Splenomegaly and Tumor Marker Response Following Selective Internal Radiation Therapy for Non-Resectable Liver Metastases from Neuroendocrine Tumor

PURPOSE:The aim of this study was to investigate changes in spleen size, the level of chromogranin Aas a tumor marker, and the relationship between these two parameters before and 3 months after selectiveinternal radiation therapy (SIRT) for non-resectable liver metastases from neuroendocrine tumor (NET).Our first serious adverse event with this relatively new treatment is also discussed.METHODS:A retrospective review of a prospective database identified patients with non-resectable livermetastases from NET who underwent SIRT between 2003 and 2007. Patients who underwent CT scansbefore and 3 months after treatment were included. The patients were divided into two groups:those withand without a 20 % or more increase in splenic volume on the CT scans. The percentages of patients showinga tumor marker response in the two groups were then comparedRESULTS:Fourteen patients were included in the present analysis. A tumor marker response was seenin 6 of 7 patients( 85.7%) who showed an increase in splenic volume of>20%, and in 3 of 7 patients( 42.9%) without an increase in splenic volume (p=0.266). There was one death as a result of oesophageal varicealbleeding due to portal hypertension at 9 months after treatment.CONCLUSION:Splenic enlargement after SIRT may be associated with tumor marker response, althoughthis could not be confirmed statistically in this study due to the small number of patients. Long-termsplenomegaly and portal hypertension may be important complications of SIRT. This issue needs to be investigatedfurther using a larger number of patients and longer follow-up

カイガイ ノ ニホンゴ キョウイク ニ オケル リソース ノ カツヨウ

教科書に代表される従来の「教材」は、教室での日本語使用のために作られ、教えるための材料であった。ここで扱うリソースは、実社会での日本語使用のための学習に使い、実際の日本語使用にも役立ち、また、日本語使用の対象となる、つまリ学ぶ材料である。「教材」から、リソースヘの移行は、学習者の教室からの解放をも意味し、リソースの活用は社会言語学、第二言語習得、教育学の側面 からも有意義である。リソースには「人的リソース」、「物的リソース」、「社会的リソース」の三種類がある(田中・斉藤1993)といわれるが、新たに「情報サービス・リソース」の項を設け、海外の、とくにシドニーのリソースを四つの角度から検討し、そのリソースを全体シラバスの中、外の両者で活用する方法を紹介し、検討する。リソースは、例えば、シラバスの中では、ゲストスピーカー、ビジター・セッション、家庭訪問などという形で、また、シラバスの外ではプロジェクトの形で活用できる。学習者が自主的にリソースを開発し、自律的に活用し、学習していくには、上記の両者が必要だろう。「教材」からリソースヘの移行は、学習者の教室からの解放、自律と共に、教師の役割の再考とも大きく関わっているといえる。What are learning resources in the teaching of Japanese as a foreign language? In the past, learners of Japanese tended to depend on such limited resources as Japanese text-books and dictionaries, which are traditionally called "teaching materials." While teaching materials are for teaching, this paper focuses on learning resources, which the learners use for learning and which the teachers use to assist the learners to learn. Use of learning resources is supported by the recent research in socio-linguistics, second language acquisition, and education. This paper examines overseas learning resources in terms of human resources, physical resources, community resources, and information service resources. It then discusses how to relate these resources to a Japanese-language program. It suggests that a language program should incorporate such learning resources into activities within a course syllabus, as well as into activities outside the course syllabus. Such examples as guest speakers, visitor sessions, Japanese-language newsletters, and projects are provided. Resource incorporation into a language program, both within and outside the course syllabus, is encouraged in order to promote learner autonomy and mutual interaction among the resources and the learners. To do this, teachers will need to re-assess their role in a language program

カイガイ ニオケル ニホンゴ キョウイク カツドウ ニ サンカ スル ニホンジン キョウリョクシャ ソノ モンダイテン ト キョウシ ノ ヤクワリ

日本語教育が、学習活動の現場を教室や教科書に限定することをやめ、地域社会の日本語学習リソースに目を向け出してから、日本人協力者が様々な形で日本語教育を支援してくれている。日本人協力者を日本語教育の現場に参加させることは、自律学習の促進のためには動機付けを高め、第二言語習得研究からも学習効果 を上げるために有効とされ、今後、日本語教育の現場でさらに広く浸透していくと思われる。しかし、すでに現在、学習者の日本人協力者に対する期待過多、協力者による学習者の能力の過大、過小評価、協力者と学習者の希望学習項目間のギャップ、動機の不純な協力者などの問題が顕在している。海外の日本語教育の現場では、当然、協力者として登用できる人材の幅に限りがあることから、この問題はさらに顕著になる。本稿では、上記の問題を検討した結果 、日本語教師が問題の深刻化を防ぎ、学習リソース活用のためのコーディネーターとして、シラバスの整備、自律学習の支援、日本語学習者のPR活動、接触場面 に必要なスキルの強化活動などを通して、本来の目的を達成するためにはどんなことが可能かを提言する。協力者の支援の様態は多岐にわたり、日本語教育は、もはや日本語教育専門家のものだけではなくなってきた。本稿では、これらの協力者と学習者との接触場面 をも含む、広範囲の日本語教育を指す用語の必要性を感じ、「日本語教育活動」という言葉を試用する。Resources used in Japanese language education are no longer limited to traditional textbooks and dictionaries. Language education involves community resources including Japanese volunteers who support Japanese language educational activities in various manners. To distinguish this new and wider concept of Japanese language education from traditional classroom-based, teacher-led environments, this paper uses the expression, "Japanese language educational activities." Japanese language volunteers\u27 participation in Japanese language educational activities elevates learners\u27 motivation as well as promotes learner autonomy, and is hoped to contribute to more efficient acquisition of the language by the learners. However, their participation does raise issues that have not been discussed in previous literature. Issues encompass learners expecting too much of volunteers, volunteers underestimating / overestimating learners\u27 abilities, gaps between learner needs and what volunteers wish to teach them, and volunteers with inadequate motivation. This paper discusses these issues and explores teacher roles that prevent or minimize problems associated with the issues. The paper suggests that teachers, as coordinators of learning, could devise syllabus which volunteers are a part of, could advocate learner autonomy through planned activities, could promote visibility of Japanese language learners to enhance volunteers\u27 understanding of the learners, and could prepare learners with specific skills necessary for anticipated contact situations with volunteers

ニホンゴ キョウイク ニオケル セイサ ノ ガクシュウ オーストラリア ノ ガクシュウシャ ノ イシキ チョウサ ヨリ

日本語の性差の研究の中で、日本語教育と関連し、しかも、データに基づいたものは数少ない。日本語教育の中での性差の理想的な指導方法を探究する研究の一環として、本稿では、先行の指導者の意識調査 (Iida and Thomson 1999) にも言及しながら、オーストラリアの学習者の意識調査アンケート(オーストラリアの 6 大学対象、回答者 704名)の結果を中心に、報告、考察していく。 学習者の調査の結果、回答者全体としては、性差の認識、受け取り方にばらつきはあるが、性差の学習には意欲的であることがわかった。人称代名詞や呼称に表れる性差の認識度は高かったが、接頭辞や、漢字語彙の使用頻度などの項目は、あまり認識されていなかった。回答者の学習レベルが上がり、日本語話者との接触頻度が高くなり、日本滞在期間が長くなると、性差の認識度が上がる。この傾向に反するのが、漢字語彙の項目で、学習レベルなどに関係なく、一般的に認識度が低く、漢字圏出身の学習者が、他のグループに比べて認識度が高いという結果が出た。 日本語に表出する性差の捉え方、そして、性差を認識し、性差表現を使えるようになりたいかという学習意欲についての質問には、両項目で、全体的には回答者が積極的な姿勢を見せている。その中で、 特に、性差を性差別と捉えるのは中国系、韓国系(特に女性)に多く、性差の学習に一番意欲的なのはオーストラリア系であるという結果が出た。母文化内で性差別の対象となりうる回答者が性差別に敏感であり、他グループと比べて、日本滞在期間の長いオーストラリア系が学習に熱心であるという考察ができる。 指導者調査に現れた教師側の性差指導に対する懸念と、学習者調査の結果には開きがあったので、教師の感覚に頼らず、実際のデータに基づく考察の必要性を再認識した。This paper examines learners\u27 perceptions of gendered language in Japanese based on the survey data of 704 students of Japanese in 6 Australian universities, in relation to the findings of earlier survey data of teachers of Japanese in Australian universities (Iida and Thomson 1999). The findings from this survey reveal that: 1) the learners have varied understandings of what gendered language is in Japanese; 2) their recognition improves on the whole when their level of study advances and when they have had longer in-country experiences; 3) they have, in general, positive attitudes toward gendered language in Japanese; 4) the majority want to learn to recognize and use gendered language in Japanese. Further analysis shows that one area of recognition that does not improve with the level of study or in-country experiences is the usage of Kanji vocabulary. In this area, conscientious, rather than natural acquisition appears to be necessary. Analysis then shows that more Chinese and Korean background learners, especially female learners, in comparison to other groups, perceive gendered language in Japanese as discrimination. Those who have been discriminated against could be more sensitive to the issue. The analysis also reveals that Australian background learners expressed the most willingness to learn gendered language in Japanese. This could be explained by the fact that the Australian group had the longest in-country experiences on average among all the respondents. These findings differ somewhat from the findings of the earlier teacher survey. There was variation between and among teachers\u27 and learners\u27 understandings of gendered language in Japanese, and the teachers\u27 concerns for teaching gendered language to Australian students of equal upbringing proved to be unfounded

ショキュウ ニホンゴ キョウカショ ト キキカエシ ノ ストラテジー

会話の中の聞き手の言語行動の1つに「聞き返し」がある。本稿は初級学習者のよくぶつかる問題点とその原因を探り、その解決策として「聞き返し」のストラテジーを取りあげる。「聞き返し」のストラテジーの重要性を、コミュニケーション能力の理論の中の方略能力の立場と、広義の学習ストラテジーの中のコミュニケーション・ストラテジーの立場から検証する。そして、初級教科書9冊の「聞き返し」の扱いを検討し、初級教科書における「聞き返し」の提示の仕方として、(1)学習目標として「聞き返し」を設定、(2)本文に「聞き返し」のモデルを提示、(3)その練習の添付、(4)実際に「聞き返し」が使える場面の提供、を提唱し、日本語を教育の対象だけで なく、教育の手段として生かすために、「聞き返し」/コミュニケーション・ストラテジーの指導の重要性を説いて結ぶ。A conversation is developed by both speaker and listener. Listeners, especially when they are beginning Japanese language learners talking to a native Japanese, encounter various problems of communication. One of the communication strategies listeners can engage in to solve their problems is a strategy of asking back ("What was it? " "What does X mean? " "I didn\u27t quite understand that." etc.). This paper discusses common problems that beginning Japanese Ianguage learners have and their causes, and examines the strategy of asking back from two viewpoints: one of communicative competence, and the other of learning strategies. Then it analyzes nine beginning Japanese textbooks in relation to the strategy and suggests a model for incorporating the strategy in elementary textbooks. The model has four presentation stages: l) set an instructional objective, 2) present a model conversation, 3) give communicative exercises, and 4) provide real-life practice opportunities. The paper concludes that the teaching of strategies that enable learners to enhance their language ability as well as their communicativeness should be promoted

フクマク チュウヒシュ 11レイ ニ タイスル Peritonectomy オ モチイタ シュウガクテキ チリョウ セイセキ

目的 当科では腹膜中皮腫に対してPeritonectomyを用いた集学的治療(術中温熱化学療法(HIPEC),術後早期腹腔内化学療法(EPIC))を施行している.この治療結果を検討し,他施設と比較した.方法 1999年～2006年にPeritonectomyを施行した腹膜中皮腫11症例を対象に検討を加えた. 11例中, 3例に2回, 1例に3回,計16回のペリトネクトミーを, 9例に11回のHIPECを, 4例に6回のEPICを施行した.結果 男女比は7対4,平均年齢52.8±18.2,明らかなアスベスト暴露を4例で認めた. 11例中1例が周術期死亡, 3例が原病死, 7例が生存中である.統計学的検討では生存期間と2回目のPeritonectomy施行に10%の有意差を認めた(P=0.0734). Kaplan-Meier生存曲線からの1, 3, 5年生存率は72.7, 62.3, 62.3%であった.結論 我々と他施設の生存率に文献的考察を加えると, Peritonectomy集学的治療は腹膜中皮腫患者の予後の向上に寄与すると考えられる.AIMS : Recently, the issue of Asbestos-related disease has increased dramatically though out the world. Deaths from mesothelioma are often caused by asbestos exposure. The aim of the study was to present our unit\u27s experience in the treatment of peritoneal mesothelioma between 1999 and 2006. In addition, the data was assessed and validated compared with other peritonectomy units. METHODS : Records of 11 patients with peritoneal mesothelioma were reviewed retrospectively. All patients were treated by cytoreductive surgery with peritonectomy procedures, 4 patients had second and 1 patient had third peritonectomy (in total 16 times peritonectomy). Hyperthermic Intraperitoneal Perioperative Chemotherapy (HIPEC) was performed 11 times across 9 patients. Early Postoperative Intraperitoneal Chemotherapy (EPIC) was performed 6 times across 4 patients. RESULTS : 4 female and 7 male patients with a mean age of 52.8±18.2 years old were studied. Asbestos exposure was recorded in 4 patients. Overall projected survival at 1, 3 and 5 years were 72.7, 62.3 and 62.3 per cent from Kaplan-Meier survival curve. The most significant positive predictive factor of survival was second peritonectomy (P=0.0734). CONCLUSION : Our unit\u27s survival rate agreed with the experience from other units and supports peritonectomy with HIPEC and EPEC as the gold standard in the treatment of peritoneal mesothelioma worldwide

Plant profit maximisation improves predictions of European forest responses to drought

- Knowledge of how water stress impacts the carbon and water cycles is a key uncertainty in terrestrial biosphere models. - We tested a new profit maximisation model, where photosynthetic uptake of CO2 is optimally traded against plant hydraulic function, as an alternative to the empirical functions commonly used in models to regulate gas exchange during periods of water stress. We conducted a multi-site evaluation of this model at the ecosystem scale, before and during major droughts in Europe. Additionally, we asked whether the maximum hydraulic conductance in the soil-plant continuum

Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners

<p>Abstract</p> <p>Background</p> <p>Genital chlamydia is the most commonly notified sexually transmissible infection (STI) in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT) has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs) are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis.</p> <p>Methods</p> <p>In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.</p> <p>Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed.</p> <p>Results</p> <p>Perceived barriers to patients telling partners (patient referral) included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral) included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT - many felt concerned that it is not best clinical practice but many also felt that it is better than nothing.</p> <p>GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people.</p> <p>Conclusions</p> <p>GPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.</p