Using Abandoned Paddy Fields for Grazing in Northern Japan

The number of abandoned paddy fields is increasing in Japan, because the government has been regulating rice production. It has been recommended that the abandoned paddy fields be used for stock raising. However, there is sometimes a lack of information about the land on the abandoned paddy fields and farmers want to know the cost of fencing and the best grass species to use. This paper seeks to provide farmers with information on how to begin to use the abandoned paddy fields as pastures in hilly rural areas in Japan

Management and Tillage Infl uence Barley Forage Productivity and Water Use in Dryland Cropping Systems

Annual cereal forages are resilient in water use (WU), water use efficiency (WUE), and weed control compared with grain crops in dryland systems. The combined influence of tillage and management systems on annual cereal forage productivity and WU is not well documented. We conducted a field study for the effects of tillage (no-till and tilled) and management (ecological and conventional) systems on WU and performance of forage barley (Hordeum vulgare L.) and weed biomass in two crop rotations (wheat [Triticum aestivum L.]–forage barley–pea [Pisum sativum L.] and wheat–forage barley–corn [Zea mays L.] –pea) from 2004 to 2010 in eastern Montana. Conventional management included recommended seeding rates, broadcast N fertilization, and short stubble height of wheat. Ecological management included 33% greater seeding rates, banded N fertilization at planting, and taller wheat stubble. Forage barley in ecological management had 28 more plants m–2, 2 cm greater height, 65 more tillers m–2, 606 kg ha–1 greater crop biomass, 3.5 kg ha–1 mm–1greater WUE, and 47% reduction in weed biomass at harvest than in conventional management. Pre-plant and post-harvest soil water contents were similar among tillage and management systems, but barley WU was 13 mm greater in 4-yr than 3-yr rotation. Tillage had little effect on barley performance and WU. Dryland forage barley with higher seeding rate and banded N fertilization in more diversified rotation produced more yield and used water more efficiently than that with conventional seeding rate, broadcast N fertilization, and less diversified rotation in the semiarid northern Great Plains

Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60\u20131.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14\u20131.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely

Biomarkers and clinical rating scales for sodium pyruvate therapy in patients with mitochondrial disease

© 2019 Biomarkers and two clinical rating scales—the Japanese mitochondrial disease-rating scale (JMDRS) and Newcastle mitochondrial disease adult scale (NMDAS)—are clinically used when treating patients with mitochondrial disease. We explored the biomarker(s) and clinical rating scale(s) that are appropriate in preparing the protocol for a future clinical trial of sodium pyruvate (SP) therapy. A 48-week, prospective, single-centre, exploratory, clinical study enrolled 11 Japanese adult patients with genetically, biochemically, and clinically confirmed mitochondrial disease; they had intractable lactic acidosis and received SP (0.5 g/kg t.i.d. PO). Plasma concentrations of lactate and pyruvate, lateral ventricular levels of lactate, and serum concentrations of growth differentiation factor 15 (GDF15) and fibroblast growth factor 21 were measured at baseline and at weeks 12 and 48 of SP therapy. At week 48, plasma lactate (P =.004), the lactate/pyruvate ratio (P =.012), serum GDF15 (P =.020), and lateral ventricular lactate (P =.038) decreased significantly from the baseline values; the JMDRS and NMDAS scores did not decrease significantly, although the NMDAS overall score showed a strong tendency (P =.059). Two patients with end-stage MELAS at baseline died during SP therapy. The present study showed significant decreases in plasma and lateral ventricular lactate, the L/P ratio, and serum GDF15. Therefore, the protocol for a future clinical study of SP therapy in this patient population needs to include plasma and lateral ventricular lactate, the L/P ratio, and serum GDF15 as diagnostic indicators, and exclude patients with end-stage mitochondrial disease

Biomarkers and clinical rating scales for sodium pyruvate therapy in patients with mitochondrial disease

© 2019 Biomarkers and two clinical rating scales—the Japanese mitochondrial disease-rating scale (JMDRS) and Newcastle mitochondrial disease adult scale (NMDAS)—are clinically used when treating patients with mitochondrial disease. We explored the biomarker(s) and clinical rating scale(s) that are appropriate in preparing the protocol for a future clinical trial of sodium pyruvate (SP) therapy. A 48-week, prospective, single-centre, exploratory, clinical study enrolled 11 Japanese adult patients with genetically, biochemically, and clinically confirmed mitochondrial disease; they had intractable lactic acidosis and received SP (0.5 g/kg t.i.d. PO). Plasma concentrations of lactate and pyruvate, lateral ventricular levels of lactate, and serum concentrations of growth differentiation factor 15 (GDF15) and fibroblast growth factor 21 were measured at baseline and at weeks 12 and 48 of SP therapy. At week 48, plasma lactate (P =.004), the lactate/pyruvate ratio (P =.012), serum GDF15 (P =.020), and lateral ventricular lactate (P =.038) decreased significantly from the baseline values; the JMDRS and NMDAS scores did not decrease significantly, although the NMDAS overall score showed a strong tendency (P =.059). Two patients with end-stage MELAS at baseline died during SP therapy. The present study showed significant decreases in plasma and lateral ventricular lactate, the L/P ratio, and serum GDF15. Therefore, the protocol for a future clinical study of SP therapy in this patient population needs to include plasma and lateral ventricular lactate, the L/P ratio, and serum GDF15 as diagnostic indicators, and exclude patients with end-stage mitochondrial disease

Translation and validation of the Japanese version of the measure of moral distress for healthcare professionals

Objectives: Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. We aimed to assess the validity and reliability of the Japanese translation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). Methods: We translated the questionnaire into Japanese according to the instructions of EORTC Quality of Life group translation manual. All physicians and nurses who were directly involved in patient care at nine departments of four tertiary hospitals in Japan were invited to a survey to assess the construct validity, reliability and factor structure. Construct validity was assessed with the relation to the intention to leave the clinical position, and internal consistency was assessed with Cronbach’s alpha. Confirmatory factor analysis was conducted. Results: 308 responses were eligible for the analysis. The mean total score of MMD-HP (range, 0–432) was 98.2 (SD, 59.9). The score was higher in those who have or had the intention to leave their clinical role due to moral distress than in those who do not or did not have the intention of leaving (mean 113.7 [SD, 61.3] vs. 86.1 [56.6], t-test p < 0.001). The confirmatory factor analysis and Cronbach’s alpha confirmed the validity (chi-square, 661.9; CMIN/df, 2.14; GFI, 0.86; CFI, 0.88; CFI/TLI, 1.02; RMSEA, 0.061 [90%CI, 0.055–0.067]) and reliability (0.91 [95%CI, 0.89–0.92]) of the instrument. Conclusions: The translated Japanese version of the MMD-HP is a reliable and valid instrument to assess moral distress among physicians and nurses.Medicine, Faculty ofOther UBCNon UBCCritical Care Medicine, Division ofMedicine, Department ofReviewedFacult