Household income relationship with health services utilization and healthcare expenditures in people aged 75 years or older in Japan: A population-based study using medical and long-term care insurance claims data

Background: This study aimed to determine whether there are disparities in healthcare services utilization according to household income among people aged 75 years or older in Japan.Methods: We used data on medical and long-term care (LTC) insurance claims and on LTC insurance premiums and needs levels for people aged 75 years or older in a suburban city. Data on people receiving public welfare were not available. Participants were categorized according to household income level using LTC insurance premiums data. The associations of low income with physician visit frequency, length of hospital stay (LOS), and medical and LTC expenditures were evaluated and adjusted for 5-year age groups and LTC needs level.Results: The study analyzed 12,852 men and 18,020 women, among which 13.3% and 41.5%, respectively, were categorized as low income. Participants with low income for both genders were more likely to be functionally dependent. In the adjusted analyses, lower income was associated with fewer physician visits (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI], 0.87–0.92 for men and IRR 0.97; 95% CI, 0.95–0.99 for women), longer LOS (IRR 1.98; 95% CI, 1.54–2.56 and IRR 1.42; 95% CI, 1.20–1.67, respectively), and higher total expenditures (exp(β) 1.09; 95% CI, 1.01–1.18 and exp(β) 1.09; 95% CI, 1.05–1.14, respectively).Conclusions: This study suggests that older people with lower income had fewer consultations with physicians but an increased use of inpatient services. The income categorization used in this study may be an appropriate proxy of socioeconomic status

Astrometric VLBI observations of H2_2O masers in an extreme OH/IR star candidate NSV17351

Results of astrometric very long baseline interferometry (VLBI) observations towards an extreme OH/IR star candidate NSV17351 are presented. We used the VERA (VLBI Exploration of Radio Astrometry) VLBI array to observe 22\,GHz H$_2$O masers of NSV17351. We derived an annual parallax of 0.247$\pm$0.035 mas which corresponds to a distance of 4.05$\pm$0.59 kpc. By averaging the proper motions of 15 maser spots, we obtained the systemic proper motion of NSV17351 to be ($\mu_{\alpha}\cos{\delta}, \mu_{\delta}$)$^{\mathrm{avg}}$ $=$ ($-$1.19 $\pm$ 0.11, 1.30 $\pm$ 0.19) mas\,yr$^{-1}$. The maser spots spread out over a region of 20 mas $\times$ 30 mas, which can be converted to a spatial distribution of $\sim$80 au $\times$ $\sim$120 au at the source distance. Internal motions of the maser spots suggest an outward moving maser region with respect to the estimated position of the central star. From single dish monitoring of the H$_2$O maser emission, we estimate the pulsation period of NSV17351 to be 1122$\pm$24 days. This is the first report of the periodic activity of NSV17351, indicating that NSV17351 could have a mass of $\sim$4\,M$_{\odot}$. We confirmed that the time variation of H$_2$O masers can be used as a period estimator of variable OH/IR stars. Furthermore, by inspecting dozens of double-peaked H$_2$O maser spectra from the last 40 years, we detected a long-term acceleration in the radial velocity of the circumstellar matter to be $0.17\pm0.03$ km\,s$^{-1}$\,yr$^{-1}$ Finally, we determined the position and kinematics of NSV17351 in the Milky Way Galaxy and found that NSV17351 is located in an interarm region between the Outer and Perseus arms. We note that astrometric VLBI observations towards extreme OH/IR stars are useful samples for studies of the Galactic dynamics.Comment: Published in the Publications of the Astronomical Society of Japa

A Novel iRFP-Incorporated in vivo Murine Atherosclerosis Imaging System

By using near-infrared fluorescent protein (iRFP)-expressing hematopoietic cells, we established a novel, quantitative, in vivo, noninvasive atherosclerosis imaging system. This murine atherosclerosis imaging approach targets macrophages expressing iRFP in plaques. Low-density lipoprotein receptor-deficient (LDLR−/−) mice transplanted with beta-actin promoter-derived iRFP transgenic (TG) mouse bone marrow (BM) cells (iRFP → LDLR−/−) were used. Atherosclerosis was induced by a nonfluorescent 1.25% cholesterol diet (HCD). Atherosclerosis was compared among the three differently induced mouse groups. iRFP → LDLR−/− mice fed a normal diet (ND) and LDLR−/− mice transplanted with wild-type (WT) BM cells were used as controls. The in vivo imaging system (IVIS) detected an enhanced iRFP signal in the thoracic aorta of HCD-fed iRFP → LDLR−/− mice, whereas iRFP signals were not observed in the control mice. Time-course imaging showed a gradual increase in the signal area, which was correlated with atherosclerotic plaque progression. Oil red O (ORO) staining of aortas and histological analysis of plaques confirmed that the detected signal was strictly emitted from plaque-positive areas of the aorta. Our new murine atherosclerosis imaging system can noninvasively image atherosclerotic plaques in the aorta and generate longitudinal data, validating the ability of the system to monitor lesion progression

The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan

BackgroundThe occurrence of multimorbidity (i.e., the coexistence of multiple chronic diseases) increases with age in older adults and is a growing concern worldwide. Multimorbidity has been reported to be a driving factor in the increase of medical expenditures in OECD countries. However, to the best of our knowledge, there is no published research that has examined the associations between multimorbidity and either long-term care (LTC) expenditure or the sum of medical and LTC expenditures worldwide. We, therefore, aimed to examine the associations of multimorbidity with the sum of medical and LTC expenditures for older adults in Japan.MethodsMedical insurance claims data for adults ≥75 years were merged with LTC insurance claims data from Kashiwa city, a suburb in the Tokyo metropolitan area, for the period between April 2012 and September 2013 to obtain an estimate of medical and LTC expenditures. We also calculated the 2011 updated and reweighted version of the Charlson Comorbidity Index (CCI) scores. Then, we performed multiple generalized linear regressions to examine the associations of CCI scores (0, 1, 2, 3, 4, or ≥ 5) with the sum of annual medical and LTC expenditures, adjusting for age, sex, and household income level.ResultsThe mean sum of annual medical and LTC expenditures was ¥1,086,000 (US$12,340; n = 30,042). Medical and LTC expenditures accounted for 66 and 34$2920); 95% Confidence Interval: ¥242,000, 271,000 (US$2750, 3080) increase in the sum of the expenditures (p < 0.001; n = 29,915).ConclusionsUsing a merged medical and LTC claims dataset, we found that greater CCI scores were associated with a higher sum of annual medical and LTC expenditures for older adults. To the best of our knowledge, this is the first study to examine the associations of multimorbidity with LTC expenditures or the sum of medical and LTC expenditures worldwide. Our study indicated that the economic burden on society caused by multimorbidity could be better evaluated by the sum of medical and LTC expenditures, rather than medical expenditures alone

〈研究論文〉新たな学校ガバナンスにおける「教育の専門性」の再定位（2）: 小学校教員の専門性認識に関する分析を中心に

Since the 1990s, the concept of “Governance” has become widely known and has been often discussed in many fields including public education. Contemporary public education reform policies basically include the restructuring of relationships between teaching professionals and other stakeholders. It should be noted that, in fact, some education policies do not take into account the “professionality of teaching” very much; thus, there is a possibility that teaching professionals will be seen as comparatively inferior to other actors. It is therefore important to consider the position of teaching professionals within the new school governance structure and replace it, taking into account the concept of “professionality of education.”..

18. asırda "Hırkai şerif" ziyareti

Taha Toros Arşivi, Dosya No: 120-Saraylar. Not: Gazetenin "Tarihten Sahifeler" köşesinde yayımlanmıştır.İstanbul Kalkınma Ajansı (TR10/14/YEN/0033) İstanbul Development Agency (TR10/14/YEN/0033

Free-Floating planet Mass Function from MOA-II 9-year survey towards the Galactic Bulge

We present the first measurement of the mass function of free-floating planets (FFP) or very wide orbit planets down to an Earth mass, from the MOA-II microlensing survey in 2006-2014. Six events are likely to be due to planets with Einstein radius crossing times, $t_{\rm E}<0.5$days, and the shortest has $t_{\rm E} = 0.057\pm 0.016$days and an angular Einstein radius of $\theta_{\rm E} = 0.90\pm 0.14\mu$as. We measure the detection efficiency depending on both $t_{\rm E}$ and $\theta_{\rm E}$ with image level simulations for the first time. These short events are well modeled by a power-law mass function, $dN_4/d\log M = (2.18^{+0.52}_{-1.40})\times (M/8\,M_\oplus)^{-\alpha_4}$ dex$^{-1}$star$^{-1}$ with $\alpha_4 = 0.96^{+0.47}_{-0.27}$ for $M/M_\odot < 0.02$. This implies a total of $f= 21^{+23}_{-13}$ FFP or very wide orbit planets of mass $0.33<M/M_\oplus < 6660$ per star, with a total mass of $80^{+73}_{-47} M_\oplus$ per star. The number of FFPs is $19_{-13}^{+23}$ times the number of planets in wide orbits (beyond the snow line), while the total masses are of the same order. This suggests that the FFPs have been ejected from bound planetary systems that may have had an initial mass function with a power-law index of $\alpha\sim 0.9$, which would imply a total mass of $171_{-52}^{+80} M_\oplus$ star$^{-1}$. This model predicts that Roman Space Telescope will detect $988^{+1848}_{-566}$ FFPs with masses down to that of Mars (including $575^{+1733}_{ -424}$ with $0.1 \le M/M_\oplus \le 1$). The Sumi(2011) large Jupiter-mass FFP population is excluded.Comment: 17 pages, 7 figures, accepted for publication in A

Brown dwarf companions in binaries detected from the 2021 season high-cadence microlensing surveys

As a part of the project aiming to build a homogeneous sample of binary-lens (2L1S) events containing brown-dwarf (BD) companions, we investigate the 2021 season microlensing data collected by the Korea Microlensing Telescope Network (KMTNet) survey. For this purpose, we first identify 2L1S events by conducting systematic analyses of anomalous lensing events. We then select candidate BD-companion events by applying the criterion that the mass ratio between the lens components is less than $q_{\rm th}\sim 0.1$. From this procedure, we find four binary-lens events including KMT-2021-BLG-0588, KMT-2021-BLG-1110, KMT-2021-BLG-1643, and KMT-2021-BLG-1770, for which the estimated mass ratios are $q\sim 0.10$, 0.07, 0.08, and 0.15, respectively. The event KMT-2021-BLG-1770 is selected as a candidate despite the fact that the mass ratio is slightly greater than $q_{\rm th}$ because the lens mass expected from the measured short time scale of the event, $t_{\rm E}\sim 7.6$~days, is small. From the Bayesian analyses, we estimate that the primary and companion masses are $(M_1/M_\odot, M_2/M_\odot)= (0.54^{+0.31}_{-0.24}, 0.053^{+0.031}_{-0.023})$ for KMT-2021-BLG-0588L, $(0.74^{+0.27}_{-0.35}, 0.055^{+0.020}_{-0.026})$ for KMT-2021-BLG-1110L, $(0.73^{+0.24}_{-0.17}, 0.061^{+0.020}_{-0.014})$ for KMT-2021-BLG-1643L, and $(0.13^{+0.18}_{-0.07}, 0.020^{+0.028}_{-0.011})$ for KMT-2021-BLG-1770L. It is estimated that the probabilities of the lens companions being in the BD mass range are 82\%, 85\%, 91\%, and 59\% for the individual events. For confirming the BD nature of the lens companions found in this and previous works by directly imaging the lenses from future high-resolution adaptive-optics (AO) followup observations, we provide the lens-source separations expected in 2030, which is an approximate year of the first AO light on 30~m class telescopes.Comment: 11 pages, 10 tables, 8 figure