Japan's Contributions to Non-Traditional Security in Asia : An Analysis within the Framework of the Expanded Asian Supercomplex Theory

早稲田大学博士(国際コミュニケーション学)早大学位記番号:新9407doctoral thesi

Cardiovascular Surgery Patients' Preferences for Clothing Style in their Physicians and Patient- Physician Relations

Aim: In this study, it was aimed to determine the relationship between the clothing style of physicians providing service in the Cardiovascular Surgery (CVS) clinic and patients' physician preferences.Methods: This cross-sectional and descriptive study was carried out with 250 patients who would undergo open-heart surgery in the CVS clinic of a training and research hospital in Istanbul between April and August 2017. Data were obtained using the questionnaire form including questions about clothing preferences and their effects on patient-physician relations by showing the pictures of different clothing styles of both male and female physicians (classic, white coat, sport, uniform). In the data analysis, descriptive statistics (frequency, percentage, mean), as well as the chi-square test for comparisons between the groups, were used.Results: The average age of the participants was 55.37±14.33 years, and 55.2% of them were male. It was determined that white coat was the most preferred clothing style for CVS physicians. Younger patients compared to older patients, and male patients compared to female patients stated that they mostly wanted their physicians to wear a white coat during a routine physical examination and while sharing their private matters.Conclusion: Patients stated that they preferred CVS physicians to primarily wear a white coat. For this reason, the white coat may positively affect patient-physician relations and may help a physician in making a good impression

Immunogenicity of a Haemophilus influenzae type b–tetanus conjugate vaccine when administered separately or in combined vaccines for primary immunization in two consecutive national schedules in Turkey

SummaryBackgroundIn Turkey, the Haemophilus influenzae type b–tetanus toxoid conjugate vaccine (Hib) was replaced by the combined diphtheria–tetanus–acellular pertussis and inactivated polio vaccine (DTaP–IPV/Hib) in 2008. This shift to the new schedule created different cohorts of vaccinated children as a consequence of the different schedules used. We evaluated the immunogenicity of the Hib vaccine in infants vaccinated with these different schedules.MethodsThree groups of children were evaluated: group 1 comprised 145 infants vaccinated with diphtheria, tetanus, and whole cell pertussis (DTwP), oral polio vaccine (OPV), and Hib vaccines simultaneously at separate sites; group 2 comprised 204 infants vaccinated with the DTaP–IPV/Hib combined vaccine; group 3 comprised 100 infants vaccinated with a mixed schedule of DTwP, OPV, and Hib for the first one or two doses, followed by DTaP–IPV/Hib vaccine to complete the series.ResultsAnti-polyribosylribitol phosphate (anti-PRP) titers ≥0.15μg/ml were similar in groups 1, 2, and 3. However, in group 1, who received all the vaccines at separate sites, ≥ l.0μg/ml long-lasting antibody titers and anti-PRP geometric mean titers were higher (p=0.001).ConclusionThis study showed that even one dose administered in combination with other vaccines in a primary series decreased the level of anti-PRP

Caesarean Section with Spinal Anesthesia and Postspinal Headache

Purpose: To find out ‘what is the leading cause of postpartum headache in patients undergoing caesarean section with spinal anesthesia under elective conditions?’Methods: Our study was conducted with retrospective, controlled assessment of 304 patients who underwent caesarean section with spinal anesthesia under elective conditions at our institution between 1 June 2012 and 1 November 2012. The patients were assessed in terms of postpartum headache. They were divided into 2 groups: the group with headache versus the group without headache (the latter was the control group). Both groups were compared with respect to age, body mass index (BMI), number of previous pregnancies, indications for caesarean section, the spinal needle used during spinal anesthesia, preoperative and postoperative amount of fluid administration, and mobilization time.Results: None of the factors that are effective in development of headache, i.e. age, multiparity, the indication for caesarean section, BMI, and needle type, was statistically significant in logistic regression analysis. Only the needle type was significantly related to headache in Chi-Square test. All headache episodes were mild and improved with conservative therapy. We did not find any difference between groups with respect to age, BMI, number of previous pregnancies, indications for caesarean section, preoperative and postoperative amount of fluid administration, and mobilization time.Conclusion: In patients undergoing cesarean section with spinal anesthesia under elective conditions the main cause of headache is the type of the spinal needle used

Evaluating the impact of climate risk on financial access and stability in G20 countries : a panel data approach (2006-2017)

The burgeoning international concern over environmental sustainability has brought to the forefront the unique challenges climate change poses to global economies and financial markets. In the light of this, the role of International Financial Institutions like the International Monetary Fund and the World Bank in transitioning towards a green economy is increasingly critical. This study aims to elucidate the influence of climate risk on financial access and stability within G20 countries, spanning from 2006 to 2017. Employing a comprehensive panel data analysis, which accounts for cross-sectional dependence and slope heterogeneity, a fixed effects model is utilized. The Global Climate Risk Index (CRI) scores, provided by Germanwatch, serve as the primary measure of climate risk, with lower scores indicating heightened risk. The investigation reveals a non-linear relationship, where enhanced financial access correlates with diminishing climate risk, underscoring the positive impact of climate change policies on financial system efficiency. However, no significant connection is found between climate risk and financial fragility, a phenomenon potentially attributed to the resilience of countries with advanced credit markets and preemptive risk insurance measures by households. These findings imply that while climate change significantly influences financial access in G20 countries, its effect on financial fragility within the studied period is negligible. The study underscores the potential for policy interventions in climate change mitigation to augment financial system efficiency. Ensuring the consistency of professional terminology, the analysis provides insights into the nuanced relationship between climate risk and financial dynamics in major economies.peer-reviewe

Germline Pathogenic Variants Identified by Targeted Next-Generation Sequencing of Susceptibility Genes in Pheochromocytoma and Paraganglioma

The aim of this study was to evaluate germline variant frequencies of pheochromocytoma and paraganglioma targeted susceptibility genes with next-generation sequencing method. Germline DNA from 75 cases were evaluated with targeted next-generation sequencing on an Illumina NextSeq550 instrument. KIF1B, RET, SDHB, SDHD, TMEM127, and VHL genes were included in the study, and Sanger sequencing was used for verifying the variants. The pathogenic/likely pathogenic variants were in the VHL, RET, SDHB, and SDHD genes, and the diagnosis rate was 24% in this study. Three different novel pathogenic variants were determined in five cases. This is the first study from Turkey, evaluating germline susceptibility genes of pheochromocytoma and paraganglioma with a detection rate of 24% and three novel variants. All patients with pheochromocytoma and paraganglioma need clinical genetic testing with expanded targeted gene panels for higher diagnosis rates

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049