高齢者の健康管理におけるウェアラブルデバイスと中国伝統医学の役割

早大学位記番号:新8258早稲田大

Southwest Research Institute assistance to NASA in biomedical areas of the technology utilization program Final report, 1 Feb. 1969 - 24 Aug. 1970

Research progress in technology transfer by NASA Biomedical Application Tea

Knowledge representation for data integration and exploration in translational medicine

Tese de doutoramento, Informática (Bioinformática), Universidade de Lisboa, Faculdade de Ciências, 2014Biomedical research has evolved into a data-intensive science, where prodigious amounts of data can be collected from disparate resources at any time. However, the value of data can only be leveraged through its analysis, which ultimately results in the acquisition of knowledge. In domains such as translational medicine, data integration and interoperability are key requirements for an efficient data analysis. The semantic web and its technologies have been proposed as a solution for the problems of data integration and interoperability. One of the tools of the semantic web is the representation of domain knowledge with ontologies, which provide a formal description of that knowledge in a structured manner. The thesis underlying this work is that the representation of domain knowledge in ontologies can be exploited to improve the current knowledge about a disease, as well as improve the diagnosis and prognosis processes. The following two objectives were defined to validate this thesis: 1) to create a semantic model that represents and integrates the heterogeneous sources of data necessary for the characterization of a disease and of its prognosis process, exploiting semantic web technologies and existing ontologies; 2) to develop a methodology that exploits the knowledge represented in existing ontologies to improve the results of knowledge exploration methods obtained with translational medicine datasets. The first objective was accomplished and resulting in the following contributions: the methodology for the creation of a semantic model in the OWL language; a semantic model of the disease hypertrophic cardiomyopathy; and a review on the exploitation of semantic web resources in translation medicine systems. In the case of the second objective, also accomplished, the contributions are the adaptation of a standard enrichment analysis to use data from patients; and the application of the adapted enrichment analysis to improve the predictions made with a translational medicine dataset.Fundação para a Ciência e a Tecnologia (FCT, SFRH/BD/65257/2009

Routledge Handbook of Chinese Medicine

The Routledge Handbook of Chinese Medicine is an extensive, interdisciplinary guide to the nature of traditional medicine and healing in the Chinese cultural region, and its plural epistemologies. Established experts and the next generation of scholars interpret the ways in which Chinese medicine has been understood and portrayed from the beginning of the empire (third century BCE) to the globalisation of Chinese products and practices in the present day, taking in subjects from ancient medical writings to therapeutic movement, to talismans for healing and traditional medicines that have inspired global solutions to contemporary epidemics. The volume is divided into seven parts: Longue Durée and Formation of Institutions and Traditions Sickness and Healing Food and Sex Spiritual and Orthodox Religious Practices The World of Sinographic Medicine Wider Diasporas Negotiating Modernity This handbook therefore introduces the broad range of ideas and techniques that comprise pre-modern medicine in China, and the historiographical and ethnographic approaches that have illuminated them. It will prove a useful resource to students and scholars of Chinese studies, and the history of medicine and anthropology. It will also be of interest to practitioners, patients and specialists wishing to refresh their knowledge with the latest developments in the field. The Open Access version of this book, available at http://www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 licens

The relaxation effect of nature images and coloured light on healthy people and hospital patients in China

The use of nature scenes in photographs, digital media and colours for stress reduction has increased in recent years. However, there are few studies of the effects of such initiatives. This study began with the researcher’s observation that whilst the practice of meditation could reduce stress and increase relaxation, many people who could benefit from it were unwilling to carry it out. They may however be willing to gain some of the benefits of meditation by engaging in other ways. The research started with a developmental investigation into the effects of three different media - photographs, coloured light and film - on participants in the UK. A large number of nature photographs and video footage was created and collected for this study. The selection of the nature scenes for the tests on participants, and the inclusion of coloured lights, was based on the researcher’s own experience and knowledge in the fields of visual art, meditation and alternative therapy practice, notably Traditional Chinese Medicine (TCM). These UK investigations were used as developmental studies to refine the methodology for China, where the research for this thesis was carried out. In China, collaboration with two different hospitals in three locations was established, and investigations were carried out with three different groups of participants: hospital patients, relatives of patients (relatives who were staying in the hospital to look after the patient’s living needs) and ‘healthy’ staff and students at associated universities. Because of the facilities provided in China, the part of the study which looked at the effects of photographs was dropped. Collaborations were formed with film makers and with hospitals to achieve the maximum research benefits. Whilst slight changes were made during the data collection phase to suit the participants and the differing environments offered by the hospitals, every attempt was made to keep the tests similar to one another. Quantitative data on pulse rate and blood pressure changes, along with participants’ post-test ratings of their relaxation levels were collected, as was qualitative information from participants consisting of their own descriptive words, phrases and comments. The process was designed to avoid any research method that might negatively affect participants, and to achieve maximum similarity of methods and fieldwork environments for the different groups of participants. This was so that the numbers of participants in each group in the different hospitals could be added together, thus creating three large groups overall, and the data from the three different groups compared. The tent structure (which was used for the coloured lights and created to provide an immediate therapeutic environment), the analytical method used and the ‘key elements’ diagram which describes the results of the qualitative data relating to nature films, were new developments which emerged during the study. The major quantitative and qualitative results, both positive and negative, are reported. Comparisons are made which show how the three different groups in China were impacted by experiencing the coloured lights and watching the films. The different impacts of the coloured lights and the films are also compared. A memory stick is included with the thesis which contains all the still and moving images used, as well as photographs of the tent structure and of some of the hospital environments encountered in China. The thesis concludes with a summary and discussion based on the findings. This argues that coloured lights and visual imagery of nature scenes both had a positive effect on participants, and that this effect could be understood as similar to some of the beneficial effects of meditation. The conclusion also discusses some of the other findings in more detail

Cancer from a spatial perspective : locating the unspeakable, healing, and hope

Illness narratives in all their variety have become a central focus of the cultural study of health and disease. These stories inform other patients of what it is like to be living with a certain illness, or about treatment options, or about the possibilities of transcendence. They represent efforts on the part of the narrator to make sense of their suffering from the illness and they thereby promote empathic understanding of the illness experience. However, narratives in general rely on a temporal structure in which each event is located in a linear sequence, and this can limit the way illness is represented, especially in relation to a disease like cancer. The story of cancer is often flattened into some kind of personal history or reduced to a strive-to-survive story. This thesis challenges the dominant linear approach to telling cancer stories and argues that a spatialised account is needed to articulate the wider, multi-dimensional cancer experience. Drawing on a range of written and filmic texts, the thesis is an attempt to free cancer from the temporal plot. Even though this is a cultural study of cancer, it is not concerned with the sociocultural/historical reconstruction of the illness. It is not about the voice of patients and the subjective illness experience, either. In fact, it attempts to move away from the very subject of cancer and look at what is outside of this frame. The notion of space offers us an alternative based on its two properties. First, space does not propel its inhabitants to move in any linear direction, but it requires us to explore it in order to know it. Second, space may contain objects and people, and their various relationships formed with one another, which, in turn, give all kinds of meanings to space. The spatial understanding of cancer can thus decentre the scientific reasoning of biomedicine and redefines healing as located within the very experience of illness itself. The spatial perspective, I argue, offers a fuller and more complex vision of the relationship between illness, death and dying that can encompass hope, despair, bad luck and miracle, which are all part of what living with cancer means. A holistic approach is utilised in the thesis, integrating literary, architectural and filmic material. Section One, Stories of Cancer, focuses on what is not being spoken in stories of cancer. It analyses scientific narratives, Dorothea Lynch's memoir Exploding into Light and the films The Bucket List and 2 Become 1. Section Two, The Spatial Story of Cancer, looks at how space tells stories through an analysis of Helen Garner's novel The Spare Room and the network of cancer support centres known as Maggie's Center. Section Three, Hope and Miracles examines the experience of hope among family members and the holistic practice of Chinese medicine

Mapping the epistemological diversity of Chinese medicine; a Q methodology study

The diversity of medical practice has been widely documented in ethnographic and historical studies; what remains is to map out that diversity. In this research how such diversity manifests is elicited through asking practitioners their perspectives of how biomedicine influences their Chinese medicine practice. This starting point is chosen since the global dominance of biomedicine inevitably impacts, to varying degrees, on Chinese medicine practices. Q methodology, a unique combination of quantitative and qualitative methods (that challenges such divisions) is chosen for its ability to attain and describe a wide diversity of different subjective perspectives on a topic. Furthermore, this method allows these to arise from the data without a priori definition by the researcher. However, whilst looking at subjective opinions it is not interested in who said what, but rather what is being said about the topic. For subjectivity is seen to be forged in the social milieu; what is of interest is how such opinions group. Acknowledging that Chinese medicine today is not, of course, contained within Chinese borders, international perspectives are sought. The commonly accepted view that the two medical systems, biomedicine and Chinese medicine, used together lead to greater clarity of the whole is challenged, on epistemological grounds, drawing on theories of knowing found in the Chinese medicine literature. Six distinct practices of Chinese medicine were found and described using the term enactment. It is proposed that practitioners can access the differing inter-subjectively formed Chinese medicines using the patient body as a boundary object. Through capturing the richness and complexity of various points of view this research can identify points of both conflict and consensus that can offer directions for future practice, education and particularly clinical research design. It offers a contribution to the Q methodology literature through applying method assemblage in the analysis of factors. Thus, the neutral zone is rendered as important in understanding the narrative of the factor as are the points of most and least agreement

Evaluation of clinical efficacy and investigation of mechanism of action of acupuncture treatment in the management of polycystic ovarian syndrome

Polycystic Ovarian Syndrome (PCOS) has the clinical manifestations of irregular menstrual cycles, anovulatory infertility, amenorrhoea, insulin resistance, polycystic ovaries, androgen disturbance, hirsutism and/or acne. The condition affects an estimated 5 to 10% of women of reproductive age (Hull 1987; Polson 1988; Lo 2006), although this varies depending on the diagnostic criteria used (Michelmore 1999). Farquhar et al. (1994) suggested the prevalence of PCOS to be 21% in a New Zealand study. Due to the lack of uniformed definition of PCOS, the prevalence of PCOS can have a highly variable prevalence estimates, ranging from 2.2% to 26% . (Nidhi 2011) Through researches, evidence suggests the potential usefulness of acupuncture in the treatment of the PCOS disorder (Ku 2001; Petti 1998; Ulett 1998). It was postulated that beta-endorphin and various neuropeptides (like protein pro-opiomelanocortin) within the nervous system may be implicated in producing the effects of acupuncture. Aleem (1987) revealed the presence of beta-endorphin in the follicular fluid of both normal and polycystic ovaries. Stener-Victorin (2000) s study suggested that acupuncture may have a role in ovulation induction. Further details of current acupuncture studies in PCOS can be found in Chapter Four. Acupuncture is currently used in public hospitals in China for the treatment of PCOS. Clinical studies conducted in China have suggested that the effectiveness of using acupuncture may be significant. However, the methodological quality of those trials was poor with limited long-term follow-up. The present study aimed to evaluate the action of body acupuncture on menstrual pattern through a pilot study (Stage II) and a randomised controlled study (Stage V). However, in order to plan the RCT properly from Chinese medicine point of view, it was important to first standardise the Chinese medicine syndrome differentiation for PCOS or otherwise an inaccurate clinical response may be obtained. This was achieved by utilising a questionnaire (Stage III) as a tool development in this study. In addition to understanding the needs of Chinese women with PCOS, an epidemiological data was performed in Stage IV, so as to attempting to address their needs in the RCT stage. An effective CM treatment protocol would then be proposed to serve as a guide for the clinical acupuncture management of adult women with PCOS. The findings are promising and further studies are required. The design for this doctoral program study composed of the following 6 stages: 1. Stage I Comprehensive systematic literature review of current acupuncture treatment for PCOS patients in human studies in all available Chinese and English Literature. This stage has been published as Cochrane Systematic Review paper; 2. Stage II Pilot Clinical Study involving real body acupuncture group; 3. Stage III Development of Traditional Chinese Medicine (TCM) Syndrome Differentiation Diagnostic Questionnaire (Tool) for PCOS according to the results of comprehensive literature review in stage I and also the National Disease Criteria set by the State Administration of Traditional Chinese Medicine in the Peoples Republic of China; This is important as to standardise the CM diagnosis of PCOS in Stage V; 4. Stage IV Collection of Epidemiological data among Asian women of PCOS, to ascertain the psychological needs of Chinese women with PCOS; and to attempting to fulfil this in Stage V; 5. Stage V Randomised Single Blinded Acupuncture Clinical Trial involving a) real body acupuncture group; b) placebo (sham) body acupuncture group; For this study, there are two types of outcome measures that are under consideration. The primary outcome measure was the return of menstruation from amenorrhea while the secondary measures were the changes in LH, FSH concentration, LH: FSH Ratio, Progesterone, Oestrogen and Androgenic hormone concentration; 6. Stage VI Investigation of the Mechanism of Acupuncture Treatment on the Management of PCOS. Based on the findings from Stage One, various case studies suggested that there may be a role for acupuncture in regulating menstruation pattern in PCOS but there was nil randomised controlled trial identified to assess the efficacy of action of acupuncture in treatment of PCOS when this project was proposed. Furthermore, preliminary evidence from the literature review suggested that acupuncture may be useful in regulating menstrual pattern in women with PCOS. This confirms the importance of this research project as to fill in the gap of current medical understanding of using acupuncture in women with PCOS. From the descriptive analysis that was performed in Stage Three, it can be concluded that the syndrome diagnostic questionnaire that developed in this project could possibly be a useful tool in Chinese medicine syndrome differentiation for women with PCOS. It is warranted for further analysis and tested for internal validity. In Stage Four, a total of 57 patients agreed to participate were interviewed. All patients responded to all 4 questions (Cronback s alpha > 0.9) asked thus for this study it has a 100% response rate. Among all the factors of concern, most of interviewed subject expressed problems of having PCOS as : difficulty to control weight, frustration about difficulty to reduce weight, frustrated due to PCOS and its related medical problems, unable to conceive and menstrual irregularity, as well as pressure from workplace. Based on the results from pilot study in Stage Two (11 subject recruited) and the RCT in Stage Five (146 subjects recruited), acupuncture can be recommended as effective menstrual regulation intervention for PCOS. In Stage V, the inter-menstrual days in the control group is 302.45 day and 348.32 days pre and post treatment respectively (p=0.001). In the interventional group, the mean inter-menstrual days are 297.69 and 33.82 days pre and post treatment respectively (p=0.000). There is no menstrual pattern change in the control group pre and post treatment. Acupuncture demonstrated statistically significant difference toward hormonal profiles before and after the real body acupuncture intervention among women with PCOS. Within the interventional group, it can be seen that there are six treatment outcomes that were found to have a significant differences (p0.05) in prolactin, oestrogen (E2) and testosterone in both control and interventional groups. Stage V is aimed to elicit whether acupuncture can assist in return of menstruation for lady with PCOS and has complete amenorrhoea. As this is the initial aim of the study, ovulation was not chosen to be the outcome measure for this RCT. This also becomes one of the limitations for this study as we cannot definitely answer whether acupuncture can induce ovulation for lady with PCOS, although improvements were noted in the LH:FSH ratio and progesterone level. It is important to note that menstruation return may not necessary to protect the uterus from hyperplasia. Overall speaking, the results from the statistical analysis and the insights that were gathered from those results have proposed the following mechanisms in relation to Chinese and Western medicine perspective: 1. Acupuncture significantly increases β-endorphin levels for periods up to 24 hours and may have regulatory effect on FSH, LH and androgen. 2. Decrease hypothalamic-pituitary-adrenal (HPA) axis activity by inhibiting release of corticotrophin-releasing factor (CRF), causing decreased adrenocorticotrophic hormone (ACTH) release from the pituitary gland and decreased cortisol and/or dehydroepiandrostenedione (sulfate) release from the adrenal cortex. 3. β-endorphin increased levels secondary to acupuncture affects the hyperthalamic-pituitary-adrenal (HPA) axis through promoting the release of ACTH through stimulation of its precursor pro-opiomelanocortin synthesis. 4. Needle insertion into the skin and muscle may stimulate ergoreceptors and initiate afferent nerves activity. 5. If acupuncture needles were placed in the same somatic segment of the ovary, they may stimulate the oxytocin axis resulting in decreased release and secretion of ovarian androgens. In conclusion, the designed acupuncture protocol for PCOS proposes that the usage of acupuncture is effective to induce return of menstruation from oligomenorrhoea

Continuous remote monitoring of COPD patients—justification and explanation of the requirements and a survey of the available technologies

Remote patient monitoring should reduce mortality rates, improve care, and reduce costs. We present an overview of the available technologies for the remote monitoring of chronic obstructive pulmonary disease (COPD) patients, together with the most important medical information regarding COPD in a language that is adapted for engineers. Our aim is to bridge the gap between the technical and medical worlds and to facilitate and motivate future research in the field. We also present a justification, motivation, and explanation of how to monitor the most important parameters for COPD patients, together with pointers for the challenges that remain. Additionally, we propose and justify the importance of electrocardiograms (ECGs) and the arterial carbon dioxide partial pressure (PaCO2) as two crucial physiological parameters that have not been used so far to any great extent in the monitoring of COPD patients. We cover four possibilities for the remote monitoring of COPD patients: continuous monitoring during normal daily activities for the prediction and early detection of exacerbations and life-threatening events, monitoring during the home treatment of mild exacerbations, monitoring oxygen therapy applications, and monitoring exercise. We also present and discuss the current approaches to decision support at remote locations and list the normal and pathological values/ranges for all the relevant physiological parameters. The paper concludes with our insights into the future developments and remaining challenges for improvements to continuous remote monitoring systems