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In this case report, we present an adult case of scoliosis following intrathecal baclofen (ITB) therapy. A 56-year-old female with stroke-induced right spastic hemiparesis for seven years underwent implantation of an ITB pump. Satisfactory spasticity control was achieved using 30 µg/day of baclofen; however, she began to complain of lumbar pain in the postoperative year (POY) 1. Scoliosis, which was not recognized preoperatively, was confirmed in POY 2 (Cobb angle of 19 degrees). It further progressed into a walking disturbance in POY 5 (Cobb angle of 28 degrees). Hence, posterior fusion with decompression was planned. Following the removal of the ITB pump, spasticity management was replaced by Botox injection. However, the progression of scoliosis and neurological conditions stabilized after the removal, and decompression surgery was electively performed in POY 6. Scoliosis remained stable during the two-year follow-up period (Cobb angle of 28 degrees). This case demonstrates the potential risk of ITB-induced scoliosis in an adult patient. Careful preoperative investigations and postoperative follow-up are recommended for patients on ITB therapy.

We have characterized highly conductive Si-doped GaN films with a high electron mobility of 112 cm2V−1s−1 at an electron concentration of 2.9 × 1020 cm−3, prepared using pulsed sputtering deposition (PSD). With an increase in the doping concentration, the absorption edge was found to shift toward a higher energy level, owing to the Burstein-Moss effect, thus making this material suitable for the transparent conductive tunneling electrodes of visible and ultraviolet-A light-emitting diodes. The full width at half maximum value of the near-band-edge (NBE) emissions in a photoluminescence spectrum measured at 77 K was as small as 185 meV, even for the sample with the highest electron concentration of 2.9 × 1020 cm−3. Such sharp NBE emissions from PSD-grown heavily Si-doped GaN films can be explained by an analytical model with a low compensation ratio θ of around 0.1, which is consistent with the exceptionally high observed electron mobility. These results indicate the strong potential of the low-temperature PSD growth technique for the formation of high-quality, heavily Si-doped GaN.

Background Phase II clinical trial funded by Ministry of Health, Labour and Welfare from 1995 to 2003 evaluated efficacy of pathology-based three-group treatment stratification for CNS germ cell tumors (GCTs). We here present long-term follow-up results. Methods Total 228 cases were registered. Germinoma was treated with carboplatin+etoposide (CARE) and extended-local irradiation, local irradiation was added for intermediate-prognosis-group, and poor-prognosis-group was treated with ifosfamide+cisplatin+etoposide (ICE) and whole-brain or craniospinal irradiation. Results Mean/median ages at diagnosis were 16.8/16 years and female-to-male ratio was 40-188. Registry included 123 germinomas, 76 intermediate-prognosis-group cases (including 38 germinoma with STGC), 28 poor-prognosis-group cases and 1 mature teratoma. Median 222-months follow-up was conducted, and 56 recurrences and 39 deaths were recorded. 10 and 20-year recurrence-free survival (RFS) for germinoma, intermediate and poor-prognosis-groups were 84/79%, 83/76% and 59/59%, respectively, and overall survival (OS) for each were 97/91%, 92/85% and 57/53%, respectively. Prognosis for germinoma with or without STGC was the same. Basal ganglia germinoma showed significantly shorter RFS but OS was not different from other locations. Median age at death was 24 years, and ages were significantly different depending on causes, such as disease-related (14 years on average) and complications (29 years). OS after recurrence at 5/10/20 years were 64/62/48%.Hormonal supplementation was seen in 82% for neurohypophyseal cases and antidiuretic hormone supplementation was most frequent (82%). Among available cases, 20-out-of-155 cases showed neoplastic/vascular complications, among which cavernous malformation was the most (n=9). Median period until complication presentation was 235 months, and the rate at 20 years was 11%. Conclusions Germinoma and intermediate-prognosis-group cases showed long-term survival for approximately 90%, while more intensive treatment would be necessitated for poor-prognosis-group. Long-term survivors often required hormonal supplementation, and increasing frequency of treatment-related complications was observed. There is no end of outpatient follow-up for CNS GCT patients.

BackgroundFamilies raising children with disabilities assume risks to their health and lives. Therefore, it is necessary to support these families to improve family empowerment, which is the ability of these families to control their own lives and to promote the collaborative raising of children with disabilities. This is the first online program development and interventional study focusing on the empowerment of families raising children with disabilities who live at home in Japan.MethodThe program consisted of four online peer-based group sessions. Moreover, the families engage in several activities in stages wherein they discover their own issues, find measures to resolve them, and take action, while visualizing interfamily relationships, including social resources, and the status of their family life, with facilitators and other peer members. This study was a non-randomized, waitlist-controlled trial. It compared the results of the intervention group (early group) and the waitlist-controlled group (delayed group). The participants were allocated to the early or delayed group in the order of their applications. The main outcome was family empowerment. Other outcomes are the caregiver burden, awareness of the use of social resources, self-compassion, and the quality of life (QOL) of primary caregivers. The timing of the online surveys was as follows: the initial evaluation (Time 1 [T1]) was conducted before the start of the first early group program, and post-intervention evaluation (Time 2 [T2]) was conducted immediately (within one week) after the early group had completed all four sessions (four weeks) of the program. Follow-up evaluation (Time 3 [T3]) was conducted four weeks after the post-intervention evaluation. This timing was the same in the delayed group, but the delayed group attended the program after a four-week waiting period, compared to the early group.DiscussionThe intention is to evaluate whether the provision of the program developed in this study and the evaluation test design are feasible and to verify the efficacy of this program.Clinical trial registrationThe UMIN Clinical Trials Registry (UMIN000044172), registration date: May 19, 2021. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050422

Background Families raising children with disabilities assume risks to their health and lives. Therefore, it is necessary to support these families to improve family empowerment, which is the ability of these families to control their own lives and to promote the collaborative raising of children with disabilities. This is the first online intervention program focusing on the empowerment of families raising children with disabilities who live at home in Japan. Method The program consists of four online peer-based group sessions. Moreover, the families engage in several activities in stages wherein they discover their own issues, find measures to resolve them, and take action, while visualizing interfamily relationships, including social resources, and the status of their family life, with facilitators and other peer members. This study is a non-randomized, waitlist-controlled trial. It compares the results of the intervention group (early group) and the waitlist-controlled group (delayed group). The participants are allocated to the early or delayed group in the order of their applications. The main outcome is family empowerment. Other outcomes are the caregiver burden, self-reported capability to use social resources, self-compassion, and the quality of life (QOL) of primary caregivers. The timeline of the online outcome evaluation is as follows: the initial evaluation (Time 1 [T1]) is conducted before the start of the first early group program, and post-intervention evaluation (Time 2 [T2]) is conducted immediately (within 1 week) after the early group completes all four sessions (4 weeks) of the program. Follow-up evaluation (Time 3 [T3]) is conducted 4 weeks after the post-intervention evaluation. This timing is the same in the delayed group, but the delayed group will attend the program after a 4-week waiting period, compared to the early group. Discussion The intention is to evaluate whether the provision of the program developed in this study and the evaluation test design are feasible and to verify the efficacy of this program. Trial registration The UMIN Clinical Trials Registry (UMIN000044172), registration date: May 19, 2021.

Stable carbon (δ13C) and oxygen isotope (δ18O) compositions of fossil brachiopod shells can be used to interpret paleoclimatic and paleoceanographic conditions. However, the initial isotopic composition of the living shells might be modified by diagenetic alteration. To assess the degree of this modification, we analyzed δ13C and δ18O and three common indicators of alteration in shells: minor element (manganese (Mn), iron (Fe), and strontium (Sr)) concentrations; cathodoluminescence (CL)/non-luminescence; and the shell microstructure of fossil Terebratalia coreanica and Laqueus rubellus (rhynchonellate brachiopod) shells from an exposure of conglomerates of the Tentokuji Formation (Pliocene, 3.85–2.75 Ma) in northeastern Japan. Two indices were used to quantify the preservation state of shell microstructure: the altered fiber ratio (AFR) and the altered fiber and puncta-filling cement ratio (AF-PCR). We qualified the degree of luminescence by measuring the mean cathodoluminescence index (MCLI), defined as the mean R values in a particular area of a CL image with RGB colors. The δ13C and δ18O values were negatively correlated with AFR or AF-PCR and MCLI. The sampling spots with high Mn and Fe concentrations also exhibited relatively low δ13C and δ18O. The δ13C and δ18O were more strongly correlated with Mn concentration than with Fe concentration. Therefore, of the three minor elements examined in this study, Mn concentration is the most reliable indicator of meteoric diagenesis in the studied shells. Unlike Mn and Fe concentrations, Sr concentrations in the modern and fossil brachiopod shells were similar, with overlapping ranges. This indicates that Sr concentration is not likely to be a good indicator of diagenetic alteration in the studied shells. Our study provides further evidence that multiple criteria should be applied and cross-checked when assessing diagenetic alteration of brachiopod shells.

Background Bispectral index (BIS) monitoring is a widely used non-invasive method to monitor the depth of anesthesia. However, in the event of surgeries requiring a frontal approach, placement of the electrode may be impossible at the designated area to achieve a proper BIS measurement. Methods We developed an investigational interface device to connect needle-electrodes to BIS sensors. The safety and clinical performance were investigated in patients who underwent surgery. Direct BIS values from a disposable BIS electrode and indirect values via the interface device were simultaneously recorded from the same areas of electrode placement in a single patient. The agreement between the direct and indirect BIS values was statistically analyzed. Results The interface device with a silver electrode demonstrated sufficient electric conduction to transmit electroencephalogram signals. The overall BIS curves were similar to those of direct BIS monitoring. Direct and indirect BIS values from 18 patients were statistically analyzed using a linear mixed model and a significant concordance was confirmed (indirect BIS = 7.0405 + 0.8286 * direct BIS, p Conclusions The interface device provides an opportunity for intraoperative BIS monitoring of patients, whose clinical situation does not permit the placement of conventional adhesive sensors at the standard location.

This paper reports AlN barrier Al0.5Ga0.5N high electron mobility transistors (HEMTs) with heavily Si-doped degenerate GaN contacts prepared by pulsed sputtering deposition. Selectively regrown n-type GaN contacts exhibit typical degenerate properties with the electron concentration and mobility of 2.6 × 1020 cm−3 and 115 cm2 V−1 s−1, respectively, resulting in a record low contact resistance R C of 0.43 Ω mm for the AlN/Al0.5Ga0.5N HEMTs. The AlN/Al0.5Ga0.5N HEMTs displayed a remarkable DC output characteristic with a maximum drain current density of 250 mA mm−1, a transconductance of 32 mS mm−1, and an On/Off ratio >106. The present results show potential overcoming challenges in ohmic contact formation for high-power and high-frequency AlGaN electron devices with high Al composition.

Objectives: Family caregivers raising children with severe motor and intellectual disabilities (SMID) experience the enormous burden of care. The concept of family empowerment is one of the important assessment indexes of family nursing from the perspective of providing comprehensive support for these families. The objective of this study was to identify the factors associated with the empowerment of families raising a child with SMID in Japan. Methods: We conducted a nationwide questionnaire survey involving 1659 primary caregivers raising a child with SMID through 89 special schools. We assessed the main outcomes using the Family Empowerment Scale (FES). We then conducted a multiple linear regression analysis to reveal the factors associated with family empowerment. Results: In total, 1362 primary caregivers were included in our study. Our results show that factors contributing to high FES scores are higher age of the primary caregiver, higher education, greater recognition of regional support, lower childcare burden, higher utilization of home visit services, higher usage of a childcare institution, higher household income, and stronger family bonding. Conclusion: Healthcare professionals should carefully assess the state of family empowerment of the primary caregivers who are younger and those who have low education, low household income, high childcare burden, and fragile bonding with the family. Second, they should encourage such families to use regional support resources for childcare. That is, policy makers should consider ways to promote home visits and institutional services for the care of children with SMID, aiming especially for the provision of well-coordinated care and services. Keywords: Caregivers, Child care, Disabled children, Family empowerment, Home nursing, Intellectual disability, Japan, Social supports

To investigate the relationship between the charge redistribution and ferromagnetism at the interface between perovskite transition-metal oxides $\mathrm{LaNi}{\mathrm{O}}_{3}$ (LNO) and $\mathrm{LaMn}{\mathrm{O}}_{3}$ (LMO), we performed x-ray absorption spectroscopy (XAS) and x-ray magnetic circular dichroism (XMCD) measurements on the sandwiched layer in the trilayer structures. In the LNO/LMO heterostructures, one electron (hole) per unit-cell area is transferred from Mn (Ni) to Ni (Mn) ions across the interface unless there is a spatial limitation in the layer accommodating the transferred charges. A detailed analysis of the $\mathrm{Ni}\ensuremath{-}{L}_{2,3}$ and $\mathrm{Mn}\ensuremath{-}{L}_{2,3}$ XMCD spectra reveals that the magnetization of Ni ions is induced only in $\mathrm{N}{\mathrm{i}}^{2+}$ ions at the interface, while that of Mn ions is induced in both $\mathrm{M}{\mathrm{n}}^{3+}$ and $\mathrm{M}{\mathrm{n}}^{4+}$ ions. Combining these results with the previous XAS results on bilayer structures revealing the asymmetric charge redistribution of the LNO/LMO interface [Kitamura et al., Appl. Phys. Lett. 108, 111603 (2016)] shows that Ni magnetization is induced only in the $\mathrm{N}{\mathrm{i}}^{2+}$ ions of the 1 ML LNO adjacent to the interface, while the magnetization of Mn ions is increased in the 3--4 ML LMO of the interfacial region. These results indicate a close relationship between the charge redistribution due to the interfacial charge transfer and the ferromagnetism of the LNO/LMO interface. Furthermore, the XMCD spectra clearly demonstrate that the vectors of induced magnetization of both ions are aligned ferromagnetically, suggesting that the delicate balance between the exchange interactions occurring inside each layer and across the interface may induce the canted antiferromagnetism of $\mathrm{N}{\mathrm{i}}^{2+}$ ions, resulting in weak magnetization in the 1 ML LNO adjacent to the interface.

m-Plane GaN and InGaN films were grown on m-plane ZnO substrates at ~350 °C by pulsed sputtering deposition. It was found that the critical thickness of the m-plane GaN films grown on ZnO lies between 25 and 62 nm, whereas 180-nm-thick m-plane In0.12Ga0.88N can be coherently grown on ZnO substrates, which is explained well by theoretical calculations based on an energy-balance model. The coherently grown m-plane InGaN on ZnO exhibited narrow X-ray rocking curves compared with the m-plane GaN grown on ZnO. These results demonstrate the benefit of lattice-matched ZnO substrates for epitaxy of high-quality nonpolar InGaN films.

GaN-based light-emitting diodes (LEDs) have been widely accepted as highly efficient solid-state light sources capable of replacing conventional incandescent and fluorescent lamps. However, their applications are limited to small devices because their fabrication process is expensive as it involves epitaxial growth of GaN by metal-organic chemical vapor deposition (MOCVD) on single crystalline sapphire wafers. If a low-cost epitaxial growth process such as sputtering on a metal foil can be used, it will be possible to fabricate large-area and flexible GaN-based light-emitting displays. Here we report preparation of GaN films on nearly lattice-matched flexible Hf foils using pulsed sputtering deposition (PSD) and demonstrate feasibility of fabricating full-color GaN-based LEDs. It was found that introduction of low-temperature (LT) grown layers suppressed the interfacial reaction between GaN and Hf, allowing the growth of high-quality GaN films on Hf foils. We fabricated blue, green, and red LEDs on Hf foils and confirmed their normal operation. The present results indicate that GaN films on Hf foils have potential applications in fabrication of future large-area flexible GaN-based optoelectronics.

This study examined quality of life and its associated factors in siblings of children with severe motor and intellectual disabilities in Japan. The participants were 789 siblings of children with a disability and their primary caregivers. We used the Kinder Lebensqualitat Fragebogen questionnaire to assess the quality of life of siblings. The mean age of the siblings in this study was 12.21 ± 3.07 years, and the mean quality of life score was 69.63 ± 12.55 points, which is higher than that of the general population of children of the same age. It was revealed that the following factors contributed to higher quality of life scores: a closer relationship with the child with a disability, younger age, the primary caregiver's lower care burden, later birth order of siblings (i.e., younger siblings), higher family empowerment, and female gender of siblings. The relationship with the child with a disability had the strongest influence on siblings' quality of life. Our study suggests the need for nursing interventions that focus on the whole family to enhance siblings' quality of life.

In this study, InAlN was grown on glass substrates using pulsed sputtering deposition (PSD) at room temperature (RT) and was applied to thin-film transistors (TFTs). The surface flatness of the InAIN films was improved by reducing the growth temperature from 350 °C to RT. Further, the electron mobility and concentration of the InAlN film that was grown at RT were observed to be strongly dependent on the In composition. It was also observed that the electron concentration could be reduced during the introduction of Al atoms into InN, which could most likely be attributed to the reduction in the position of the Fermi level stabilization energy with respect to the conduction band edge. Further, InAlN-TFT was fabricated, and successful operation with a field-effect mobility of 8 cm2 V−1 s−1 was confirmed. This was the first demonstration of the operation of TFTs based on the growth of InAlN on an amorphous substrate at RT.

Herein, we report the growth method of ultrathin indium nitride (InN) films on aluminum nitride (AlN) templates by sputtering and its application to field-effect transistors (FETs). Although island-like InN surfaces were formed at the initial film growth stage, the height of the islands on the surface could be controlled by changing the growth temperature. The height of the InN islands grown at 500 °C was lower than those grown at 440 °C and 480 °C. To demonstrate an application of the InN/AlN heterostructure to FETs, we fabricated FETs using a 2-nm-thick InN film grown on an AlN template. The FET with the InN channel grown at 500 °C exhibited a drain current density of 0.19 mA/mm and an on/off ratio of approximately 102 although the drain current of the FET with the InN grown at 450 °C was not adequately controlled by the gate bias. These results indicate that the growth condition of InN films is responsible for the characteristics of InN/AlN FETs.

Background: The number of Japanese children with developmental disabilities (DDs) has seen a steady increase in recent years. The parents and families of children with DD experience distress both at the time of DD diagnosis and afterward. Aim: This study aimed to elucidate the issues and needs of the parents of children with DD to facilitate the development of effective support strategies necessary to help the family handle the special needs of their child with DD. Methods: Japanese-speaking parents with children who were aged 3Y14 years and currently being treated in a hospital for DDs were invited to participate in one of three focus groups. A trained moderator led each 90-minute audio-recorded group using a semistructured interview guide. All transcripts were coded using thematic content analysis. Results: Six categories of parents’ significant issues were identified, with three of the categories classified as critical needs. Conclusions: The issues and needs identified in this study are useful for developing an effective family support program and a related performance framework. Key concerns include providing relevant information support, providing counseling and consultation support for parents and siblings, and providing resources to children with DD that are necessary to help them deal effectively with their disabilities.

Background: About 70% of Japanese children with severe motor and intellectual disabilities (SMID) live at home, and the number is increasing. Family members have an enormous burden of daily physical care for these children. A top priority is to understand quality of life (QoL), family function, and family empowerment to effectively support these families. We aimed to assess current living situations of families with a SMID child, and to reveal the relationships between QoL, family function, and family empowerment. Methods: Sixty-five family members from 34 families with a SMID child participated in this study. We assessed 5 parameters using the Japanese versions of the following instruments: World Health Organization Quality of Life 26 (WHOQOL26), Kinder Lebensqualitats Fragebogen (KINDL), Family Assessment Device (FAD), Family Adaptability and Cohesion Evaluation Scale KG-4 (FACESKG-4), and Family Empowerment Scale (FES). Correlation and multiple regression analyses were conducted; QoL score was the objective variable. Results: Participants included 54 parents (34 mothers, 20 fathers) and 11 siblings. The mean age of SMID children was 10.4 ± 5.03 years. Twenty-two children needed multiple types of medical care. The mean age of parents and siblings was 41.5 ± 6.16 years and 15.5 ± 2.35 years, respectively. The mean QoL score (3.28 ± 0.5) was similar to the Japanese average. The mean KINDL score (77.2 ± 12.1) was higher than those of previous studies. The mean FAD score was 1.97 ± 0.32. For FACEKG-4, the score of adaptability was correlated with WHOQOL score (r = 0.459, p < 0.05). The mean score of FES was 113.6 ± 14. As the result of multiple regression analysis, lower family FAD scores ([sb] = ?0.61, p < 0.01) indicated higher family function and greater age of participants (sb = 0.495, p < 0.01) was correlated with higher WHOQOL scores (F = 15.208, p < 0.01). Conclusions: Our results indicated that the individual QoL depended on the age of participants (equals the years of experience caring for a SMID child) and the recognition of family function as a whole. Thus, to improve family members’ QoL, we should focus on individuals and also approach the family as a whole.

The number of children with Severe Motor and Intellectual Disabilities (SMID) receiving medical treatment/recovering at home is rising yearly. Although benefits of this care are emphasized, the stress and duties of family members in the household are extremely great, especially because Japan is becoming a society of nuclear families. In this study, we described the lifestyles of nuclear families providing in-home medical care for children with SMID, focusing on family members’ roles. Roles of mothers, fathers, and siblings of children with SMID were summarized from semi-structured inter-views. As a result, for “the roles of each family member living with a child with SMID”, mothers had five roles, fathers seven, and siblings five. For “the hopes of each family member living with a child with SMID”, parents desired the whole family collaboration in care for children with SMID, and as caregivers, parents’ common thoughts included wanting siblings in order to help care for the child with SMID and wanting siblings to treasure their own lives. Siblings wanted their mother to have some time for rest and expected their fathers to have two main roles. They also expected their grandparents and other siblings to fulfill roles.

Background: “Children with severe motor and intellectual disabilities” refers to children with markedly limited activity due to severe overlapping of physical and intellectual disabilities. The physical and mental burden placed on families raising severely disabled children, particularly the primary caregivers, is great in home settings. For families to effectively utilize services and over-come child rearing problems, the families themselves need the “strength” to cooperate with others for the purpose of raising a severely disabled child. The ultimate goal of family support is to enable such families to achieve satisfaction and self-growth in child rearing. Methods: We used a questionnaire to survey 75 primary caregivers to empirically elucidate the empowerment and positive feelings towards child rearing of families raising children with severe motor and intellectual disabilities and the related factors. The t-test and Spearman’s rank correlation coefficient were used to examine the association with bivariates. A multiple regression analysis was conducted for empowerment and positive feelings. Results: Results revealed that life events, livelihood, awareness of social support and the child’s sleep problems were factors related to empowerment. Of these, awareness of social support from outside of the family was found to contribute the most to empowerment. Furthermore, improvement and maintenance of positive feelings towards child rearing reaffirmed the existence of empowerment in addition to reducing negative feelings towards child rearing and ensuring social support. Conclusions: Raising children with severe motor and intellectual disabilities requires specialist knowledge and skills. Support from professionals to empower the entire family is therefore important in order to strengthen positive feelings towards child rearing.

We examined the human papilloma virus (HPV) vaccination process in adolescent Japanese girls, including protective and obstructive factors to develop and practice enlightenment activities and educational interventions for promoting HPV vaccination to adolescent Japanese girls and their families. We conducted semistructured interviews with 20 adolescent Japanese girls who lived in the wider Tokyo area. To analyze the interview data, we adopted the modified grounded-theory approach. We identified three stages in the vaccination process: first encounter with cervical cancer and HPV vaccine, thoughts about vaccination, and adjustment with parents toward vaccination. The girls "knew" their knowledge and information on cervical cancer and the HPV vaccine from experts, parents, and friends, "considered and discussed" HPV vaccination in their own way or with parents, and "arranged" actual vaccination. This process was influenced by the promoting/obstructive factors in each stage. Healthcare providers should understand the experiences and feelings of adolescent girls who were confronted with HPV vaccination in the context of their vaccination process and conduct enlightenment activities to promote vaccination, keeping the promoting and obstructive factors suggested in this study in mind.