A Quantitative Approach to Human Capital Management

AbstractThe objective is to provide a quantitative technique to help managers to make decisions by objectively evaluating their Human Capital Management (HCM) and projecting profit increase generated by HCM. This study approach is divided into two steps. In the first step, this study selects and formulates the factors which represent HCM practices by means of principal component and factor analysis. In the second step, personnel adjusted added (PAV) value is defined as the corporate output. Multiple regression model is constructed to identify the HCM factors which influence PAV. This process establishes the model for objectively judging their success of HCM

Swallowing rehabilitation with nutrition therapy improves clinical outcome in patients with dysphagia at an acute care hospital

Dysphagia is associated with nutritional deficits and increased risk of aspiration pneumonia. The aim of the present study was to evaluate the impact of nutrition therapy for the patients with dysphagia at an acute care hospital. We also tried to clarify the factors which improve swallowing function in these patients. Seventy patients with dysphagia were included in the present study. Multidisciplinary nutrition support team evaluated swallowing function and nutrition status. Most patients were fed by parenteral or enteral nutrition at the time of the first round. Of these 70 patients, 36 became able to eat orally. The improvement of swallowing function was associated with higher BMI in both genders and higher AMC in men. Mortality was high in the patients with lower BMI and %AMC, suggesting importance of maintaining muscle mass. Thirteen (38.2%) of 34 patients who did not show any improvement in swallowing function died, but no patients who showed improvement died (p22 kcal/kg/day. These results suggest that it is important to maintain nutritional status to promote rehabilitation in patients with dysphagia even in an acute care hospital

Understanding anthropometry, metabolism and menstrual status of Japanese college female long-distance runners

Aim: To understand the anthropometry, metabolism, and menstrual status of Japanese collegiate female long-distance runners. Methods: This was a cross-sectional study of 29 Japanese college female long-distance runners divided into three menstruation status groups: 1) Regular; 2) Irregular; and 3) Amenorrhea. The amenorrhea group was further divided into participants who consulted a gynecologist and those who did not. Metabolism was measured using resting metabolic rate, total energy expenditure, and physical activity level. Energy was measured using energy intake, exercise energy expenditure, and energy availability (EA). Anthropometric measurements were performed following standardized techniques from the International Society for the Advancement of Kinanthropometry. Results: Of the 29 runners, 68% had menstrual dysfunction. The amenorrhea group who had consulted a gynecologist had lower body mass index (BMI) and lower skinfolds than the other groups. All groups had more than 30 kcal/kg fat free mass/day for EA with no difference between the groups. Conclusions: There was high prevalence of menstrual dysfunction in the female Japanese college long-distance runners. Runners with amenorrhea had lower BMI and lower skinfolds than the other groups, despite having consulted a gynecologist for medical support. All the runners had an energy deficiency higher than the published threshold; therefore, this threshold did not differentiate the amenorrhea or irregular menstruating athletes from regular menstruating athletes. Longitudinal tracking of athletes should include measurement of height, body mass, and skinfolds to enable evaluation of BMI, the sum of eight skinfold sites, and leanness ratio score as possible indicators over time for menstrual dysfunction.Objetivo: Comprender la antropometría, el metabolismo y el estado menstrual de las corredoras de larga distancia universitarias japonesas. Métodos: Este fue un estudio transversal de 29 corredoras de larga distancia universitarias japonesas divididas en tres grupos de estado de menstruación: 1) Regular; 2) Irregular; y 3) amenorrea. El grupo de amenorrea se dividió en participantes que consultaron a un ginecólogo y los que no lo hicieron. El metabolismo se midió utilizando la tasa metabólica en reposo, el gasto energético total y el nivel de actividad física. La energía se midió utilizando la ingesta de energía, el gasto energético del ejercicio y la disponibilidad de energía (EA). Las mediciones antropométricas se realizaron siguiendo técnicas estandarizadas de la Sociedad Internacional para el Avance de la Cineantropometría. Resultados: De las 29 corredoras, el 68% tenía disfunción menstrual. El grupo de amenorrea que había consultado a un ginecólogo tenía un índice de masa corporal (IMC) más bajo y pliegues cutáneos más bajos que los otros grupos. Todos los grupos tenían más de 30 kcal / kg de masa libre de grasa / día para EA sin diferencias entre los grupos. Conclusiones: Hubo una alta prevalencia de disfunción menstrual en las corredoras de larga distancia universitarias japonesas. Las corredoras con amenorrea tenían un IMC más bajo y pliegues cutáneos más bajos que los otros grupos, a pesar de haber consultado a un ginecólogo para recibir apoyo médico. Todos los corredores tenían una deficiencia energética superior al umbral publicado; por lo tanto, este umbral no diferenciaba la amenorrea o los atletas con menstruación irregular de los atletas con menstruación regular. El seguimiento longitudinal de los atletas debe incluir la medición de la altura, la masa corporal y los pliegues cutáneos para permitir la evaluación del IMC, la suma de ocho sitios de pliegues cutáneos y la puntuación del índice de delgadez como posibles indicadores a lo largo del tiempo de la disfunción menstrual

The Moment of Establishing Transpersonal Caring in a Grieving Adolescent Daughter beside Her Mother’s Deathbed and Hansen’s Disease Survivors Sharing Their Life Review

Evidence-based nursing (EBN) ensures the science of nursing practice, while the philosophical and ethical aspects of nursing practice are based on caring. Caring not only leads to the patient and their family’s healing but also to the nurse’s professional and personal growth since caring includes mutual approval and reciprocity. In the latter half of the chapter, we explain how to establish Dr. Jean Watson’s transpersonal caring using the following two events: ① case study: An expert nurse unintentionally says, “Your mother continues to be near and protect you,” to a crying daughter beside her mother’s deathbed; and ② our project: sanatorium’s nurses listen to Hansen’s disease survivors’ life review

Neoadjuvant Chemotherapy with or without Concurrent Hormone Therapy in Estrogen Receptor-Positive Breast Cancer:NACED-Randomized Multicenter Phase II Trial

Although in the neoadjuvant setting for estrogen receptor (ER)-positive breast cancers, chemotherapy or hormone therapy alone does not result in satisfactory tumor response, it is unknown whether concurrent chemo-endocrine therapy is superior to chemotherapy alone in clinical outcomes. We conducted a randomized phase II trial to test the responses of ER-positive patients to concurrent administration of chemo-endocrine therapy in the neoadjuvant setting. Women with stage II-III, ER-positive, invasive breast cancer (n=28) received paclitaxel followed by fluorouracil, epirubicin, cyclophosphamide (T-FEC) and were randomized to receive concurrent chemo-endocrine therapy consisting of goserelin administered subcutaneously for premenopausal women or an aromatase inhibitor for postmenopausal women. The primary endpoint was the pathological complete response (pCR) rate after neoadjuvant therapy. Twenty-eight patients were randomized. There were no significant differences in pCR rate between the concurrent group (12.5%;2/16) and the chemotherapy alone group (8.3%;1/12). Tumor size after therapy was significantly reduced in the concurrent therapy group (p=0.035), but not in the chemotherapy-alone group (p=0.622). Neoadjuvant chemotherapy with concurrent hormone therapy provided no significant improvement in pCR rate in ER-positive breast cancers. These preliminary results should be followed up by further studies

Hormonal Therapy Resistant Estrogen-receptor Positive Metastatic Breast Cancer Cohort (HORSE-BC) Study : Current Status of Treatment Selection in Japan

The Hormonal therapy resistant estrogen-receptor positive metastatic breast cancer cohort (HORSE-BC) study is a multicenter observational study evaluating the efficacy and safety of secondary endocrine therapy (ET) for postmenopausal cases of metastatic breast cancer (MBC) with poor response to primary ET. In this initial report we analyze the HORSE-BC baseline data to clarify the current status of treatment selection for MBC in Japan. Baseline data for the 50 patients enrolled in HORSE-BC were analyzed, including patient characteristics, types of secondary ET, and reasons for selecting secondary ET. Postoperative recurrence was detected in 84% of patients (42/50) and de novo stage IV breast cancer in 16% (8/50). Forty-one patients (41/50; 82%) received fulvestrant, 5 patients (10%) received selective estrogen receptor modulators (SERMs), 3 patients (6%) received ET plus a mammalian target of rapamycin (mTOR) inhibitor, and 1 patient received an aromatase inhibitor (AI) as the secondary ET. Forty-five patients selected their secondary ET based on its therapeutic effect, while 14 patients selected it based on side effects. Most patients with progression after primary ET selected fulvestrant as the secondary ET based on its therapeutic and side effects. We await the final results from the HORSE-BC study

Effectiveness of simulation learning program for mastering public health nursing skills to enhance strength of community: A quasi-experimental design

Purpose: The purpose of this study is to develop a simulation learning program for mastering public health nursing skills to enhance strength of community, and to verify its effectiveness. Methods: The program is one-day session to master the skills from three exercises. This study adopts a quasi-experimental design. We selected unbiased 34 participants in intervention group and 30 participants in control group, and conducted self-administered questionnaire surveys at three points in time: pre, post 1 and post 2. Three tools were used to measure the required outcome. For the outcome evaluation, we calculated the changes in the mean value of each tool between pre and post 1 and between pre and post 2, and compared them between the two groups. Results: The change of intervention group in the total score at the post 1 stage from the pre stage was significantly higher than control group regarding each of the scales (P < .05). Conclusions: The program was found to be effective in upgrading the skills of less-experienced public health nurses to enhance strength of community

Immunohistochemical Ki67 after short-term hormone therapy identifies low-risk breast cancers as reliably as genomic markers

Background: The purpose of this study was to test whether immunohistochemical (IHC) Ki67 levels after short-term preoperative hormone therapy (post-Ki67) predict similar numbers of patients with favorable prognoses as genomic markers. Results: Thirty paired cases (60 samples) were enrolled in this study. Post-Ki67 levels were significantly lower than pre-treatment Ki67 levels (P < 0.001). Post-Ki67 predicted more low-risk cases (83.3%, 25/30) than pre-genomic surrogate signature(GSS) (66.7%: 20/30), but the difference in predictive power was not significant (P = 0.233). Proliferation (MKI67, STK15, Survivin, CCNB1, and MYBL2) and estrogen (ER, PGR, BCL2, and SCUBE2) related signatures were significantly downregulated after therapy (P < 0.001 and 0.041, respectively). Materials and Methods: Core needle biopsy specimens of primary breast cancer were collected at Okayama University Hospital from hormone receptor-positive and human epidermal growth factor 2-negative patients that subsequently received two weeks of neoadjuvant hormone therapy. Paired post-treatment specimens from surgical samples were also collected. IHC Ki67 levels and GSS were compared between pre- and post-hormone treatment samples. Changes of gene expression pattern in short-term hormone therapy were also assessed. Conclusions: IHC based post-Ki67 levels may have distinct predictive power compared with the naïve IHC Ki67. Future studies with larger cohorts and longer follow-up periods may be needed to validate our results

Inhibition of bone erosion, determined by high-resolution peripheral quantitative computed tomography (HR-pQCT), in rheumatoid arthritis patients receiving a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) plus denosumab vs csDMARD therapy alone: an open-label, randomized, parallel-group study

Background: This exploratory study compared the inhibition of bone erosion progression in rheumatoid arthritis (RA) patients treated with a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) plus denosumab versus csDMARD therapy alone and investigated the effects of denosumab on bone micro-architecture and other bone-related parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT).Methods: In this open-label, randomized, parallel-group study, patients with RA undergoing treatment with a csDMARD were randomly assigned (1:1) to continue csDMARD therapy alone or to continue csDMARDs with denosumab (60-mg subcutaneous injection once every 6 months) for 12 months. The primary endpoint was the change from baseline in the depth of bone erosion, measured by HR-pQCT, in the second and third metacarpal heads at 6 months after starting treatment. Exploratory endpoints were also evaluated, and adverse events (AEs) were monitored for safety.Results: In total, 46 patients were enrolled, and 43 were included in the full analysis set (csDMARDs plus denosumab, N = 21; csDMARD therapy alone, N = 22). Most patients were female (88.4%), and the mean age was 65.3 years. The adjusted mean (95% confidence interval) change from baseline in the depth of bone erosion, measured by HR-pQCT, in the 2–3 metacarpal heads at 6 months was − 0.57 mm (− 1.52, 0.39 mm) in the csDMARDs plus denosumab group vs − 0.22 mm (− 0.97, 0.53 mm) in the csDMARD therapy alone group (between-group difference: − 0.35 mm [− 1.00, 0.31]; P = 0.2716). Similar results were shown for the adjusted mean between-group difference in the width and volume of bone erosion of the 2–3 metacarpal heads. Significant improvements in bone micro-architecture parameters were shown. The incidence of AEs and serious AEs was similar between the csDMARDs plus denosumab and the csDMARD therapy alone groups (AEs: 52.2% vs 56.5%; serious AEs: 4.3% vs 8.7%).Conclusions: Although the addition of denosumab to csDMARDs did not find statistically significant improvements in bone erosion after 6 months of treatment, numerical improvements in these parameters suggest that the addition of denosumab to csDMARDs may be effective in inhibiting the progression of bone erosion and improving bone micro-architecture