ナラティヴアプローチを基盤とした看護実践によるうつ病高齢者の語りの変化に関する研究

This practical research study sought to clarify the treatment effect of, and means of a narrative approach toward, the depressed elderly that could by applied in nursing care with the hope of contributing to the development of a nursing-specific treatment approach that can help to alleviate depression among the elderly. Five hospitalized elderly patients with depression, aged 65 or older, participated in individual interviews based on a narrative approach that were conducted by the nurse researcher. Changes that occurred in the patients’ discourses and the researcher’s nursing practice over time were recorded and subjected to qualitative inductive analysis. In addition, the process of reciprocal interaction between the patients and researcher were examined with reference to Travelbee’s “human-to-human relationship model”. In the initial phase of the encounters between the patients and researcher, the patients’ discourses focused mainly on their physical suffering. The researcher attempted to build mutual trust by accompanying their mental and physical suffering, and through the mutual trust that developed the researcher prompted them to share their experiences without anxiety. Through this relationship, a coidentity emerged between the two parties. As the interviews progressed, the patients’ discourses changed to express their suffering in an intrapsychic world. A deepening of relationship and changes in it occurred between the patients and researcher, and the researcher had “opportunities to reach the heart of the depressed elderly through mutual identification” and listen to their psychological suffering. When their relationship progressed from identification to empathy, the patients told the researcher of their psychological suffering and life history : the discourses now contained previously untold stories, details of the times in which they lived, meaning in their life, and sociality. The discourses finally developed to express self-insights and hopes. This is when the patients and the researcher shared vividly that they now had a connection and rapport was established. The researcher supported the reestablishment of positives in the patients’ discourses by “wishing for their recovery and actualizing their hopes”, while also accepting their feelings of hopelessness that their depression would never be cured. The continuous narrative approach provided as part of nursing practice enabled the elderly patients who had been experiencing depressive feelings due to physical and intrapsychic suffering to alleviate their depression.本研究は、うつ病高齢者に対するナラティヴアプローチの治療的効果とその実践方法に ついて明らかにすることを目的とした実践研究である。 　入院治療を受けているうつ病高齢者５名に対して、ナラティヴアプローチを行い、研究 参加者の語りの変化と研究者の看護実践をデータとして質的帰納的に分析を行った。また、 ナラティヴアプローチの実践によって、参加者と研究者の相互作用が進展していくプロセ スをTravelbee13) の理論に則って捉えた。 　研究参加者の語りは、初期の出会いの位相では《身体の苦悩を基軸とした語り》が中心 であった。研究者は、『うつ病高齢者の心身のつらさに添いながら相互信頼を構築する』か かわりを基盤とし、参加者が研究者とともに安心して自己の体験を語ることができるよう に配慮していた。そのようなかかわりによって、両者の間に同一性が出現した。面接の経 過を経るに従い語りの内容は変化し、参加者は《精神内界の苦悩を表出》するようになっ た。研究者は、参加者との関係性の深まりや変化をみながら、状況に応じて『相互に一体 感をもちうつ病高齢者の琴線に触れる』かかわりを行い、精神的な苦悩を傾聴していた。 参加者と研究者の相互関係は同一化から共感の位相に進展したことによって、精神的な苦 悩や生活史が語られるようになり、そこには各参加者のいまだ語られていなかった物語や 生きられた時間、意味性、社会性が表現されていた。そして、同感の位相を経て、最終的 に参加者の語りは《自己洞察と希望の表出》という形に展開した。ここには、参加者と研 究者の間に、お互いが結ばれているという生き生きとした体験が基盤にあり、ラポールが 構築された。研究者は、参加者の抑うつ感情や「病気が治ることはない」という絶望感に 添い、受容しながらも、『回復や希望の実現を願う』ことで参加者の語りがポジティブに再 構築されるように支援していた。これまで、身体の苦悩や抱え込んでいた精神内界の苦悩 によって抑うつを体験していた参加者は、継続したナラティヴアプローチによって、抑う つを緩和することができていた

Human Interface Technology for Operation Support of LargeSized Crane

In this research, a Human Interface system is designed intended to mobile crane. The intervention of human is unavoidable to attain the high performance of electro mechanical system. As is known, crane operation is complicated. Recently, the decrease of expert person induced crane accident. So in near future, it is required a partial automation of crane operation and human support technology. We are aiming at the development of the operation support system for a crane. In this research, development of the hydro mechanical models representing both of static and dynamics movements are made. Further, actual experimental data of operating mobile crane, which are electrical signal data and three-dimension (3D) position of moving load is measured. The actual operating data are compared with the model and it is found that the developed electromechanical model can explain the behaviors of actual data

Concurrent presentation of cryptococcal meningoencephalitis and systemic lupus erythematosus

金沢大学医薬保健研究域医学系医学教育研究センターCryptococcal meningitis is a recognized complication of systemic lupus erythematosus (SLE), with high mortality rates, particularly in those treated with immunosuppressive agents. We describe a patient diagnosed simultaneously with cryptococcal meningoencephalitis and SLE and reviewed four similar cases reported in the literature. In our case, profound low CD4 lymphocyte count and low complement levels were observed. The patient was treated with prednisolone, fluconazole, and 5-flucytosine and evinced good clinical improvement. This case suggests that intrinsic immunological abnormality related to SLE predisposed to opportunistic infections. © 2010 Japan College of Rheumatology

Soft chromophore featured liquid porphyrins and their utilization toward liquid electret applications

Optoelectronically active viscous liquids are ideal for fabricating foldable/stretchable electronics owing to their excellent deformability and predictable π-unit-based optoelectronic functions, which are independent of the device shape and geometry. Here we show, unprecedented 'liquid electret' devices that exhibit mechanoelectrical and electroacoustic functions, as well as stretchability, have been prepared using solvent-free liquid porphyrins. The fluidic nature of the free-base alkylated-tetraphenylporphyrins was controlled by attaching flexible and bulky branched alkyl chains at different positions. Furthermore, a subtle porphyrin ring distortion that originated from the bulkiness of alkyl chains was observed. Its consequences on the electronic perturbation of the porphyrin-unit were precisely elucidated by spectroscopic techniques and theoretical modelling. This molecular design allows shielding of the porphyrin unit by insulating alkyl chains, which facilitates its corona-charged state for a long period under ambient conditions

Integration of In Vivo Genotoxicity and Short-term Carcinogenicity Assays Using F344 gpt Delta Transgenic Rats: In Vivo Mutagenicity of 2,4-Diaminotoluene and 2,6-Diaminotoluene Structural Isomers

An important trend in current toxicology is the replacement, reduction, and refinement of the use of experimental animals (the 3R principle). We propose a model in which in vivo genotoxicity and short-term carcinogenicity assays are integrated with F344 gpt delta transgenic rats. Using this model, the genotoxicity of chemicals can be identified in target organs using a shuttle vector λ EG10 that carries reporter genes for mutations; short-term carcinogenicity is determined by the formation of glutathione S-transferase placenta form (GST-P) foci in the liver. To begin validating this system, we examined the genotoxicity and hepatotoxicity of structural isomers of 2,4-diaminotoluene (2,4-DAT) and 2,6-diaminotoluene (2,6-DAT). Although both compounds are genotoxic in the Ames/Salmonella assay, only 2,4-DAT induces tumors in rat livers. Male F344 gpt delta rats were fed diet containing 2,4-DAT at doses of 125, 250, or 500 ppm for 13 weeks or 2,6-DAT at a dose of 500 ppm for the same period. The mutation frequencies of base substitutions, mainly at G:C base pairs, were significantly increased in the livers of 2,4-DAT–treated rats at all three doses. In contrast, virtually no induction of genotoxicity was identified in the kidneys of 2,4-DAT–treated rats or in the livers of 2,6-DAT–treated rats. GST-P–positive foci were detected in the livers of rats treated with 2,4-DAT at a dose of 500 ppm but not in those treated with 2,6-DAT. Integrated genotoxicity and short-term carcinogenicity assays may be useful for early identifying genotoxic and nongenotoxic carcinogens in a reduced number of experimental animals

Robotic Renal Autotransplantation: A Feasibility Study in a Porcine Model

We investigated the feasibility of robotic renal autotransplantation (RAT) in a porcine model to reduce invasiveness of RAT. Five pigs underwent robotic RAT using the da Vinci® robotic system. A robotic left nephrectomy was performed in all cases. Robotic RAT was performed on the left side in all but one case. Four ports were used. In 3 cases, the kidney was taken out through the GelPort® and irrigated on ice with Ringer’s solution. In 2 cases, a complete intracorporeal robotic RAT was performed. An end-to-side anastomosis was performed between the renal vein and the external iliac vein and between the renal artery and the external iliac artery. Ureteroneocystostomy was also performed in 2 cases. All cases were performed robotically without open conversion. The median (IQR) console time was 3.1 (0.7) h, and the operative time was 3.8 (1.1) h. The estimated blood loss was 30 (0) ml. The warm ischemia time was 4.0 (0.2) min, and the cold ischemia time was 97 (17) min. Intracorporeal transarterial hypothermic renal perfusion was feasible in the 2 complete intracorporeal robotic RAT cases by using a perfusion catheter through a laparoscopic port. Robotic RAT has the potential to be a new minimally invasive substitute for conventional open surgery

Paleoclimatic and paleoceanographic records through Marine Isotope Stage 19 at the Chiba composite section, central Japan: A key reference for the EarlyeMiddle Pleistocene Subseries boundary

Marine Isotope Stage (MIS) 19 is an important analogue for the present interglacial because of its similar orbital configuration, especially the phasing of the obliquity maximum to precession minimum. However, sedimentary records suitable for capturing both terrestrial and marine environmental changes are limited, and thus the climatic forcing mechanisms for MIS 19 are still largely unknown. The Chiba composite section, east-central Japanese archipelago, is a continuous and expanded marine sedimentary succession well suited to capture terrestrial and marine environmental changes through MIS 19. In this study, a detailed oxygen isotope chronology is established from late MIS 20 to early MIS 18, supported by a U-Pb zircon age and the presence of the Matuyama–Brunhes boundary. New pollen, marine microfossil, and planktonic foraminiferal δ18O and Mg/Ca paleotemperature records reveal the complex interplay of climatic influences. Our pollen data suggest that the duration of full interglacial conditions during MIS 19 extends from 785.0 to 775.1 ka (9.9 kyr), which offers an important natural baseline in predicting the duration of the present interglacial. A Younger Dryas-type cooling event is present during Termination IX, suggesting that such events are linked to this orbital configuration. Millennial- to multi-millennial-scale variations in our δ18O and Mg/Ca records imply that the Subarctic Front fluctuated in the northwestern Pacific Ocean during late MIS 19, probably in response to East Asian winter monsoon variability. The climatic setting at this time appears to be related to less severe summer insolation minima at 65˚N and/or high winter insolation at 50˚N. Our records do not support a recently hypothesized direct coupling between variations in the geomagnetic field intensity and global/regional climate change. Our highly resolved paleoclimatic and paleoceanographic records, coupled with a well-defined Matuyama–Brunhes boundary (772.9 ka; duration 1.9 kyr), establish the Chiba composite section as an exceptional climatic and chronological reference section for the Early–Middle Pleistocene boundary.ArticleQuaternary Science Reviews 191: 406-430(2018)journal articl

A unique actual experience for recognizing the various roles of healthcare professionals while enhancing pharmacy students\u27 motivation

薬学生に医療従事者の役割や医療チームの重要性を認識させることは極めて重要である。そこで我々は、病院診療科の視察体験が薬学生にどのような効果をもたらすか検討した。本学薬学4年生15名に宮崎大学医学部附属病院放射線科への視察の機会を与え、他の15名には、対照群として視察の機会を与えなかった。視察体験をした学生は、医療従事者が行う診断や患者への治療を、説明を受けながら観察し、さらに医療従事者と質疑応答の時間を持った。視察体験が学生に及ぼす効果は、学生への質問調査によって評価した。視察体験をした学生は医師及びコメディカル職員とのコミュニケーションに大きな興味を示した。また、視察体験をした全ての学生は医療チームの重要性を認識し、医療における知識の修得が必要と考えていた。それ故に診療科の視察体験は、高学年の薬学生において医療従事者の役割の重要性を理解する有意な実地演習であり、教育方略になると考えた。This study aimed to have pharmacy students understand the medical care team and recognize the importance of each healthcare professional\u27s role in medical practice through the implementation of a oneday visitation experience. Thirty fourth-year pharmacy students participated in the study. Half were given an opportunity to visit the Department of Radiology at University of Miyazaki Hospital; the other half were not, and served as the control group. The students observed the medical team diagnose and provide medical treatment to patients and received explanations from various healthcare professionals. They then had a question-and-answer session with healthcare professionals. The students were subsequently given questionnaires to evaluate the impact the visitation experience had on them. Students evinced huge enthusiasm in communicating with physicians and allied healthcare professionals in the one-day experience. The experience increased their motivation to study pharmacy and helped them recognize the importance of the medical care team. Students showed a positive attitude toward the one-day experience. This experiential visit was therefore very meaningful for senior-year pharmacy students. A visitation experience in a department providing diagnosis and treatment for patients affords a unique practical training and educational strategy for understanding the role of each healthcare professional

High-resolution seismic reflection profiling across the Senya fault at Hanaoka, northern Honshu, Japan: Data acquisition and processing

The Senya fault, northern Honshu, Japan, which generated the Rikuu earthquake (Mj 7.2) 1896, is a typical intra-arc active thrust. Subsurface geometry provides essential information for better understanding strong ground motions and crustal deformation processes. A high-resolution seismic reflection survey was conducted along the 63km long seismic line across the toe of the thrust to reveal the subsurface geometry. The seismic source was a Mini-vibrator truck and the receiver interval was 10 m. The seismic data were processed by the standard common mid-point method. The Senya fault is clearly identified as a boundary between horizontal reflectors of the basin fill in the Yokote basin and moderately dipping reflectors beneath the Senya hills. The thrust occurred in late Miocene mudstone, and shows a flat and ramp geometry. The emergent thrust dips 30 degrees down to 500m, and changes its dip to subhorizontal following the distribution of the mudstone