Prediction of stroke patients’ bedroom-stay duration: machine-learning approach using wearable sensor data

Background: The importance of being physically active and avoiding staying in bed has been recognized in stroke rehabilitation. However, studies have pointed out that stroke patients admitted to rehabilitation units often spend most of their day immobile and inactive, with limited opportunities for activity outside their bedrooms. To address this issue, it is necessary to record the duration of stroke patients staying in their bedrooms, but it is impractical for medical providers to do this manually during their daily work of providing care. Although an automated approach using wearable devices and access points is more practical, implementing these access points into medical facilities is costly. However, when combined with machine learning, predicting the duration of stroke patients staying in their bedrooms is possible with reduced cost. We assessed using machine learning to estimate bedroom-stay duration using activity data recorded with wearable devices.Method: We recruited 99 stroke hemiparesis inpatients and conducted 343 measurements. Data on electrocardiograms and chest acceleration were measured using a wearable device, and the location name of the access point that detected the signal of the device was recorded. We first investigated the correlation between bedroom-stay duration measured from the access point as the objective variable and activity data measured with a wearable device and demographic information as explanatory variables. To evaluate the duration predictability, we then compared machine-learning models commonly used in medical studies.Results: We conducted 228 measurements that surpassed a 90% data-acquisition rate using Bluetooth Low Energy. Among the explanatory variables, the period spent reclining and sitting/standing were correlated with bedroom-stay duration (Spearman’s rank correlation coefficient (R) of 0.56 and −0.52, p < 0.001). Interestingly, the sum of the motor and cognitive categories of the functional independence measure, clinical indicators of the abilities of stroke patients, lacked correlation. The correlation between the actual bedroom-stay duration and predicted one using machine-learning models resulted in an R of 0.72 and p < 0.001, suggesting the possibility of predicting bedroom-stay duration from activity data and demographics.Conclusion: Wearable devices, coupled with machine learning, can predict the duration of patients staying in their bedrooms. Once trained, the machine-learning model can predict without continuously tracking the actual location, enabling more cost-effective and privacy-centric future measurements

臨地実習における看護学生のインシデントレポート分析

本研究の目的は、臨地実習におけるインシデント発生状況の実態を明らかにすることにより、今後の臨地実習に求められる医療安全教育の質の向上への示唆を得ることである。2008年度から2015年度までに本学看護学生が提出したインシデントレポートを基に分析を行った。インシデント発生件数は計41件であり、「個人情報の保護」に関するものが最も多く、次いで「転倒・転落」「転倒リスク」「安静度の制限を超えた行動」「医療器具の取扱い」「食事・水分摂取」であった。インシデントのうち「移動・移乗」「安静度の制限を超えた行動」「弾性ストッキングの着脱」「酸素管理」「接遇・コミュニケーション」については他者による指摘でインシデントの発生が把握されていた。インシデントの発生の原因は「判断誤り」が最も多く、「指導者への報告・連絡・相談の不足」「知識不足」「観察不足」「技術の未熟」などであった。看護実践の振り返りから患者の安全を確保した看護へ繋げる教育が重要である

タンキ ダイガク ニ オケル 2ネンセイ カテイ ツウシンセイ ノ キョウイク ノ イギ ト カダイ

平成16年3月に看護学校養成所指定規則が改正し、2年課程(通信制)の教育課程が提示され、翌17年に本学看護学科に通信制課程が開設された。平成19年には全国で20校となったが、本学はその中で唯一短期大学としての教育機関である。そこで、第1期生の卒業時の質問紙調査の結果を踏まえ、あらためて短期大学における2年課程(通信制)の教育の意義と課題について明らかにした。調査結果から、第1期生が2年間の通信教育で、看護学を新しく学び、看護の専門性の理解とともに看護観を大きく変化させ、自信や誇りを持って看護実践に臨んでいることが明らかになった。また、卒業後の進路に活路を見いだし、学びの継続を考えている。この制度の目的である「質の高い看護を提供できる看護実践者として、施設や地域で活躍できる人材の育成」や、短期大学として社会人を対象とする教育の使命としてのリカレント教育や生涯教育としての役割を果たすことに本学の意義があると考える。In March 2004, with the revision of the specific rules and regulation concerning nursing training school, a two-year correspondence course was set up, and in the following year a correspondence course was established in our school\u27s nursing curriculum. As of the year 2007, throughout the country there are twenty schools that have established this course and, among them, our school is the only junior college. On the basis of studying questionnaires filled out at the time of the graduation by those students who took the course for the first time, what we have clarified here are the educational significance and agenda in a two-year nursing correspondence course. It has become clear that, through the two-year correspondence education, these students have studied nursing anew and, with an understanding of the professionalism involved in nursing and great transformation in their sense of nursing, are endeavoring to practice nursing with confidence and pride. They also seek a path for their life in making progress after graduation and are thinking about continuing their education. We believe the purpose of our school to be "the training of human beings who can provide high-quality nursing as nursing practitioners and can flourish institutionally and regionally" and fulfilling the function of recurrent and lifetime education as part of a junior-college mission to target members of our society

総合看護学実習におけるポートフォリオ導入プロセス

本学の総合看護学実習では、学生が自律・自立した看護実践を意識できるように運営してきたが、学生の受け身的な姿勢は課題となっていた。ポートフォリオを活用した教育実践には、ポートフォリオの活用により学生が主体的で能動的な学習ができる（坂田,佐藤，石塚，2013；杉浦，2012）と報告されている。本研究では、ポートフォリオを活用した総合看護学実習の導入プロセスを明らかにすることを目的に、1．文献検討　2．実習内容の検討・実習記録フォーマット改訂　3．教員研修の開催を行った。その結果、ポートフォリオの活用が学生の主体性を促し能動的な学習につながることが分かり、「看護に対する自己の課題を明確にし、自己課題の達成を目指して主体的に取り組むことができる」という新たな実習目標を立て、本学の総合看護学実習のツールとして導入できた。臨地実習指導者とポートフォリオの教育手法を共有したことにより、ポートフォリオのメリットを活かしながら協働して実習指導にあたることが期待できる。さらに今後の運用を評価し、具体的な指導指針の作成を目指し総合看護学実習の運用方法の構築に活かしたい

Clinical and molecular features of 66 patients with musculocontractural Ehlers-Danlos syndrome caused by pathogenic variants in CHST14 (mcEDS-CHST14)

Background Musculocontractural Ehlers-Danlos syndrome is caused by biallelic loss-of-function variants in CHST14 (mcEDS-CHST14) or DSE (mcEDS-DSE). Although 48 patients in 33 families with mcEDS-CHST14 have been reported, the spectrum of pathogenic variants, accurate prevalence of various manifestations and detailed natural history have not been systematically investigated. Methods We collected detailed and comprehensive clinical and molecular information regarding previously reported and newly identified patients with mcEDS-CHST14 through international collaborations. Results Sixty-six patients in 48 families (33 males/females; 0-59 years), including 18 newly reported patients, were evaluated. Japanese was the predominant ethnicity (27 families), associated with three recurrent variants. No apparent genotype-phenotype correlation was noted. Specific craniofacial (large fontanelle with delayed closure, downslanting palpebral fissures and hypertelorism), skeletal (characteristic finger morphologies, joint hypermobility, multiple congenital contractures, progressive talipes deformities and recurrent joint dislocation), cutaneous (hyperextensibility, fine/acrogeria-like/wrinkling palmar creases and bruisability) and ocular (refractive errors) features were observed in most patients (>90%). Large subcutaneous haematomas, constipation, cryptorchidism, hypotonia and motor developmental delay were also common (>80%). Median ages at the initial episode of dislocation or large subcutaneous haematoma were both 6 years. Nine patients died; their median age was 12 years. Several features, including joint and skin characteristics (hypermobility/extensibility and fragility), were significantly more frequent in patients with mcEDS-CHST14 than in eight reported patients with mcEDS-DSE. Conclusion This first international collaborative study of mcEDS-CHST14 demonstrated that the subtype represents a multisystem disorder with unique set of clinical phenotypes consisting of multiple malformations and progressive fragility-related manifestations; these require lifelong, multidisciplinary healthcare approaches.Genetics of disease, diagnosis and treatmen

The whole blood transcriptional regulation landscape in 465 COVID-19 infected samples from Japan COVID-19 Task Force

「コロナ制圧タスクフォース」COVID-19患者由来の血液細胞における遺伝子発現の網羅的解析 --重症度に応じた遺伝子発現の変化には、ヒトゲノム配列の個人差が影響する--. 京都大学プレスリリース. 2022-08-23.Coronavirus disease 2019 (COVID-19) is a recently-emerged infectious disease that has caused millions of deaths, where comprehensive understanding of disease mechanisms is still unestablished. In particular, studies of gene expression dynamics and regulation landscape in COVID-19 infected individuals are limited. Here, we report on a thorough analysis of whole blood RNA-seq data from 465 genotyped samples from the Japan COVID-19 Task Force, including 359 severe and 106 non-severe COVID-19 cases. We discover 1169 putative causal expression quantitative trait loci (eQTLs) including 34 possible colocalizations with biobank fine-mapping results of hematopoietic traits in a Japanese population, 1549 putative causal splice QTLs (sQTLs; e.g. two independent sQTLs at TOR1AIP1), as well as biologically interpretable trans-eQTL examples (e.g., REST and STING1), all fine-mapped at single variant resolution. We perform differential gene expression analysis to elucidate 198 genes with increased expression in severe COVID-19 cases and enriched for innate immune-related functions. Finally, we evaluate the limited but non-zero effect of COVID-19 phenotype on eQTL discovery, and highlight the presence of COVID-19 severity-interaction eQTLs (ieQTLs; e.g., CLEC4C and MYBL2). Our study provides a comprehensive catalog of whole blood regulatory variants in Japanese, as well as a reference for transcriptional landscapes in response to COVID-19 infection

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target

〈原著〉マウス・アストロサイトでのmiR-29依存性の遺伝子発現の網羅的解析

[Synopsis] MicroRNAs (miRNAs) are an evolutionarily conserved large class of small non-coding RNAs that mediate posttranscriptional silencing of genes and influence a broad spectrum of biological processes ranging from embryonic development to organismal death. Our previous study identified the miR-29 family, three paralogous species of miR-29a/b/c, as the most predominantly expressed small RNA in aged mouse brain compared to the neonate one. Mouse brain miR-29 is highly astrocytic. Its expression is quiescent during early brain development, and then steadily increases to a plateau state around reproductive maturity. To explore the functional relevance of miR-29 expression in early life to the neural physiology of the mouse brain from the mechanistic perspective of mammalian species-specific lifespan, we here undertook a gain-of-function approach through exogenous expression of miR-29 in astrocyte from mouse fetus and surveyed the resulting alteration in both the transcriptional and translational levels. DNA microarray analyses retrieved a total of 5,589 genes showing temporal significant expression changes in the miR-29-transfected fetal astrocytes, and classified them into two gene groups: positively or negatively regulated by miR-29. Mass spectrometry (MS)-based quantification of translational products of miR-29-responsive genes identified 18 species of miR-29 target candidates. We performed functional enrichment analyses utilizing bioinformatics resources to characterize the gene sets thus identified, and found their expression trend that favor the processes for facilitating cell differentiation while supporting normal cell proliferation/survival, which is somewhat different from the functional signatures of miR-29 as observed at adult stages, implying a pleiotropic property of miR-29 depending on the developmental context. Our present results strongly suggest that miR-29 in the developing mouse brain serves as the central coordinator to shift the global gene expression toward adult phenotypes, through which ensure the programmed transition in the life course to the post-developmental/reproductive stage which has inherently been set to delimit the mouse life potential. [要約] マイクロRNA(miRNA)は多くの生物種の多岐にわたる生命現象において遺伝子発現の転写後制御機能を担っている小分子非コードRNAである。前回, 著者らは加齢マウスの脳内において発現が最も顕著に上昇している小分子RNAとしてmiR-29を同定した。miR-29は脳組織では主にアストロサイトで発現するmiRNAで, 脳発達の初期にはほとんど発現は認められないが, 若齢期から繁殖最盛期にかけて発現の上昇が続いた後その最大発現レベルを寿命終末期まで維持するという発現パターンを示す。miRNA本来の生物学的機能とmiR-29のこのような発現挙動を考え合わせると, miR-29がその多面発現性を通して哺乳類生物種固有の寿命プログラミングの中心的存在として働いているのではないかとの期待がもたれる。今回, この寿命決定機構解明の観点から寿命プログラム初期のマウス脳内でのmiR-29の機能的役割を明らかにする目的で, miR-29が未発現のマウス胎児由来のアストロサイト内でこのmiRNAを強制発現させ, そのゲノムワイドでの影響を転写と翻訳の両レベルで調べた。マイクロアレイから得られた転写レベルでの発現プロファイルではmiR-29発現に応答した多数の遺伝子の発現変動が観察された。また, 質量分析による翻訳レベルでのプロファイリングからはmiR-29の標的についての複数の候補遺伝子が特定された。これらmiR-29応答性の発現遺伝子の機能アノテーションをインフォマティックな手法により行った結果から, 脳発達段階でのmiR-29は細胞内代謝活性と正常な細胞増殖能は維持しながらも, 成体としての完成状態への成熟を着実に誘導すべく多数の遺伝子の発現を統御しているという構図が想定された。このような機能的特徴は繁殖期以降の成体で従来報告されているものとは異なった側面をもち, miR-29がライフステージ依存的に下流遺伝子の発現調節様式を巧妙に制御しながら寿命プログラムの進行役を果たしている様相が示唆された。KOHNO, Nozom