PLANNING OF FLEXIBLE TRANSPORT SERVICES FOR RURAL AREA CONSIDERING OPERATION COST

This paper focuses on the potential role of Flexible Transport Service (FTS) in low and dispersed demand area. In Japan, after the deregulation in 2002, some mass transit companies left from bus services in local areas. This causes problems to some older people and disabled people with difficulties on traveling in rural areas. To meet these needs, the term demand responsive transit (DRT) has been increasingly applied because it can provide passengers with alternative options on route, schedule, at a lower operating cost compared to the infrequent fixed route local public bus services. DRT needs, however, a quite large subsidy for the low density area and is not so popular for elderly people because of it’s level of service. On the other hand, Taxi Subsidy Scheme (TSS) that subsidizes on the taxi fare is being carried out widely by local authorities in Japan to support the special groups’ transport needs. In this research, we aimed to examine the role of taxi subsidy system from the relation with on demand ride-sharing taxi in depopulated area

A Case of Refractory Langerhans Cell Histiocytosis Complicated with Hemophagocytic Lymphohistiocytosis Rescued by Cord Blood Transplantation with Reduced-intensity Conditioning

　We diagnosed a female infant with Langerhans cell histiocytosis (LCH) who was refractory to conventional chemotherapy. She showed refractory inflammation that was complicated with hemophagocytic lymphohistiocytosis (HLH) during LCH chemotherapy; therefore, we changed the protocol to HLH2004 (dexamethasone, cyclosporine A and VP16). However, there were no signs of hematological recovery. We therefore performed cord blood transplantation with reduced-intensity conditioning, and she achieved complete remission for over 2 years. As salvage therapy for refractory LCH, hematopoietic stem cell transplantation may be a good therapeutic choice, especially when LCH is complicated with HLH

Difficulties and Coping Strategies Experienced by Employed People with HIV in Japan: A Qualitative Study Comparing High and Low Sense of Coherence Groups

People with HIV experience anxiety about discrimination in the workplace and disclosing their disease. Effective coping ability toward HIV-related challenges may be associated with a person’s sense of coherence (SOC). This study describes the range of difficulties HIV-positive individuals experience and their coping strategies, especially in the workplace. The experiences of those with high and low SOC are compared. Data were collected in Japan from 2007 to 2009 using a qualitative approach. Semistructured interviews were conducted with 40 participants with HIV with work experience. Interviews focused on individual’s perspectives, including self-perceptions of physical and mental functioning, work conditions, and perceived changes in their circumstances. Participants were divided into high and low SOC groups based on SOC-13 scores. A number of categories and subcategories of experiences were extracted, including “acute feeling of the severe social positioning of HIV,” with some categories specific to those with low SOC. Those with high SOC appeared to have a unique perspective that supported more successful coping, for example, “Awareness of death is linked to valuing living in the present,” “Do not be discouraged by uncertainties and difficulties,” and so on. It suggests that development of coping skills may help people with HIV

Study of Sustained Blood Pressure-Lowering Effect of Azelnidipine Guided by Self-Measured Morning and Evening Home Blood Pressure: Subgroup Analysis of the At-HOME Study

BACKGROUND: Morning hypertension is a risk factor for cardiovascular and cerebrovascular events, and consequently diagnosis and control of morning hypertension are considered very important. We previously reported the results of the Azelnidipine Treatment for Hypertension Open-label Monitoring in the Early morning (At-HOME) Study, which indicated that azelnidipine effectively controlled morning hypertension. OBJECTIVES: The objective of this At-HOME subgroup analysis was to evaluate the sustained blood pressure (BP)-lowering effect of azelnidipine, using mean morning and evening systolic BP [ME average] and morning systolic BP minus evening systolic BP (ME difference). METHODS: We analyzed the self-measured home BP data (measured in the morning and at bedtime) from this 16-week prospective observational study to clarify the effect of morning dosing of azelnidipine (mean [± standard deviation] maximum dose 14.3 ± 3.6 mg/day). A subgroup of patients from the At-HOME Study who had an evening home BP measurement within 28 days prior to the baseline date were used for efficacy analysis (n = 2,546; mean age, 65.1 years; female, 53.6 %). RESULTS: Home systolic BP/diastolic BP levels in the morning and evening were significantly lowered (p < 0.0001) by −19.4 ± 17.1/−10.3 ± 10.6 and −16.9 ± 17.0/−9.4 ± 10.6 mmHg, respectively. Home pulse rates in the morning and evening were also significantly lowered (p < 0.0001) by −3.5 ± 7.8 and −3.5 ± 7.3 beats/min, respectively. At baseline, patients whose ME average was ≥135 mmHg and whose ME difference was ≥15 mmHg (defined as morning-predominant hypertension) accounted for 20.4 % of the study population. However, at the end of the study, the number of such patients was significantly reduced to 7.9 % (p < 0.0001). Patients whose ME average was ≥135 mmHg and whose ME difference was <15 mmHg (defined as sustained hypertension) accounted for 71.1 % of the study population at baseline. This was reduced significantly to 42.8 % at the end of the study (p < 0.0001). ME average decreased significantly from 153.8 ± 15.5 mmHg to 135.6 ± 11.9 mmHg, and ME difference also decreased significantly from 6.7 ± 13.1 mmHg to 4.7 ± 10.8 mmHg (both p < 0.0001). CONCLUSION: These results suggest that azelnidipine improved morning hypertension with its sustained BP-lowering effect. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40268-013-0007-7) contains supplementary material, which is available to authorized users

チュウゴクゴ ボゴワシャ ヲ タイショウ トシタ ニホンゴ チョウカイテスト ニオケル センタクシ テイジケイシキ ノ エイキョウ

本研究は、中国で学ぶ中国語母語話者を対象に、日本語聴解テストにおける選択肢提示形式の影響を考察したものである。研究の目的は、1)選択肢を文字で提示したテストと音声で提示したテストとでは、結果に違いが生じるか、2)文字提示形式と音声提示形式との間で正答率について有意差が確認された項目は、どのような特徴があるか、という点について考察することである。 調査協力者は、文字提示形式のテストを受験した63名と音声提示形式のテストを受験した63名である。テスト項目のうち、実験項目は24項目であった。統計的分析の結果、文字提示形式と音声提示形式、それぞれの得点の平均値には有意差がないことが明らかになった。しかし、実験項目の各項目について統計的分析を行った結果、文字提示形式のほうが正答率が高い項目が4項目、音声提示形式のほうが高い項目が1項目認められた。そこで、この5項目について、その要因を探るために、4名の協力者を対象にインタビュー調査を実施した。その結果、文字条件が有利となる項目は、a)学習者になじみのない語が正答選択肢に含まれている、b)設問から推測される選択肢内容と実際の選択肢内容が異なる、という特徴を有していた。音声提示形式のほうが有利となる項目については、その要因は特定できず、可能性を指摘するにとどまった。本研究の結果は、中国語母語話者にとっては、文字による選択肢が有利に働くであろうという予測を覆すものであった。これは、中国の学習者は、文字を読みながら聞くという言語行動に慣れていない、日本語能力試験の対策を行っているため音声提示形式の聴解問題に慣れている、などの理由が考えられる。This study aims to investigate the effect of multiplechoice option presentation style in written and recorded formats on the results of a Japanese listening comprehension test for native speakers of Chinese studying in China. Sixty-three examinees underwent a listening test consisting of twenty-four items with written response options, and sixty-three examinees underwent a listening test consisting of twenty-four items with recorded response options. The results showed that there was no significant difference in the mean scores of the two styles. However, an analysis of each item revealed that four items appeared less difficult when the response options were printed and one item was perceived as less difficult when the options were presented in a recorded format. Four participants underwent a test comprising these five items and were asked to answer each question after listening to it. The results of the analysis were as follows: (a) items whose correct answer included a word unfamiliar to the examinees were less difficult in the written format and (b) items whose answer students could not discern after listening to the question were less difficult in the written format. The reason for one item being less difficult in the recorded format was not found. Contrary to the hypothesis, the result indicated that the style in which the options were presented in the written format was not less difficult for Chinese learners. A possible explanation for this is that Chinese studying in China are not familiar with listening andreading simultaneously, and are used to listening comprehension tests whose options are presented in a recorded format as practice for the Japanese-Language Proficiency Test

Catheter ablation of non-inducible atrial tachycardia after surgical repair of heart disease

We present a patient with non-inducible atrial tachycardia (AT) after atriotomy for surgical repair of heart disease who underwent ablation successfully. Using a 3-D mapping system, we presumed the atriotomy site on the lateral right atrial wall by searching for linear double potentials (DP) during sinus/paced rhythm from the coronary sinus, but it was evaluated incompletely. We could verify the edges of the atriotomy scar precisely by pacing from close to the linear DP lesion and the opposite site. After ablation between the presumed atriotomy scar and the inferior vena cava and cavotricuspid isthmus, no AT recurred without anti-arrhythmic drugs.ArticleHEART AND VESSELS. 27(1):114-118 (2012)journal articl

出産クラス受講前後の妊婦の自己効力感と指導者のProfessional Learning Climate との関連性

【目的】出産クラス受講前後の妊婦の自己効力感と指導者の Professional Learning Climate （以下、PLCとする）との関連性を明らかにする。 【方法】２００８年７月～９月に北陸の産科施設で開催された３１の出産クラスに参加した妊婦 ２４４名とクラス指導者３９名を対象に自記式質問紙調査を行った。妊婦には出産に対する自 己効力感と指導者に対して感じたPLCについて、クラス指導者にはクラスの指導経験年数 など属性項目を調査した。また、クラスの参加観察によりクラス内容や雰囲気、参加者や 指導者の交流タイプなどを調査した。 【結果】対象全体では、自己効力感と PLCに有意な関連は認めなかった。しかし、出産経験 別の検討では、初産婦にのみ自己効力感と PLCに有意な正相関を認めた。 PLCの要素別で は「リラックスできる空間の創造」、「ユーモアとウィット」の２要素と自己効力感との間 に有意な正相関を認めた。一方、経産婦においては自己効力感と PLCに関連性は認めな かった。さらに、クラス後の自己効力感の高さには、 PLCとクラス前の自己効力感が影響 していた。 　以上より、 PLCは出産クラスを運営する際に、指導者にとって身につけることが望まし い必要な要素であることが示唆された。 : The purpose of this study was to clarify the relationship between the professional learning climate (PLC) of educators and the self-efficacy of pregnant women before and after they took a childbirth class. : A self-completed questionnaire survey was conducted on 244 pregnant women who had participated in 31 childbirth classes held in a maternity hospital in the Hokuriku district, and 39 class educators. It investigated the pregnant women s feelings of self-efficacy to cope with childbirth and PLC with the educator, and such educator attributes as the number of years of experience in teaching childbirth classes. Class content and atmosphere, and the types of interaction between participants and educators, were investigated through participant observation of the classes. The survey was conducted from July to September 2008. : No significant relationship was observed between self-efficacy and PLC in all subjects. However, among women with parity, a significant positive correlation was observed between self-efficacy and PLC in nullipara. Among individual elements of PLC, significant positive correlations were observed between self-efficacy and “creation of a relaxing space” and “humor and wit.” Among multipara, no relationship was observed between self-efficacy and PLC. In addition, the level of self-efficacy after the class was affected by PLC and self-efficacy before the class. 　The present findings suggest that skill in creating PLC is an element which educators should acquire in order to conduct childbirth classes.[原著

A Long-term Survivor after Congenital Acute Myeloid Leukemia with t(8 ; 16)(p11 ; p13)

The treatment of patients with congenital leukemia is difficult and often results in a poor prognosis. We present here the case of a female child with congenital acute myeloid leukemia (AML) with t(8 ; 16) (p11 ; p13) who received chemotherapy and survived for more than 10 years without relapse. A novel MOZ-CBP chimera was found in her diagnostic sample. Although adult AML patients with MOZ-CBP have mainly been reported as having therapy-related AML and showed poor prognoses, the present case supports the idea that AML with MOZ-CBP in the pediatric population might show better prognoses

Detection of RBM15-MKL1 Fusion Was Useful for Diagnosis and Monitoring of Minimal Residual Disease in Infant Acute Megakaryoblastic Leukemia

Acute megakaryocytic leukemia (AMKL) with t(1;22)(p13;q13) is a distinct category of myeloid leukemia by WHO classification and mainly reported in infants and young children. Accurate diagnosis of this type of AMKL can be difficult, because a subset of patients have a bone marrow (BM) blast percentage of less than 20% due to BM fibrosis. Therefore, it is possible that past studies have underestimated this type of AMKL. We present here the case of a 4-month-old female AMKL patient who was diagnosed by presence of the RBM15-MKL1 (OTT-MAL) fusion transcript by RT-PCR. In addition, we monitored RBM15-MKL1 fusion at several time points as a marker of minimal residual disease (MRD), and found that it was continuously negative after the first induction chemotherapy even by nested RT-PCR. Detection of the RBM15-MKL1 fusion transcript thus seems to be useful for accurate diagnosis of AMKL with t(1;22)(p13;q13). We recommend that the RBM15-MKL1 fusion transcript be analyzed for all suspected AMKL in infants and young children. Furthermore, monitoring of MRD using this fusion transcript would be useful in treatment of AMKL with t(1;22)(p13;q13)