Current Situation and Challenges of Formative Assessment in Developing Countries

This paper defined “formative assessment” as frequent and interactive assessment regarding learners’ understanding and progress of learning achievement in order to confirm learners’ needs and deliver appropriate lessons. This paper aimed at revealing the research question “How does formative assessment defined in this paper appear in policies and practices in each participating country?”. As a result, it was found that while learning improvement was stipulated as goals in policy objectives and various implementing measures were presented, scores based on formative assessment were emphasized for judgement of progressing grades or promoting to higher level of education and/or accountability to guardians. Reflecting practices on the field, implementation of formative assessment has various challenges including teachers’ professional capacity, which was observed through their predictions and reactions of pupils’ answers before and after a simple maths test. This paper uncovered that in developing countries, measures after lessons, which include conducting quiz, collecting and analyzing its result, and planning remedial classes based on the result, were taken into consideration, however, it was confronted with limitation of time. With regards to this challenge, Japanese teachers emphasized using formative assessment before and during lessons. Such experiences can be shared in the JICA-supported Knowledge Co-Creation Program and be utilized in developing countries Finally, the authors expect that dialogues between research and development aid will continue as this paper did and more practices on formative assessment will be accumulated for the sake of pupils’ learning and lesson improvement both in Japan and developing countries

Efficacy of lenvatinib in a patient with anaplastic thyroid cancer

We experienced a case of an 82-year-old woman who presented to our hospital with a 1-month history of dysphagia and dyspnea. Cervical contrast-enhanced computed tomography revealed diffuse thyroid neoplasms causing significant tracheal stenosis with tumors, particularly of the superior mediastinum, which were associated with an embolism of the brachiocephalic vein and suspected invasion to the bilateral common carotid arteries. Anaplastic thyroid cancer (ATC) was diagnosed by fine-needle aspiration; thus, emergency tracheostomy and gastrostomy were performed. We made a definitive diagnosis of ATC (T4bN0M0 Stage IVB) and initiated continuous lenvatinib administration at 24 mg/day. Although several adverse events occurred, the tumor size reduced remarkably over a short period. However, the patient died from rupture of the common carotid artery 30 days after treatment initiation. Here, we report our experience with lenvatinib therapy for ATC and include a literature review

Joint AWI-NIPR airborne operations in the past and the future

The Alfred Wegener Institute for Polar and Marine Research (AWI) has in the past operated two ski equipped aircraft (Dornier Do228-101) for scientific and logistic purposes in polar regions-called POLAR 2 and POLAR 4. Both aircraft are easily able to be adapted to different science programs. Aero-geophysical instrumentation and various atmospheric systems are available. In recent years, a long and fruitful cooperation with the National Institute of Polar Research (NIPR), Tokyo, has been established, whereby so far three joint airborne campaigns have been already performed in the Arctic, namely ASTAR 2000 (Arctic Study of Tropospheric Aerosol and Radiation), AAMP 2002 (Arctic Airborne Measurement Program), and ASTAR 2004. The ANTSYO (Antarctic flight missions at Syowa region: Airborne Geophysical, Glaciological, and Atmospheric Research in East Antarctica) operations of the AWI research aircraft, POLAR 2, started in the season 2005/06, from S17, near Syowa Station in December 2005. Running such surveys presents a logistical challenge that can only be met with the combined support of Alfred Wegener Institute, Bremerhaven, and the NIPR, Tokyo. Therefore, both national Antarctic programs put their logistical capabilities together in order to perform the first extensive airborne missions in this area over a period of three Antarctic summer seasons (2005/06 till 2007/08)

Laparoscopic Synchronous Resection for Descending Colon Cancer and Tailgut Cyst

A 67-year-old woman underwent polypectomy for a tumor at the descending colon. Pathologically, the tumor was diagnosed as adenocarcinoma with an invasion of 2000 μm. Computed tomography showed a swollen paracolic lymph node and a mass lesion in the presacral space. Magnetic resonance imaging revealed a multio-cular cystic lesion. On diagnosis of descending colon cancer and tailgut cyst, she underwent synchronous lapa-roscopic resection. Histopathologically, the colon cancer was diagnosed as pT1bN1M0, pStage IIIa. The pre-sacral cystic lesion was diagnosed as a nonmalignant tailgut cyst with negative surgical margin. The patient is currently doing well without recurrence at 28 months

Designing isolation guidelines for COVID-19 patients with rapid antigen tests

新型コロナウイルス感染者の隔離短縮は可能か？. 京都大学プレスリリース. 2022-08-24.Appropriate isolation guidelines for COVID-19 patients are warranted. Currently, isolating for fixed time is adopted in most countries. However, given the variability in viral dynamics between patients, some patients may no longer be infectious by the end of isolation, whereas others may still be infectious. Utilizing viral test results to determine isolation length would minimize both the risk of prematurely ending isolation of infectious patients and the unnecessary individual burden of redundant isolation of noninfectious patients. In this study, we develop a data-driven computational framework to compute the population-level risk and the burden of different isolation guidelines with rapid antigen tests (i.e., lateral flow tests). Here, we show that when the detection limit is higher than the infectiousness threshold values, additional consecutive negative results are needed to ascertain infectiousness status. Further, rapid antigen tests should be designed to have lower detection limits than infectiousness threshold values to minimize the length of prolonged isolation

Analysis of the 619 Brånemark System TiUnite Implants : A Retrospective Study

The purpose of this retrospective study was to determine the outcome of Brånemark System TiUnite® implants (Nobel Biocare/Sweden), and to identify the risk factors associated with implant failure. A total of 151 patients (83 maxillae and 91 mandibles) received 619 implants from July 2003 until May 2010. The patients included 86 males and 65 females, with a median age of 51.6 years and an age range of 16 to 90 years at the time of implant surgery. Seventeen maxillae and 16 mandibles were completely edentulous, and 66 maxillae and 75 mandibles were partially edentulous. All the patients were followed until June 2011. Among the 619 implants, 9 maxillary implants and 8 mandibular implants were unsuccessful. The overall survival rate was 96.82%. A logistic regression analysis identified that a history of steroid treatment, application of a dento-maxillary prosthesis, a lack of mechanical coupling between the implants, and the length of the implants (≤8.5mm) were significant predictors of implant failure

Successful recovery of infective endocarditis-induced rapidly progressive glomerulonephritis by steroid therapy combined with antibiotics: a case report

BACKGROUND: The mortality rate among patients with infective endocarditis, especially associated with the presence of complications or coexisting conditions such as renal failure and the use of combined medical and surgical therapy remains still high. Prolonged parenteral administration of a bactericidal antimicrobial agent or combination of agents is usually recommended, however, the optimal therapy for infective endocarditis associated with renal injury is not adequately defined. CASE PRESENTATION: Patient was a 24-years old man who presented to our hospital with fever, fatigue, and rapidly progressive glomerulonephritis. He had a history of ventricular septum defect (VSD). A renal biopsy specimen revealed crescentic glomerulonephritis and echocardiogram revealed VSD with vegetation on the tricuspid valve. Specimens of blood demonstrated Propionibacterium Acnes. The intensive antibiotic therapy with penicillin G was started without clinical improvement of renal function or resolution of fever over the next 7 days. After the short-term treatment of low dose of corticosteroid combined with continuous antibiotics, high fever and renal insufficiency were dramatically improved. CONCLUSION: Although renal function in our case worsened despite therapy with antibiotics, a short-term and low dose of corticosteroid therapy with antibiotics was able to recover renal function and the patient finally underwent tricuspid valve-plasty and VSD closure. We suggest that the patients with rapidly progressive glomerulonephritis associated with infective endocarditis might be treated with a short-term and low dose of corticosteroid successfully

Examination of density and mixing ratio of barium preparations, using an originally created phantom

胃Ⅹ線検査に造影剤として用いられる硫酸バリウム懸濁液の濃度を,簡便に,客観的に決定する目的で,歯科用アルギン酸塩印象材を用いて,コインの図柄を写しとったファントムを制作した｡これを使って二種類の硫酸バリウム製剤の適正濃度(PD)を調べた結果,BARITOP PとBARICON MEALを単体,若くは混合した場合には,おおよそ,PD(W/V%)=0.75C+165(ただし,CはBARICON MEALの混合比(%))となった｡また,BARICON MEALはコントラストが高く,精密検査に有利だと考えられ,BARITOP PとBARICON MEALを混合すると濃度の許容範囲が広がるため,通常の検査に都合がよいと考えられた｡更に,このファントムは簡便に作成することができ,しかも,硫酸バリウム懸濁 液との親和性も良いことから,硫酸バリウム製剤やⅩ線TV装置の評価,増感紙･フィルム系の評価等にも応用できると考えられた｡A phantom copied designs of coins was created with alginate dental impression material to establish a objective, simple and easy method for deciding density of barium sulfate suspensions which are used for stomach X-ray examination as contrast media. As a result of examining proper density (PD) of two kind of barium preparations with this phantom, in case of BARITOP P and BARICON MEAL, PD were almost shown by the next equation : PD(W/V%)=0.75C+165(C meant content of BARICON MEAL (%)). As BARICON MEAL resulted in hight contrast, it was thought to be suitable for a close examination. Mixture of BARITOP P and BARICON MEAL was thought to be suited to a routine examination becouse of wide permissible level of density. This phantom would be able to apply to the test of balium preparations, X-ray TV systems, screen/film systems and so on

Detection of significant antiviral drug effects on COVID-19 with reasonable sample sizes in randomized controlled trials : a modeling study

Background Development of an effective antiviral drug for Coronavirus Disease 2019 (COVID-19) is a global health priority. Although several candidate drugs have been identified through in vitro and in vivo models, consistent and compelling evidence from clinical studies is limited. The lack of evidence from clinical trials may stem in part from the imperfect design of the trials. We investigated how clinical trials for antivirals need to be designed, especially focusing on the sample size in randomized controlled trials. Methods and findings A modeling study was conducted to help understand the reasons behind inconsistent clinical trial findings and to design better clinical trials. We first analyzed longitudinal viral load data for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) without antiviral treatment by use of a within-host virus dynamics model. The fitted viral load was categorized into 3 different groups by a clustering approach. Comparison of the estimated parameters showed that the 3 distinct groups were characterized by different virus decay rates (p-value < 0.001). The mean decay rates were 1.17 d−1 (95% CI: 1.06 to 1.27 d−1), 0.777 d−1 (0.716 to 0.838 d−1), and 0.450 d−1 (0.378 to 0.522 d−1) for the 3 groups, respectively. Such heterogeneity in virus dynamics could be a confounding variable if it is associated with treatment allocation in compassionate use programs (i.e., observational studies). Subsequently, we mimicked randomized controlled trials of antivirals by simulation. An antiviral effect causing a 95% to 99% reduction in viral replication was added to the model. To be realistic, we assumed that randomization and treatment are initiated with some time lag after symptom onset. Using the duration of virus shedding as an outcome, the sample size to detect a statistically significant mean difference between the treatment and placebo groups (1:1 allocation) was 13,603 and 11,670 (when the antiviral effect was 95% and 99%, respectively) per group if all patients are enrolled regardless of timing of randomization. The sample size was reduced to 584 and 458 (when the antiviral effect was 95% and 99%, respectively) if only patients who are treated within 1 day of symptom onset are enrolled. We confirmed the sample size was similarly reduced when using cumulative viral load in log scale as an outcome. We used a conventional virus dynamics model, which may not fully reflect the detailed mechanisms of viral dynamics of SARS-CoV-2. The model needs to be calibrated in terms of both parameter settings and model structure, which would yield more reliable sample size calculation. Conclusions In this study, we found that estimated association in observational studies can be biased due to large heterogeneity in viral dynamics among infected individuals, and statistically significant effect in randomized controlled trials may be difficult to be detected due to small sample size. The sample size can be dramatically reduced by recruiting patients immediately after developing symptoms. We believe this is the first study investigated the study design of clinical trials for antiviral treatment using the viral dynamics model

発症早期ALS患者に対する超高用量メチルコバラミンの有効性・安全性について : ランダム化比較試験

Importance: Post hoc analysis in a phase 2/3 trial indicated ultra-high dose methylcobalamin slowed decline of the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) total score at week 16 as well as at week 182, without increase of adverse events, in patients with amyotrophic lateral sclerosis (ALS) who were enrolled within 1 year from onset. Objective: To validate the efficacy and safety of ultra-high dose methylcobalamin for patients with ALS enrolled within 1 year of onset. Design: A multicenter, placebo-controlled, double-blind, randomized phase 3 trial with 12-week observation and 16-week randomized period, conducted from October 2017 to September 2019. Setting: Twenty-five neurology centers in Japan. Participants: Patients with ALS diagnosed within 1 year of onset by the updated Awaji criteria were initially enrolled. Of those, patients fulfilling the following criteria after 12-week observation were eligible for randomization: 1- or 2-point decrease in ALSFRS-R total score, a percent forced vital capacity over 60%, no history of noninvasive respiratory support and tracheostomy, and being ambulant. The target number was 64 in both methylcobalamin and placebo groups. Of 203 patients enrolled in the observation, 130 patients (age, 61.0 ± 11.7 years; female, 56) met the criteria and were randomly assigned through an electronic web-response system to methylcobalamin or placebo (65 for each). Of these, 129 patients were eligible for the full analysis set, and 126 completed the double-blind stage. Interventions: Intramuscular injection of methylcobalamin 50 mg or placebo twice weekly for 16 weeks. Main outcomes and measures: The primary endpoint was change in ALSFRS-R total score from baseline to week 16 in the full analysis set. Results: The least-squares mean difference in ALSFRS-R total score at week 16 of the randomized period was 1.97 points greater with methylcobalamin than placebo (−2.66 versus −4.63; 95% CI, 0.44–3.50; P = 0.012). The incidence of adverse events was similar between the two groups. Conclusions and relevance: Ultra-high dose methylcobalamin was efficacious in slowing functional decline and safe in the 16-week treatment period in ALS patients in the early stage and with moderate progression rate. Trial registration: UMIN-CTR Identifier: UMIN000029588 (umin.ac.jp/ctr); ClinicalTrials.gov Identifier: NCT03548311 (clinicaltrials.gov