作業療法におけるクリニカルリーズニングの概念分析

Introduction: Acquiring competence in clinical reasoning is regarded as key to meet the challenges of integrating knowledge into one\u27s practice. Learners and educators need a shared understanding of what is clinical reasoning because they need appropriate means for reflection and feedback. However, the clinical reasoning concept needs revisiting in the current context, which is becoming increasingly diverse and complex. The purpose of this study was to analyse the clinical reasoning concept and develop a common framework. Methods: Rodgers\u27 concept analysis was selected for this theoretical study. Accordingly, a systematically search of multiple databases yielded 903 articles and 135 articles that met the inclusion criteria were extracted, and of these 30 articles randomly sampled for analysis. Data analysis was done following Rodgers\u27 method of thematic analysis. Results: The attributes were four ‘therapeutic thinking processes’ and two ‘professional thinking skills.’ The application contexts were ‘clinical and non-clinical practice settings,’ and ‘professional education.’ Moreover, the antecedents were ‘professional factors’ and ‘practice factors,’ and the consequences were ‘professional developments’ and ‘professional attitudes and behaviours.’ Conclusion: The resulting framework of clinical reasoning can be the basis for developing pedagogies and assessment of clinical reasoning competence acquisition.東京都立大学学位論文甲第1163号　副論

Prediction of transcriptional regulatory elements for plant hormone responses based on microarray data

<p>Abstract</p> <p>Background</p> <p>Phytohormones organize plant development and environmental adaptation through cell-to-cell signal transduction, and their action involves transcriptional activation. Recent international efforts to establish and maintain public databases of <it>Arabidopsis </it>microarray data have enabled the utilization of this data in the analysis of various phytohormone responses, providing genome-wide identification of promoters targeted by phytohormones.</p> <p>Results</p> <p>We utilized such microarray data for prediction of <it>cis</it>-regulatory elements with an octamer-based approach. Our test prediction of a drought-responsive RD29A promoter with the aid of microarray data for response to drought, ABA and overexpression of DREB1A, a key regulator of cold and drought response, provided reasonable results that fit with the experimentally identified regulatory elements. With this succession, we expanded the prediction to various phytohormone responses, including those for abscisic acid, auxin, cytokinin, ethylene, brassinosteroid, jasmonic acid, and salicylic acid, as well as for hydrogen peroxide, drought and DREB1A overexpression. Totally 622 promoters that are activated by phytohormones were subjected to the prediction. In addition, we have assigned putative functions to 53 octamers of the Regulatory Element Group (REG) that have been extracted as position-dependent <it>cis</it>-regulatory elements with the aid of their feature of preferential appearance in the promoter region.</p> <p>Conclusions</p> <p>Our prediction of <it>Arabidopsis cis</it>-regulatory elements for phytohormone responses provides guidance for experimental analysis of promoters to reveal the basis of the transcriptional network of phytohormone responses.</p

Motor generated torque drives coupled yawing and orbital rotations of kinesin coated gold nanorods

Kinesin motor domains generate impulses of force and movement that have both translational and rotational (torque) components. Here, we ask how the torque component influences function in cargo-attached teams of weakly processive kinesins. Using an assay in which kinesin-coated gold nanorods (kinesin-GNRs) translocate on suspended microtubules, we show that for both single-headed KIF1A and dimeric ZEN-4, the intensities of polarized light scattered by the kinesin-GNRs in two orthogonal directions periodically oscillate as the GNRs crawl towards microtubule plus ends, indicating that translocating kinesin-GNRs unidirectionally rotate about their short (yaw) axes whilst following an overall left-handed helical orbit around the microtubule axis. For orientations of the GNR that generate a signal, the period of this short axis rotation corresponds to two periods of the overall helical trajectory. Torque force thus drives both rolling and yawing of near-spherical cargoes carrying rigidly-attached weakly processive kinesins, with possible relevance to intracellular transport

CYK4 relaxes the bias in the off-axis motion by MKLP1 kinesin-6

Centralspindlin, a complex of the MKLP1 kinesin-6 and CYK4 GAP subunits, plays key roles in metazoan cytokinesis. CYK4-binding to the long neck region of MKLP1 restricts the configuration of the two MKLP1 motor domains in the centralspindlin. However, it is unclear how the CYK4-binding modulates the interaction of MKLP1 with a microtubule. Here, we performed three-dimensional nanometry of a microbead coated with multiple MKLP1 molecules on a freely suspended microtubule. We found that beads driven by dimeric MKLP1 exhibited persistently left-handed helical trajectories around the microtubule axis, indicating torque generation. By contrast, centralspindlin, like monomeric MKLP1, showed similarly left-handed but less persistent helical movement with occasional rightward movements. Analysis of the fluctuating helical movement indicated that the MKLP1 stochastically makes off-axis motions biased towards the protofilament on the left. CYK4-binding to the neck domains in MKLP1 enables more flexible off-axis motion of centralspindlin, which would help to avoid obstacles along crowded spindle microtubules

Virtual Human Generative Model: Masked Modeling Approach for Learning Human Characteristics

Identifying the relationship between healthcare attributes, lifestyles, and personality is vital for understanding and improving physical and mental conditions. Machine learning approaches are promising for modeling their relationships and offering actionable suggestions. In this paper, we propose Virtual Human Generative Model (VHGM), a machine learning model for estimating attributes about healthcare, lifestyles, and personalities. VHGM is a deep generative model trained with masked modeling to learn the joint distribution of attributes conditioned on known ones. Using heterogeneous tabular datasets, VHGM learns more than 1,800 attributes efficiently. We numerically evaluate the performance of VHGM and its training techniques. As a proof-of-concept of VHGM, we present several applications demonstrating user scenarios, such as virtual measurements of healthcare attributes and hypothesis verifications of lifestyles.Comment: 14 pages, 4 figure

Analysis of mineral apposition rates during alveolar bone regeneration over three weeks following transfer of BMP-2/7 gene via in vivo electroporation

Alveolar bone is not spontaneously regenerated following trauma or periodontitis. We previously proposed an animal model for new alveolar bone regeneration therapy based on the non-viral BMP-2/7 gene expression vector and in vivo electroporation, which induced the formation of new alveolar bone over the course of a week. Here, we analysed alveolar bone during a period of three weeks following gene transfer to periodontal tissue. Non-viral plasmid vector pCAGGS-BMP-2/7 or pCAGGS control was injected into palatal periodontal tissue of the first molar of the rat maxilla and immediately electroporated with 32 pulses of 50 V for 50 msec. Over the following three weeks, rats were double bone-stained by calcein and tetracycline every three days and mineral apposition rates (MAR) were measured. Double bone-staining revealed that MAR of alveolar bone was as similar level three days before BMP-2/7 gene transfer as three days after gene transfer. However, from 3 to 6 days, 6 to 9 days, 9 to 12 days, 12 to 15 days, 15 to 18 days, and 18 to 20 days after, MARs were significantly higher than prior to gene transfer. Our proposed gene therapy for alveolar bone regeneration combining non-viral BMP-2/7 gene expression vector and in vivo electroporation could increase alveolar bone regeneration potential in the targeted area for up to three weeks

Increased prostaglandin e2 has a positive correlation with plasma calcium during goldfish reproduction

We recently demonstrated that prostaglandin E2 PG¿ increases osteoclastic activity and induces bone resorption in both in vitro and in vivo experiments using goldfish. In the fish reproductive period, the plasma calcium (Ca) level in female teleosts increases remarkably to make vitellogenin, which is a major component of egg protein and a Ca-binding protein. In this period, however, there is no reported relationship between PGE2 and Ca metabolism in fish. To clarify the Ca metabolism in fish reproduction, we examined plasma PGE2 and Ca levels and measured tartrate-resistant acid phosphatase (TRAP) activities as an indicator of osteoclastic activity in goldfish. Plasma PGE2 levels in the reproductive stage significantly increased as compared with those in non-reproductive stages. Also, both plasma Ca and TRAP increased in the reproductive stage. Significant positive correlations were recognized between plasma Ca and the gonad somatic index (r=0.81, p<0.001), plasma Ca and plasma PGE2 levels (r=0.635, p<0.05), and plasma Ca and plasma TRAP activities (r=0.584, p<0.05) from the analysis using samples of both reproductive and nonreproductive stages. Taking these data into consideration, we suggested that PGE, acts on osteoclasts and increases plasma Ca as a result of osteoclastic bone resorption, and we concluded that PGE, is an important hormone in Ca metabolism during fish reproduction

The Effect of Medical Cooperation in the CKD Patients: 10-Year Multicenter Cohort Study

Introduction: While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and multidisciplinary care teams. Although it has been reported that multidisciplinary care teams contribute to the prevention of worsening renal functions and cardiovascular events, there are few studies on the effect of a medical cooperation system. Methods: We aimed to evaluate the effect of medical cooperation on all-cause mortality and renal prognosis in patients with CKD. One hundred and sixty-eight patients who visited the one hundred and sixty-three clinics and seven general hospitals of Okayama city were recruited between December 2009 and September 2016, and one hundred twenty-three patients were classified into a medical cooperation group. The outcome was defined as the incidence of all-cause mortality, or renal composite outcome (end-stage renal disease or 50% eGFR decline). We evaluated the effects on renal composite outcome and pre-ESRD mortality while incorporating the competing risk for the alternate outcome into a Fine-Gray subdistribution hazard model. Results: The medical cooperation group had more patients with glomerulonephritis (35.0% vs. 2.2%) and less nephrosclerosis (35.0% vs. 64.5%) than the primary care group. Throughout the follow-up period of 5.59 +/- 2.78 years, 23 participants (13.7%) died, 41 participants (24.4%) reached 50% decline in eGFR, and 37 participants (22.0%) developed end-stage renal disease (ESRD). All-cause mortality was significantly reduced by medical cooperation (sHR 0.297, 95% CI 0.105-0.835, p = 0.021). However, there was a significant association between medical cooperation and CKD progression (sHR 3.069, 95% CI 1.225-7.687, p = 0.017). Conclusion: We evaluated mortality and ESRD using a CKD cohort with a long-term observation period and concluded that medical cooperation might be expected to influence the quality of medical care in the patients with CKD

Stress rotations and the long-term weakness of the Median Tectonic Line and the Rokko-Awaji Segment

International audienceWe used a field analysis of rock deformation microstructures and mesostructures to reconstructthe long-term orientation of stresses around two major active fault systems in Japan, the Median TectonicLine and the Rokko-Awaji Segment. Our study reveals that the dextral slip of the two fault systems, activesince the Plio-Quaternary, was preceded by fault normal extension in the Miocene and sinistral wrenching inthe Paleogene. The two fault systems deviated the regional stress field at the kilometer scale in their vicinityduring each of the three tectonic regimes. The largest deviation, found in the Plio-Quaternary, is a more faultnormal rotation of the maximum horizontal stress to an angle of 79° with the fault strands, suggesting anextremely low shear stress on the Median Tectonic Line and the Rokko-Awaji Segment. Possible causes of thislong-term stress perturbation include a nearly total release of shear stress during earthquakes, a low staticfriction coefficient, or lowelastic properties of the fault zones comparedwith the country rock. Independently ofthe preferred interpretation, the nearly fault normal orientation of the direction of maximum compressionsuggests that the mechanical properties of the fault zones are inadequate for the buildup of a pore fluidpressure sufficiently elevated to activate slip. The long-term weakness of the Median Tectonic Line and theRokko-Awaji Segment may reside in low-friction/low-elasticity materials or dynamic weakening rather than inpreearthquake fluid overpressures