (SOM) in vegetated coastal ecosystems, including mangrove forests, are poorly understood, limiting our ability to predict the consequences of disturbances. Here, we introduce density fractionation to mangrove soils to identify the distribution and properties of the functional components of SOM regarding degradation state, stability, and origin, namely, the free low-density fraction (f-LF), mineral-associated LF (m-LF), and high-density fraction (HF). Three soil cores (1 m) were collected in a mangrove forest on Ishigaki Island, Japan, and cut into 10 cm intervals and analyzed. Although HF was the most abundant, the massive production of mangrove fine roots resulted in a high abundance of LFs throughout the cores, which markedly differed from terrestrial soils. Relative abundance of LFs together accounted for 38–66% of total soil C. The m-LF was as abundant as f-LF and 1.6 times higher in relative abundance than the global average of terrestrial soils. The C/N ratios and δ13C values clearly increased with depth in all fractions, which was attributed to the increased contribution from roots. We found a consistent pattern in Δ14C values of density fractions. HF was the oldest with Δ14C between −149‰ and −97‰ followed by m-LF (between −130‰ and −87‰) and then f-LF (between −89‰ and 78‰), suggesting that mineral association may be pivotal in long-term carbon storage in the mangrove mineral soil. Our analysis successfully identified meaningful functional components of mangrove SOM, yet several questions remained unanswered, including a large variability in Δ14C in different cores. Future studies would benefit from a coupled analysis of the quantity and quality of density fractions and geochemical factors in mangrove soils. [ABSTRACT FROM AUTHOR]

This study reconsidered educational materials by analyzing educators' opinions regarding handmade manipulative materials (HMMs) for children with profound intellectual and multiple disabilities in Japan. Instead of concurring with the view that educational materials are static and inert products, the author adopted an agential realist perspective and considered them as agencies working and becoming with teachers and children. The author interviewed two retired teachers who had spent more than 30 years in HMM production and analyzed the obtained data using a diffractive methodology. Findings showed that making and remaking HMMs allowed teachers and children to engage with actualizing concepts without language and demonstrated the open-ended nature of learning for teachers and children with HMMs. [ABSTRACT FROM AUTHOR]

Homicide followed by suicide (HS) is a tragic event with varied characteristics across countries and regions. Compared to Western countries, there are limited studies on HS in Asian countries. Therefore, this study aimed to clarify the characteristics of recent HS cases by examining forensic autopsy records from 2008 to 2020 collected from the Department of Legal Medicine, Chiba University, in Japan. A total of 77 HS cases were identified, involving 77 perpetrators (52 completed suicides, 25 attempted suicides), with 28 perpetrator and 89 victim autopsies. Our findings showed that older adults accounted for nearly half of the victims; victims were mostly females, whereas most perpetrators were male. The most common HS relationship was that between a parent and a child. Autopsy findings showed that the most common cause of death was strangulation, and illegal drugs were detected only in a few cases; however, psychotropic drugs were detected in child victims. No obvious evidence of past child physical abuse by caregivers was found. In contrast, intimate partner violence (IPV) was present, with a history of IPV found in half of HS cases involving adult intimate partner relationships. Notably, gender differences in age and relationship to the victim were identified. Likewise, some perpetrators may have expressed their plans and intentions for HS before the event, which may represent an important sign for HS prevention. However, to accurately reveal the course of HS, nationwide integrated statistics, forensic autopsies, including toxicological analyses of the deceased; and forensic psychiatric perspectives, including psychological autopsy, are required. [ABSTRACT FROM AUTHOR]

Oral care for critically ill patients helps provide comfort and prevent ventilator-associated pneumonia. However, a standardized protocol for oral care in intensive care units is currently unavailable. Thus, this study aimed to determine the overall oral care practices, including those for intubated patients, in Japanese intensive care units. We also discuss the differences in oral care methods between Japanese ICUs and ICUs in other countries. This study included all Japanese intensive care units meeting the authorities' standard set criteria, with a minimum of 0.5 nurses per patient at all times and admission of adult patients requiring mechanical ventilation. An online survey was used to collect data. Survey responses were obtained from one representative nurse per intensive care unit. Frequency analysis was performed, and the percentage of each response was calculated. A total of 609 hospitals and 717 intensive care units nationwide participated; among these, responses were collected from 247 intensive care units (34.4%). Of these, 215 (87.0%) and 32 (13.0%) reported standardized and non-standardized oral care, respectively. Subsequently, the data from 215 intensive care units that provided standardized oral care were analyzed in detail. The most common frequency of practicing oral care was three times a day (68.8%). Moreover, many intensive care units provided care at unequal intervals (79.5%), mainly in the morning, daytime, and evening. Regarding oral care methods, 96 (44.7%) respondents used only a toothbrush, while 116 (54.0%) used both a toothbrush and a non-brushing method. The findings of our study reveal current oral care practices in ICUs in Japan. In particular, most ICUs provide oral care three times a day at unequal intervals, and almost all use toothbrushes as a common tool for oral care. The results suggest that some oral care practices in Japanese ICUs differ from those in ICUs in other countries. [ABSTRACT FROM AUTHOR]

Background: In Japan, rituximab (RTX) for adult-onset frequently relapsing (FR)/steroid-dependent (SD) minimal change disease (MCD) is not explicitly reimbursed by insurance, and its standard regimen has not been established. Methods: We conducted a cross-sectional web-based survey between November and December 2021. The participants were nephrologists certified by the Japanese Society of Nephrology and answered 7 items about RTX for adult MCD. Factors related to the experience of RTX administration at their facilities were estimated by generalized estimating equations. Results: Of 380 respondents, 181 (47.6%) reported the experience of RTX use for adult MCD at their current facilities. Those who worked at university hospitals (vs. non-university hospitals, proportion difference 13.7%) and at facilities with frequent kidney biopsies (vs. 0 cases/year, 19.2% for 1–40 cases/year; 37.9% for 41–80 cases/year; 51.9% for ≥ 81 cases/year) used RTX more frequently. Of 181 respondents, 28 (15.5%) answered that there was no insurance coverage for RTX treatment. Of 327 respondents who had the opportunity to treat MCD, which was a possible indication for RTX, 178 (54.4%) indicated withholding of RTX administration. The most common reason was the cost due to lack of insurance coverage (141, 79.2%). Regarding RTX regimens for FR/SD MCD, introduction treatment with a single body surface area-based dose of 375 mg/m2 and maintenance treatment with a 6-month interval were the most common. Conclusion: This survey revealed the nephrologists' characteristics associated with RTX use, the barriers to RTX use, and the variation in the regimens for adult MCD in Japan. [ABSTRACT FROM AUTHOR]

We previously established the selection-marker-free rice-based oral cholera vaccine (MucoRice-CTB) line 51A for human use by Agrobacterium-mediated co-transformation and conducted a double-blind, randomized, placebocontrolled phase I trial in Japan and the United States. Although MucoRice-CTB 51A was acceptably safe and well tolerated by healthy Japanese and U.S. subjects and induced CTB-specific antibodies neutralizing cholera toxin secreted by Vibrio cholerae, we were limited to a 6-g cohort in the U.S. trial because of insufficient production of MucoRice-CTB. Since MucoRice-CTB 51A did not grow in sunlight, we re-examined the previously established marker-free lines and selected MucoRice-CTB line 19A. Southern blot analysis of line 19A showed a single copy of the CTB gene. We resequenced the whole genome and detected the transgene in an intergenic region in chromosome 1. After establishing a master seed bank of MucoRice-CTB line 19A, we established a hydroponic production facility with LED lighting to reduce electricity consumption and to increase production capacity for clinical trials. Shotgun MS/MS proteomics analysis of MucoRice-CTB 19A showed low levels of a-amylase/trypsin inhibitor-like proteins (major rice allergens), which was consistent with the data for line 51A. We also demonstrated that MucoRice-CTB 19A had high oral immunogenicity and induced protective immunity against cholera toxin challenge in mice. These results indicate that MucoRice-CTB 19A is a suitable oral cholera vaccine candidate for Phase I and II clinical trials in humans, including a V. cholerae challenge study. [ABSTRACT FROM AUTHOR]

Introduction: Bronchopulmonary dysplasia (BPD) poses a substantial global health burden. Individualized treatment strategies based on early prediction of the development of BPD can mitigate preterm birth complications; however, previously suggested predictive models lack early postnatal applicability. We aimed to develop predictive models for BPD and mortality based on immediate postnatal clinical data. Methods: Clinical information on very preterm and very low birth weight infants born between 2008 and 2018 was extracted from a nationwide Japanese database. The gradient boosting decision trees (GBDT) algorithm was adopted to predict BPD and mortality, using predictors within the first 6 h postpartum. We assessed the temporal validity and evaluated model adequacy using Shapley additive explanations (SHAP) values. Results: We developed three predictive models using data from 39,488, 39,096, and 40,291 infants to predict "death or BPD," "death or severe BPD," and "death before discharge," respectively. These well-calibrated models achieved areas under the receiver operating characteristic curve of 0.828 (95% CI: 0.828–0.828), 0.873 (0.873–0.873), and 0.887 (0.887–0.888), respectively, outperforming the multivariable logistic regression models. SHAP value analysis identified predictors of BPD, including gestational age, size at birth, male sex, and persistent pulmonary hypertension. In SHAP value-based case clustering, the "death or BPD" prediction model stratified infants by gestational age and persistent pulmonary hypertension, whereas the other models for "death or severe BPD" and "death before discharge" commonly formed clusters of low mortality, extreme prematurity, low Apgar scores, and persistent pulmonary hypertension of the newborn. Conclusions: GBDT models for predicting BPD and mortality, designed for use within 6 h postpartum, demonstrated superior prognostic performance. SHAP value-based clustering, a data-driven approach, formed clusters of clinical relevance. These findings suggest the efficacy of a GBDT algorithm for the early postnatal prediction of BPD. [ABSTRACT FROM AUTHOR]

Some countries have reported a post-pandemic resurgence in syphilis prevalence, but trend data in the World Health Organization Western Pacific Region (WHO-WPRO), including Japan, are severely lacking. Thus, the present study compares the number of syphilis cases before and after the COVID-19 pandemic in some WHO-WPRO countries. In addition, temporal trends in the number of syphilis cases in Japan pre- and post-pandemic are described. Annual numbers of syphilis cases during the study periods from China, New Zealand, Australia and Japan were compared. Annual trends of the numbers of syphilis cases during the same study periods were examined in Japan. In 2020, the number of syphilis-positive cases decreased in all four countries. In 2021, though, China, Australia and Japan all showed an increase in the numbers of syphilis cases. However, the rate of increase in China (+2.8%) and Australia (+4.8%) was low compared to Japan (+36.0%). The number of syphilis cases in New Zealand in 2021 was 12.6% lower than in 2020. In 2022, the number of cases of syphilis in China was 7.4% lower than in 2021. The increase of syphilis-positive cases was approximately 6.3-fold higher in Japan compared to Australia (+66.2% vs. +10.5%) in 2022. In conclusion, post-pandemic resurgence of syphilis occurred in Australia and Japan, but not in China and New Zealand. The reason for the substantial increase in syphilis-positive cases in Japan remains unclear. Post-pandemic, prevention and control of sexually transmitted infections still require attention. [ABSTRACT FROM AUTHOR]

Hypertensive disorders of pregnancy (HDP) increase the risk of preterm births and cesarean delivery. This study aimed to investigate whether maternal blood leukocyte, monocyte, or neutrophil counts in the first trimester are related to the development of HDP. Data were collected from the Japan Environment and Children's Study, a large birth cohort study (n = 38,194) that recruited pregnant women in 15 Regional Centers across Japan (from January 2011 to March 2014). The odds ratios (ORs) for mild/severe HDP according to the cut-off value of leukocyte/neutrophil/monocyte counts by the receiver operating characteristic curve showed high ORs. Furthermore, pregnant women with the highest quartiles of leukocyte and monocyte counts had higher adjusted ORs (aORs) for mild (leukocyte: aOR = 1.27, 95% confidence interval [CI]: 1.02–1.58; monocyte: aOR = 1.30, 95% CI 1.04–1.63) and severe HDP (leukocyte: aOR = 1.51, 95% CI 1.08–2.13; monocyte: aOR = 1.44, 95% CI 1.03–2.01) compared with those with the lowest quartiles of those counts. In addition, pregnant women with the highest neutrophil counts had higher aOR for mild HDP (aOR = 1.26, 95% CI 1.02–1.56) compared with those with the lowest count. In conclusion, high leukocyte and monocyte counts in the first trimester are associated with the development of HDP. Thus, they may be used to predict subsequent HDP. [ABSTRACT FROM AUTHOR]

Background: The dysphoric milk ejection reflex (D-MER) is a reflex that causes temporary discomfort during milk ejection. D-MER develops due to the effects of hormones involved in lactation, and it has been reported that it is a physiological symptom different from postpartum depression, but the actual situation is unknown in Japan. Methods: This study was conducted using a self-administered, anonymous survey of mothers of children who had undergone health checkups at three years of age at five health centers in Kagoshima city and aimed to clarify the reality and perceptions of mothers regarding D-MER. The survey period was from May to September, 2022. The questionnaires were distributed to 389 mothers, and 216 (55.5% recovery rate) responses were received, of which 202 (valid response rate 93.5%) were included in the analysis. Results: Regarding the experience of D-MER, 202 mothers in the study population had given birth to a total of 403 children and experienced D-MER when breastfeeding 62 children (15.4%). Of the 202 mothers included in the analysis, 47 (23.3%) answered that they had experienced D-MER with at least one child while breastfeeding. Sixty-six mothers (32.7%) knew about D-MER. Compared to those who had not experienced D-MER, those who had experienced D-MER had significantly higher scores on the items related to having had trouble breastfeeding (odds ratio (OR]: 3.78; 95% confidence interval (CI]: 1.57, 9.09) and knowing about D-MER (OR 2.41; 95% CI 1.20, 4.84). Regarding symptoms, irritability (n = 24, 51.1%), anxiety (n = 22, 46.8%), and sadness (n = 18, 38.3%) ranked high. Coping strategies included distraction, focusing on the child, and, in some cases, cessation of breastfeeding. Thirty mothers (63.8%) answered that they did not consult anyone, citing reasons such as a belief that no one would be likely to understand their symptoms, and that they could not sufficiently explain their symptoms. Conclusion: The low level of awareness of D-MER suggests that it is necessary to inform and educate mothers and the public about the physiological symptoms of D-MER. Moreover, it is necessary to listen to the feelings of mothers with D-MER and support them in coping with their symptoms. [ABSTRACT FROM AUTHOR]

Background: This study evaluates cost reduction in participants of a health awareness program (the Center of Healthy Aging Program, CHAP) in a Japanese rural area, characterized by an annual check-up and personalized interview on health issues and related risks immediately after the check-up. Methods: This is a cross-sectional study using medical and caregiving costs and Japan-specific health check-up results in Hirosaki residents stored by the local government, which were individually-based linked to the CHAP information collected by Hirosaki University. This is the first study that used anonymized data with individually-based linkages to both a research institute and a local government in Japan under a strict limitation regarding linking to third-party data. We included residents who had been continuously enrolled for > 6 months as of 1 July 2015. We compared 5-year all-cause costs between three groups (with CHAP, with Japan-specific health check-up, and no check-up) using a multivariate negative binomial regression model considering risk factors including lifestyle habits and an inverse probability weight to adjust for baseline characteristics: age, sex, Charlson comorbidity index, baseline care level, and risk score of coronary heart diseases. Results: A total of 384, 9805, and 32,630 residents aged 40–74 years were included for the CHAP, Japan-specific health check-up, and no check-up groups, respectively. The Japan-specific health check-up group showed older and higher Charlson comorbidity index than the others. After inverse probability weight adjusting, the amount of all-cause medical costs was significantly lower only in the CHAP group. Faster walking speed and exercise habits were independently associated with lower all-cause medical and caregiving costs. Conclusions: We demonstrated a 5-year all-cause cost reduction in residents who participated in the CHAP and also suggested the effect of exercise habits in Hirosaki, which indicated the significance of individually-based data linkages to external third-party data for all local governments to improve the health condition of residents. [ABSTRACT FROM AUTHOR]