Lessons learned from the history of postgraduate medical training in Japan: from disease-centred care to patient-centred care in an aging society.

BACKGROUND: Health workers, the core of health service delivery and a key driver of progress towards universal health coverage, must be available in sufficient numbers and distributed fairly to serve the entire population. In addition, the planning and management of the health workforce must be responsive to the changing needs of society, including changes in age structure and epidemiology. Considering these issues, this paper examines in historical perspective the evolution of postgraduate medical training and practice in Japan, from the late nineteenth century to the present. MAIN TEXT: When the first medical schools were established in the country towards the end of the nineteenth century, Japan was a largely agrarian society, with a population of about 30 million and an average life expectancy of 30-40 years. During the twentieth century, life expectancy and the national population continued to increase in a context of rapid economic growth. Since the 1980s, another demographic transition has occurred: low fertility rates and an aging society. As a result, the inputs and skills required from health professionals have changed considerably over time, posing new challenges to the national health sector and the management of human resources for health. CONCLUSIONS: The case of Japan offers valuable lessons for other countries experiencing a rapid epidemiological and demographic transition. To provide medical care that meets health priorities in the communities, we must consider not only the training of specialists, but also ensure the availability of a large cadre of physicians who possess basic skills and can provide patient-centred care. Furthermore, the Japanese experience shows that a highly hierarchical system and organisational culture are ill-suited to respond quickly to the changing demands of society

ミルコト ミエルコト ミセルコト タイフウ ヨンブサク ト ロンブローゾ ノルダウ ノ ワクグミ

The purpose of this paper is 1) to suggest an “inner consistency” of Joseph Conrad’s set of stories (‘Typhoon’, ‘Amy Forster’, ‘Falk’, ‘To-morrow’, 1901–2), which is the recurrent pattern of the apparent coincidence between ‘physiognomy’ and ‘mind’; 2) to show its affinities with the then prevailing Lombroso = Nordau framework; and 3) to argue that Conrad whose purpose seems only to “make you see” appearances of life, either ‘to see’ or ‘to be seen’, actually problematizes our unconscious way of constructing stories. This make-you-see style opens up the possibility for an attitude towards a new literary expression and a kind of morality

Structural basis for the sequence-specific RNA-recognition mechanism of human CUG-BP1 RRM3

The CUG-binding protein 1 (CUG-BP1) is a member of the CUG-BP1 and ETR-like factors (CELF) family or the Bruno-like family and is involved in the control of splicing, translation and mRNA degradation. Several target RNA sequences of CUG-BP1 have been predicted, such as the CUG triplet repeat, the GU-rich sequences and the AU-rich element of nuclear pre-mRNAs and/or cytoplasmic mRNA. CUG-BP1 has three RNA-recognition motifs (RRMs), among which the third RRM (RRM3) can bind to the target RNAs on its own. In this study, we solved the solution structure of the CUG-BP1 RRM3 by hetero-nuclear NMR spectroscopy. The CUG-BP1 RRM3 exhibited a noncanonical RRM fold, with the four-stranded b-sheet surface tightly associated with the N-terminal extension. Furthermore, we determined the solution structure of the CUG-BP1 RRM3 in the complex with (UG)3 RNA, and discovered that the UGU trinucleotide is specifically recognized through extensive stacking interactions and hydrogen bonds within the pocket formed by the b-sheet surface and the N-terminal extension. This study revealed the unique mechanism that enables the CUG-BP1 RRM3 to discriminate the short RNA segment from other sequences, thus providing the molecular basis for the comprehension of the role of the RRM3s in the CELF/Bruno-like family

Nursing Activity Sensing Using Mobile Sensors and Proximity Sensors

In recent years, big data are utilized in many industries.In this study, in order to analyze duties of thenurses, we performed experiments to collect the dutiesactivity data of the nurses for a long term. Weset 38 nurses as subjects and asked them to carry outduties while attaching a wearable small sensor device,and collected the acceleration data, meeting informationbetween nurses and the nurse duties information.In addition, we collected the location information of the nurses by using infrared information and communication equipment at the same time. From various data collected, we analyzed intensity and positional information of duties activity of the nurse, meeting information and the duties information between nurses and considered the influence that each factor affected to the nurse. As the result, we found that intensity of the activity increases in such nurses as who has many times of meeting with other nurses, visits the patient room many times, or who works on jobs concerning with the assistance of the patients such as rehabilitation assistance duties or the activity assistance dutiesThe 47th ISCIE International Symposium on Stochastic Systems Theory and Its Applications (SSS\u2715), December 5-8, 2015, Waikiki Beach Marriott Resort & Spa, Hawaii, US

PITHD1 is essential for male fertilization

The proteasome is a protein-degrading molecular complex that is necessary for protein homeostasis and various biological functions, including cell cycle regulation, signal transduction, and immune response. Proteasome activity is finely regulated by a variety of proteasome-interacting molecules. PITHD1 is a recently described molecule that has a domain putatively capable of interacting with the proteasome. However, it is unknown as to whether PITHD1 can actually bind to proteasomes and what it does in vivo. Here we report that PITHD1 is detected specifically in the spermatids in the testis and the cortical thymic epithelium in the thymus. Interestingly, PITHD1 associates with immunoproteasomes in the testis, but not with thymoproteasomes in the thymus. Mice deficient in PITHD1 exhibit severe male infertility accompanied with morphological abnormalities and impaired motility of spermatozoa. Furthermore, PITHD1 deficiency reduces proteasome activity in the testis and alters the amount of proteins that are important for fertilization capability by the sperm. However, the PITHD1-deficient mice demonstrate no detectable defects in the thymus, including T cell development. Collectively, our results identify PITHD1 as a proteasome-interacting protein that plays a nonredundant role in the male reproductive system