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"Assumptions" play a fundamental role in disciplinary mathematical practice, especially concerning the relativity of truth. However, much is still unclear about ways to help students recognize key aspects of this role. In this paper, we propose a set of principles for task design to introduce students to the role of assumptions in mathematical activity, with particular attention to the following two learning goals: recognize that (1) a conclusion depends on the assumption(s) underlying the argument that led to it; and (2) making the underlying assumption(s) explicit is crucial to reaching consensus on the conclusion. In the context of a 3-year design research study, we first used existing literature to construct an initial version of task design principles which we then empirically tested and refined by designing and implementing two tasks in Japanese school classrooms. One of the tasks was in the area of functions at the secondary level and the other in the area of geometry at the elementary level. We analyze two classroom episodes to discuss the promise and evolution of our proposed task design principles. In addition, our analysis sheds light on the role of the teacher's instructional moves and the students' mathematical knowledge during the implementation of the designed tasks.

East Asian students consistently top comparative assessments of academic achievement. Yet, rather than attempting to develop more sophisticated understandings of this difference, the most common reaction is to attribute East Asian performance to longer study hours and/or the attendance at schools focused on academic skill enhancement and test preparation (i.e., juku). Herein we seek to contribute to a richer debate both by presenting new data and findings in relation to Japan, and by highlighting new analytical strategies to understand the relationship between East Asian performance and shadow education. Specifically, we highlight that comparatively high levels of achievement among Japanese students were apparent even at the level of fourth graders, even though juku attendance was low prior to this stage. This suggests that juku attendance is not the primary factor for the high academic achievement of Japanese students. The wider significance of these findings lies in countering both common portrayals of East Asian success and factually inaccurate information disseminated by organizations such as the OECD. In so doing, researchers are in better position to elaborate new, more sophisticated theories that explain East Asia's consistently world-leading academic achievement.

Purpose: Amidst ongoing attempts to think beyond Western frameworks for education, there is a tendency to overlook Japan, perhaps because it appears highly modern. This is striking given that some prominent strands of Japanese philosophy have formulated an explicit and exacting challenge to the core onto-epistemic premises of modern Western thought. It is also surprising because Japanese educational practices have resulted in some of the highest achievement outcomes--both cognitive and noncognitive--found anywhere in the world and inculcate a worldview that is distinct. Design/Approach/Methods: Herein, we thus attempt to make visible the potential contribution of modern Japanese philosophy by outlining some of the core ideas, then turn to sketch resonances with and responses to other projects outlined in this Special Issue. Our approach is elucidation through relational comparison. Findings: Through this process, we suggest that the notion of self-negation as a mode of learning may be helpful in explaining why--at the empirical level--the outlook of Japanese students, and perhaps other East Asian students, diverge markedly from their Western peers. Yet we also find that an attempt, such as ours, to link divergent onto-epistemic thought to alternative empirical hypotheses quickly gives rise to various doubts and discomforts, even among otherwise sympathetic scholars. Originality/Value: In directly responding to these doubts, one original contribution of our piece is to show just how difficult it may ultimately be to divest from the symbolic foundations already laid by Western liberalism: Even if divergent thought can be imagined and different cultural narratives explored, dominant readings of empirical "realities" continue to be entrapped in the logic laid by Western liberalism.

This paper pays attention to the meaning of things in educational space. Students learn not only from words but also things with which they interact in the learning process. Especially in art education various things such as materials, tools, art works are indispensable. This paper tries to analyze the process of both creation and appreciation of art in the viewpoint of folding and unfolding of things. The methodology is the hermeneutic approach to the relationship between art works and viewers, materials or tools and their users, and created image and creators. In creating art works the process of unfolding things which means the interaction with materials and the learning of skills and tools can emerge only by folding the image of the creator into the things. On the other hand, it is important for appreciation to receive the image of art works by developing it freely in the inner world. As in the case of creation, appreciation needs both folding a new meaning and unfolding the multilayered art works. In conclusion both creation and appreciation of art are so complicated processes that need a high degree of intelligence. Art education can be regarded as the process of fostering intelligence as well as sensibility.

Background/Objectives: This cross-sectional study aimed to investigate the relationship between swallowing function and low serum albumin levels in older Japanese people (aged ≥ 75 years). Methods: A total of 3258 participants (1325 males, 1933 females; mean age, 80.8 years) who had a dental checkup in Gifu City, Japan, between April 2020 and March 2021 were recruited. Swallowing function was assessed using the repetitive saliva swallow test, with poor swallowing function defined as swallowing fewer than three times in 30 s. A serum albumin level < 3.6 G/dL was considered low. Results: In total, 78 participants (2%) had a low serum albumin level. Furthermore, after adjusting for age, gender, circulatory disease, support/care-need certification, number of present teeth, and tongue and lip function, a low serum albumin level was positively associated with older (odds ratio [OR]: 1.115; 95% confidence interval [CI]: 1.064–1.169), male (OR: 2.208; 95% CI: 1.360–3.584), circulatory disease (OR: 1.829; 95% CI: 1.079–3.099), support/care-need certification (OR: 2.087; 95% CI: 1.208–3.606), and poor swallowing function (OR: 2.379; CI: 1.377–4.112). Conclusions: These results indicate that poor swallowing function was associated with a low serum albumin level in older Japanese people aged ≥ 75 years. [ABSTRACT FROM AUTHOR]

Introduction: Combination therapy of anti-programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) antibodies and platinum-based chemotherapy has been widely used as a first-line treatment for patients with unresectable advanced non-small cell lung cancer (NSCLC) in clinical settings; however, prognostic biomarkers associated with survival outcomes have not been sufficiently investigated. Methods: We enrolled 147 previously untreated patients with advanced NSCLC who were treated with a combination therapy of anti-PD-1/-PD-L1 antibodies and platinum-based chemotherapy at eight institutions in Nagano Prefecture between December 2018 and April 2023. We evaluated the prognostic value of the geriatric nutritional risk index (GNRI), a systemic inflammatory nutritional biomarker calculated from body weight and serum albumin level, for patients with NSCLC treated with a combination therapy of anti-PD-1/-PD-L1 antibodies and platinum-based chemotherapy. Results: The cutoff value of the GNRI was set at 92. The high GNRI and low GNRI groups included 88 and 59 patients, respectively. The median follow-up period was 15.9 months. The overall survival (OS) in the high GNRI group was significantly longer than that in the low GNRI group (27.9 vs. 15.6 months, p = 0.015). Multivariate analysis revealed that a high GNRI was an independently favorable prognostic predictor for OS (hazard ratio, 1.73; 95% confidence interval, 1.06–2.86; p = 0.031). Conclusion: The present study demonstrates that the GNRI is a useful prognostic predictor in patients with NSCLC treated with a combination therapy of anti-PD-1/-PD-L1 antibodies and platinum-based chemotherapy in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Discrepancies existed between the medical knowledge sections of the Model Core Curriculum for Medical Education (MCC) and the Guidelines for the National Examination for Medical Practitioners (GNEMP) in Japan. These discrepancies have been one of the underlying factors hindering the development of learner-centered medical education in the country. The project team responsible for the 'Problem-Solving' section of the MCC aimed to address discrepancies between the disease lists in the MCC and the GNEMP. Method: We refined the disease list for the 2022 revision of the MCC using a three-phase process: (a) procedure development, (b) selection, and (c) adjudication. First, we developed a scoring system for sifting and prioritizing diseases in the GNEMP, selecting those that met our scoring criteria. An expert adjudication panel then finalized the list of diseases through discussion. Results: Among the 1,456 diseases identified in the GNEMP, 781 met the selection criteria. The adjudication panel selected 56 of these diseases to be newly added to the 2022 MCC, resulting in a total of 691 diseases. Conclusions: The list of diseases defined as required medical knowledge in the MCC was finalized through dialogue among medical education stakeholders, effectively minimizing discrepancies between the MCC and GNEMP. [ABSTRACT FROM AUTHOR]

Facing increasing critique that PISA focuses too narrowly on cognitive achievement and human/knowledge capital, the OECD has recently shifted some of its focus to student happiness. The 2017 Students' Well-Being report distinguishes between 'happy schools' and 'unhappy schools', showing that among students who combined high performance and life satisfaction, northern European countries topped the charts. Meanwhile, students in East Asian countries including Japan, China, Taiwan, Hong Kong, and Korea registered the lowest 'life satisfaction' scores among all participating countries. This piece points out some of the problems inherent in the OECD's recent turn to happiness, problematizing the OECD yardstick of life satisfaction. Attempting to keep the critique constructive, we suggest that the OECD may want to consider using alternative metrics, then briefly highlight one developed in East Asia from different first assumptions: the Interdependent Happiness Scale. In conclusion we flag, but cannot answer, some related educational questions concerning policy, pedagogy, and priorities for the future.

Herein we examine the dominant image of East Asian schools as marked by a darker side of widespread bullying, leading to high rates of youth suicide. First outlining the substantial literature on bullying in the English language, we turn to show how -- paradoxically -- the rates of bullying and suicide are no higher, or in nearly all cases, lower than both Anglo-American systems (Australia, England, New Zealand, United States) and high PISA performers (Canada, Finland, Estonia). To explain this, we extend a constructivist approach proposed by sociologists of Japanese youth, suggesting that recurrent 'moral panics' such as bullying are determined, at least in part, by underlying differences in self-construal and views of how society functions. This analysis contributes to recent work that has challenged persistent stereotypes of East Asian education, those images blocking deeper engagement with the underlying differences in approach and philosophy these systems represent.

Aim: A new treatment interval for nivolumab administration at 480 mg every 4 weeks, in addition to 240 mg every 2 weeks, was approved in Japan in 2020. Using model‐based evaluation, it was speculated that the effects or safety of nivolumab do not differ between the two treatment intervals; however, real‐world data on nivolumab efficacy, safety, and economic impact are lacking. Accordingly, we aimed to examine the effects of nivolumab treatment intervals (2 weeks vs. 4 weeks) in terms of efficacy, safety, and economic impact in Japanese patients with cancer. Methods: We retrospectively analyzed 126 patients treated with nivolumab. The patients were divided into two groups depending on whether they received nivolumab at 240 mg every 2 weeks (2‐week group) or 480 mg every 4 weeks (4‐week group). Results: Efficacy results found no significant difference between the 4‐ and 2‐week groups considering median overall survival (p = 0.70) and median progression‐free survival (p = 0.57). The incidence of any grade and ≥ grade 3 immune‐related adverse events did not differ between the 4‐week and 2‐week groups (any grade, p = 0.13; ≥ grade 3, p = 0.36). Excluding drug costs, the 4‐week group had significantly lower medical costs than the 2‐week group (2‐week vs. 4‐week: mean, 94,659 JPY [679.0 USD] vs. 58,737 JPY [421.3 USD]; p < 0.05). Conclusion: Collectively, our findings suggest that nivolumab 480 mg every 4 weeks may be more effective than nivolumab 240 mg every 2 weeks in terms of economic impact. [ABSTRACT FROM AUTHOR]

Severe cases of hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome requiring plasma exchange or dialysis should be differentiated from other thrombotic microangiopathy (TMA) and treated appropriately. To evaluate the prevalence and clinical characteristics of such cases in Japan, a questionnaire‐based survey was conducted among obstetricians who are members of the Perinatal Research Network Group in Japan. There were a total of 335 cases of HELLP syndrome over a 3‐year period in the 48 facilities that responded to the survey. Four patients required plasma exchange or dialysis, of which two were diagnosed with atypical hemolytic uremic syndrome and two with TMA secondary to systemic lupus erythematosus. Although such severe HELLP syndrome is rare, identifying the clinical features and making accurate differential diagnosis are critical for optimal clinical outcomes for mothers and neonates. [ABSTRACT FROM AUTHOR]

Background The association between care needs level (CNL) at hospitalisation and postdischarge outcomes in older patients with acute heart failure (aHF) has been insufficiently investigated. Methods This population-based cohort study was conducted using health insurance claims and CNL data of the Longevity Improvement & Fair Evidence study. Patients aged ≥65 years, discharged after hospitalisation for aHF between April 2014 and March 2022, were identified. CNLs at hospitalisation were classified as no care needs (NCN), support level (SL) and CNL1, CNL2–3 and CNL4–5 based on total estimated daily care time as defined by national standard criteria, and varied on an ordinal scale between SL&CNL1 (low level) to CNL4–5 (fully dependent). The primary outcomes were changes in CNL and death 1 year after discharge, assessed by CNL at hospitalisation using Cox proportional hazard models. Results Of the 17 724 patients included, 7540 (42.5%), 4818 (27.2%), 3267 (18.4%) and 2099 (11.8%) had NCN, SL&CNL1, CNL2–3 and CNL4–5, respectively, at hospitalisation. One year after discharge, 4808 (27.1%), 3243 (18.3%), 2968 (16.7%), 2505 (14.1%) and 4200 (23.7%) patients had NCN, SL&CNL1, CNL2–3, CNL4–5 and death, respectively. Almost all patients' CNLs worsened after discharge. Compared to patients with NCN at hospitalisation, patients with SL&CNL1, CNL2–3 and CNL4–5 had an increased risk of all-cause death 1 year after discharge (hazard ratio [95% confidence interval]: 1.19 [1.09–1.31], 1.88 [1.71–2.06] and 2.56 [2.31–2.84], respectively). Conclusions Older patients with aHF and high CNL at hospitalisation had a high risk of all-cause mortality in the year following discharge. [ABSTRACT FROM AUTHOR]

This hospital-based, cross-sectional study aimed to explore the association between diet and fluctuating intestinal bacteria in early-stage colorectal cancer (CRC) (Atopobium parvulum, Actinomyces odontolyticus, Solobacterium moorei, and Bifidobacterium longum). Healthy participants (n = 212) who underwent total colonoscopy at National Cancer Center Hospital (Tokyo, Japan) were divided into two groups according to the relative abundance of bacteria in their feces: those in the top 25% of relative bacterial abundance as cases and the bottom 25% as controls. The participants were divided into three groups (low, medium, and high) according to their intake of food groups associated with CRC. Multivariable logistic regression analysis was conducted to estimate the association between dietary intake and higher relative abundance of bacteria. Dairy products were inversely associated with a higher relative abundance of A. parvulum, A. odontolyticus, and S. moorei, with odds ratios (high vs. low) and 95% confidence interval as follows: 0.16 (0.06–0.44), 0.25 (0.08–0.82), and 0.29 (0.11–0.78), respectively. Additionally, dietary fiber was inversely associated with a higher relative abundance of S.moorei (0.29 [0.11–0.78]). No association was observed between diet and B.longum. In conclusion, healthy adults with a higher intake of dairy products and fiber had lower odds of having a higher relative abundance of CRC-associated microbiota. [ABSTRACT FROM AUTHOR]

Social technology can improve the quality of social lives of older adults (OAs) and mitigate negative mental and physical health outcomes. When people engage with technology, they can do so to stimulate social interaction (stimulation hypothesis) or disengage from their real world (disengagement hypothesis), according to Nowland et al.'s model of the relationship between social Internet use and loneliness. External events, such as large periods of social isolation like during the COVID-19 pandemic, can also affect whether people use technology in line with the stimulation or disengagement hypothesis. We examined how the COVID-19 pandemic affected the social challenges OAs faced and their expectations for robot technology to solve their challenges. We conducted two participatory design (PD) workshops with OAs during and after the COVID-19 pandemic. During the pandemic, OAs' primary concern was distanced communication with family members, with a prevalent desire to assist them through technology. They also wanted to share experiences socially, as such OA's attitude toward technology could be explained mostly by the stimulation hypothesis. However, after COVID-19 the pandemic, their focus shifted towards their own wellbeing. Social isolation and loneliness were already significant issues for OAs, and these were exacerbated by the COVID-19 pandemic. Therefore, such OAs' attitudes toward technology after the pandemic could be explained mostly by the disengagement hypothesis. This clearly reflect the OA's current situation that they have been getting further digitally excluded due to rapid technological development during the pandemic. Both during and after the pandemic, OAs found it important to have technologies that were easy to use, which would reduce their digital exclusion. After the pandemic, we found this especially in relation to newly developed technologies meant to help people keep at a distance. To effectively integrate these technologies and avoid excluding large parts of the population, society must address the social challenges faced by OAs. [ABSTRACT FROM AUTHOR]

Higher frequencies of inflammatory adverse effects of clozapine have been reported in Japan. As the international titration protocol for Asians has set slower dose titration than the Japanese package insert, we hypothesized that a dose titration speed slower than the recommendation of the guideline would be associated with fewer inflammatory-related adverse events. The medical records of all 272 patients who were first started on clozapine at seven hospitals between 2009 and 2023 were studied retrospectively. Of those, 241 were included in the analysis. The patients were divided into two groups regarding whether the titration speed was faster or slower than the guideline for Asians. The incidence of inflammatory adverse events with clozapine was compared between the groups. The frequency of inflammatory adverse events was 34 % (37/110) in the faster titration group and 13 % (17/131) in the slower titration group, and a significant difference was observed by Fisher exact test (odds ratio 3.38; 95 % confidence interval 1.71–6.91; p < 0.001). Serious adverse effects, fever for more than five days, and clozapine discontinuation were significantly more frequent in the faster titration group. Logistic regression analysis indicated significantly more inflammatory adverse events in the faster titration group (adjusted odds ratio 4.01; 95 % confidence interval 2.02–7.87; p < 0.001) considering age, sex, body mass index, concomitant valproic acid, and smoking as confounding factors. Clozapine-induced inflammatory adverse events were less frequent in Japanese individuals when a titration rate was more gradual than the protocol recommended in the Japanese package insert. [Display omitted] [ABSTRACT FROM AUTHOR]

Aim: We investigated whether the Dementia Assessment Sheet for Community‐based Integrated Care System‐21 Items (DASC‐21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in‐hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure. Methods: We retrospectively assessed the DASC‐21 score at the time of admission, in‐hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019. Results: The mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC‐21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC‐21 score was associated with an increased risk of in‐hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010–1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B‐type natriuretic peptide. Difficulties (3 or 4) with the self‐management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05–10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19–11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00–20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49–25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85–19.35, P = 0.003) were identified as risk factors for in‐hospital death. Patients in the highest tertile of the DASC‐21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001). Conclusions: In elderly patients hospitalized for heart failure, higher DASC‐21 scores were associated with an increased risk of in‐hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; 24: 546–553. [ABSTRACT FROM AUTHOR]

High student achievement across East Asia is often explained as an outcome of highly competitive, stress-inducing college entrance exams across the region. This 'exam hell' drives students to study longer and harder than their peers worldwide, a race that leads--unsurprisingly--to higher marks in international comparisons such as the Programme for International Student Assessment (PISA). Yet, the race comes at a considerable cost: psychological pressure, forfeited childhoods, regimes of rote memorisation, lack of creativity and private outlays for cram schools. In this article, we seek to refute this outdated narrative by focusing on changes in Japanese education over the past three decades. We first analyse quantitative data for learning time based on three longitudinal surveys conducted by researchers in Japan to show that learning time for Japanese upper secondary students declined during 1980-2000 (Study 1). We then turn to analyse PISA 2015 data to show that now Japanese students study less than their peers in major Anglo-American countries: the USA, the UK and Australia (Study 2). These findings run counter to well-worn images frequently rehearsed in both the academic and popular literature. In helping to remove one of the most persistent stereotypes about East Asian education, we seek to help make visible other explanations for East Asian student achievement.

East Asian dominance in international large-scale assessments is widely known. This is often explained as an outcome of highly competitive, exam-oriented education systems in East Asia, wherein students partake in a fierce competition for limited college entrance. Although achievement scores may be comparatively higher, the argument goes, the relative success comes at a steep price, with the emphasis on high-stakes tests heightening student stress and anxiety. In this paper we refute this persistent and out-dated stereotype by focusing on changes in Japanese education over the past several decades. The two original studies we report herein show that not only do Japanese students feel less school-related anxiety and stress than they once did, but these levels are now comparable to students in America, Australia, and the United Kingdom. In showing that stereotypes do not match empirical realities, we seek to open a richer discussion around East Asian student achievement. We conclude by extending the discussion to recent changes in China, Taiwan, and South Korea. We then raise the possibility that fundamentally different outlooks on the learning process explain both differences in achievement and the persistence of the West's distorted images of Japanese and East Asian education.

Lesson Study is a Japanese approach to teacher development borrowed by American researchers in the late 1990s seeking to break from top-down, "best practice" approaches. Two decades later, Lesson Study has gained a strong foothold in American policy circles. Seeking to contribute to the growing research base, this article looks deeper into the cultural obstacles obstructing effective practice in the American context. It suggests that the divergent onto-cultural basis of the Japanese context may be one major factor that helps make Lesson Study successful in Japan but challenging in other national contexts worldwide, perhaps most of all in the United States. The account is based on a meta-analysis of existing research on Lesson Study (1999-2015), combined with a reconceptualization of a rich ethnographic literature on compulsory schooling in Japan. This account frames the American borrowing of Japanese teacher developed practice in terms of educational borrowing and lending, suggesting that scholars need to return to the puzzle of culture, engage philosophically, and be open to ontological alterity.

In clinical practice, patient assessments rely on established scales. Integrating data from these scales into the International Classification of Functioning, Disability, and Health (ICF) framework has been suggested; however, a standardized approach is lacking. Herein, we tested a new approach to develop a conversion table translating clinical scale scores into ICF qualifiers based on a clinician survey. The survey queried rehabilitation professionals about which functional independence measure (FIM) item scores (1–7) corresponded to the ICF qualifiers (0–4). A total of 458 rehabilitation professionals participated. The survey findings indicated a general consensus on the equivalence of FIM scores with ICF qualifiers. The median value for each item remained consistent across all item groups. Specifically, FIM 1 had a median value of 4; FIM 2 and 3 both had median values of 3; FIM 4 and 5 both had median values of 2; FIM 6 had a median value of 1; and FIM 7 had a median value of 0. Despite limitations due to the irreconcilable differences between the frameworks of existing scales and the ICF, these results underline the ICF's potential to serve as a central hub for integrating clinical data from various scales. [ABSTRACT FROM AUTHOR]

Background and Aim: To date, no randomized trials have compared the efficacy of 7‐day vonoprazan, amoxicillin, and metronidazole triple therapy (VAM) versus 7‐day vonoprazan, amoxicillin, and clarithromycin triple therapy (VAC) as a first‐line treatment for Helicobacter pylori eradication. This study was performed to compare the efficacy of VAM and VAC as first‐line treatments. Methods: This prospective multicenter randomized trial was performed in Japan and involved 124 H. pylori‐positive patients without a history of eradication. Patients without antibiotic resistance testing of H. pylori were eligible. The patients were randomized to receive either VAC (vonoprazan 20 mg + amoxicillin 750 mg + clarithromycin 200 or 400 mg twice a day) or VAM (vonoprazan 20 mg + amoxicillin 750 mg + metronidazole 250 mg twice a day) for 7 days, with stratification by age and sex. Eradication success was evaluated using the 13C‐urea breath test. We evaluated safety using patient questionnaires (UMIN000025773). Results: The intention‐to‐treat and per‐protocol eradication rates of VAM were 91.3% (95% confidence interval [CI], 82.0–96.7%) and 92.6% (95% CI, 83.7–97.6%), respectively, and those of VAC were 89.1% (95% CI, 77.8–95.9%) and 96.1% (95% CI, 86.5–99.5%), respectively. No significant difference was observed between VAM and VAC in either analysis (P = 0.76 and P = 0.70, respectively). Abdominal fullness was more frequent in patients who received VAM than VAC. Conclusions: These findings suggest that VAM as a first‐line treatment in Japan can be categorized as grade B (intention‐to‐treat cure rate of 90–95%) and have potential as a first‐line national insurance ‐approved regimen. [ABSTRACT FROM AUTHOR]

Introduction: Most patients with Brugada syndrome (BrS) are first diagnosed in their 40s, with sudden cardiac death (SCD) often occurring in their 50s. Ventricular fibrillation (VF) may occur in some patients with BrS despite having been asymptomatic for a long period. This study aimed to assess the incidence and risk factors for late life‐threatening arrhythmias in patients with BrS. Methods: Patients with BrS (n = 523; mean age, 51 ± 13 years; male, n = 497) were enrolled. The risk of late life‐threatening arrhythmia was investigated in 225 patients who had experienced no cardiac events (CEs: SCD or ventricular tachyarrhythmia) for at least 10 years after study enrollment. The incidence of CEs during the follow‐up period was examined. Results: During the follow‐up of the 523 patients, 59 (11%) experienced CEs. The annual incidences of CEs were 2.87%, 0.77%, and 0.09% from study enrollment to 3, 3−10, and after 10 years, respectively. Among 225 patients who had experienced no CEs for at least 10 years after enrollment, four patients (1.8%) subsequently experienced CEs. Kaplan–Meier analysis revealed significant differences in the incidence of late CEs between patients with and without a history of symptoms (p =.032). The positive and negative predictive values of late CEs for the programmed electrical stimulation (PES) test were 2.9% and 100%, respectively. Conclusion: Our results suggest that patients with BrS who are asymptomatic and have no ventricular tachycardia/VF inducibility by PES are at extremely low risk of experiencing late life‐threatening arrhythmias. [ABSTRACT FROM AUTHOR]

Background: The decision‐making of older adults and people with dementia is attracting more attention among healthcare professionals. While cognitive impairment has been examined as a factor related to decision‐making, it can also be assumed that involvement in decision‐making leads to the maintenance of cognitive function. This study examined the association of the decision‐making process with the onset of cognitive impairment. Methods: We analyzed data from a 2‐year longitudinal panel survey of community‐dwelling care recipients aged ≥65 years in Japan. The sample included 406 participants who responded to both baseline and follow‐up surveys, were cognitively intact at baseline, and had no missing cognitive impairment data regarding onset at follow‐up. The status of decision‐making involvement was assessed using a single item and classified into four categories: 'very involved,' 'less involved,' 'unclear about desired care,' and 'having no one to share the decision.' Results: Among the participants (women, 65.0%; ≥75 years old: 68.2%), the incidence of cognitive impairment during the follow‐up was 26.6%. Multivariable logistic regression showed that, compared with highly involved participants, those who lacked clarity about desired care were more likely to develop an onset of cognitive impairment (odds ratio: 5.49; 95% confidence interval: 1.63–18.54; P = 0.006). Conclusion: Even among cognitively intact care recipients, those who are not able to formulate their desired care may be at risk of cognitive decline. Therefore, support for the decision‐making process, not limited to the final decision, is essential to improving the prognosis of community‐dwelling care recipients. [ABSTRACT FROM AUTHOR]

Aim: To determine the postpartum urinary retention rate and risk factors after delivery using epidural analgesia. Methods: This single‐center retrospective study targeted 341 women who gave birth after at least 37 weeks of gestation from April to August 2021; from this cohort, 208 patients were examined. The postpartum urinary retention rate was compared between the no epidural analgesia group (n = 107) and epidural analgesia group (n = 101). Subsequently, risk factors for postpartum urinary retention were investigated in the epidural analgesia group. Results: After adjustment by propensity score matching for age, body mass index, being primiparous, and labor induction as covariates, the analysis of the incidence of postpartum urinary retention revealed that the epidural analgesia group exhibited a significantly higher postpartum urinary retention rate than the no epidural analgesia group (30% vs. 11%, p = 0.02). The investigation results regarding risk factors for postpartum urinary retention in the epidural analgesia group obtained through a univariate analysis showed that being primiparous and having a prolonged second stage of labor were significantly correlated with postpartum urinary retention. Multivariate analysis indicated that a prolonged second stage of labor was an independent risk factor for postpartum urinary retention (p = 0.03; odds ratio: 3.18; 95% confidence interval: 1.08–9.77). All patients recovered from postpartum urinary retention by day 4. Conclusions: The postpartum urinary retention rate after delivery using epidural analgesia was 25.7%. In the case of epidural analgesia deliveries, a prolonged second stage of labor was an independent risk factor for postpartum urinary retention. [ABSTRACT FROM AUTHOR]

Introduction: Hypersensitivity reactions (HSRs) to chemotherapy are serious adverse events associated with cancer drug therapy and can occur with any antitumor drug. This study investigated the safety and efficacy of carboplatin desensitization therapy in Japan and established a method for treating carboplatin HSRs. Methods: Patients diagnosed with gynecological (ovarian, endometrial, or cervical) cancers who underwent carboplatin desensitization therapy between 2016 and 2020 at the Gynecologic Cancer Study Group of Japan Clinical Oncology Group were included. The carboplatin desensitization therapy at each institution and the implementation cases were registered in an online case report form. Results: This retrospective study enrolled 136 patients (ovarian, 108; endometrial, 17; and cervical cancer, 11). Pre‐existing allergies were present in 37 (27.2%) patients, and 32 (23.5%) patients exhibited prodromal symptoms during treatment before HSR onset. Erythema was the most common symptom at HSR onset, affecting 93 (68.4%) patients, followed by itching in 72 (52.9%) patients and decreased oxygen saturation in 43 (31.6%) patients. Loss of consciousness occurred in three (2.2%) patients. The most common timing of HSR onset was during the first recurrence treatment (47%). The mean total carboplatin dose until HSR onset was 7331 (2620–18,282) mg, and the mean number of doses was 14 (4–63). Desensitization treatment was completed in 75% of cases, and breakthrough HSRs occurred in 25% (34/136). No deaths occurred in the study cohort. The risk factors for HSRs were not identified. Conclusion: Although carboplatin desensitization therapy has high success rates in Japan, erythema and pruritus are important HSRs to consider. [ABSTRACT FROM AUTHOR]

Background. The Coccomyxa sp. strain KJ (Coccomyxa KJ), a microalga found in Japan, has a potential function in controlling viral infections. Recently, its dry powder has been marketed as a health food product. Objectives. This pilot study investigated the effects of Coccomyxa KJ powder tablet intake on allergic reactions and immune functions in healthy participants. Materials and methods. Nine healthy volunteers (4 males and 5 females) who expressed interest in foods containing Coccomyxa KJ, and were willing to undergo blood tests, were recruited. Each individual was asked to take 2 Coccomyxa KJ powder tablets (0.3 g) before breakfast once a day for 4 weeks. The salivary immunoglobulin A (IgA) level and blood parameters (white blood cell (WBC) count, eosinophil and lymphocyte counts and percentages, natural killer (NK) cell activity, interleukin (IL)-6 level, and T helper (Th)1/Th2 cell ratio) were evaluated at baseline and weeks 2 and 4. Results. The 4-week intake of Coccomyxa KJ did not affect salivary IgA levels, WBC count, eosinophil and lymphocyte counts and percentages, or the Th1/Th2 ratio. There were significant differences in the NK cell activity after 4 weeks, with an average increase of 11.78 (95% confidence interval (95% CI): 6.80-16.76). None of the patients experienced adverse reactions during or after the study. Conclusions. Long-term Coccomyxa KJ intake improved NK cell activity without causing adverse effects on the indicators of local immunity, systemic inflammation and immune response balance. This study suggests that Coccomyxa KJ powder tablets can induce beneficial immune modifications without causing any adverse effects. [ABSTRACT FROM AUTHOR]

In both England and Japan, art education was viewed as having nothing to do with self-expression, but was considered to be an efficient means for industrial development. In England, it was designed to train the eyes and hands of artisans. The art critic Ruskin has often been referred to in the context of the transition to self-expression in the history of art education. This article shows, however, that Ruskin was not an advocate of self-expression. In Japan, drawing was introduced into the general education curriculum at the beginning of the Meiji era, and the aim of that instruction was to train the students' eyes and hands. In response to this trend, the Free Drawing Movement was introduced by Kanae Yamamoto. He attempted to introduce the methods of creation used by professional artists into general education. But this aspect was neglected by both his supporters and opponents, and Yamamoto has been presented instead as an advocate of self-expression. Drawing on the genealogical approach, as developed by Foucault, this paper re-examines this well-known history of art education. By replacing Ruskin and Yamamoto in the historical context of the transition of art education in two respective countries, the genealogy of self-expression will be revealed.

In this Forum article, Komatsu and Rappleye report that the results of PISA 2015 released December 2016 revealed a major oddity: reading scores in several of the "leading" East Asian countries had apparently plummeted. An interesting point is that Japan, Taiwan, Korea and Hong Kong are among the most advanced technological societies in the world and the highest scoring in international tests, but yet computers and the Internet are virtually absent from their classrooms. Against this apparent paradox, Komatsu and Rappleye intend in this short piece to explore three reasoning's. First, they seek to empirically confirm the casual observations of Ministry officials and media around East Asia. Second, they use these results to spotlight the implicit ideologies and obvious contradictions embedded in the work of the OECD. And third, they seek to show that the "view from East Asia" is crucially important to help scholars locate their own implicit assumptions about education.

Background: The influence of the coronavirus disease 2019 (COVID-19) pandemic on the number of newly diagnosed gynecological cancers has not been extensively investigated in Japan. This study determined the impact of COVID-19 on the incidence of gynecological cancer. Methods: Using the Japanese Society of Obstetricians and Gynecologic Oncology registry database, the distribution of the number of patients based on clinical staging or tumor-node-metastasis classifications before and during the COVID-19 pandemic was analyzed to compare the trends. The clinical staging classification of cervical cancer in Japan was based on the International Federation of Gynecology and Obstetrics (FIGO) 2008 from 2018 to 2020 and on the FIGO 2018 from 2021. Since FIGO-2018 classified N1 cases as stage IIIC, we focused on T classification without referencing the clinical staging (FIGO staging) of patients with cervical cancer in 2021. Results: The number of patients with endometrial cancer and malignant ovarian tumors of all clinical stages increased uniformly yearly, while that of those with stage III cervical cancer rapidly increased in 2021 owing to the adoption of the revised classification. On comparing cases of cervical cancer in 2020 and 2021, we found that T1 cases decreased and T2 and T3 cases increased in 2021 compared to those in 2020 (p = 0.006). Cervical intraepithelial neoplasia/adenocarcinoma in situ incidence decreased in 2020 compared to that in 2019 but increased again in 2021. The number of patients with cervical cancer decreased in most prefectures in 2020. Conclusion: The incidence of locally advanced cervical cancer increased during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Zizania latifolia plants infected with the basidiomycete fungus Ustilago esculenta develop an edible stem gall, called makomotake in Japan. In our paddy fields, we often find the appearance of Z. latifolia plants that grow only vegetatively without forming stem galls. In this study, we performed PCR-based quantitative assays to investigate the temporal changes in the colonization levels of U. esculenta in various parts of Z. latifolia plants that formed and those that did not form stem galls. Throughout the cultivation period, the colonization levels of U. esculenta in plants that formed stem gall were always higher at almost all plant parts examined than those in plants that did not form stem galls. In particular, after the vegetative stage, the plants that formed stem galls showed an increasing pattern of the fungal colonization in the culm and leaf, a decreasing pattern in the culm base, and an unchanged pattern in the runner. In contrast, the fungal colonization levels in the plants that did not form stem galls consistently remained very low at all plant parts from the seedling stage and beyond. In addition, histological observation of plant tissues showed that the hyphal structures and clusters were found extensively in plants with stem gall formation but very occasionally in plants without stem gall formation. Our results suggest that high colonization levels of U. esculenta during the seedling stage and its subsequent efficient systemic proliferation in the plant are strongly associated with successful stem gall formation. [ABSTRACT FROM AUTHOR]

Japan faces the serious challenge of a decreasing and aging population, impacting the maintenance and upgrade of public libraries. Concurrently, public libraries, crucial social education facilities in Japan, are expected to assume broader societal roles. In response, some Japanese public libraries relocated to address these challenges and new demands. However, there has been limited research focusing on the relocation process and its subsequent evaluation. This paper fills this gap by concentrating on relocated public libraries (RPLs) in Japan during the recent decade (2010–2020), aiming to investigate their relocation motivations and spatial improvement and evaluate their role fulfillment after relocation. By posting questionnaire sheets to 217 target RPLs, we collected 143 valid responses, did a cross‐analysis on motivations, spatial changes, and library types, and evaluated improved role fulfillment postrelocation. Results suggest that public libraries are serving multiple roles in their communities, and their role fulfillment after relocation was linked to certain locational and spatial improvements. This research could help upgrade and reorganize public libraries in the future and contribute to the literature by understanding the relocation of public libraries from a dynamic perspective. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. Their clinical profiles have not been fully investigated. Methods: A multicenter retrospective cohort study was conducted in 21 acute care hospitals in Japan. Patients included were adults aged 18 or older who had been hospitalized from January 1, 2012, to December 31, 2016 due to DKA or HHS. The data were extracted from patient medical records. A four-group comparison (mild DKA, moderate DKA, severe DKA, and HHS) was performed to evaluate outcomes. Results: A total of 771 patients including 545 patients with DKA and 226 patients with HHS were identified during the study period. The major precipitating factors of disease episodes were poor medication compliance, infectious diseases, and excessive drinking of sugar-sweetened beverages. The median hospital stay was 16 days [IQR 10–26 days]. The intensive care unit (ICU) admission rate was 44.4% (mean) and the rate at each hospital ranged from 0 to 100%. The in-hospital mortality rate was 2.8% in patients with DKA and 7.1% in the HHS group. No significant difference in mortality was seen among the three DKA groups. Conclusions: The mortality rate of patients with DKA in Japan is similar to other studies, while that of HHS was lower. The ICU admission rate varied among institutions. There was no significant association between the severity of DKA and mortality in the study population. Trial Registration: This study is registered in the UMIN clinical Trial Registration System (UMIN000025393, Registered 23th December 2016). [ABSTRACT FROM AUTHOR]

Background: In 2020, the Committee of Clinical Practical Guideline for IgA Nephropathy (IgAN) revised the clinical practice guidelines. Herein, we conducted a questionnaire survey to assess the potential discrepancies between clinical practice guidelines and real-world practice in Japan. Methods: A web-based survey of members of the Japanese Society of Nephrology was conducted between November 15 and December 28, 2021. Results: A total of 217 members (internal physicians: 203, pediatricians: 14) responded to the questionnaire. Of these respondents, 94.0% answered that the clinical practice guidelines were referred to "always" or "often." Approximately 66.4% respondents answered that histological grade (H-Grade) derived from the "Clinical Guidelines for IgA nephropathy in Japan, 3rd version" and the "Oxford classification" were used for pathological classification. Moreover, 73.7% respondents answered that the risk grade (R-grade) derived from the "Clinical Guidelines for IgA nephropathy in Japan, 3rd version" was referred to for risk stratification. The prescription rate of renin–angiotensin system blockers increased based on urinary protein levels (> 1.0 g/day: 88.6%, 0.5–1.0 g/day: 71.0%, < 0.5 g/day: 25.0%). Similarly, the prescription rate of corticosteroids increased according to proteinuria levels (> 1.0 g/day: 77.8%, 0.5–1.0 g/day: 52.8%, < 0.5 g/day: 11.9%). The respondents emphasized on hematuria when using corticosteroids. In cases of hematuria, the indication rate for corticosteroids was higher than in those without hematuria, even if the urinary protein level was 1 g/gCr or less. Few severe infectious diseases or serious deterioration in glycemic control were reported during corticosteroid use. Conclusion: Our questionnaire survey revealed real-world aspects of IgAN treatment in Japan. [ABSTRACT FROM AUTHOR]

This Japanese cross-sectional survey evaluated the symptoms, daily living activities, and treatment needs of patients with polycythemia vera (PV), as perceived by patients themselves and their physicians. The study was conducted at 112 centers (March to July 2022) and included PV patients aged ≥20 years (n = 265) and their attending physicians (n = 151). The patient and physician questionnaires included 34 and 29 questions, respectively, to assess daily living, PV symptoms, treatment goals, and physician-patient communication. Concerning daily living (primary endpoint), work (13.2%), leisure activities (11.3%), and family life (9.6%) were most affected by PV symptoms. Patients aged <60 years more frequently reported an impact on daily living than patients aged ≥60 years. Some patients (30%) reported anxiety about their future condition. The most common symptoms were pruritus (13.6%) and fatigue (10.9%). Pruritus was ranked as the first treatment need for patients, while physicians ranked it fourth. Concerning treatment goals, physicians prioritized thrombosis/vascular event prevention, while patients prioritized delaying PV progression. Physicians were less satisfied with physician-patient communication than patients. Patients' daily living was largely affected by PV symptoms. There are differences in physician and patient perceptions of symptoms, daily living, and treatment needs in Japan. UMIN Japan identifier: UMIN000047047. [ABSTRACT FROM AUTHOR]

Since MPL mutation is a rare driver gene mutation found in a small number of essential thrombocythemia (ET) patients, the clinical characteristics of patients with MPL mutations and their association with thrombotic events have not yet been elucidated in Japan. We enrolled 579 Japanese ET patients based on the diagnostic criteria of the WHO classification 2017 and compared clinical characteristics of MPL-mutated patients (n = 22; 3.8%) to JAK2V617F-mutated (n = 299; 51.6%), CALR-mutated (n = 144; 24.9%), and triple-negative (TN) (n = 114; 19.7%) patients. Thrombosis during follow up was observed in 4 out of 22 (18.2%) in the MPL-mutated group, which was the highest among all driver gene mutation groups (JAK2V617F-mutated, 8.7%; CALR-mutated, 3.5%; TN,1.8%). The MPL- and JAK2V617F-mutated groups had worse thrombosis-free survival (TFS) than the CALR-mutated (p = 0.043) and TN groups (p = 0.006). Univariable analysis revealed that a history of thrombosis was a possible risk factor for thrombosis among MPL-mutated patients (hazard ratio: 9.572, p = 0.032). MPL-mutated ET patients should require more intensive management to prevent recurrence of thrombosis. [ABSTRACT FROM AUTHOR]

Objectives: Several studies have investigated that anticholinergic drugs cause cognitive impairment. However, the risk of dementia associated with anticholinergics has not been extensively investigated in the super‐aging society of Japan. We conducted this study to assess the association between anticholinergic drugs and the risk of dementia in older adults in Japan. Methods: This nested case‐control study used data from the Longevity Improvement & Fair Evidence Study, which includes claim data in Japan from 2014 to 2020. We included 66,478 cases of diagnosed dementia and 328,919 matched controls aged ≥65 years, matched by age, sex, municipality, and cohort entry year. Primary exposure was the total cumulative anticholinergic drugs prescribed from cohort entry date to event date or matched index date, which was the total standardized daily doses for each patient, calculated by adding the total dose of different types of anticholinergic drugs in each prescription, divided by the World Health Organization‐defined daily dose values. Odds ratios for dementia associated with cumulative exposure to anticholinergic drugs were calculated using conditional logistic regression adjusted for confounding variables. Results: The mean (standard deviation) age at index date was 84.3 (6.9), and the percentage of women was 62.1%. From cohort entry date to event date or matched index date, 18.8% of the case patients and 13.7% of the controls were prescribed at least one anticholinergic drug. In the multivariable‐adjusted model, individuals with anticholinergic drugs prescribed had significantly higher odds of being diagnosed with dementia (adjusted odds ratio, 1.50 [95% confidence interval, 1.47–1.54]). Among specific types of anticholinergic drugs, a significant increase in risk was observed with the use of antidepressants, antiparkinsonian drugs, antipsychotics, and bladder antimuscarinics in a fully multivariable‐adjusted model. Conclusions: Several types of anticholinergic drugs used by older adults in Japan are associated with an increased risk of dementia. These findings suggest that the underlying risks should be considered alongside the benefits of prescribing anticholinergic drugs to this population. Key points: The risk of dementia associated with anticholinergics has not been extensively investigated in the super‐aging society of Japan.This nested case‐control study found a statistically significant association between anticholinergic drug use and the risk of dementia, especially for antipsychotics, antiparkinsonian agents, antidepressants, and bladder antimuscarinics, after adjusting for confounding variables.The prescription of specific types of anticholinergic drugs to older adults should be made with caution due to the associated risk of dementia. [ABSTRACT FROM AUTHOR]

Seeking to contribute to recent attempts to rethink the deepest foundations of the field, this paper offers news ways of contemplating time, specifically its relations to self, nihilism, and schooling. We briefly review how some leading Western thinkers have contemplated time before detailing Japanese scholars who have offered divergent, original, and arguably more sophisticated, theoretical accounts. We then illustrate these ideas by sketching how Japan "borrowed time" following the abrupt political rupture of 1868, showing how "Linear Time" came to be disseminated and diffused, largely through modern schooling. Last, we spotlight the nihilism that has arisen as consequence. Our primary aim is not empirical elaboration, however, but instead disclosure of a complex of relations that the field of comparative education has yet to discuss. We offer both the experience-cum-thought of Japan and this complex itself as reconstructive resources for the field which remains shallow in its parochial presumptions and unwillingness to engage ontologically.

This cross-sectional study aimed to investigate the promoting and inhibitory factors of diabetic retinopathy (DR) according to diabetes mellitus (DM) stage using standardized evaluation of fundus images by artificial intelligence (AI). A total of 30,167 participants underwent blood and fundus examinations at a health screening facility in Japan (2015–2016). Fundus photographs were screened by the AI software, RetCAD and DR scores (DRSs) were quantified. The presence of DR was determined by setting two cut-off values prioritizing sensitivity or specificity. DM was defined as four stages (no DM: DM0; advanced DM: DM3) based on treatment history and hemoglobin A1c (HbA1c) levels. Associated factors of DR were identified using logistic regression analysis. For cutoff values, multivariate analysis revealed age, sex, systolic blood pressure (SBP), smoking, urinary protein, and HbA1c level as positively associated with the risk of DR among all DM stages. In addition to glycemic control, SBP and Fibrosis-4 index might act as promoting factors for DR at all or an earlier DM stage. T-Bil, cholinesterase, and T-cho level might be protective factors at an advanced DM stage. [ABSTRACT FROM AUTHOR]

Legionella is an important waterborne pathogen that causes legionellosis. Public baths are considered the primary cause of legionellosis infection in Japan. We investigated the prevalence and genetic distribution of 338 Legionella spp. isolates from 81 public bath facilities, includ- ing 35 hot springs and 46 other facilities, through annual periodic surveillance in Kobe, Japan, from 2016 to 2021. In addition, the genotypes of nine clinical strains of unknown infectious source from the same period were compared to those of bathwater isolates. We elucidated the differences in the distribution of Legionella species, serogroups, and genotypes between hot springs and other public baths. Legionella israe- lensis, L. londiniensis, and L. micdadei colonized hot springs along with L. pneumophila. The minimum spanning tree analysis based on multiple-locus variable number tandem repeat analysis (MLVA) also identified four major clonal complexes (CCs) in L. pneumophila SG1 and found that CC1 of the four CCs is a specific novel genotype with the lag-1 gene in hot springs. The same MLVA genotypes and sequence types as those of the clinical strains were not present among the strains isolated from bath water. Thus, our surveillance is useful for estimat- ing the sources of legionellosis infection in Japan and developing prevention strategies. [ABSTRACT FROM AUTHOR]

In 2019–2020, showy rattlepod (Crotalaria spectabilis) in Tokyo developed symptoms including yellowing, wilt, and damping off. A fungus forming white mycelia and brown sclerotia on potato dextrose agar plate was isolated, which reproduced the original symptoms on showy rattlepod by inoculation assay. The fungus was identified as Athelia rolfsii by morphological and molecular characteristics. The host range of the fungus was examined which suggested a wide spectrum. This is the first report of showy rattlepod southern blight caused by A. rolfsii in Japan. [ABSTRACT FROM AUTHOR]

To investigate the factors that contribute to subjective quality of life (QOL) in adolescents with cerebral palsy (CP). We evaluated the subjective QOL in 51 adolescents with CP through interviews using the Japanese version of KIDSCREEN-27 (J-KIDSCREEN-27) and compared the scores with those of 60 typically developing adolescents. Correlations of subjective QOL with age, sex, the levels of functions (gross motor, manipulation, and communication), intelligence, the level of activity of daily living (ADL), and the type of educational support were examined. Thereafter, we investigated the predictors of the subjective QOL by multiple regression analysis. The total QOL scores and individual J-KIDSCREEN-27 domains were not significantly different from those of typically developing adolescents. Sex, manipulation and communication functions, and intelligence had no relationship with subjective QOL. Gross motor function and ADL level negatively correlated with satisfaction with the school environment. Multiple regression analysis revealed that higher age predicts lower psychological well-being, lower gross motor function predicts higher satisfaction with the school environment, and attending schools or classes for special needs predicts higher physical well-being. Seeking adequate support for mildly affected adolescents attending regular classes will be the key to further improving subjective QOL in adolescents with CP. [ABSTRACT FROM AUTHOR]

Objectives: We developed a predictive model for all‐cause mortality and examined the risk factors for cause‐specific mortality among people with cognitive impairment in a Japanese memory clinic‐based cohort (2010–2018). Methods: This retrospective cohort study included people aged ≥65 years with mild cognitive impairment or dementia. The survival status was assessed based on the response of participants or their close relatives via a postal survey. Potential predictors including demographic and lifestyle‐related factors, functional status, and behavioral and psychological status were assessed at the first visit at the memory clinic. A backward stepwise Cox regression model was used to select predictors, and a predictive model was developed using a regression coefficient‐based scoring approach. The discrimination and calibration were assessed via Harrell's C‐statistic and a calibration plot, respectively. Results: A total of 2610 patients aged ≥65 years (men, 38.3%) were analyzed. Over a mean follow‐up of 4.1 years, 544 patients (20.8%) died. Nine predictors were selected from the sociodemographic and clinical variables: age, sex, body mass index, gait performance, physical activity, and ability for instrumental activities of daily living, cognitive function, and self‐reported comorbidities (pulmonary disease and diabetes). The model showed good discrimination and calibration for 1–5‐year mortality (Harrell's C‐statistic, 0.739–0.779). Some predictors were specifically associated with cause‐specific mortality. Conclusions: This predictive model has good discriminative ability for 1‐ to 5‐year mortality and can be easily implemented for people with mild cognitive impairment and all stages of dementia referred to a memory clinic. Key points: There is a paucity of mortality prediction models applicable to people with all stages of dementia, including mild cognitive impairment.Based on a memory clinic‐based cohort, we developed a model to predict 1–5‐year mortality among older adults with mild cognitive impairment and all stages of dementia with good discriminative ability and calibration.The model included 9 factors: age, sex, body mass index, gait performance, physical activity, ability for instrumental activities of daily living, cognitive function, and self‐reported comorbidities (pulmonary disease and diabetes). Some predictors were specifically associated with cause‐specific mortality.Further studies are required to investigate the external validity of the model and its usefulness for patients and informal caregivers as well as health professionals in terms of management and care planning. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare introduced robotic‐assisted hysterectomy (RAH) and skilled total laparoscopic hysterectomy (TLH) for the treatment of benign gynecological diseases. Methods: Patients who underwent RAH or TLH by two surgeons at the Tottori University Hospital between January 2018 and May 2022 were included in this retrospective study. Inclusion criteria were patients with 100–300 g of uterine weight. The exclusion criteria were patients with stage IV endometriosis. Mean operative time and learning curve were compared among the first‐half RAH, second‐half RAH, and TLH groups. Results: There were 40 eligible cases (first‐half RAH: 20 cases, second‐half RAH: 20 cases) in the RAH group and 44 cases in the TLH group. The total operative time (TOT) of the second half of RAH was significantly shorter than that of the first half of RAH (p = 0.021) and was comparable to that of the TLH group. The operative time (OT) of the second half of RAH was shorter than that of TLH (p = 0.023). The preparation time of TLH was shorter than that of the RAH group (p < 0.01). The learning curve of the TOT in RAH crossed that of TLH on the 31st case of RAH. In contrast, both curves of the OT crossed on the 11th case of RAH. Conclusion: The TOT of the introduced RAH was equivalent to that of skilled TLH in approximately 30 cases since the first RAH. Furthermore, the OT of RAH was comparable to that of TLH in approximately 10 cases of surgery since the first RAH. [ABSTRACT FROM AUTHOR]

Since the early phase of the coronavirus disease 2019 (COVID-19) pandemic, a number of research institutes have been sequencing and sharing high-quality severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes to trace the route of infection in Japan. To provide insight into the spread of COVID-19, we developed a web platform named SARS-CoV-2 HaploGraph to visualize the emergence timing and geographical transmission of SARS-CoV-2 haplotypes. Using data from the GISAID EpiCoV database as of June 4, 2022, we created a haplotype naming system by determining the ancestral haplotype for each epidemic wave and showed prefecture- or region-specific haplotypes in each of four waves in Japan. The SARS-CoV-2 HaploGraph allows for interactive tracking of virus evolution and of geographical prevalence of haplotypes, and aids in developing effective public health control strategies during the global pandemic. The code and the data used for this study are publicly available at: https://github.com/ktym/covid19. [ABSTRACT FROM AUTHOR]

Available soil nitrogen (Av-N) is an important indicator for understanding the soil fertility in paddy fields. Previous studies have reported a decline in Av-N resulting from paddy-upland rotation at a regional scale in Japan, while the factors influencing this phenomenon on a national scale are not well understood. This study aims to assess the effects of soil temperature, land use, soil type and soil texture on Av-N in paddy fields across Japan. Soil surveys were conducted in 13 prefectures in 2020 and 2021, involving the collection of soil samples from the plow layer in a total of 2,600 paddy fields. Our results revealed that soil temperature had the most significant influence on Av-N, followed by land use and soil type. Av-N exhibited a negative correlation with soil temperature, whereby the average Av-N in the thermic soil temperature regime (>15°C, Av-N: 107 ± 48 mg kg-1) significantly lower than that in the mesic soil temperature regime (≤15°C, Av-N: 166 ± 74 mg kg-1). Increased upland frequency in paddy fields led to a decrease in Av-N, particularly pronounced in the thermic soil temperature regime, while partially mitigated in the mesic soil temperature regime. In the thermic soil temperature regime, paddy fields with long-term upland usage (upland frequency of paddy fields was more than 50%) had an average Av-N of 50 mg kg-1, necessitating additional organic matter application. Furthermore, the results concerning soil type and soil texture indicated that Av-N was higher in wet soil compared to semi-wet soil, and fine-textured soil had higher Av-N than medium-course textured soil. These findings underscore the negative effect of accelerated drying in paddy fields due to the expanding practice of paddy-upland rotation, leading to decreased Av-N. In conclusion, our study proposes the importance of organic matter management practices, with a primary emphasis on soil temperature, further refined by considering land use and soil type, to ensure the maintenance of adequate Av-N levels in paddy fields in Japan. [ABSTRACT FROM AUTHOR]

We infer the temporal changes in the pressure sources that induced crustal deformation during the 2018 Shinmoe-dake eruption using strain and tilt observations and discern that the deep magmatic activity associated with the early stage of this eruption began approximately 19 h earlier than the previously defined onset of magmatic activity. Distinct tilt changes were observed from around 09:00 on 6 March to 12:00 on 8 March 2018 (JST), coincident with observed lava outflow into the crater and lava dome formation. Existing studies have attributed this tilt change to the onset of the deflation of a spherical pressure source located at ~ 7 km bsl (below sea level) to the northwest of Shinmoe-dake. Here we examine strain and tilt data that were acquired in the Kirishima volcanic group, and we find that the distinct changes in the measured strain at Isa-Yoshimatsu Observatory began at around 14:00 on 5 March. This change can be explained by the deflation of a spherical pressure source, thereby suggesting that the onset of magma ascent was earlier than previously thought. The time variation in the spherical pressure source is estimated using the time-dependent inversion of the Ensemble Kalman Filter; the deflation source ascended from ~ 11 to 7 km bsl during Phase 1 (14:00 on 5 March to 06:00 on 6 March) and descended from 7 to 8 km bsl during Phase 2 (06:00 on 6 March to 12:00 on 8 March). Interferometric synthetic aperture radar analysis suggests that a dike intrusion had occurred just below Shinmoe-dake crater until 5 March, and this inflatable crustal deformation is attributed to the emplacement of residual volcanic fluids from the 2011 eruption. It is also known that the surface eruptive activity increased during Phase 1, including an increase in ash venting from the night of 5 March. These strain and tilt observations, therefore, suggest that magma ascended from ~ 11 km bsl to the magma reservoir at 7 km bsl during Phase 1, followed by a deflation of the magma reservoir during Phase 2 due to the large magma supply to the surface. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to elucidate the difficulties faced by adult native liver survivors with biliary atresia (BA) in Japan. Methods: A single-center, retrospective, observational study of 57 adult patients with BA was conducted. The clinical course of BA was compared between native liver survivors and non-survivors who reached adulthood. Indications and outcomes of liver transplantation (LT) among non-survivors were assessed. Results: A significantly larger portion of non-survivors (n = 10) met the criteria for LT (p < 0.001) and received treatment for portal hypertension after reaching 20 years of age (p < 0.01) compared with the survivors. Causes of death included liver cirrhosis (n = 8), graft failure of living donor liver transplantation (LDLT) (n = 1), and hepatocarcinoma (n = 1). Two of the non-survivors who died of liver cirrhosis had no indication for LT because of alcohol dependence and uncontrolled infection. An appropriate donor candidate could not be found for the five patients who opted for LDLT. All six patients waitlisted for deceased donor liver transplantation (DDLT) died after a median waiting period of 17 months. Conclusion: Adult BA patients in Japan have limited options for LT, mainly owing to low donor candidate availability for LDLT and a low prevalence of DDLT. [ABSTRACT FROM AUTHOR]

Objective: The authors conducted a large‐scale cohort study using the Japan Society of Obstetrics and Gynecology's perinatal registry database to determine the effect of myomectomy on perinatal outcomes. Methods: This retrospective cohort study enrolled 203 745 women who gave birth between January and December 2020 in Japan. The participants were classified into two groups based on their history of myomectomy (open/laparoscopic) to investigate fertility treatment, delivery information, obstetric complications, maternal treatment, infant information, fetal appendages, obstetric history, underlying disease, infectious disease, drugs used, and case information regarding maternal and infant death. Results: In total, 1161 pregnant women had a history of myomectomy and 202 584 did not. Compared with the nonmyomectomy group, the myomectomy group had a higher occurrence rate of uterine rupture (0.9% vs 0.06%, P < 0.01) and placenta accreta (1.5% vs 0.5%, P < 0.01). In addition, history of myomectomy (odds ratio [OR], 2.62 [95% confidence interval (CI), 1.500–4.226]; P < 0.001) was found to be an independent factor for placenta accrete and uterine rupture (OR, 14.4 [95% CI, 6.75–27.02]; P < 0.001). Furthermore, myomectomy increased the risk of uterine rupture by 14 times. Conclusion: Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture. Synopsis: Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture. [ABSTRACT FROM AUTHOR]

In Japan, a huge portion of the population is aged people, who are prone to various diseases and injuries on a regular basis. Injuries due to falls are one of the biggest risk factors. Consequently, the demand for fall detection sensors, especially the ones that used a triboelectric nanogenerator (TENG) has recently increased. In a previous study, our group reported the development of a wearable sensor for fall detection with privacy protection using the principle of TENG. Conventional TENGs use polymer films as friction material. However, it is difficult for film-based TENGs to harvest output from various angles of contact separation, as the films have two-dimension structures. Consequently, our previous study focused on developing brush-based TENG (B-TENG), and B-TENG harvested output from various angles of contact-separation. However, the B-TENGs we developed were not sensitive enough to detect signals of lower contact force, and thereby could not be used in fall detection sensors. In this study, we focused on improving the performance of B-TENG by investigating the properties of the brushes and the effect of various external parameters on the harvested output voltage of B-TENGs. Consequently, we have constructed an optimized B-TENG, which harvests almost 18 times higher output voltage than the previous one developed by our group. Thus, this optimized B-TENG has the potential for practical use in fall detection sensors. [ABSTRACT FROM AUTHOR]