The ecology of medical care on an isolated island in Okinawa, Japan: a retrospective open cohort study.

BACKGROUND: We aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island's primary care clinic through comparison with a previous nationwide survey. METHODS: We conducted this retrospective, open cohort study on Iheya, an isolated island in Okinawa Prefecture that has one primary care clinic. We considered Iheya as unique location in which to examine the role of primary care in Japan. Participants were patients who visited the island's clinic between February 1, 2013 and January 31, 2014. We calculated the number of visits to the clinic and referrals to off-island medical facilities using electronic medical records. We also compared data for Iheya with a nationwide survey conducted in 2003. RESULTS: Iheya had 1314 inhabitants in 2013. Of the 5682 visits to the clinic in the 1-year study period, 290 people were referred to off-island medical institutions. There were 64 referrals to emergency departments; of these, 57 people were admitted to hospital. The rate of visits to the clinic per month per 1000 inhabitants was 360.4 visits (95% confidence interval: 351.0-369.7). Of these, 18.4 (16.3-20.5) were referred off-island, with 4.1 (3.1-5.1) referrals to emergency departments and 3.6 (2.6-4.6) hospitalizations. Despite the high incidence of visits to the primary care clinic, the rates of hospital-based outpatient clinic visits, emergency department visits, and hospitalizations were lower than rates reported in a previous Japanese study. CONCLUSIONS: This suggests that several dimensions of primary care, its gatekeeping function in particular, are likely to play important roles in this geographical setting

The ecology of medical care on an isolated island in Okinawa, Japan: a retrospective open cohort study

Abstract Background We aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island’s primary care clinic through comparison with a previous nationwide survey. Methods We conducted this retrospective, open cohort study on Iheya, an isolated island in Okinawa Prefecture that has one primary care clinic. We considered Iheya as unique location in which to examine the role of primary care in Japan. Participants were patients who visited the island’s clinic between February 1, 2013 and January 31, 2014. We calculated the number of visits to the clinic and referrals to off-island medical facilities using electronic medical records. We also compared data for Iheya with a nationwide survey conducted in 2003. Results Iheya had 1314 inhabitants in 2013. Of the 5682 visits to the clinic in the 1-year study period, 290 people were referred to off-island medical institutions. There were 64 referrals to emergency departments; of these, 57 people were admitted to hospital. The rate of visits to the clinic per month per 1000 inhabitants was 360.4 visits (95% confidence interval: 351.0–369.7). Of these, 18.4 (16.3–20.5) were referred off-island, with 4.1 (3.1–5.1) referrals to emergency departments and 3.6 (2.6–4.6) hospitalizations. Despite the high incidence of visits to the primary care clinic, the rates of hospital-based outpatient clinic visits, emergency department visits, and hospitalizations were lower than rates reported in a previous Japanese study. Conclusions This suggests that several dimensions of primary care, its gatekeeping function in particular, are likely to play important roles in this geographical setting

GenORM: Generalizable One-shot Rope Manipulation with Parameter-Aware Policy

Due to the inherent uncertainty in their deformability during motion, previous methods in rope manipulation often require hundreds of real-world demonstrations to train a manipulation policy for each rope, even for simple tasks such as rope goal reaching, which hinder their applications in our ever-changing world. To address this issue, we introduce GenORM, a framework that allows the manipulation policy to handle different deformable ropes with a single real-world demonstration. To achieve this, we augment the policy by conditioning it on deformable rope parameters and training it with a diverse range of simulated deformable ropes so that the policy can adjust actions based on different rope parameters. At the time of inference, given a new rope, GenORM estimates the deformable rope parameters by minimizing the disparity between the grid density of point clouds of real-world demonstrations and simulations. With the help of a differentiable physics simulator, we require only a single real-world demonstration. Empirical validations on both simulated and real-world rope manipulation setups clearly show that our method can manipulate different ropes with a single demonstration and significantly outperforms the baseline in both environments (62% improvement in in-domain ropes, and 15% improvement in out-of-distribution ropes in simulation, 26% improvement in real-world), demonstrating the effectiveness of our approach in one-shot rope manipulation

TRAIL Team Description Paper for RoboCup@Home 2023

Our team, TRAIL, consists of AI/ML laboratory members from The University of Tokyo. We leverage our extensive research experience in state-of-the-art machine learning to build general-purpose in-home service robots. We previously participated in two competitions using Human Support Robot (HSR): RoboCup@Home Japan Open 2020 (DSPL) and World Robot Summit 2020, equivalent to RoboCup World Tournament. Throughout the competitions, we showed that a data-driven approach is effective for performing in-home tasks. Aiming for further development of building a versatile and fast-adaptable system, in RoboCup @Home 2023, we unify three technologies that have recently been evaluated as components in the fields of deep learning and robot learning into a real household robot system. In addition, to stimulate research all over the RoboCup@Home community, we build a platform that manages data collected from each site belonging to the community around the world, taking advantage of the characteristics of the community

Smooth sectioning of biological samples by FIB-TOF-SIMS

Spheroids, which are three-dimensionally cultured cells that resemble actual living organisms, have been attracting attention. FIB-TOF-SIMS (Focused Ion Beam Time-of-Flight Mass Spectrometry) is capable of simultaneous mass imaging of multiple elements without the need for labeling. FIB-TOF-SIMS is expected to process the spheroid and image the cross-sectional components. However, FIB processing of spheroids larger than 100μm often results in uneven cross sections due to the so-called curtain effect. The unevenness of the cross-section affects the sputtering and hinders component imaging. In this experiment, we considered the processing of spheroids by FIB from multiple directions to suppress the curtain effect. The curtain effect was evaluated by comparing the processing from one direction and from multiple directions

Association between hospital acquired disability and post-discharge mortality in patients after living donor liver transplantation

Background: Hospital-acquired disability (HAD) in patients who undergo living donor liver transplantation (LDLT) is expected to worsen physical functions due to inactivity during hospitalization. The aim of this study was to explore whether a decline in activities of daily living from hospital admission to discharge is associated with prognosis in LDLT patients, who once discharged from a hospital.Methods: We retrospectively examined the relationship between HAD and prognosis in 135 patients who underwent LDLT from June 2008 to June 2018, and discharged from hospital once. HAD was defined as a decline of over 5 points in the Barthel Index as an activity of daily living assessment. Additionally, LDLT patients were classified into four groups: low or high skeletal muscle index (SMI) and HAD or non-HAD. Univariate and multivariate Cox proportional hazard models were used to evaluate the association between HAD and survival.Results: HAD was identified in 47 LDLT patients (34.8%). The HAD group had a significantly higher all-cause mortality than the non-HAD group (log-rank: p < 0.001), and in the HAD/low SMI group, all-cause mortality was highest between the groups (log-rank: p < 0.001). In multivariable analysis, HAD was an independent risk factor for allcause mortality (hazard ratio [HR]: 16.54; P < 0.001) and HAD/low SMI group (HR: 16.82; P = 0.002).Conclusion: HAD was identified as an independent risk factor for all-cause mortality suggesting that it could be a key component in determining prognosis after LDLT. Future larger-scale studies are needed to consider the overall new strategy of perioperative rehabilitation, including enhancement of preoperative physiotherapy programs to improve physical function

Evaluation of a Triage Checklist for Mild COVID-19 Outpatients in Predicting Subsequent Emergency Department Visits and Hospitalization during the Isolation Period: A Single-Center Retrospective Study

Managing mild illness in COVID-19 and predicting progression to severe disease are concerning issues. Here, we investigated the outcomes of Japanese patients with mild COVID-19, and identified triage risk factors for further hospitalization and emergency department (ED) visits at a single tertiary hospital. A triage checklist with 30 factors was used. Patients recommended for isolation were followed up for 10 days for subsequent ED visits or hospital admission. Overall, 338 patients (median age, 44.0; 45% women) visited the clinic 5.0 days (median) after symptom onset. Thirty-six patients were immediately hospitalized following triage; others were isolated. In total, 72 non-hospitalized patients visited the ED during their isolation, and 30 were hospitalized after evaluation for oxygen desaturation. The median ED visit and hospitalization durations after symptom onset were 5.0 and 8.0 days, respectively. The checklist factors associated with hospitalization during isolation were age > 50 years, body mass index > 25 kg/m2, hypertension, tachycardia with pulse rate > 100/min or blood pressure > 135 mmHg at triage, and >3-day delay in hospital visit after symptom onset. No patients died. Altogether, 80% of patients with mild COVID-19 could be safely isolated at home. Age, BMI, underlying hypertension, date after symptom onset, tachycardia, and systolic blood pressure at triage might be related to later hospitalization

Factors associated with the status of usual source of care during the COVID-19 pandemic: a nationwide survey in Japan

Abstract Background To ensure that high-quality primary care is available to every individual, increasing the proportion of residents with a usual source of care (USC) is a challenge for each country. However, the status of USC after the spread of COVID-19 and the factors associated with it remain unclear internationally. Therefore, we aimed to explore the associations of sociodemographic and clinical factors with the presence and type of USC (kakaritsukei in Japanese) during the pandemic in Japan. Methods We conducted a nationwide cross-sectional survey of a representative sample of the general Japanese adult population in May 2021. The main outcome measures were the presence and type of USC. We assessed sociodemographic and clinical factors, including age, gender, marital status, years of education, employment status, annual household income, social isolation, health literacy, number of chronic conditions, and health-related quality of life. Results Of the 1,757 participants, 1,011 (57.5%) had a USC. There were 769 (76.1%) participants who had a USC in a clinic and 227 (22.5%) in a hospital. As a result of multivariable modified Poisson regression analysis, male gender, no chronic condition, lower health literacy, and social isolation were significantly associated with not having a USC. Among participants with a USC, male gender, the presence of one or more chronic conditions, and lower health-related quality of life were associated with having a hospital-based USC. Conclusions We identified factors associated with the status of USC during the COVID-19 pandemic, including health literacy and social isolation. These findings provide primary care providers and policymakers with insight into the potential barriers to having a USC in the aftermath of the pandemic