Utility of Regular Management of Physical Activity and Physical Function in Hemodialysis Patients

Background/Aims: Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care in hemodialysis patients. However, there is no clear evidence to support these recommendations. We investigated whether the proportion of attendance at a regular program for management of physical activity and physical function can predict all-cause mortality and cardiovascular events in hemodialysis patients. Methods: This retrospective cohort study consisted of 266 hemodialysis patients participating in the management program at least once. Participants were tracked for 3 years after their first attendance at the management program to determine their attendance proportion. The main study outcomes included all-cause mortality and a composite of fatal and nonfatal cardiovascular events. Results: Median patient age was 64.5 (interquartile range, 56.8 – 72.0) years, 45% were women, and the median time on hemodialysis was 35.5 (interquartile range, 12.0 – 114.3) months at baseline. Sixty-five patients died over a median follow-up of 79 months. The incidence of cardiovascular events was 60 over a median follow-up of 68 months. Even after adjusting for any of the prognostic models, participants who attended ≤ 75% of sessions (n = 140) had higher risks of mortality (hazard ratio (HR), 1.79; 95% confidence interval (CI): 1.00 – 3.36; P = 0.049) and cardiovascular events (HR, 1.84; 95% CI: 1.07 – 3.48; P = 0.03) than those attending > 75% of sessions (n = 126). Conclusion: Hemodialysis patients in whom physical activity and physical function could be assessed more regularly had better prognosis than those with only intermittent assessment

Students’ self-directed learning activities during the OSCE preparation period

This study aimed to clarify the self-directed learning activities of students in preparation for the OSCE, while examining the influences of such an examination on all students’ recognition of learning. A questionnaire survey was conducted, involving students who took the OSCE. The questionnaire consisted of 15 questions; the first one regarded <students’ recognition of their own self-directed learning activities>, followed by those regarding cognitive domain, aff ective domain, psychomotor domain, and self-effi cacy. Based on responses to the first question, students who were not sufficiently performing selfdirected learning activities were identifi ed at the beginning, and, focusing on changes in their self-directedness, they were classifi ed into the following 2 groups at the end of the OSCE preparatory period: those who maintained a passive attitude; and those whose selfdirectedness was enhanced. At the beginning of the period, 48.1% of all students recognized that they were not sufficiently performing self-directed learning activities. While self-directedness was subsequently enhanced in the majority of such students, 16.2% （7.8% of all students） maintained a passive attitude until the end. On comparison between the beginning and end of the period, the recognition of learning was signifi cantly enhanced in all questions in all those whose self-directedness increased during the period. In contrast, in those who maintained a passive attitude toward learning, such improvement was observed for 4 questions, excluding the <recognition of self-directed learning activities>. Furthermore, in all students who took the OSCE, a significant enhancement of recognition was observed for all questions regarding the knowledge and skills necessary for clinical training at the end of the period.本研究の目的は、OSCEの実施準備期間に学習活動の主体性が低い学生に着目しその傾向を把握することと、OSCEの実施が受講学生全体の学習自覚にどう影響しているかについて明らかにすることである。対象と方法は、OSCEを受講した77名の学生に対するアンケート調査とした。質問は15項目で、最初に主体的な学習活動の自覚を質問し、以降、「認知領域」「情意領域」「精神運動領域」に関する項目と自己効力感について質問した。また、全対象学生から学習活動の主体性が低い学生に対象を絞り、さらに、終了時まで主体性が低く留まった学生と終了時には主体性が上昇した学生に分け、分析対象とした。開始時に主体性が低いと自覚していた学生は全体の48.1％であり、そのうちの多くは終了時に主体性が上昇したが、16.2％（全体の7.8％）の学生は継続して主体性が低く留まった。それぞれの学生の学習期間の開始時と終了時の比較では、主体性が上昇した学生は全ての項目で有意に自覚の上昇が認められ、主体性が低く留まった学生では「主体的な学習活動の自覚」を除き4 項目で有意に自覚の上昇が認められた。また、OSCE受講全学生における学習期間前後の比較では、臨床実習に必要な知識や技術を反映する項目の全てにおいて有意に自覚の上昇が認められた

Here and now : Foundations and practice of human-experiential design

The thesis claims that an experiential approach to design really does promise the possibility of scientific design of everyday life. The purpose of this thesis is to show the promise. René Descartes conceptualized the classical formulation of a mind-body dichotomy. Various resulting and unbalanced dichotomies, such as subjective-objective, internal-external, experiential-practical and so on, raise serious concerns surrounding the concept of design. The thesis raises a crucial issue about the imbalance between technological and human concerns in the context of human-computer interaction, an imbalance that has been caused partly by the mechanistic aspect of informatics and its impact on designing human computer interaction. The thesis first explores the origin of design as a distinct activity during the industrial revolution, and reviews the tide of design history from then until today. The brief review of design history indicates that design is not merely the skill of making things or presentations. This gives direction to how design can be positioned in our modern information society. Second, the author starts a critical discussion about ordinary design approaches that, it is suggested, may have hindered true human-centred design, and then introduces an alternative approach to design and research, which the author calls Human-Experiential Design. Third, the notion of Tangible Presence in Blended Reality Space is introduced. The conceptual grounding that illustrates the experiential approach to interaction design is discussed. Fourth, the thesis presents use cases and provides examples of Human-Experiential Design in specific practical contexts. The concrete examples suggest that the emphasis on ‘balance’ or appropriate blending is very important in the development of better interactive systems for health, capitalizing on seamless combinations of the virtual and the physical in Blended Reality Space. As exemplified in the thesis, the human-experiential approach, striving for optimal combinations of tangibility and evoked presence, offers a promising tool in designing for special needs groups such as elderly people with some cognitive weaknesses, and children undertaking physical rehabilitation programmes. It is suggested that such virtual-physical blends will release human beings from the strain that existing perceived dichotomies bring. Finally, the author concludes by offering a way forward, a way that is neither subjective nor objective but rather a meaningfully integrated blend of the dichotomies, which responds to the question of what it means to be human

Social Ageing in Japan: Demographic and Socio-Cultural Aspects Nowadays

Darba nosaukums ir Sabiedrības novecošanās Japānā: demogrāfiskie un sociāli-kulturālie procesi mūsdienās. Sabiedrības novecošanās Japānā ir globāls jautājums Japānā, jo tas tieši ietekmē dzīves standartus un paradumus, tādēļ ir būtiski noskaidrot kādi procesi to veicināja. Darba uzdevumi: 1. Veikt zinātniskās literatūras analīzi par demogrāfiskiem, sociāliem un kultūras procesiem Japānā. 2. Analizēt zinātnisku literatūru par demogrāfisku, sociālu un kultūras vidi dažādām vecuma kategorijām. 3. Veikt analīzi par Japānas vecāka gada gājuma cilvēku populācijas pieaugumu. Darba hipotēze ir apstiprinājusies: “demogrāfiskie un sociāli-kulturālie procesi veicināja sabiedrības novecošanos Japānā” Galvenie secinājumi: 1. Sabiedrības novecošanās Japānā būtiski ietekmē jauno cilvēku skaitu Japānā. Tas strauji samazinās, bet vecāka gadagājuma cilvēku skaits proporcionāli palielinās, palielinās arī ilgmūžība. Prognozē, ka vecāka gadagājuma cilvēku skaits vecumā no 65 gadiem un vairāk līdz 2050. gadam palielināsies līdz 40 %. Vecāka gada gājuma cilvēki sekmē sociālu lejupslīdi un darba spēka trūkumu. 2. Galvenie demogrāfiskie un sociāli-kulturālie procesi, kas veicināja Japānas sabiedrības novecošanos bija: četras demogrāfiskās pārejas, atliktās laulības, industrializācijas process, jauniešu pārcelšanās lielpilsētās, Japānas augsta standarta veselības aprūpe un labi attīstīta sociālā sistēma un sociālā apdrošināšana. Darbs sastāv no 3 daļām, 41 lpp.The work title is the Social Ageing in Japan: Demographic and Socio-Cultural Aspects Nowadays. The ageing of the population in Japan is a global issue, which has a direct impact on living standards and habits, which is why it is essential to clarify which aspects contributed to it. Work tasks: 1. Carry out an analysis of the scientific literature on demographic, social and cultural aspects in Japan. 2. Analysis of scientific literature on demographic, social and cultural environments for different age categories. 3. Carry out an analysis of the population growth of the Japanese elderly population. Key findings: Hypothesis has been confirmed: “demographic and socio-cultural processes contributed to an ageing population in Japan” 1. The ageing of the population in Japan has a significant impact on the number of young people in Japan. The ageing of the population in Japan has a significant impact on the number of young people in Japan. It is declining sharply, but the number of older people will increase proportionally, and the longevity will also increase. The number of older people aged over 65 is expected to rise to 40 % by 2050. Elderly people contribute to social decline and lack of labour force. 2. The main demographic and socio-cultural aspects which contributed to it were: the four demographic transitions, delayed marriages, the process of industrialization, young people moving to cities, Japanese high standard health care and a well-developed social system and social insurance. The work consists of 3 parts, 41 p

Designing blended reality space : conceptual foundations and applications

The present paper starts with a crucial discussion about the imbalance between technological and human concerns in the context of human-computer interaction, an imbalance that has arisen partly from the mechanistic aspect and its impact on interaction design. We then introduce the concept of Blended Reality Space, interactive mixed reality environments where the physical and the virtual are seamlessly combined and affect each other. The conceptual grounding and practical examples that illustrate our approach to interaction design are then discussed, adopting a standard figurative representation of blends. This helps understanding the role of blending that meaningfully bridges unbalanced separations between cognition and action, and the physical and the virtual. As a concrete example, the AGNES project, which is aimed at developing “user sensitive home-based systems for successful ageing in a networked society”, is introduced. We believe that the emphasis on ʻbalanceʼ or appropriate blending is very important in the development of better interactive systems for health, capitalizing on seamless combinations of the virtual and the physical in Blended Reality Space