The aim of this study was to translate the Cumulated Ambulation Score (CAS) from English into Japanese in cooperation with different types of healthcare providers and to investigate its inter-rater reliability and internal consistency.Two physical therapists at each of three general hospitals in Japan measured the mobility of 50 consecutive post-operative hip fracture patients on two occasions between 2 and 6 days after surgery using the Japanese version of the CAS (CAS-JP). We analyzed the inter-rater reliability and agreement using both the linear weighted kappa and the interclass correlation coefficient; we also analyzed the internal consistency using Cronbach's alpha coefficient.The mean age of patients was 81 (SD: 11.6) years and 82% were women. Approximately half of the patients had severe cognitive impairment. Kappa was ≥ 0.93 for the three mobility activities and for the total CAS-JP score, the percentage agreement was ≥ 0.98, the ICC was ≥ 0.95, and Cronbach's alpha coefficient was 0.85.We found that the CAS-JP possessed good inter-rater reliability, agreement, and internal consistency. The CAS-JP is a reliable and easy-to-use evaluation tool suitable for daily clinical practice across different healthcare providers to monitor mobility in older hip fracture patients in Japan. We suggest that CAS-JP be evaluated in future studies for use in younger patients and in other patient groups with mobility problems.
Ge and III-V compound semiconductors are expected to be used for non-Si channel MOSFETs as one of the effective technical booster to reduce the power consumption of next generation VLSI because of its higher carrier mobility than that of Si. Various approaches to introduce those non-Si channel materials into Si platform have been proposed, among which the ELO(epitaxial lift off) technique may have a good potential for manufacturing such a composite wafer consist of non-lattice-matched crystalline materials. High quality Ge and GaAs/InGaAs epitaxial thin film can be grown on lattice-matched/quasi-lattice-matched GaAs or InP single crystal substrate using CVD/MOCVD technology. The thin epitaxial film can be chemically lifted-off by selectively removing sacrificial epitaxial layer grown between the epitaxial film and the substrate, transferred and directly bonded onto Si substrate using thin oxide film made of Al 2 O 3 and/or SiO 2 as an adhesive layer, thus successively providing GOI and/or III-VOI(Ge and/or III-V compound semiconductors on insulator) composite wafer including the oxide film as an effective BOX(buried oxide) layer. The area size of transferred Ge/III-V film can be modified according to its application die size. The epitaxial layer quality after transferred onto Si substrate and initial device performance of Ge/III-V channel MOSFET formed on the Ge/III-V OI substrate will be introduced .
Understanding patient journey and burden of disease in patients with chronic thromboembolic pulmonary hypertension (CTEPH) helps improve diagnostic and treatment processes.This study aimed to explore patient journey from time of disease onset to a definitive diagnosis and disease burden in Japanese patients with CTEPH.A mixed-methods study exploring patient journey and disease burden of 33 Japanese patients with a definitive diagnosis of CTEPH. The patients from 2 university hospitals underwent semistructured interviews. Data were transcribed into verbatim records, and 2 independent researchers conducted thematic analyses. Data concerning patient journey were also analyzed quantitatively with supplementary use of medical records.Median times from initial onset of symptoms to a confirmed diagnosis and first visitation to a medical institution to a definitive diagnosis of CTEPH were 32 and 20 months, respectively. Thematic analyses found that, for patients, reasons for delay in seeking initial consultations included misattribution of symptoms to aging or lack of physical strength. For healthcare providers, reasons for delays in diagnosis included poor recognition of CTEPH and difficulty in recalling the disease as a differential diagnosis. Burdens of CTEPH were caused by physical symptoms, and mental and social issues, including restriction of daily activities owing to oxygen therapy, disappointment with the intractable nature of the disease, poor understanding of the disease by other people, and lack of social networks.This study highlighted physical, mental, and social burdens in patients with CTEPH and possible missed opportunities in making the diagnosis of CTEPH during the patient journey. Increasing disease awareness in healthcare providers and networking among patients may contribute to better patient care.
Low participation rates are one of the most serious disadvantages of Web-based studies. It is necessary to develop effective strategies to improve participation rates to obtain sufficient data.The objective of this trial was to investigate the effect of emphasizing the incentive in the subject line of the invitation email and the day of the week of sending the invitation email on the participation rate in a Web-based trial.We conducted a 2×2 factorial design randomized controlled trial. We contacted 2000 primary care physicians from members of the Japan Primary Care Association in January 2017 and randomly allocated them to 1 of 4 combinations of 2 subject lines (presence or absence of an emphasis on a lottery for an Amazon gift card worth 3000 yen or approximately US $30) and 2 delivery days (sending the invitation email on Tuesday or Friday). The primary outcome was the response rate defined as the number of participants answering the first page of the questionnaire divided by the number of invitation emails delivered. All outcomes were collected between January 17, 2017, and February 8, 2017.We analyzed data from 1943 out of 2000 participants after excluding those whose email addresses were invalid. The overall response rate was 6.3% (123/1943). There was no significant difference in the response rates between the 2 groups regarding incentive in the subject line: the risk ratio was 1.12 (95% CI 0.80 to 1.58) and the risk difference was 0.7% (95% CI -1.5% to 2.9%). Similarly, there was no significant difference in the response rates between the 2 groups regarding sending the email on Tuesday or Friday: the risk ratio was 0.98 (95% CI 0.70 to 1.38) and the risk difference was -0.1% (95% CI -2.3% to 2.1%).Neither emphasizing the incentive in the subject line of the invitation email nor varying the day of the week the invitation email was sent led to a meaningful increase in response rates in a Web-based trial with primary care physicians.University Hospital Medical Information Network Clinical Trials Registry UMIN000025317; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029121 (Archived by WebCite at http://www.webcitation. org/6wOo1jl9t).
To examine the association between primary care facility types and the quality of preventive care, especially adult vaccination and cancer screening, with a focus on the differences between community clinics and hospitals.Multicenter cross-sectional study.A primary care practice-based research network in Japan (25 primary care facilities).Adult outpatients for whom the participating facility serves as their usual source of care.None.Influenza and pneumococcal vaccination delivery and performance of colorectal, breast and cervical cancer screening.Data collected from 1725 primary care outpatients were analyzed. After adjustment of possible confounders and clustering within facilities, hospital-based practices were significantly associated with poorer uptake of influenza [adjusted odds ratio (aOR) = 0.64, 95% confidence interval (CI) 0.42-0.96] and pneumococcal vaccines (aOR = 0.55, 95% CI 0.40-0.75) and colorectal cancer screening (aOR = 0.59, 95% CI 0.39-0.88) compared with clinic-based practices. In contrast, the associations of types of primary care facilities with uptake of breast and cervical cancer screening were not statistically significant.Differences in the performance of adult vaccination and cancer screening raised concerns about the provision of preventive care at hospital-based compared with clinic-based primary care practices. Efforts to improve preventive care at hospital-based primary care practices should help to promote equalization of the quality of primary care. Further study is needed on the comparisons of other quality indicators among different structures of primary care facilities.
We have realized patterned Ge-on-Insulator wafers by large-scale layer transfer technology. In conjunction with low-temperature bonding and patterned Epitaxial Lift-Off (ELO) technique, high quality Ge layer transfer was achieved in full-wafer scale.
