Encounter of Pepper-CPGE

In Japan, humanoid robots has been introduced in the medical and elderly care environment. The application program of Care Prevention Gymnastics Exercises for Pepper (Pepper-CPGE) made by Xing Company, Japan is a body-brain gymnastics recreation program for 40 minutes tailored to the elderly's functional level. It consists of moving, watching/healing, and playing. “Move the body” exercise and other active range of motion activities are done according to the music. Pepper-CPGE was introduced as a clinical trial at the Mifune hospital, beginning in May 2018. At the units where clinical trials are done, 80% of the patients are with mental illness diagnosis with decreased physical functions often moving by wheelchair only. When Pepper-CPGE was introduced, the following changes were observed : (1) communication between patients and nurses during rehabilitation care using Pepper-CPGE was increased ; (2) patients were interactive, engaged, and actively participated in the Care Prevention Gymnastic Exercises using Pepper-CPGE ; (3) patients had fun and enjoyed talking to Pepper-CPGE. Interventions using Pepper-CPGE appear to be an effective rehabilitation strategy to increase engagement and participation of elderly patients who require long-term care and rehabilitation

ショウガッコウ コウガクネン ジドウ ノ スイミン カクセイ リズム ト ジリツ シンケイ カツドウ ノ カンケイ : 6ジレイ ノ ホウコク

The purpose of this study was to clarify the relationship between sleep-wake rhythms and autonomic nerve activities using actigraphy and heart rate variability（HRV）analysis. Subjects were comprised of six children who were in the fourth to sixth grade levels of elementary school（four boys and two girls）. The study was conducted between January and December 2015. The data collection procedure was performed following the Private Information Protection Law, with approval from Tokushima University Hospital Ethics Board（approval number 2021）. These subjects were evaluated in an Attentive-Care-Needed stress state based on the PSI（Public Health Research Foundation Type Stress Inventory）and PSQI-J（Pittsburgh Sleep Quality Index, Japanese Version）. In analyzing their sleep-wake rhythms, autonomic nervous activities were determined using an actigraph and HRV through RR interval sequence electrocardiography. The results of actigraph data of sleep efficiency in Subject Number 6 was low（76.47％）. Regardless, the subject experienced subjective sleep satisfaction. However, Subject Number 2, insisted that she could not easily wake up in the morning because of being sleepy. Low Frequency（LF）/High Frequency（HF）data indicated sympathetic nervous activity showing that all subjects had significantlyhigher LF/HF value during wakefulness than when asleep. HF data indicated parasympatheticactivity of five out of the six children showing significantly higher value during sleep than when awake. Subject number 3 expressed that he was sleepy and could not get up in the morning,and also had trouble going to and maintaining sleep. However, this subject’s results of the PSQI-Jindicated that he had no problem expressing subjective sleep satisfaction. Furthermore, in the actigraph and HRV analysis, findings showed that subjects had good sleeping patterns. These findings strongly signify the importance of determining the sleep-wake rhythms of school children based on data from subjective and physiological evaluation methods

精神科病院の看護職員の獲得のための魅力ある職場環境の特徴

Purpose: The purpose of this study is to identify characteristics of work environments in psychiatric hospitals which are appealing to nurses. Understanding characteristics of work environments of psychiatric hospital nurses can lead to attracting nurses to work in this environment, thereby increasing human resources and alleviating nurse-staffing problems. Methods: Questionnaire copies focusing on staffing shortages of nurses in psychiatric hospitals were provided to 277 psychiatric hospital nurse administrators in Japan from May-April 2016. Data analyses included descriptive and multivariate statistics. Factor analysis together with the Kaiser-Meyer-Olkin and the Bartlett’s test of Sphericity were used to assess adaptive validity. Factor loadings were set at 0.4 or more for the configuration of items, while internal consistency and reliability of the assessment data scores were done using Cronbach’s alpha coefficient. Mean factor points were calculated and student's t-test and one-way analysis of variance were performed. Significance probability level was set at 0.001. Results: Factor analysis revealed nine factors: (1) Educational system, (2) Reputation at hospitals, (3) Support system for acquisition of certificate of clinical nurse specialist/certified nurse, (4) Reputation at hospitals as places of employment, (5) Knowledge of nursing philosophy and of culture of working places, (6) Reputation of teaching for students’ clinical practice, (7) Working hours and leave privileges, (8) Salary and other allowances, (9) Support system for license acquisition. Data revealed that nurse administrators who employed new graduate registered nurses found their hospitals' attractive points were: educational system, support system to acquire certificate of clinical nurse specialist, reputation of hospital as place of employment, knowledge of nursing philosophy and culture of working places, teaching students' clinical practice, and salary and other allowances. Conclusion: Nurse administrators who have no difficulty recruiting nursing staff recognized that their hospital environments were considered appealing based on working hours and leave privileges

施設に入所中の認知症高齢者の自律神経活動の特徴

This study clarified the characteristic autonomic nervous activity of institutionalized elders diagnosed with dementia using Hasegawa’s Dementia Scale-Revised. Twenty-six healthy adult persons (HPs) in their 20 s - 40 s met the inclusion criteria, and 16 persons (27.6 ± 8.2 years old) completed the research procedure. Of 70 persons with dementia (PDs) residing at the one geriatric health services facilities, only 24 persons met the inclusion criteria, and only nine (N = 9, 83.44 ± 9.45 years old) completed the procedure. Actigraph and ambulatory electrocardiographic instruments measuring autonomic nervous activity were attached to the subjects for 24 hours. Activities and behaviors of PDs and HPs were observed by clinically experienced staff nurses and care workers. High frequency (HF) power indicating parasympathetic activity and LF/HF ratio indicating sympathetic activity were calculated. When awake, PDs’ LF/HF ratio was significantly lower than HP’s (Z = −2.60, p < 0.01), showing significant differences in the LF/HF ratios between waking and sleeping, more than those of the PDs (p < 0.001). Similarly, when awake, significant positive correlations were observed in the LF/HF ratio and actigraph activity count (AC) in 11 HPs and 3 PDs (range r = 0.17 to 0.49, p < 0.05); however, significant negative correlation was found in HF and AC of 12 HPs and 3 PDs (range r = −0.55 to −0.18, p < 0.05). While sleeping, significant positive correlations were observed in LF/HF and AC of 3 HPs and 1 PD (range r = 0.35 to 0.42, p < 0.05) and significant negative correlation was found in the HF and AC of 1 HP (r= −0.32, p < 0.001) and 1 PD (r = −0.32, p < 0.05). The mean value of LF/HF in a wakeful state was significantly lower for PDs than HPs. Combined results of behavioral observation, actigrapy and heart rate variability (HRV) analyses suggested that PDs showed positive correlations between LF/HF and AC in a wakeful state. Compared to those who showed no positive correlation, they did not require much nursing care

多職種連携による作業療法活動への積極的動機付け

Patients with mental health problems in long-term hospitalization have severe impairments and disabilities in their daily social life, thereby needing constant assistance. The purpose of this study was to clarify the relationships between the status of the improved duration of participation in occupational therapy activities through active motivation and interdisciplinary collaboration in enhancing mental health and severe physical functional level as evaluated by the Global Assessment of Function（GAF）score. Subjects were１７５hospitalized patients in psychiatric units at a Psychiatric hospital in Kagawa Prefecture. The duration of participation in the occupational therapy group activities was divided into Groups A-０‐５, B-６‐１０, C-１１‐１５, and D-１６‐２０times per month. The number of the occupational therapy group activities per month was ２０ times in August ２０１７ and ２１ times in March２０１８, respectively. The number of classified four group participants before and after were calculated by the chi-square test with adjusted residuals. Comparing the number of participants in the four groups before and after ７ months by the active motivation, the number of participants was significantly decreased in group C but was increased in group D（χ２ = ６．８２, p <.０５）. Findings show the number of participants was increased because of the active motivation by interdisciplinary collaboration and enhanced relations. However, the degree of GAF was not related to the duration of participation times. Moreover, it was clearly found that respect for individuality and patient’s will were critical motivational factors in effective patient participation

Factors Affecting Energy Metabolism and Prognosis in Patients with Amyotrophic Lateral Sclerosis.

Background/aims:Nutritional status is a factor affecting prognosis in patients with amyotrophic lateral sclerosis (ALS). Here, we aimed to clarify the factors associated with hypermetabolism and the prognosticators of ALS.Methods:Forty-two inpatients (22 men, 20 women) diagnosed with ALS according to the revised El-Escorial criteria were investigated. The following data were retrospectively analyzed: anthropometric measurements, blood biochemistry, disease severity, basal energy expenditure (BEE), resting energy expenditure (REE) measured by indirect calorimetry, spirometry, and bioelectrical impedance analysis. Single and multiple regression analysis was performed to examine factors affecting REE and metabolic changes (defined as the ratio of REE to fat-free mass [FFM]). The Kaplan-Meier method was used to examine factors associated with the occurrence of cumulative events (death or tracheostomy).Results:Among the 42 inpatients, REE was significantly higher than BEE, indicating hypermetabolism in ALS. Multiple regression analysis revealed that REE/FFM is strongly associated with the skeletal muscle index (-3.746 to -1.532, p < 0.0001) and percent forced vital capacity (%FVC) (-0.172 to -0.021, p = 0.013). Moreover, both the skeletal muscle index and %FVC were significant prognosticators associated with the occurrence of cumulative events.Conclusions:Energy metabolism was elevated in ALS, and respiratory status and muscle mass were associated with the hypermetabolism and poor prognosis. Adequate nutritional support may improve outcomes in ALS by preventing deterioration of respiratory status and reduction in muscle mass

<Collaborative Research>The Conception of Teachers in Supreme Court School Cases and Their Freedom : Consequences of Recognizing Educational Process as "Personal Interaction"

While some Boards of Education have recently compelled teachers to stand up and sing the National Anthem at school ceremonies, Supreme Court of Japan revoked some severer disciplinary sanctions thereon on the ground of the teacher\u27s personal freedom on 16th January 2012. These epoch-making judgments, however, have an ambivalent meaning to rights of teachers because the judgments also build upon the Court\u27s own conception of educational process and the profession of teachers described in its fundamental school case decision in 1976. In this elaborated analysis of the case law, the Court\u27s underlying conception of teachers proves to be personal (rather than professional), individual (rather than collective), and apolitical (rather than politically conscious) in its nature

Monocarboxylate Transporter-1 Is Required for Cell Death in Mouse Chondrocytic ATDC5 Cells Exposed to Interleukin-1β via Late Phase Activation of Nuclear Factor κB and Expression of Phagocyte-type NADPH Oxidase*

Interleukin-1β (IL-1β) induces cell death in chondrocytes in a nitric oxide (NO)- and reactive oxygen species (ROS)-dependent manner. In this study, increased production of lactate was observed in IL-1β-treated mouse chondrocytic ATDC5 cells prior to the onset of their death. IL-1β-induced cell death in ATDC5 cells was suppressed by introducing an siRNA for monocarboxylate transporter-1 (MCT-1), a lactate transporter distributed in plasma and mitochondrial inner membranes. Mct-1 knockdown also prevented IL-1β-induced expression of phagocyte-type NADPH oxidase (NOX-2), an enzyme specialized for production of ROS, whereas it did not have an effect on inducible NO synthase. Suppression of IL-1β-induced cell death by Nox-2 siRNA indicated that NOX-2 is involved in cell death. Phosphorylation and degradation of inhibitor of κBα (IκBα) from 5 to 20 min after the addition of IL-1β was not affected by Mct-1 siRNA. In addition, IκBα was slightly decreased after 12 h of incubation with IL-1β, and the decrease was prominent after 36 h, whereas activation of p65/RelA was observed from 12 to 48 h after exposure to IL-1β. These changes were not seen in Mct-1-silenced cells. Forced expression of IκBα super repressor as well as treatment with the IκB kinase inhibitor BAY 11-7082 suppressed NOX-2 expression. Furthermore, Mct-1 siRNA lowered the level of ROS generated after 15-h exposure to IL-1β, whereas a ROS scavenger, N-acetylcysteine, suppressed both late phase degradation of IκBα and Nox-2 expression. These results suggest that MCT-1 contributes to NOX-2 expression via late phase activation of NF-κB in a ROS-dependent manner in ATDC5 cells exposed to IL-1β

Energy Metabolism and Nutritional Status in Hospitalized Patients with Chronic Heart Failure.

Introduction: Malnutrition is a factor that defines vital prognosis in chronic heart failure.Objective: This study investigated nutritional and metabolic disorders in patients with heart failure by examining the association of severity of heart failure with inflammatory cytokines, appetite-regulating hormones, and energy metabolism.Methods: Subjects were 50 patients with heart failure. On admission, nutritional status was assessed, and biochemical blood tests were performed, including for serum tumor necrosis factor-α, interleukin-6, ghrelin, and leptin levels. Resting energy expenditure (REE) was also measured by indirect calorimetry to examine its association with severity of heart failure and levels of inflammatory cytokines and appetite-regulating hormones.Results: There were significant associations between serum brain natriuretic peptide (BNP) level and nutrition indices, indicating that nutritional status was worse when heart failure was more severe. Inflammatory cytokine levels showed significant positive correlations with BNP level. Measured REE/bodyweight was not associated with severity of heart failure, but was negatively correlated with body fat percentage and leptin levels.Conclusions: Energy metabolism was not associated with serum BNP level among patients with heart failure with New York Heart Association functional class up to III. Body fat percentage and leptin levels may be a good predictor of energy metabolism in patients with heart failure