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Seismic exploration was conducted along a profile running through the Aira caldera located in southern Kyushu, Japan. The caldera was formed by an ignimbrite eruption approximately 30 ka BP, namely, the “AT eruption,” which produced the Ito ignimbrite and widespread Aira-Tanzawa ash. This analysis aimed to clarify the detailed P-wave velocity structure beneath the caldera. Accordingly, 829 inland seismic stations and 42 ocean bottom seismographs were deployed along the 195 km-long seismic profile to record seismic waves generated by numerous controlled seismic sources. A detailed velocity structure of the active Aira caldera was successfully obtained to depths of 20 km through travel-time tomography. A substantial structural difference was observed in the thicknesses of the low-velocity zones between the eastern and western sides in the shallowest region of the Aira caldera, suggesting that the Aira caldera is composed of at least two calderas: the AT caldera associated with the AT eruption, and the Wakamiko caldera associated with the post-AT eruption. Perhaps the most interesting feature of the caldera structure is the existence of a substantially high-velocity zone at depths of 6–11 km beneath the center area of the AT caldera, which can be interpreted as the cooled and solidified magma reservoir formed during or after the AT eruption. In addition, a low-velocity region with approximately 15 km depths indicated a deep magma reservoir. Based on these novel and past research results, a new magma supply model in the Aira caldera was proposed. Further, the spatial distribution of the magma reservoir associated with the AT eruption 30 ka BP was estimated, while the future possibility of larger eruptions in this caldera was discussed.

Many older people with end-stage dementia die of pneumonia, but the details of their distress have been unclear. The present study clarified the distress experienced by such individuals due to pneumonia.We searched for literature corresponding to 5 clinical questions (CQs) concerning including "What distress is experienced by older people with end-stage dementia due to pneumonia (CQ1) ?" using a search formula with the Web version of the Central Medical Magazine, MEDLINE (STN)/EMBASE (STN), Cochrane Library, and extracted 604 articles. Forty-two articles corresponding to 5 CQs were extracted by primary screening using abstracts, and 17 articles were adopted after the secondary screening. A total of six articles corresponding to CQ1 were ultimately analyzed.Older people with end-stage dementia who died of pneumonia reported more discomfort and dyspnea than those who died of dehydration. Their main symptoms were respiratory symptoms, such as cough, sputum, and dyspnea, a fever and somnolence. Distress such as dyspnea and discomfort among older people with end-stage dementia recovering from pneumonia peaked on the day of the diagnosis. Furthermore, in older people with end-stage dementia dying of pneumonia, distresses began approximately one week before death and peaked on the day before death. A few days before death, several distressing symptoms, such as pain, dyspnea and restlessness/agitation, were often observed at the same time.If older people with end-stage dementia contract pneumonia and die from it, attentive palliative care is needed to manage their severe discomfort, dyspnea and other sources of distress.

Background Metachronous pancreatic and gallbladder cancer is a rare condition and has a dismal prognosis. Herein, we present a patient with triple metachronous primary pancreatic and gallbladder cancer associated with pancreaticobiliary maljunction who achieved long-term survival after undergoing repeat curative surgery. Case presentation A 65-year-old female patient with advanced gallbladder cancer associated with pancreaticobiliary maljunction underwent extended cholecystectomy with extrahepatic bile duct resection. The pathological diagnosis was T3N0M0 stage III A papillary adenocarcinoma with hepatic invasion. During a monthly follow-up, a diffuse hypovascular 2.0 × 1.5-cm mass was detected in the pancreatic head 6.2 years after the initial surgery. Hence, the patient underwent pancreaticoduodenectomy. Histological examination revealed T3N0M0 stage IIA well-differentiated adenocarcinoma without lymph node metastases. Marked inflammatory reaction was observed in the non-cancerous lesions of the proximal pancreatic head parenchyma containing bile pigment within ductular lumens. After 12.5 years from the initial surgery, total pancreatectomy for a 4.0 × 3.0-cm mass in the remnant pancreas was performed. Histological examination revealed T3N1M0 stage IIB moderately differentiated adenocarcinoma with lymph node metastases. Hence, surgical curative resection was achieved. Based on the pathological findings, a definitive diagnosis of triple metachronous pancreatic and gallbladder cancer was made. The pathology suggests no precursor lesions such as pancreatic intraepithelial neoplasia (PanIN) and atypical flat lesions, but marked inflammations in the non-cancerous lesions, strengthening our hypothesis that chronic inflammation induced by the pancreaticobiliary maljunction is related to carcinogenesis of the pancreas. Despite further adjuvant chemotherapy, the patient’s general condition worsened; however, she remained alive 15.2 years after the initial surgery while receiving the best supportive care. Conclusions Repeat curative surgery for triple metachronous cancer was associated with a favorable prognosis. Both the biliary tract and the pancreas should be closely monitored during follow-up among patients with pancreaticobiliary maljunction, which can be managed with curative surgery.

Older adults at the end-of-life stage receiving home visits from physicians often experience symptoms such as dyspnea, pain and fatigue, among others. This study aimed to investigate the practices and opinions of physicians providing home visits regarding palliative care for older adults with respiratory symptoms due to non-malignant diseases in Japan.A nationwide questionnaire survey on home palliative care for non-cancer chronic respiratory diseases was sent to 2988 home-care physicians in 2020 through postal mail and/or email. The questions focused on their background, their use of rating scales to evaluate the intensity of dyspnea, and their practices and opinions regarding home palliative care for respiratory diseases or symptoms.Valid responses were collected from 592 physicians (19.8%). A total of 251 participants (43.1%) used a rating scale to evaluate the intensity of dyspnea. While 87.8%, 86.6%, 67.3%, and 60.0% of physicians considered pulmonary rehabilitation, morphine, sedative medications, and non-invasive positive pressure ventilation (NPPV), respectively, as effective in relieving respiratory distress, 73.0%, 66.9%, 57.3%, and 55.2% of those physicians, respectively, used each modality to relieve respiratory distress. Frequently involved physicians in the aforementioned care prescribed morphine or sedative medications and used NPPV more frequently.This study found a discrepancy between the proportion of physicians who considered palliative care as effective and those who prescribed it. Geriatr Gerontol Int 2022; 22: 943-949.

Primary palliative care is essential for the continuity of care in severe COPD. This study aimed to identify essential factors and aspects to enhance the quality of primary palliative care for adults with severe COPD living in the community. Interviews with medical professionals from six institutions located in two major metropolitan areas in Japan were conducted, and these interviews were analyzed by using a qualitative content analysis approach. Results indicate that effective collaborative communication among team members, long-term care insurance system and related services, and palliative care techniques were the primary themes.

The Japan Geriatrics Society has so far announced "The Japan Geriatrics Society Position Statement 2012" and "Guidelines for the Decision-Making Processes in Medical and Long-Term Care for the Elderly - Focusing on the Use of Artificial Hydration and Nutrition" related to end-of-life care for older adults. In 2018, the Ministry of Health, Labor and Welfare revised the "Guidelines for the Decision-Making Processes in Medical and Long-Term Care in the End of Life," recommending the practice of advance care planning (ACP). This was the first time when the Japanese government publicized its stance on ACP. Immediately after the government's announcement, the Japan Medical Association announced its committee report, "The Super-aged Society and the End-of-life Care," which also recommended the practice of ACP. The guidelines were published when the society was experiencing substantial changes related to geriatric care in Japan, and required timely and ethically appropriate decision-making processes. However, because ACP is a concept imported from English-speaking countries, some Japanese people could find it difficult to understand the role and methodology of ACP because of differences in culture and the medical/long-term care system. Therefore, the Japan Geriatrics Society has decided to publish the "Recommendations for the Promotion of Advance Care Planning" for medical and long-term care professionals nationwide with the aim of using the recommendations on a daily basis. The society recognizes ACP as indispensable to improve end-of-life care for individuals, particularly for older adults. We anticipate that the recommendations will provide practical guidance for those strenuously working toward this goal. Geriatr Gerontol Int 2020; 20: 1024-1028..

Nutritional problems after gastrectomy affect continuation of postoperative chemotherapy. There have been no studies limited to total gastrectomy, which is particularly prone to nutritional problems. In this study, we aimed to investigate the factors that predict the continuation of postoperative chemotherapy.We included 101 patients who underwent curative total gastrectomy and postoperative chemotherapy at Hiroshima Memorial Hospital. The effects of 37 factors, including perioperative inflammatory, nutritional, and tumor status, on the persistence of postoperative chemotherapy were analyzed.In univariate analysis of preoperative factors, age, carbohydrate antigen 19-9, platelet-to-neutrophil ratio, Onodera's prognostic nutritional index (PNI), controlling nutritional status score, and nutritional risk screening (NRS-2002) score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of preoperative factors, age (≥74 years) was an independent factor for a shorter duration of postoperative chemotherapy (hazard ratio [HR], 5.24; 95% confidence interval [CI], 2.19-12.96; P0.01). In univariate analysis of factors before postoperative chemotherapy, intraoperative blood loss, perioperative weight loss rate, postoperative performance status, PNI, albumin-to-bilirubin index, and NRS-2002 score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of factors before postoperative therapy, age (≥74 years) (HR, 5.75; 95% CI, 1.90-19.49; P0.01) and PNI (39) (HR, 3.29; 95% CI, 1.26-8.56; P=0.02) were independent factors for a shorter duration of postoperative chemotherapy.Age and PNI are useful predictors of postoperative chemotherapy intolerance after total gastrectomy and may determine the treatment strategy and timing of chemotherapy initiation.

A 79-year-old woman visited our hospital complaining of bloating. An abdominal enhanced CT scan revealed pancreatic body cancer with cancerous ascites and multiple liver metastases. We started gemcitabine(GEM)plus nab-paclitaxel chemotherapy. Chemotherapy was not continued because she was unable to take oral medication owing to increased cancerous ascites. We conducted modified KM-cell-free and concentrated ascites reinfusion therapy(KM-CART). Her symptoms improved, and she began having oral intake after KM-CART. Chemotherapy was then re-initiated. Seven months have now passed since we started chemotherapy, and we can continue chemotherapy while conducting KM-CART repeatedly. KM- CART is useful for treating unresectable pancreatic cancer with massive cancerous ascites in terms of continuing chemotherapy.

Since the end of 2019, a life-threatening infectious disease (coronavirus disease 2019: COVID-19) has spread globally, and numerous victims have been reported. In particular, older persons tend to suffer more severely when infected with a novel coronavirus (SARS-CoV-2) and have higher case mortality rates; additionally, outbreaks frequently occur in hospitals and long-term care facilities where most of the residents are older persons. Unfortunately, it has been stated that the COVID-19 pandemic has caused a medical collapse in some countries, resulting in the depletion of medical resources, such as ventilators, and triage based on chronological age. Furthermore, as some COVID-19 cases show a rapid deterioration of clinical symptoms and accordingly, the medical and long-term care staff cannot always confirm the patient's values and wishes in time, we are very concerned as to whether older patients are receiving the medical and long-term care services that they wish for. It was once again recognized that it is vital to implement advance care planning as early as possible before suffering from COVID-19. To this end, in August 2020, the Japan Geriatrics Society announced ethical recommendations for medical and long-term care for older persons and emphasized the importance of conducting advance care planning at earlier stages. Geriatr Gerontol Int 2020; 20: 1112-1119.

Nivolumab is one of the immune checkpoint inhibitors available for chemotherapy-resistant gastric cancer. There have been few reports of confirmed prominent shrinkage of the primary tumor and some reports of prolonged antitumor effect after discontinuance of the drug, but it is not universal. A 67-year-old male was admitted to our hospital and diagnosed with metastatic gastric cancer that had spread to the bilateral lobe of the liver, distant lymph nodes, and peritoneum. He received five courses of S-1 plus oxaliplatin, followed by three courses of ramucirumab plus paclitaxel leading to disease progression. Then, the patient was administered nivolumab as third-line therapy. Tumor size was markedly reduced after three courses, esophagogastroduodenoscopy (EGD) revealed scar formation on the lower gastric corpus after seven courses, and biopsy specimen showed no malignancy. When a slight lower limb muscle weakness manifested, possibly an immune-related adverse event (irAE) after 15 courses, we stopped administration of nivolumab. The patient has survived for 26 months since his first visit, and elimination of the primary tumor and ascites with noted shrinkage of liver and lymph node metastases have followed for more than 10 months since discontinuance of nivolumab.

A previous pooled analysis demonstrated significant relief of breathlessness following opioid administration in patients with chronic obstructive pulmonary disease. However, in clinical practice, it is important to know the characteristics of patients responding to opioids, the best prescription methods, and the evaluation measures that can sufficiently reflect these effects. Thus, we performed a systematic review of systemic opioids for non-cancer chronic respiratory diseases. Fifteen randomized controlled studies (RCTs), four non-randomized studies, two observational studies, and five retrospective studies were included. Recent RCTs suggested that regular oral opioid use would decrease the worst breathlessness in patients with a modified Medical Research Council score ≥ 3 by a degree of 1.0 or less on a scale of 1–10. Ergometer or treadmill tests indicated mostly consistent significant acute effects of morphine or codeine. In two non-randomized studies, about 60% of patients responded to opioids and showed definite improvement in symptoms and quality of life. Furthermore, titration of opioids in these studies suggested that a major proportion of these responders had benefits after administration of approximately 10 mg/day of morphine. However, more studies are needed to clarify the prescription method to reduce withdrawal due to adverse effects, which would lead to significant improvements in overall well-being.

Objectives The importance of social capital in promoting interprofessional collaborations is well known. This study examined the effects of an interprofessional educational program for homecare professionals on building social capital in terms of homecare in an urban area.Methods The program was conducted at Kita Ward, Tokyo, from July 2014 to January 2015. We used a self-administered questionnaire before and after the program to collect data from homecare professionals in the ward, as well as from those who were interested in providing homecare. Physicians attended a five-day program, while other professionals attended a four-and-a-half-day program. Participants' attitude toward homecare practices was assessed to evaluate their motivation level for the job (i.e., the formation of a practical view of homecare and efficacy to engage in homecare practices). Regarding social capital, we assessed trust and norm of reciprocity for those in the same profession as the respondent (bonding and cognitive social capital) as well as for those in a different profession (bridging and cognitive social capital). Additionally, to professionals other than physicians, we asked about trust and norm of reciprocity regarding physicians (bridging and cognitive social capital) and collaborative conditions with physicians, which included the two sub-domains of cooperation and interaction (bridging and structural social capital). A generalized estimating equation was used to detect the effect size.Results Of the 54 program participants, 52 (including two physicians) completed both the pre- and post-program questionnaires. Participants' practical view of homecare was formed after the program, although their efficacy for homecare practices was unchanged. With regard to social capital, scores for both trust and norm of reciprocity for the same profession (bonding and cognitive social capital) increased, while those for different professions (bridging and cognitive social capital) were unchanged. Scores for both trust and norm of reciprocity regarding physicians and cooperation with physicians (bridging and cognitive social capital, and bridging and structural social capital) also increased. Finally, trust and norm of reciprocity for the participants improved after the program.Conclusion The interprofessional educational program for homecare professionals may foster social capital among the participants. The study results imply that this program can be a possible strategy to foster social capital in the field of homecare.

In Japan, patients who require home medical care are increasing especially in the elderly. In home medical care settings, devices such as gastrostomy tubes, tracheal cannulas, and urethral catheters are usually replaced by visiting physicians or nurses. However, device replacement services are not always available in Japan. Unless device replacement services are sufficiently provided to patients at home, patients have to suffer various disadvantages, including a forced visit to a hospital for device replacement despite inability to walk. We therefore investigated background factors of clinics and nursing stations providing home-care visits using a cross-sectional postal survey from August to September 2013. We targeted physicians from 5,828 clinics providing home medical care and nurses from 1,798 home-visit nursing stations across six prefectures (Tokyo, Kanagawa, Saitama, Chiba, Miyagi and Iwate). Responses were received from 933 clinics (16.5%) and 552 stations (31.3%). We analyzed the responses using multivariable logistic regression with two models. "Model 1" mainly included the number of full-time staff and the availability of a 24-hour care service system, and "Model 2" mainly included the number of clinics, the number of home-visit nursing stations, and the ratio of the population aged ≥ 65 years to study the influence of medical resources. We thus found that clinic staff numbers and 24-hour care availability were associated with physicians' replacement of gastrostomy tubes and tracheal cannulas (p < 0.001 for each). In conclusion, single-handed and group practices need to cooperate to ensure the replacement of these devices in home medical care settings.

Aim The present study investigated the association between the structure of catheter replacement services in home medical care settings and regional characteristics. Methods An anonymous self-administered questionnaire was carried out from August to September 2013. Participants were physicians from 5338 clinics that provided medical care services at home, and nurses from 1619 home-visit nursing stations in Tokyo and three adjoining prefectures. The questionnaire covered catheter replacement (gastrostomy tubes, nasogastric tubes, tracheal cannulas) during home medical care, and the professions of those who replaced urethral catheters for male and female patients. Regions were divided into two groups (higher- and lower-density regions) based on the number of clinics, number of home-visit nursing stations and the ratio of the population aged ≥65 years. The rates of respondents that reported catheter replacement was usually executed, and those who reported catheters were replaced by “physicians in principle” were compared between the groups. Results Responses were received from 842 clinics (16.3%) and 499 home-visit nursing stations (31.4%). In the higher-density regions, the rate of physicians who reported urethral catheters for male patients were replaced by “physicians in principle” was significantly higher than in the lower-density regions (P

Objective To examine the short-term effects of an inter-professional educational program developed for physicians and other home care specialists to promote home care in the community.Methods From March 2012 to January 2013, an inter-professional educational program (IEP) was held four times in three suburban areas (Kashiwa city and Matsudo city in the Chiba prefecture, and Omori district in the Ota ward). This program aimed to motivate physicians to increase the number of home visits and to encourage home care professionals to work together in the same community areas by promoting inter-professional work (IPW). The participants were physicians, home-visit nurses, and other home care professionals recommended by community-level professional associations. The participants attended a 1.5-day multi-professional IEP. Pre- and post-program questionnaires were used to collect information on home care knowledge and practical skills (26 indexes, 1-4 scale), attitudes toward home care practice (4 indexes, 1-6 scale), and IPW (13 indexes, 1-4 scale). Data from all of the participants without labels about the type of professionals were excluded, and both pre-test and post-test responses were used in the analysis. A Wilcoxon signed-rank test and a paired t-test were conducted to compare pre- and post-program questionnaire responses stratified for physicians and other professionals, and the effect size was calculated.Results The total number of participants for the four programs was 256, and data from 162 (63.3%) were analyzed. The physicians numbered 19 (11.7%), while other professionals numbered 143 (88.3%). Attending this program helped participants obtain home care knowledge of IPW and a practical view of home care. Furthermore, indexes about IPW consisted of two factors: cooperation and interaction; non-physician home care professionals increased their interactions with physicians, other professionals increased their cooperation with other professionals, and physicians increased their cooperation with other physicians.Conclusion Short-term effects to motivate physicians to increase home visits were limited. However, physicians obtained a practical view of home care by attending the IEP. Also, the participation of physicians and other home care professionals in this program triggered the beginning of IPW in suburban areas. This program is feasible when adapted for regional differences.

Furnished cages for laying hens have advantages in allowing normal behaviors and maintaining productivity. As the cost of introduction is a barrier for farms, we developed furnished cages that re-use conventional cages. To determine the minimum and functional cage design, we compared six designs, combinations of two floor designs (artificial turf or wire cage floor) and three screening designs in the integrated area (no screening, one entrance side or four sides). In total, 144 hens were used, and we measured behavior, physical condition and productivity. Comparing the floors, the percentages of hens performing dust-bathing and laying eggs in the integrated area were higher in cages with turf than wire floor (P

Objective There is a lack of sufficient information on the employment of home care for the treatment of hematologic malignancies. Methods We provided home care to 580 patients from 1 January through 31 October 2007. Patients with hematologic malignancies were selected from these 580 patients; subsequently, by reviewing their medical records. Results The main clinical condition in 15 (2.6%) of 580 patients was hematologic malignancies. The median age of the patients was 78 years (range, 64-92). Of the 15 patients, 12 showed a performance status (PS) of 3-4, and the condition of 6 patients was complicated with dementia. Food intake via the oral route was possible in 14 patients. These patients were administered palliative care. Among the seven patients who required pain control, four had been opioid users; however, none had used anticancer drugs for pain relief. Furthermore, three patients received blood transfusion. Although three patients developed severe complications (acute appendicitis, pneumonia and hyperglycemia), we were able to treat all cases adequately. Eight patients died at home due to aggravation of the primary diseases. The remaining seven patients were transferred to other hospitals for the treatment of complications or for the convenience of their respective families. Conclusions Even patients with hematologic malignancies could be candidates for home care if their underlying diseases are slowly progressive, and they can sustain themselves by oral intakes. Dementia and poor PS are not contraindicated to it.

In order to verify the hypothesis that hens in different housing systems have the same time budget for different beak-related behaviours, we compared the pecking behaviour of hens in six housing systems: small (SC) and large (LC) conventional cages, small (SF) and large (LF) furnished cages, single-tiered aviary (SA), and free-range (FR). At the age of 16 weeks, 284 medium hybrid layers were randomly divided into six groups and moved to the six housing systems. The number of hens performing behaviours using the beak (grazing, eating, drinking, preening, aggressive pecking, gentle feather pecking, severe feather pecking, litter pecking, and object pecking) was recorded at various ages up to 63 weeks of age. Grazing by a large proportion of hens was observed in FR, and litter pecking by a large proportion of hens in SA. The proportions of hens eating, drinking, and preening were higher in SC, LC, SF, and LF than in SA, and higher in SA than in FR (all P P P

The aim of the present study was to compare old layers' level of welfare and performance between conventional and large furnished cages under hot environmental conditions. At the age of 80 weeks, 104 Boris Brown layers were divided into two groups: 12 conventional cages (two hens/cage) and four large furnished cages (20 hens/cage, 240 cm wide × 62 cm deep). The room temperature was set to fluctuate between 25 and 33°C in a day. The hens' behavior, immune response, performance and physical condition were measured. Aggression and moving were more frequent in furnished than in conventional cages (P

We conducted long-period magnetotelluric observations in northeastern Japan from 2010 to 2013 to investigate the three-dimensional electrical resistivity distribution of the subduction zone. Incorporating prior information of the subducting slab into the inversion scheme, we obtained a three-dimensional resistivity model in which a vertically continuous conductive zone is imaged from the subducting slab surface to the lower crust beneath the Ou Backbone Range. The conductive body indicates a saline fluid and/or melt pathway from the subducting slab surface to the lower crust. The lower crust conductor is less than 10 Ωm, and we estimate a saline fluid and/or melt fraction of at least 0.7 vol. %. Other resistivity profiles in the across-arc direction reveal that the conductive body segregates from the subducting slab surface at 80–100 km depth and takes an overturned form toward the backarc. The head of the conducting body reaches the lower crust just beneath Mt. Gassan, one of the prominent backarc volcanoes in the system.

The present study investigated the association between the structure of catheter replacement services in home medical care settings and regional characteristics.An anonymous self-administered questionnaire was carried out from August to September 2013. Participants were physicians from 5338 clinics that provided medical care services at home, and nurses from 1619 home-visit nursing stations in Tokyo and three adjoining prefectures. The questionnaire covered catheter replacement (gastrostomy tubes, nasogastric tubes, tracheal cannulas) during home medical care, and the professions of those who replaced urethral catheters for male and female patients. Regions were divided into two groups (higher- and lower-density regions) based on the number of clinics, number of home-visit nursing stations and the ratio of the population aged ≥65 years. The rates of respondents that reported catheter replacement was usually executed, and those who reported catheters were replaced by "physicians in principle" were compared between the groups.Responses were received from 842 clinics (16.3%) and 499 home-visit nursing stations (31.4%). In the higher-density regions, the rate of physicians who reported urethral catheters for male patients were replaced by "physicians in principle" was significantly higher than in the lower-density regions (P 0.001). In the lower-density regions, the rate of nurses who reported urethral catheters for male patients were replaced by "nurses in principle" was significantly higher compared with the higher-density regions (P 0.016).In home medical care settings, urethral catheters for male patients are replaced by nurses in regions where physician resources are limited. Geriatr Gerontol Int 2017; 17: 628-636.

Taking advantage of the feature that creep around an asperity is necessary for the recurrent rupture of the same small asperity (small repeating earthquakes), we have estimated the spatio-temporal distribution of quasistatic slip (creep) around the 2005 Miyagi-oki earthquake (M=7.2) using the distribution of small repeating earthquakes. The creep was detected mainly outside of the coseismic slip areas for the 2005 Miyagi-oki, 1978 Miyagi-oki (M=7.6) and 2003 Fukushima-oki (M=6.8) earthquakes. The creep rates estimated from the recurrence intervals and slip amounts of small repeating earthquakes for 21 years were almost constant for the areas near the western limit of the interplate earthquakes but they varied temporally in the areas nearer to the Japan trench. The changes in the creep rates before and after the 2005 Miyagi-oki earthquake were not significant with the exception of small slip accelerations in some areas near the Japan trench. These results suggest that the plate boundary around the source area for the 2005 earthquake is still mostly locked.

A destructive large earthquake (the 2004 mid Niigata prefecture earthquake) sequence occurred in the central part (Chuetsu district) of Niigata prefecture, central Japan on October 23, 2004. We have deployed a temporary seismic network composed of 54 stations for aftershock observation just above and around the focal area of the earthquake for about a month. Using travel time data from the temporary seismic network and surrounding routine stations, we obtained precise aftershock distribution and 3D seismic velocity structure in and around the fault planes of the earthquake and four major (M ≥ 6) aftershocks by double-difference tomography. The results clearly show three major aftershock alignments. Two of them are almost parallel and dipping toward the WNW. The shallow and deep aftershock alignments correspond to the fault plane of the mainshock and that of the largest aftershock (M6.4), respectively. The third alignment is almost perpendicular to the WNW-ward dipping planes and perhaps corresponds to the fault plane of the M6 aftershock on October 27. General feature of the obtained velocity structure is that the hanging wall (western part of the focal area) has lower velocity and the footwall (eastern part of the focal area) has higher velocity. Major velocity boundary seems to shift westward in comparison to in northern and southern parts at a location near the central part of the focal area, where the main shock rupture started. Some parts of the fault planes were imaged as low velocity zones. This complex crustal structure would be one of possible causes of the multi-fault rupture of the 2004 mid Niigata prefecture earthquake sequence.

From May to October 2011, we conducted an 8-day homecare educational program for physicians, dentists, pharmacists, visiting nurses, long-term care managers, and hospital staff in Kashiwa city, Chiba, which was primarily intended to increase home visits by physicians. The characteristics of the program were as follows: 1) active and busy community physician participation, 2) attendance of practical training by physicians, 3) interprofessional discussion, 4) recruitment of participants from the same city, 5) recommendation of participant recruitment by a community-level professional association such as Kashiwa City Medical Association. By comparison of the pre- and post-program questionnaires completed by participants, the motivation for homecare practice, knowledge about homecare, and interactions with other professionals have increased. We will further standardize and generalize this program in order to contribute to homecare promotion in Japan.

Background We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases. Methods Of 607 patients who were treated in 10 clinics specialized in home care between January and December 2007 at Chiba, Fukuoka, Iwate, Kagoshima, Tochigi and Tokyo prefectures across Japan, 346 (57%; 145 men and 201 women) had malignant diseases. We collected information on medical and social backgrounds, details of home care, and its outcomes based on their medical records. Results Median age of the patients was 77 years (range, 11-102), and 335 patients were economically self-sufficient. Their general condition was poor; advanced cancer (n = 308), performance status of 3-4 (n = 261), and dementia (n = 121). At the beginning of home care, 143 patients and 174 family members expressed their wish to die at home. All the patients received supportive treatments including fluid replacement and oxygenation. Median duration of home care was 47 days (range, 0-2,712). 224 patients died at home. For the remaining 122, home care was terminated due to complications (n = 109), change of attending physicians (n = 8), and others (n = 5). The factors which inhibited the continuity of home care were the non-use of home-visit nursing care (hazard ratio [HR] = 1.78, 95% confidence interval [CI]: 1.05-3.00, p = 0.03), the fact that the patients themselves do not wish to die at home (HR = 1.83, CI: 1.09-3.07, p = 0.02), women (HR = 1.81, CI: 1.11-2.94, p = 0.02), and age (HR = 0.98, CI: 0.97-1.00, p = 0.02). Conclusions Continuation of home care is influenced by patients' age, gender, will, and use of home-visit nursing.

To increase the validity of evaluations and facilitate expansion and maintenance of assessment systems, we constructed a database of studies on the welfare of laying hens around the world. On the basis of this database, we devised a science-based welfare assessment model. Our model includes measurements, levels and weightings based on the scientific studies in the database, and can clarify the advantages and disadvantages of housing systems for laying hens from the viewpoint of the five freedoms. We also evaluated the usefulness of our model by comparing it with environment-based Animal Needs Index (ANI), another science-based model called FOWEL, and animal-based measurements. Our model showed that freedom from injury, pain and disease, and freedom from discomfort were more secure in the cage system, while non-cage systems scored better for natural behavior and freedom from fear and distress. A significant strong-positive correlation was found between the animal-based assessment and the total scores of ANI (rs = 0.94, P0.05), FOWEL (rs = 0.99, P0.05) or our model (rs = 0.99, P0.05), which indicate that these different approaches to welfare assessment may be used almost interchangeably to 'measure' a common property ('overall laying hen welfare'). However, assessments using our model and FOWEL were more sensitive than ANI and can be applied to cage systems, which suggest that our model and FOWEL may have added value.

1. The advantages and disadvantages of various housing systems for laying hens were compared as a pilot study for work in commercial conditions. 2. At 16 weeks of age, 284 hens were introduced into one of 6 housing systems: two types of conventional cages (small: SC; large: LC), furnished cages (small: SF; large: LF), and non-cage systems (single-tiered aviary: SA; free-range: FR). 3. We evaluated the welfare, egg production, and immune response of the birds in these housing systems, built in the same location, for 18 months. For welfare evaluation, we examined their ethology, physiology, anatomy, production, and physical condition. 4. The non-cage systems, especially FR, had a low score for freedom from pain, injury, and disease, together with other disadvantages, such as pale eggs and increased feed intake for production. However, the score for freedom to express normal behaviour was high and immune response was good in the non-cage systems. 5. In the furnished cages, behaviour was more diverse in SF than in LF, and in SF immune response was comparable with the non-cage systems. 6. For freedom from fear and distress, the non-cage systems had high scores for some indicators such as TI duration, H/L ratio and claw length, while aggressive pecking and feather pecking was worse in the housing systems with large group sizes.

1. The objective was to determine the relation between social rank and use of resources in a small furnished cage with sufficient resources per hen (SF) and a commercial large one with less adequate allowance of facilities per hen (LF). 2. Ninety-two cross layers were used. At the age of 16 weeks, the hens were divided at random into two groups. There were 4 furnished cages with 5 birds per cage and 4 large furnished cages with 18 birds per cage. The dominance hierarchy was determined, in which highest, medium and lowest ranking hens in each cage were identified. Behaviour, use of facilities and physical conditions of these hens were measured (one in each rank category in SF, two in each in LF). 3. Dustbathing and litter scratching were more frequent in the high ranking hens than the medium and low ranked hens in LF, while no significant difference was found between them in SF. 4. No significant difference between SF and LF was found in use of nest boxes. However, pre-laying sitting tended to be less frequent in low ranking than medium and high ranking hens in LF (Social order x Cage design). In the nest box most of time was spent in pre-laying sitting by SF hens, LF high and medium ranked hens (average 94.9%). However, LF low ranking hens spent their time escaping (33.1%), pre-laying sitting (27.7%) standing (25.7%) and moving (13.5%) in the nest. 5. In the large furnished cages with less facilities per hen, high ranking hens may be expected to have priority using the dust bath. In contrast, low ranking hens rarely performed nesting behaviour fully, and spend more time using the nest box as a refuge than for laying.

1. The objective of the present study was to examine the behaviour of laying hens in single-tiered aviaries with and without outdoor areas with particular reference to the proportion of each behaviour and the ways it changed. 2. In all, 144 interbred cross layers (WL/RIR cross-breed) were used. At the age of 16 weeks, the hens were divided at random into two groups and moved to single-tiered aviary (SA) and free-range systems (FR, SA with in addition an outdoor range area covered with clover) with 18 hens per pen. Behavioural observations were conducted before, during and after access to the range. 3. All behaviours using the beak (eating, grazing, drinking, preening, aggressive pecking, feather pecking, litter pecking, object pecking and mate pecking) were recorded as pecking behaviour. 4. While most of the FR hens spent their time outside foraging, the proportion of hens eating, preening, litter pecking, object pecking, aggressive pecking and feather pecking was higher in SA than in FR hens. 5. The proportion of hens performing pecking behaviour of all types was very similar in SA (61.7 +/- 2.0%) and in FR (64.0 +/- 0.8%). The proportion of hens performing overall pecking behaviour increased as pre-laying sitting decreased. 6. The proportion of hens feather pecking decreased in FR during access to range and a similar tendency was found for aggressive pecking. 7. In conclusion, the total proportion of hens pecking was almost the same regardless of whether an outdoor area was provided or not, but the incidence of different types of pecking behaviour differed between SA and FR. The risk of feather pecking in FR may be lower when an outdoor grazing area is provided, although further testing on a larger scale would be essential.