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A pipelined 8 bit-serial single-flux-quantum microprocessor integrating cache memories, called CORE1g, has been designed and implemented. The CORE1g has 16 byte and 8 byte shift-register-based cache memories for instructions and for data, respectively. The microprocessor overlaps four instructions in pipeline executions. The pipeline stages are optimized to control the cache memories and a new circuit component is developed to manage the pipeline execution according to whether each cache hits or misses. Advanced passive transmission line techniques with use of the cell library of the 2.5 kA cm[?]2 niobium standard process are utilized to implement the CORE1g accompanied by extremely complex interconnects. The CORE1g is made up of 295 passive interconnects, and 22302 Josephson junctions are integrated on a 6.36 × 6.36 mm2 area. The logic simulation shows that the peak performance is estimated at 1000 million operations per second, and it is kept even during memory access as long as the cache memories hit. [ABSTRACT FROM AUTHOR]

The nursing practice environment is essential for improving the quality of nursing practice and patient service. Performing secondary analysis of data from the work environment for hospital nurses in Japan (WENS-J) study, this research investigated whether an improved, healthier work environment could enhance nurses' psychological empowerment. Self-administered questionnaire responses of 2,438 participants from 23 participating general hospitals with over 200 beds in municipalities with a population of 200,000 or more were analyzed. The questionnaire recorded participating nurses' demographic characteristics and utilized two scales: the Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Psychological Empowerment Instrument (PEI), which identified adequate work environments and measured the internalization of organizational goals and objectives, respectively. Most participants (93.7%) were female nurses with a mean age of 33.7 years. Multilevel analysis (hierarchical linear models) revealed that the total PEI score was significantly related to the PES-NWI composite score and all subscales after adjusting for nurses' demographic characteristics, such as age (coefficient 0.33-0.72, all p < .001). The results suggest that a work environment such as that presented in the PES-NWI may contribute to nurses' psychological empowerment. These findings could provide insight for creating healthier work environments., (© 2024. The Author(s).)

Despite concerns raised on the inequality in healthcare provision in Japan, little is known about the factors that hinder candidates' application to medical schools. A nationwide cross-sectional survey was conducted to identify the impact of economic factors and living place on students' choice of and preparation for medical school. The survey was administered to high school teachers with career advisory roles, as they support and likely influence students' choice and decision on this matter. Responses totaling 1,094 were obtained from 1,746 high schools across Japan. The ratio of high schools with two or more students enrolled in medical schools every year is higher in private schools, those with high tuition, and those located in big cities. Approximately 66.8% of the respondents agreed that "It is difficult for students in economically disadvantaged families to enroll in medical schools;" 42.0% agreed that "Some students gave up on aspiring to enter medical schools because they could not afford it," and 61.2% agreed that "Students living in urban areas are more likely to enroll in medical schools." When asked about the percentage of students attending prep school among those aspiring for a medical career, significantly more respondents from private versus public high schools answered "80% or more." When asked about the percentage of parents who are doctors or dentists among students aspiring for a medical career, significantly more respondents from private versus public high schools answered "50% or more." The results suggest that students from lower-income families and those living in rural areas are more likely to be disadvantaged when choosing a medical career (because of financial difficulties) than those who live in urban areas and come from wealthier families. The results imply that economic and geographical divides in medical admission are reflected in high school teachers' perception of and support provided to students., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: This research was supported by the Grant-in-Aid for Scientific Research (JSPS KAKENHI Grant Number 24390133) of the Japanese Ministry of Education, Culture, Sports, Science and Technology. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

This study aimed to develop a questionnaire on the quality of working life among female medical and healthcare professionals and examine its validity and reliability. The questionnaire was developed from an item pool drawing on the literature. The four trait scales included 40 items, covering female-specific stress in continuing a career, stress of lifestyle in maintaining personal values, job satisfaction and social support network. The questionnaire's validity and reliability were assessed using data from 1,784 female doctors, dentists, and nurses. Validity was examined using exploratory factor analysis on each trait for construct validity, and multitrait scaling analysis for convergent and discriminant validity. Reliability was tested using Cronbach's alpha for trait subscales and scales. Exploratory factor analysis on each trait was convergent. One trait derived three subscales, and another two. The remaining two traits were convergent for one factor. Multitrait scaling analysis showed that all scales and subscales were independent. The questionnaire was therefore internally consistent and had construct validity. Cronbach's alpha was 0.85 for the total and between 0.72 and 0.83 for the subscales. These results validate the four-trait combination questionnaire and suggest that it would be suitable for use in future research, perhaps in combination with other existing scales.

Aim: To investigate nurses' perceptions of their work environment and to investigate the relationships between variables measuring the work environment (WE) and nursing outcomes (NO s )., Design: A 2-year prospective longitudinal survey (2013-2015)., Method(s): Descriptive statistics of nurse demographics, organizational WE and NOs were calculated by position. The associations between Practice Environment Scale of the Nursing Work Index (PES-NWI) and NOs were examined for each unit., Results: The participants were 2,992 staff nurses, 137 nurse managers (NMs), and 8 chief nursing officers in Phase 1 and 7,849, 371 and 23 in Phase 2, respectively. The higher the job position, the better the WE was rated. The higher the PES-NWI scores, the better the outcomes. Descriptive statistics about organizational WEs and NOs and the statistically significant associations between the two were identified., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Purpose: Although many studies have assessed the impact of interventions to increase medical students' empathy by improving their understanding of patients' perspectives and feelings, the impact of hospitalization experiences remains unclear., Methods: Fifth-year medical students at Kyushu University from 2009-2013 participated in a 2-day/1-night course to provide a hospitalization experience. After the course, participants answered an online, anonymous, open-ended questionnaire created by the authors., Results: Of 488 participants, 462 provided responses (95% response rate), which were evaluated by thematic analysis. Students understood inpatients not only through their own hospitalization experience, but also through observations of and conversations with the inpatients they encountered, from a shared perspective of both. Students experienced the realities of hospital life, stress and psychological states of being an inpatient, and psychological pressure from physicians. In addition, students observed the distress of other inpatients and dedication of medical staff. Furthermore, through communication with these inpatients, students understood other inpatients' anxiety about illness and empathy as one of the requirements of health care providers from the patients' perspective., Conclusion: This qualitative study investigated the effectiveness of a course on the hospitalization experience. Results showed that medical students understood the perspectives, distress, and anxiety of being an inpatient, not only from their own experiences but also from observation and communication with other inpatients they encountered during their hospitalization. This experience appeared to be an effective teaching strategy for enhancing medical students' empathy by improving their understanding of patients' perspectives and feelings.

Aim: Many instruments for evaluating clinical teaching have been developed, albeit most in Western countries. This study aims to develop a validated cultural and local context sensitive instrument for clinical teachers in an East Asian setting (Japan), Japanese Clinical Teacher Evaluation Sheet (JaCTES)., Methods: A multicenter, cross-sectional evaluation study was conducted. We collected a total of 1368 questionnaires on 304 clinical teachers, completed by residents in 16 teaching hospitals. The construct validity was examined by conducting a factor analysis and using structural equation modeling (SEM). We also assessed the reliability using generalizability analysis and decision study., Results: Exploratory factor analysis resulted in three-factor (role model, teaching activities, and accessibility) model including 18 items. Confirmatory factor analysis was performed, using SEM. The comparative fit index was 0.931 and the root mean square error of approximation was 0.087, meaning an acceptable goodness of fit for this model. To obtain a reliable dependability-coefficient of at least 0.70 or higher, 5-8 resident responses are necessary., Discussion and Conclusion: JaCTES is the first reported instrument with validity evidence of content and internal structure and high feasibility in Japan, an East Asian setting. Medical educators should be aware of the local context and cultural aspects in evaluating clinical teachers.

Background: The faculty of nursing schools plays an important role in the successful execution of nursing education. Therefore, faculty behavior strongly affects the professional development of nurses. However, few studies have examined professional nursing behaviors from the perspective of nursing faculty., Purpose: Members of nursing faculty in Japan were surveyed regarding their perspectives on behaviors related to professionalism., Methods: The model, Miller's Wheel of Professionalism in Nursing, was used as the theoretical framework. The Behavioral Inventory for Professionalism in Nursing (BIPN) was completed by 74 full-time nursing faculty who were currently working at 10 institutes of nursing education in Japan., Results: The mean BIPN score for the participants was 11.56 (SD = 6.08) of a possible total of 27. The highest and lowest BIPN category scores were for "research development, use, and evaluation" and "community service," respectively. Professionalism was found to relate significantly to higher educational preparation (F = 32.17, p < .0001). The Tukey-Kramer multiple comparison test found a significant association between having a graduate degree and higher scores for professionalism (p < .0001). The Spearman correlation coefficient was significant and positive for the relationship between professionalism and both educational preparation (r = .85, p < .0001) and number of years as a nursing educator (r = .31, p = .0077)., Conclusions: The results support the idea that a higher level of educational preparation and more years of experience as a member of a nursing faculty are associated with higher levels of nursing professionalism. The professional behavior scores suggest that "community service" is an issue that requires further improvement among Japanese nursing faculty. Awareness of extrinsic factors such as education is important to maximize nursing professionalism. The findings of this study may help nursing faculty continue their self-development.

Background: Clinical practice enables nursing students to acquire essential professional skills, but little is known about nursing students' perceptions of the clinical learning environment (CLE) in Nepal., Objectives: To examine Nepalese nursing students' perceptions regarding the CLE and supervision., Design: A cross-sectional questionnaire design was used., Settings: Government and private hospitals in Nepal where the undergraduate nursing college students undertook their clinical practice., Participants: Students with clinical practice experience were recruited from years 2-4 of the B.Sc. nursing program in Nepal (n=350). The final sample comprised 263 students., Methods: A self-administered questionnaire including demographic characteristics, latest clinical practice site, and general satisfaction was administered February-March 2014. The previously validated Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale was used in the questionnaire. The analytical approach used exploratory factor analysis, assessments of the scale and sub-dimension reliability, correlations of factors between scale sub-dimensions, and multiple regression analysis., Results: Students' practicum satisfaction level at government hospitals was significantly higher than those at private hospitals (p<0.0001). Five factors explained 85.7% of the variance, with minor factorial structure differences compared with the original scale. Reliability was confirmed (Cronbach's alpha=0.93 for total scale, 0.76-0.92 for sub-dimensions). Inter-correlations between the five original sub-dimensions were 0.27-0.68 (p<0.0001). Students undertaking their practicum in private hospitals evaluated their clinical placements significantly more negatively on most sub-dimensions than those in government hospitals. Multiple regression analysis revealed a significant positive relationship between satisfaction and pedagogical atmosphere (p<0.0001)., Conclusion: This is the first study to investigate nursing students' perceptions of the CLE in undergraduate nursing programs in Nepal. Students were satisfied with the CLE overall, but satisfaction varied by practicum hospital sector. The most influential factor explaining satisfaction was pedagogical atmosphere., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Students in clerkship are expected to gain clinical expertise by interacting with real patients in clinical situations. Monitoring and predicting the students' encounter diseases (EDs) is important for providing an optimal experience. EDs should be compared with the available diseases (ADs) at the clerkship site and with the required diseases described in some guidelines for the clinical curriculum., Aims: To explore the differences in ADs as learning resources among different types of clerkship sites and to investigate discrepancies between EDs and ADs., Method: A retrospective observational study used secondary data from government statistics to compare ADs of various types of observable clerkship sites by biplot analyses, which allowed multivariate comparisons. EDs collected from logbooks during clerkships at a university hospital were also compared with ADs across sites., Results: The distributions of ADs differed according to institutional type, and EDs at Kyushu University Hospital were similar to the ADs for the category of hospitals in which it was placed., Conclusion: EDs at a clerkship site may be predictable to some extent by analysing the site's distribution of ADs, but further study is needed. Biplot is useful for visualising these types of statistical similarity.

Aim: To examine the perception of professional behaviours and factors contributing to nursing professionalism among nurse managers., Background: Professional behaviours influence nursing professionalisation and managers' behaviours strongly impact professional development. In Japan, few studies have examined professional nursing behaviours from the nurse managers' perspective., Methods: The Behavioural Inventory for Professionalism in Nursing was performed with 525 nurse managers representing 15 facilities in Japan., Results: The highest professional behaviours score obtained was 'competence and continuing education' and the lowest behavioural score was 'publication and communication'. The results demonstrate that higher nursing professionalism is related significantly to the increased length of nursing experience, a higher level of educational preparation and the current position as a nurse administrator., Conclusion: This study demonstrated that nursing professionalism is influenced by years of experience and nursing management education., Implications for Nursing Management: Awareness of extrinsic professional factors is important continually to maintain nursing professionalism. The findings of our study may help nurse managers to continue their self-development and to realise the potential of their nursing staff by developing professionalism. These findings also provide an understanding of international professionalism trends to achieve higher levels of nursing professionalism through the evaluation of professional nursing behaviours., (© 2014 John Wiley & Sons Ltd.)

Peripheral artery disease (PAD) is a highly prevalent disease, which still has unmet medical needs. Therapeutic angiogenesis for PAD, achieved by gene therapy, has achieved promising results in preclinical studies and early-phase clinical trials, yet few late-phase clinical trials have been conducted or have not shown efficacy. This article provides an overview of the progression of angiogenesis research in gene therapy field as it applies to PAD. The focus of angiogenic growth factors and clinical trials are introduced as a frontier of therapeutic angiogenesis. The article also includes insights into future directions from bench to bedside.

Peripheral artery disease (PAD) is a highly prevalent disease, which still has unmet medical needs. Therapeutic angiogenesis for PAD, achieved by gene therapy, has achieved promising results in preclinical studies and early-phase clinical trials, yet few late-phase clinical trials have been conducted or have not shown efficacy. This article provides an overview of the progression of angiogenesis research in gene therapy field as it applies to PAD. The focus of angiogenic growth factors and clinical trials is introduced as a frontier of therapeutic angiogenesis. The article also includes insights into future directions from bench to bedside.

We experienced a case of spontaneous rupture of the esophagus which was successfully managed by suture of the ruptured site and pedicled omental covering. A 47-year-old male was referred to our department in unstable condition 60 hours after the onset of acute symptoms. Upon presentation to the hospital, the patient was in shock and complained of severe chest pain and dyspnea, the onset of which followed vomiting after consumption of alcohol. A diagnosis of spontaneous rupture of the esophagus was made on the basis of the history of the episode and chest X-ray and chest CT findings. After construction of a pedicled omentum created during laparotomy, left-sided thoracotomy and debridment of the mediastinum was performed, which was seen to contain necrotic tissue and purulental fluid. The site of esophageal rupture, nearly 3 cm in length, was sutured shut and reinforced with a pedicled omental covering, the postoperative course was uneventful, and oral intake was resumed 20 days following the surgery. The pedicled omental covering procedure was useful for reinforcing sutures at the site of rupture and for control of infection in this patient for whom institution of surgical therapy for spontaneous esophageal rupture was delayed following the acute onset of symptoms.

A 54-year-old woman who underwent a hysterectomy and radiation therapy for carcinoma of the uterine cervix developed mucosal de novo cancer of the rectum 12 years later. The rectal lesion was elevated, measuring 0.8 x 0.7 x 0.3 cm, and its surface was relatively smooth. Microscopically, this tumor consisted of a well-differentiated tubular adenocarcinoma which had invaded the depth of the mucosa. Late radiation injuries were observed around the tumor. We diagnosed this lesion as a radiation-induced mucosal de novo adenocarcinoma of the rectum on the basis of the criteria of Black and Ackerman (Clin Radiol 16:278, 1965). This case underscores the need for careful long-term follow-up studies of the large intestines of patients who underwent therapeutic irradiation for uterine cancer.

A 14-year-old girl was admitted because of cough, chest pain and hemosputum. Chest roentgenogram on admission showed a pneumothorax and a cavitary lesion with niveau formation in the right lung and cystic lesions in the bilateral lung fields. After bed rest and intravenous administration of antibiotics for two weeks, the right lung inflated well and the niveau formation disappeared, and the patient was discharged. One week later, she was readmitted with sudden-onset severe dyspnea, caused by bilateral pneumothoraces. Emergency tube thoracostomy and wedge resection of the bullous lesion was performed. Macroscopically, multiple small cystic changes were seen on the surface of the right lung. Histological examination revealed nodular proliferations of smooth muscle cells in the interstitium and vessel walls in the lung, which contained slit-like lymphatic channels. The diagnosis of pulmonary lymphangiomyomatosis was made. In this case, we could not measure receptors for estrogen and progesterone. Recently, hormonal therapy and oophorectomy have been reported as being useful. Tamoxifen (Norvadex) was therefore initiated, and the patient has remained well with slight dyspnea on exertion. There has been no recurrence of pneumothorax. Lymphangiomyomatosis is a rare disease of unknown etiology which occurs exclusively in women, mostly in those of reproductive age. We report a 14-year-old female patient with lymphangiomyomatosis associated with repeated pneumothorax, who had been under treatment for epilepsy. We believe this case to be of importance because of the long discussed relation between pulmonary lymphangiomyomatosis and tuberous sclerosis.