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Angle-resolved photoemission is a direct probe of the momentum-resolved electronic structure and proved influential in the study of bulk crystals with novel electronic properties. Thanks to recent technical advances, this technique can now be applied for the first time for the study of van der Waals heterostructures built by stacking two-dimensional crystals. In this article we will present the current state of the art in angle-resolved photoemission measurements on two-dimensional materials and review this still young field. We will focus in particular on devices similar to those used in transport and optics experiments, including the latest developments on magic-angle twisted bilayer graphene and on the in-operando characterization of gate tunable devices.

Increasing numbers of medical students participate in international electives. However, this recent trend has yet to be examined in non-Western high-income countries such as Japan. The aim of this study is to assess recent trends in Japan, and to suggest ways in which those trends might be influenced. A retrospective cross-sectional analysis of responses to an 8-item questionnaire sent in August 2019 to 82 medical schools in Japan is reported. The responses were received in September 2019. Narrative responses were obtained regarding rationales for exchange programs, participant feedback, and challenges encountered. Responses were translated into English and categorized into themes. Of 82 Japanese medical schools, 56 (68%) responded to the questionnaire. Both the number of incoming and outgoing exchange students had increased steadily over the preceding 3-year period. The leading destinations for Japanese students were the United States (30%), other Asian (36%), and European countries (24%). Narrative responses reveal different rationales from those reported by medical schools in Western high-income countries. Only a few Japanese students chose low or middle-income countries as their destinations, as opposed to the trend seen in Western high-income countries. The reported challenges encountered by the exchange programs may provide insights for improvement. Exchanges have been greatly affected by the coronavirus disease 2019 pandemic. The results can serve as prepandemic baseline data and should promote further international collaboration for medical education under current circumstances. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Diabetes mellitus is reported as a risk factor for increased coronavirus disease 2019 (COVID‐19) severity and mortality, but there have been few reports from Japan. Associations between diabetes mellitus and COVID‐19 severity and mortality were investigated in a single Japanese hospital. Materials and Methods: Patients aged ≥20 years admitted to Osaka City General Hospital for COVID‐19 treatment between April 2020 and March 2021 were included in this retrospective, observational study. Multivariable logistic regression analysis was carried out to examine whether diabetes mellitus contributes to COVID‐19‐related death and severity. Results: Of the 262 patients included, 108 (41.2%) required invasive ventilation, and 34 (13.0%) died in hospital. The diabetes group (n = 92) was significantly older, more obese, had longer hospital stays, more severe illness and higher mortality than the non‐diabetes group (n = 170). On multivariable logistic regression analysis, age (odds ratio [OR] 1.054, 95% confidence interval [CI] 1.023–1.086), body mass index (OR 1.111, 95% CI 1.028–1.201), history of diabetes mellitus (OR 2.429, 95% CI 1.152–5.123), neutrophil count (OR 1.222, 95% CI 1.077–1.385), C‐reactive protein (OR 1.096, 95% CI 1.030–1.166) and Krebs von den Lungen‐6 (OR 1.002, 95% CI 1.000–1.003) were predictors for COVID‐19 severity (R2 = 0.468). Meanwhile, age (OR 1.104, 95% CI 1.037–1.175) and Krebs von den Lungen‐6 (OR 1.003, 95% CI 1.001–1.005) were predictors for COVID‐19‐related death (R2 = 0.475). Conclusions: Diabetes mellitus was a definite risk factor for COVID‐19 severity in a single Japanese hospital treating moderately‐to‐severely ill patients. [ABSTRACT FROM AUTHOR]

Home adaptations are integral for inpatients with fall-related fractures, especially during discharge. However, it is unclear as to how patient-implemented home evaluations can be prioritized with limited professional rehabilitation resources. This study examines the associations between predisposing, enabling, and needs factors with the implementation of home evaluations in the eastern district of Tokyo. Being a female and lower comprehension in cognitive function was significantly associated with the implementation of home evaluations. It may be necessary to consider patients' cognitive function when deciding who to target for housing evaluations and to seek strategies to best estimate their needs. [ABSTRACT FROM AUTHOR]

Little is known about Marshallese palliative care practices. We explored traditional and contemporary Marshallese palliative care practices and examined generational differences. We performed three focus groups in 2011-2012 among Marshall Islanders in Hawai'i. A native speaking interpreter assisted group facilitators. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices, the effect of economic and social challenges in Hawai'i, and generational differences comparing young and old. Nineteen persons (10 men and 9 women, youth aged 17-27 years, and elders as defined in Marshallese culture, aged 46-79) participated. A "good death" was defined as "peaceful and pain free," occurring from natural causes. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, "black magic/curses," or lack of timely or proper burial. Comparing generational differences, older Marshallese had differing opinions regarding preferred place of death, burial site, cultural practice preservation, artificial prolongation of life, and cremation. Barriers included mortuary fees, cost of transporting bodies, United States (US) government policies, and wait times for death certificates. Many cultural factors contribute to "good" or "bad" deaths. Attitudes toward palliative care practices differ by generation. Having previously documented different approaches by Yapese, a generalized "one size fits all" approach to Micronesians is inappropriate. Overcoming identified barriers may facilitate practices necessary for a good death in Micronesian populations in their home nations and as they migrate to communities throughout the US. [ABSTRACT FROM AUTHOR]

Thin films of the correlated transition-metal oxide LaNiO3 undergo a metal–insulator transition when their thickness is reduced to a few unit cells. Here, we use angle-resolved photoemission spectroscopy to study the evolution of the electronic structure across this transition in a series of epitaxial LaNiO3 films of thicknesses ranging from 19 u.c. to 2 u.c. grown in situ by RF magnetron sputtering. Our data show a strong reduction in the electronic mean free path as the thickness is reduced below 5 u.c. This prevents the system from becoming electronically two-dimensional, as confirmed by the largely unchanged Fermi surface seen in our experiments. In the insulating state, we observe a strong suppression of the coherent quasiparticle peak, but no clear gap. These features resemble previous observations of the insulating state of NdNiO3. [ABSTRACT FROM AUTHOR]

An 83-year-old man developed hypoglycemia after undergoing total gastrectomy for gastric cancer in 200X-4. The patient was admitted to our hospital in May 200X and placed on continuous glucose monitoring (CGM). Glycemic excursions were examined while on 3-meal/day (1700 kcal) and 6-meal/day (1800 kcal) diets. Oxyhyperglycemia followed about 2 h later by a sudden drop in glucose levels was seen with both regimens. These findings were consistent with late dumping syndrome. CGM was continued, oral miglitol at 150 mg/day or sitagliptin at 50 mg/day was started, and glycemic excursions were compared. Results were similar for both drugs, with reductions in postprandial glucose elevations. Meal tolerance testing 3 months after oral sitagliptin, compared to before starting treatment, showed reductions in both early postprandial hyperglycemia and insulin hypersecretion. These findings suggest that DPP-4 inhibitors such as sitagliptin may be effective for treating post-gastrectomy late dumping syndrome. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes (T2DM) and sarcopenia have a reciprocal association and could cause a vicious cycle. Resistance training has been proposed to prevent the cycle. It has been postulated that the associated factors with upper limb muscle volume (MV) and lower limb MV were different in T2DM. For efficient resistance training programs, it is needed to understand the factors affect to the imbalance between upper and lower limb MV in T2DM. Aim: We aimed to clarify the clinical associated factors for lower-to-upper limb MV ratio in T2DM. Method: We assessed in 505 patients with T2DM visited at Osaka City Hospital (male: n=303, mean ages 63.5±13.1, female: n=202, mean ages 64.3±13.4). MV in upper and lower limb were measured by a bioelectrical impedance analysis. The association between lower-to-upper limb MV ratio and clinical parameters were investigated. Results: Mean body mass index (BMI) were 26.2±5.0kg/m2 in male and 26.8±5.5kg/m2 in female. Mean lower-to-upper limb MV ratio were significantly lower in male than female (male: 2.9±0.3 vs. female: 3.2±0.5, p<0.001). Mean lower-to-upper limb MV ratio in male was correlated with age, BMI, visceral fat area (VFA), estimated GFR (eGFR), hemoglobin (Hb), C reactive protein (CRP). In female, that was correlated with age, BMI, VFA, Hb, CRP and HbA1c. Multiple regression analysis showed that BMI and Hb were the negative independent factors, and VFA and systolic blood pressure were the positive independent factors for lower-to-upper limb MV ratio in male T2DM (R2=0.262, p<0.001). In female T2DM, BMI was the negative independent factor for lower-to-upper limb MV ratio. Notably, VFA exhibit positive correlation to lower-to-upper limb MV ratio in male obese T2DM (r=-0.252, p=0.001), but VFA negatively correlated in male non-obese T2DM (r=0.244, p=0.006). Conclusions: Gender, blood pressure, Hb and especially visceral obesity, were the important relevant factors for imbalance between upper and lower limb muscle volume in type 2 diabetes. Disclosure: K. Motoyama: None. S. Tazoe: None. A. Tamai: None. T. Sakura: None. M. Ohara: None. Y. Yakushiji: None. M. Fukumoto: None. M. Hosoi: Speaker's Bureau; Self; Eli Lilly and Company. [ABSTRACT FROM AUTHOR]

Background: It has been reported that the combination therapy of Glucagon-like peptide-1 receptor agonists (GLP-1RA) and Sodium-glucose Cotransporter 2 Inhibitors (SGLT2i) decrease micro-albuminuria in type 2 diabetes (T2DM) with nephropathy. There is the possibility that protective effects on estimate glomerular filtration rate (eGFR) and micro-albuminuria are different between (1) GLP-1RA add-on therapy to SGLT2i and (2) SGLT2i to GLP-1RA. Objective: In this study, we aimed to clarify whether there are differences in the changes of eGFR and micro-albuminuria depending on the order of combination therapy between (1) and (2) in T2DM. Method: We studied 69 patients with T2DM who took GLP-1RA together with SGLT2i in Our Hospital, retrospectively. We investigated urine albumin to creatinine ratio (ACR), eGFR, body mass index (BMI), systolic blood pressure (SBP), HbA1c, UA, Na, Cl, hematocrit (Ht) and platelet (Plt) before and after six months of the therapy. Six months changes (delta:Δ) of clinical parameters were compared between each combination therapy. Result: In all subjects, HbA1c, BMI and logACR were significantly decreased with the therapies, respectively. As the comparison of Δ in each clinical factors between (1) and (2) groups, ΔHbA1c of (1) significantly showed lower levels than (2). Whereas ΔNa and ΔCl of (1) significantly showed higher levels. Multiple regression analysis including ΔPlt, ΔHt, ΔUA, ΔBMI, ΔHbA1c, and the type of combination therapy as an independent factor for eGFR, ΔUA, ΔHt and ΔHbA1c were the significant contributing factors. Multiple regression analysis including ΔBMI, ΔHDL-C, ΔHbA1c, age, sex and the type of combination therapy as an independent factor for ΔlogACR, ΔHDL-C was the significant contributing factor. The type of combination therapy was not shown as a significant associated factor for ΔlogACR. Conclusions: Both GLP-1RA add-on therapy to SGLT2i and SGLT2i to GLP-1RA equally reduce albuminuria in T2DM with nephropathy. Disclosure: M. Ohara: None. K. Motoyama: None. A. Tamai: None. T. Sakura: None. Y. Yakushiji: None. M. Hosoi: Speaker's Bureau; Self; Eli Lilly and Company. [ABSTRACT FROM AUTHOR]

2D electron gases (2DEGs) in oxides show great potential for the discovery of new physical phenomena and at the same time hold promise for electronic applications. In this work, angle‐resolved photoemission is used to determine the electronic structure of a 2DEG stabilized in the (111)‐oriented surface of the strong spin–orbit coupling material KTaO3. The measurements reveal multiple sub‐bands that emerge as a consequence of quantum confinement and form a sixfold symmetric Fermi surface. This electronic structure is well reproduced by self‐consistent tight‐binding supercell calculations. Based on these calculations, the spin and orbital texture of the 2DEG is determined. It is found that the 2DEG Fermi surface is derived from bulk J = 3/2 states and exhibits an unconventional anisotropic Rashba‐like lifting of the spin‐degeneracy. Spin‐momentum locking holds only for high‐symmetry directions and a strong out‐of‐plane spin component renders the spin texture threefold symmetric. It is found that the average spin‐splitting on the Fermi surface is an order of magnitude larger than in SrTiO3, which should translate into an enhancement in the spin–orbitronic response of (111)‐KTaO3 2DEG‐based devices. [ABSTRACT FROM AUTHOR]

Introduction: Many Marshall Islanders seek healthcare services in Hawai'i. Little is known about traditional Marshallese palliative care practices. Our purpose was to learn about traditional Marshallese palliative care practices to provide culturally appropriate care. Methods: We performed 2 focus groups in 2011-2012 among Marshall Islanders living in or visiting the island of Oahu, Hawai'i. Group facilitators were uniformly trained to conduct focus groups using prepared script, with a native speaking interpreter. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices and the effect of economic and social challenges in Hawai'i. Results: Six females and seven males, ages 46-79 years, participated. A "good death" was defined as "peaceful and pain free," occurring naturally with avoidance of artificial life prolongation. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices such as Ilomej (wake) and Eorak (post-burial memorial service). Dying at home is the norm among people living in the Marshall Islands. After migrating to Hawai'i, having family present at the time of death was more important than the actual locale of death. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, or "black magic/curses," lack of timely burial or proper burial site. Barriers included mortuary fees, cost of transporting bodies, US government policies, and wait times for death certificates. Conclusions: There are many underlying cultural factors contributing to "good or bad" death. Overcoming identified barriers may facilitate cultural practices necessary for a good death. [ABSTRACT FROM AUTHOR]

Background: Unnecessary percutaneous endoscopic gastrostomy (PEG) tube feeding in nursing homes (NH) is a growing concern and an important area of research. Hawaii has one of the highest rates of PEG tube feeding in NH patients in the US, yet has lower rates than many NHs in Asian countries. We examined prevalence and factors associated with PEG tube feeding in NH patients in Hawaii. Methods: We conducted an observational cohort study of all patients admitted between 2003 and 2006 to an urban 180-bed hospital-affiliated NH in Honolulu, Hawaii. Data were collected from time of admission until discharge or death through 6/30/2011, from electronic and paper medical records and Minimum Data Set (MDS). Data included demographic characteristics, baseline medical conditions, functional status, cognitive status and code status. We created a Charlson Comorbidity Index (CCI) score based on baseline medical conditions on admission, and a disability score (ADL score) and Cognitive Performance Score (CPS) using baseline MDS data. Multivariable logistic regression was used to analyze factors associated with PEG tube feeding. Results: Of 238 NH patients aged 45-104 years (mean 83 years), 35 (14.7%) had PEG tube feeding. Of the NH cohort, 130 (54.6%) were female, 218 (92.3%) were Asian, 123 (51.9%) had a prior stroke and 163 (72%) had dementia based on CPS score. Among the 35 PEG tube fed patients, 23 (66%) had PEG placement prior to NH admission, 12 (34%) had PEG placement after NH admission, and 26 (74%) patients had PEG tube feeding until death or the end of follow-up (61 days to 8.4 years, mean 2.4 years). Prior stroke was associated with increased likelihood of PEG tube feeding (aOR = 2.52, 95%CI = 1.03-6.17, P = .04); with borderline increased likelihood for high comorbidity index (aOR = 2.21, 95%CI = 0.89-5.52, P = .09) and high ADL disability score (aOR = 2.03, 95%CI = 0.87-4.73, P = .10). DNR status was inversely associated with PEG tube feeding (aOR = 0.31, 95%CI = 0.11-0.85, P = .02). Age, dementia, Medicaid status, previous speech or physical therapy, and weight loss were not significantly associated with PEG tube feeding. Conclusion: In this predominantly Asian-American NH cohort with high prevalence of PEG tube feeding, prior stroke was strongly associated with PEG tube feeding, while dementia was not. Further study is needed to examine ways to identify and reduce unnecessary tube feeding in this population. [ABSTRACT FROM AUTHOR]

Background: Nursing home residents are at high risk of vitamin D deficiency. There has been only one previous study about vitamin D status on admission to the nursing home, and limited data are available about associations with functional disability and chronic diseases. Methods: Data were collected by retrospective chart review of electronic medical records and Minimum Data Set (MDS) for all veterans admitted to a VA nursing home in Honolulu, Hawai'i, between January 2011 and June 2012. All veterans had a comprehensive geriatric assessment and measurement of serum 25-hydroxyvitamin D level within 7 days of admission. Females, hospice patients, vitamin D supplement users, and those transferred from other nursing homes were excluded, leaving a final analytic sample of 104 patients. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D level <20 ng/mL. Baseline data collected included age, ethnicity, BMI, functional disability (mobility, bathing, dressing, toileting, continence, and feeding) and prevalent chronic diseases to study cross-sectional associations of vitamin D deficiency using logistic regression. Results: Prevalence of vitamin D deficiency on admission to the nursing home was 49.0% (51/104) among male veterans not taking supplements. The mean age was 70.6 years (range 35-95), with ethnicity as follows: 51 (49.0%) White, 34 (32.7%) Asian, and 6 (5.8%) Black. In multiple logistic regression models adjusted for age, ethnicity and BMI, vitamin D deficiency was signiicantly associated with number of ADL disabilities (OR = 1.36 for each increase in ADL disability, 95%CI = 1.03-1.78, P = .03) and prevalent diabetes (OR = 2.99, 95%CI = 1.12-7.99, P = .03). When all six ADL disabilities were entered separately into the multivariate logistic regression model instead of total number of ADL disabilities, only the disability in feeding (OR = 4.74, 95%CI = 0.97-23.23, P = .05) and prevalent diabetes (OR = 2.92, 95%CI = 1.03-8.24, P = .04) remained significant. There were no significant associations between vitamin D deficiency and prevalent hypertension, hypercholesterolemia, coronary artery disease, stroke, cancer, depression or dementia. Conclusions: Almost half the male patients entering a nursing home in Hawai'i had vitamin D deficiency. A high number of ADL disabilities, disability in feeding, and prevalent diabetes were independently associated with vitamin D deficiency. Future studies should focus on targeting these patients for screening and intervention with supplementation to possibly prevent adverse health outcomes of vitamin D deficiency. [ABSTRACT FROM AUTHOR]

The article presents an overview of a discussion on the evolving palliative care practices among Marshall Islanders in Hawaii, at the Third Cross-Cultural Health Care Conference on February 8-9, 2013 in Hawaii.