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A prevalent error among English as a second language (ESL) writers of various native language groups is the overuse of passive sentences (overpassivization) when writing in English. Oshita (2001) proposed the unaccusative trap hypothesis, which posits that intermediate learners tend to overpassivize unaccusative (rather than unergative) verbs, and that novice learners are less prone to making these errors. The present study tested this hypothesis by analyzing written compositions from a group of 208 Japanese high school students who were considered at the early learning stage. The study also analyzed the effect of subject animacy on overpassivization, a point rather neglected by prior studies. Ten alternating unaccusative verbs, 15 non-alternating unaccusative verbs, and 15 unergative verbs were extracted from an approximately 60,000-word corpus of English compositions written by the participants. The results of this study did not support the unaccusative trap hypothesis, as they showed a relatively higher rate of overpassivized unergatives, compared with unaccusatives. It also showed that learners produced relatively more overpassivized unaccusatives with animate (rather than inanimate) objects, which contradicts the findings of previous studies. The resulting discussion centers around the possibility of Japanese learners’ equating English copula with Japanese topic markers, and directly translating Japanese causative-passives into overpassivized unergatives in English.

OBJECTIVE Randomized controlled trials have shown kidney-protective effects of sodium–glucose cotransporter 2 (SGLT2) inhibitors, and clinical practice databases have suggested that these effects translate to clinical practice. However, long-term efficacy, as well as whether the presence or absence of proteinuria and the rate of estimated glomerular filtration rates (eGFR) decline prior to SGLT2 inhibitor initiation modify treatment efficacy among type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) patients, is unknown. RESEARCH DESIGN AND METHODS Using the Japan Chronic Kidney Disease Database (J-CKD-DB), a nationwide multicenter CKD registry, we developed propensity scores for SGLT2 inhibitor initiation, with 1:1 matching with patients who were initiated on other glucose-lowering drugs. The primary outcome included rate of eGFR decline, and the secondary outcomes included a composite outcome of 50% eGFR decline or end-stage kidney disease. RESULTS At baseline, mean age at initiation of the SGLT2 inhibitor (n = 1,033) or other glucose-lowering drug (n = 1,033) was 64.4 years, mean eGFR was 68.1 mL/min per 1.73 m2, and proteinuria was apparent in 578 (28.0%) of included patients. During follow-up, SGLT2 inhibitor initiation was associated with reduced eGFR decline (difference in slope for SGLT2 inhibitors vs. other drugs 0.75 mL/min/1.73 m2 per year [0.51 to 1.00]). During a mean follow-up of 24 months, 103 composite kidney outcomes occurred: 30 (14 events per 1,000 patient-years) among the SGLT2 inhibitors group and 73 (36 events per 1,000 patient-years) among the other drugs group (hazard ratio 0.40, 95% CI 0.26–0.61). The benefit provided by SGLT2 inhibitors was consistent irrespective of proteinuria and rate of eGFR decline before initiation of SGLT2 inhibitors (Pheterogeneity ≥ 0.35). CONCLUSIONS The benefits of SGLT2 inhibitors on kidney function as observed in clinical trials translate to patients treated in clinical practice with no evidence that the effects are modified by the underlying rate of kidney function decline or the presence of proteinuria.

Big data has been a hot topic in medical and healthcare research. Big data in healthcare is considered to comprise massive amounts of information from various sources, including electronic health records (EHRs), administrative or claims data, and data from self-monitoring devices. Biomedical research has also generated a significant portion of big data relevant to healthcare. Other large datasets arise from cohorts that are recruited and followed on the basis of specific questions, although such research questions may later be expanded to enable other investigations. While the availability of big data offers many possibilities for an improved understanding of disease and treatment, the need for careful and productive use of statistical concepts should be kept in mind. Patient data routinely collected via electronic means are called real-world data (RWD) and are becoming common in healthcare research. RWD and big data are not synonymous with each other, but the two terms seem to be used without distinction with respect to observational studies. In this article, we review hypertension-related papers that use big data or RWD. There are many other sources of big data or RWD that are not covered here, each of which may pose special challenges and opportunities. While randomized clinical trials (RCTs) are considered to be the criterion standard for generating clinical evidence, the use of real-world evidence (RWE) to evaluate the efficacy and safety of medical interventions is gaining interest. On-going efforts to make use of RWD to generate RWE for regulatory decisions, as well as the challenges confronted, including reliability (quality) and relevance (fitness for purpose) of data, will also be addressed.

The Japan Chronic Kidney Disease (CKD) Database (J-CKD-DB) is a large-scale, nation-wide registry based on electronic health record (EHR) data from participating university hospitals. Using a standardized exchangeable information storage, the J-CKD-DB succeeded to efficiently collect clinical data of CKD patients across hospitals despite their different EHR systems. CKD was defined as dipstick proteinuria ≥1+ and/or estimated glomerular filtration rate 2 base on both out- and inpatient laboratory data. As an initial analysis, we analyzed 39,121 CKD outpatients (median age was 71 years, 54.7% were men, median eGFR was 51.3 mL/min/1.73 m2) and observed that the number of patients with a CKD stage G1, G2, G3a, G3b, G4 and G5 were 1,001 (2.6%), 2,612 (6.7%), 23,333 (59.6%), 8,357 (21.4%), 2,710 (6.9%) and 1,108 (2.8%), respectively. According to the KDIGO risk classification, there were 30.1% and 25.5% of male and female patients with CKD at very high-risk, respectively. As the information from every clinical encounter from those participating hospitals will be continuously updated with an anonymized patient ID, the J-CKD-DB will be a dynamic registry of Japanese CKD patients by expanding and linking with other existing databases and a platform for a number of cross-sectional and prospective analyses to answer important clinical questions in CKD care.

BackgroundThe Japan Chronic Kidney Disease Database (J-CKD-DB) is a nationwide clinical database of patients with chronic kidney disease (CKD) based on electronic health records. The objective of this study was to assess the prevalences of hyperuricemia and electrolyte abnormalities in Japanese patients with CKD.MethodsIn total, 35,508 adult outpatients with estimated glomerular filtration rates of 5-60 ml/min/1.73 m2 in seven university hospitals were included this analysis. The proportions of patients with CKD stages G3b, G4, and G5 were 23.5%, 7.6%, and 3.1%, respectively.ResultsLogistic regression analysis showed that prevalence of hyperuricemia was associated with CKD stages G3b (adjusted odds ratio [95% confidence interval]: 2.12 [1.90-2.37]), G4 (4.57 [3.92-5.32]), and G5 (2.25 [1.80-2.80]). The respective prevalences of hyponatremia, hypercalcemia, hyperphosphatemia, and narrower difference between serum sodium and chloride concentrations were elevated in patients with CKD stages G3b, G4, and G5, compared with those prevalences in patients with CKD stage G3a. The prevalences of hyperkalemia were 8.3% and 11.6% in patients with CKD stages G4 and G5, respectively. In patients with CKD stage G5, the proportions of patients with optimal ranges of serum uric acid, potassium, corrected calcium, and phosphate were 49.6%, 73.5%, 81.9%, and 56.1%, respectively.ConclusionsWe determined the prevalences of hyperuricemia and electrolyte abnormalities in Japanese patients with CKD using data from a nationwide cohort study.

BackgroundThe Japan Chronic Kidney Disease Database (J-CKD-DB) is a nationwide clinical database of patients with chronic kidney disease (CKD) based on electronic health records. The objective of this study was to assess the prevalence of anemia and the utilization rate of erythropoiesis-stimulating agents (ESAs) in Japanese patients with CKD.MethodsIn total, 31,082 adult outpatients with estimated glomerular filtration rates of 5-60 ml/min/1.73 m2 in seven university hospitals were included this analysis. The proportions of patients with CKD stages G3b, G4, and G5 were 23.5%, 7.6%, and 3.1%, respectively.ResultsThe mean (standard deviation) hemoglobin level of male patients was 13.6 (1.9) g/dl, which was significantly higher than the mean hemoglobin level of female patients (12.4 (1.6) g/dl). The mean (standard deviation) hemoglobin levels were 11.4 (2.1) g/dl in patients with CKD stage G4 and 11.2 (1.8) g/dl in patients with CKD stage G5. The prevalences of anemia were 40.1% in patients with CKD stage G4 and 60.3% in patients with CKD stage G5. Logistic regression analysis showed that diagnoses of CKD stage G3b (adjusted odds ratio [95% confidence interval]: 2.32 [2.09-2.58]), G4 (5.50 [4.80-6.31]), and G5 (9.75 [8.13-11.7]) were associated with increased prevalence of anemia. The utilization rates of ESAs were 7.9% in patients with CKD stage G4 and 22.4% in patients with CKD stage G5.ConclusionsWe determined the prevalence of anemia and utilization rate of ESAs in Japanese patients with CKD using data from a nationwide cohort study.

To help clinicians find better evidence, a metadata schema for Evidence Based Medicine (EBM) is developed. Dublin Core metadata standard (DC) was adopted to help build a metadata schema. An experimental system was developed to test the validity of the metadata and full text papers of clinical therapy on stomach ulcer extracted using PubMed. An EBM metadata schema was developed. Citations were created from original papers using the metadata schema. Three clinicians evaluated papers by utilizing metadata and full texts respectively. Agreement of evaluation was analyzed, and the result on weighted kappa was 0.55 (95%CI, 0.42---0.67). It reveals that there is moderate agreement between evaluation of metadata citations and full texts. It is possible to use the metadata to select papers before reading the full texts. A further study should be made to prove the applicability of the metadata in the real world setting.

当院において、業務の効率化を図る目的でコンピュータオーダリングシステムが導入された。しかし、ORTの業務はますます複雑多様化している。そこで、さらに適切でかつ安全な視能矯正管理を行い、これを患者に還元するため、視能矯正のワークフロー分析により電子的業務マニュアルを作成した。分析はKJ法により行い、臨床に関する業務項目を関連図にまとめた。これをもとに電子的業務マニュアルを作成、視能矯正全体の流れ、外来システム、入院システム、各業務の詳細を示した。本マニュアルにより視能矯正システムが視覚化および標準化され、臨床全体の流れと部分的な詳細な内容との相互関係が明確になった。これは、臨床面、教育面、研究面で有用であり、各要素が相互に結びつき機能することで患者中心のより良い医療を提供できるものと考えた。

Photoinduced electron-transfer (ET) reaction between zinc- or magnesium myoglobin and a variety of quenchers, such as [Ru(NH3)6]3+, cationic viologens, copper(II) protein (stellacyanin) and anlhraquinone-2-sulfonate has been studied in an aqueous degassed solution. Not only photoinduced ET but also thermal backward ET reactions were insensitive to the driving force of reactions, suggesting that the reactions are controlled by conformational changes in myoglobins.

Photoinduced electron transfer (ET) between zinc myoglobin (ZnPPMb) and a variety of quenchers, such as hexacyanoferrate(III) ([Fe(CN)6]3−) and hexaammineruthenium(III) ([Ru(NH3)6]3+) ions, cationic viologens, copper(II) protein (stellacyanin), and metmyoglobins, has been studied in aqueous degassed solutions. The excited triplet state of ZnPPMb (*ZnPPMb) was quenched by [Fe(CN)6]3− in a self-associated complex. Both quenching rate constant and formation constant of the self-associated complex decrease with increasing ionic strengths. The thermal backward ET reaction for this system was not observed; it is most likely that the backward ET step is much faster than the quenching reaction. All of the cationic quenchers examined in this work did not form a self-associated complex with *ZnPPMb, and the intermolecular quenching occurred. The thermal backward ET reaction was observed for these cationic quenchers. Not only photoinduced ET but also thermal backward ET reactions were insensitive to the driving forc...

An approach to the nurse scheduling problem is presented. The critical problem in nurse scheduling in a hospital is how to determine the day-to-day shift assignments of each nurse for a specified period in a way that satisfies the given requirements as much as possible, where the requirements differ greatly depending on the hospital. We present a method for constructing an agency-independent core procedure which can be tailored to the peculiar requirements of an individual hospital. As a basis, a formal analysis of the problem was performed, and a general scheduling procedure was established. Based on the method, a software system which produces a scheduling program for a given institution was developed. A declarative program that represents institution-specific information is generated through an interview with the user and incorporated into the general procedure. Some of the programming technicalities and an application of the system are also presented.

Both photoinduced electron-transfer and thermal backward electron-transfer reactions of zinc myoglobin with cationic quenchers were bimolecular steps and the reaction rates were insensitive to the driving force of reactions, suggesting that the reactions are controlled by conformational changes of zinc myoglobin.

A computer-based learning system called Electronic Patient Record (EPR) Laboratory has been developed for students to acquire knowledge and practical skills of EPR systems. The Laboratory is basically for self-learning. Among the subjects dealt with in the system is health information ethics. We consider this to be of the utmost importance for personnel involved in patient information handling. The variety of material on the subject has led to a problem in dealing with it in a methodical manner. In this paper, we present a conceptual model of health information ethics developed using UML to represent the semantics and the knowledge of the domain. Based on the model, we could represent the scope of health information ethics, give structure to the learning materials, and build a control mechanism for a test, fail and review cycle. We consider that the approach is applicable to other domains.

pulse wave velocity (PWV), PWV vadprssure, and Serum lipid levels are tested whether or not they are there 1s no dgnificmt difference PWV measurements in healthy sulsiects -9 - '. E is arid the in patients with cardiovd disease. to exclude subjects who ' in the future Since it is very dSficuk will epective analysis of the data archives Seems to be essentiaL

There is an ever-increasing demand for statistical information in health-care societies, and voluminous statistics are collected every year. When one needs information on survey results, it is generally not allowed to access the original data, and the summary tables are the most important source of information which can be shared. In order to store summary tables as a well-organized database and to perform flexible retrieval, a formal study has been made on the structure of summary tables. We introduce the notion of summary table scheme and define the operations called table transformation. A statistical database management system has been implemented based on the study. In our study, a statistical database is a collection of summary tables obtained from a survey. If a survey is conducted periodically, a database consists of all the tables obtained in the past. System utilities have been implemented for handling time-oriented information.

A hypertext-based system called IntroStat has been developed to introduce fundamental methods of biomedical statistics. The system has been developed on a Macintosh II using HyperCard. It is written mainly in Hypertalk, a scripting language of HyperCard. Being an electronic textbook of probability and statistics, the system features computational capabilities. At the end of the sections describing basic methods of statistics, pages are provided where a user may enter data and try the methods right there. Some means for branching are provided for easy access to a page of interest, including branching by contents, by index, and by keyword reference. The system design is proposed as a model of an electronic textbook for biomedical statistics.

In order to investigate the problem of comedical staff shortage in hospital, a survey has been conducted on radiological technologists. The questionnaire included questions about the size of hospital, amount of work, and respondents themselves. We present the main results of the survey, and discuss that the standpoint of comedical staff is a valid ground for evaluating shortage of comedical staff and for determining staffing which is appropriate in a real sense.

An intelligent terminal has been developed to provide the clinical staffs with a means of utmost simplicity to communicate with the computer. Only 16 keys and a single switch are all which are involved in any terminal operation. The members of the operating system are the interpreter of TEXTOR (a language developed in this study), editor, monitor, and data-communication handler. This system configuration greatly reduces the cost for data communication compared with the conventional communication systems.

We have developed a computer method to make a diagnosis for an emergency patient using the data reported by a person who has no technical knowledge of medicine such as a member of the public or an ambulance attendant. The speedy instruction will be made possible by a computer diagnosis, by which an ambulance attendant could deliver the patient expeditiously to the most appropriate medical facility. We first conducted a survey by means of questionnaire and investigated the relationship between the patients' data and diagnosis of medical doctors. It was shown that fairly accurate diagnosis could be made on treatment, hospitalization, an appropriate medical department and need of urgent care, using simple information like age, sex, cause of illness or injury, and 15 symptoms which trained laymen could judge. Accuracy of the diagnosis was 79.3% on the average.

Hierarchical organization of information on drug-drug interactions is presented. The drug categories and drugs known to be involved in interactions are represented as nodes, and they are partly ordered according to inclusive relationships. Interactions among them are represented by a relation called the interacting relation. A partial ordering is defined on the solution set of the interacting relation based on the inclusive relationships among the nodes, and the set of the maximal elements is defined as the maximal interacting relation. These maximal elements are stored in a computer as explicit links joining the nodes, and during the process of interaction checking, they are superimposed on all the subordinate nodes. Thus possible interactions between given drugs can be found by applying the general rules of interactions. An experimental system is implemented based on this representational scheme, and the efficiency of the scheme as a basis of an advanced information management system for drug-drug interactions is discussed.

The system FLXFL (FLeXible File) is a general purpose file processing system developed to support the function of conversational data handling for nonprogrammers. The operations provided, including the definition of (or modification of) the record format and statistical computations as well as data retrieval, are all carried out in a simple question-and-answer manner throughout the system. FLXFL allows even a user with no computer background to have the complete control over the computerized management and analysis of the varied types of data. At present, FLXFL runs on minicomputer PDP 11 40 with 32K words of memory. The system is designed for general purpose, but is particularly suitable for research works.

We have established a discrimination value that classifies serum lipid levels, that is, total cholesterol, phospholipid, triglyceride, and beta-lipoprotein, into normal or abnormal state. The analysis was made using the linear discriminant function based on 720 normal subjects and 294 patients with coronary heart disease and/or diabetes mellitus. Basically, the function denoted as f is a linear combination of the predictor variables x(1),x(2),...,x(n) weighted by w(0),w(1),w(2),...,w(n). First, we obtained a function from the training set that consists of age-matched 204 normals and 204 patients. The predictor variables used are four serum constituents and age. Next, we tested the cross-validation of this function by the remainder of the samples (test set). Finally, we obtained a discrimination value, by which 96.1% of the training set and 96.3% of the test set was correctly classified.

We have been developing a database for gastric cancer screening test since 1979. People who live in the city area voluntarily undergo the test once a year, and the data of each examinee are stored into the file constituting a record for each visit. Up to the present time, 91 400 records have been entered into the database. The file is supported by FLXFL, an interactive system for programming-free data management and analysis, which runs on a PDP 11/44. A record consists of 56 items, that is: examinee's name, address, telephone number, past history, family history, present complaints, radiographic findings of the gastrointestinal tract and so forth. Data other than X-ray and gastro-camera findings are taken by questionnaire. Using the data in the file, we have statistically analysed whether each data item is useful or not for detecting a patient with gastric cancer. The results of the analyses are presented in this paper.

It has been generally considered that FORTRAN is inferior to MUMPS and other computer languages in its facility to manipulate files and that it is not satisfactorily competent to handle databases. However, it is our finding that FORTRAN is the most widely used language in patient data management systems discussed in recently published papers. Therefore, it now seems appropriate to review and evaluate the validity of this general belief. The objective of this study is to establish a file management system in FORTRAN 77 for use in the construction of a clinical database. Comparative study is conducted on several problems associated with file manipulation, that is, time requirement for file access and access methods for data retrieval.

An algorithm to archive patient data at free size in disk storage is presented. A record, assumed to be a character string such as an ASCII-coded text, is compressed and divided into fixed-length blocks. One block consists of a data field and a pointer field, and the blocks comprising a record are chained with pointers forwardly. A head pointer of each record is sequentially saved on a separate file. The data compression is performed as follows: if the same character code appears more than twice in succession, we count the number of the repetitions and save it with initial two characters. The algorithms for fetching, re-saving, and purging a record are also presented. These were implemented in FORTRAN77 and tested for performance using a practical patient data file. As the algorithm allows highly flexible record manipulation and can easily be implemented in conventional programming languages, it will make a useful tool for constructing a portable data base management system.

A software tool for inputing and outputing patient data (1/O routine) has been developed. Since this I/O routine is programmed exclusively in FORTRAN77, it will make a powerful tool for constructing a portable database system. Basically the routine manipulates an ASCII-coded text string that consists of lines demarcated by the CR code (13) and is terminated by the null code (0). The editing commands are preceded by one of the following ASCII characters: @, !, ], [, ∗ , and _, and all the strings with an initial character other than these are interpreted as data to be inserted into the text. Since the voutine uses two FORTRAN tools already reported, i.e. the subroutines to manipulate key files and the subroutines to manage variable length records, character strings can be stored without any restriction in format or in size, and can be retrived either sequentially or in an indexed manner.

An approach to the problem of nursing staff scheduling in a hospital is presented. For scheduling nurses, a variety of requirements with varied levels of significance has to be taken into account simultaneously. Because of the nature of the problem, where it is difficult to define what is the optimal solution in a strict sense, we aimed at automating scheduling by following the manual method in a faithful manner. A system for nurse scheduling has been implemented on a personal computer using Prolog. It determines favorable shift assignments on a day-to-day basis, referring to the information accumulated in the data base. In Prolog, various requirements can be expressed with relative ease, and the process of the manual method can be incorporated into the system in a natural way. The computer simulation has been conducted to test the system performance, and the obtained results demonstrated the validity of the approach.

An algorithm to obtain the number of different values that appear a specified number of times in a given data field of a given data file is presented. Basically, a well-known B-tree structure is employed in this study. Some modifications were made to the basic B-tree algorithm. The first step of the modifications is to allow a data item whose values are not necessary distinct from one record to another to be used as a primary key. When a key value is inserted, the number of previous appearances is counted. At the end of all the insertions, the number of key values which are unique in the tree, the number of key values which appear twice, three times, and so forth are obtained. This algorithm is especially powerful for a large size file in disk storage.

Pulse wave patterns at a finger and a toe are obtained using photoplethysmography. The data recorded at two recording sites are transformed by digital filters into six waveforms and the transmission time of each wave is estimated by the crosscorrelation function. Relationships between the transmission times, age, and parameters obtained from several laboratory tests are examined using multiple regression analysis. The results may be summarised as follows: the power of photoplethysmograms of a finger and a toe is concentrated in the range below 6 or 8 Hz; age correlates highly with the transmission time of a pulse wave rather than with velocity; the multiple correlation coefficients between age and the transmission times is 0·853 in male and 0·866 in female; there are no differences of transmission time among disease types; the correlations between age and other parameters measured by laboratory tests, that is, total cholesterol, phospholipid, triglyceride, β-lipoprotein, are very small.