This paper deals with the development of a new wireless EMG electrode ‘VAMPIRE-BAT/WASPS’ for man–machine interface that can not only stream up EMG signal in real-time, but also give electric stimulus feedback to human operator. The authors’ unique idea is ‘stimulus feedback nearby the actuation point’. Their statement is that human response may be faster if feedback is applied exactly on or nearby the point of actuation (i.e. muscle). Firstly, they introduce their new EMG electrode device and its technical details with performance test result. Then, they also show experiments and their results to verify effectiveness of the idea of stimulus feedback nearby the actuation point.
Abstract This article examines the impact of working‐hour restrictions on the well‐being, performance, and education of medical residents in Japan. Despite Japan's plan to introduce new regulations for resident working hours by 2024, there is still an ongoing debate regarding their appropriateness. This review provides a comprehensive overview of the current regulations of resident working hours worldwide, with a specific focus on weekly hours. The varying regulations are highlighted, including the 80‐hour‐per‐week regulation in the United States and the 48‐h‐per‐week regulation in the European Union influencing other regions. The article also discusses the effectiveness of working‐hour restrictions on residents' mental health, with shorter working hours having potentially greater benefits. However, the impacts on medical safety and resident education are mixed, and further reduction in working hours must be carefully considered to avoid adverse effects. The planned changes to working‐hour limits for residents in Japan offer a unique opportunity to gain new evidence on the impact of such regulations, which will be of interest to policymakers and researchers worldwide.
Burnout is a psychological syndrome consisting of emotional exhaustion, cynicism, and decreased professional efficacy. The Maslach Burnout Inventory (MBI) is widely used as the standard measure. However, the MBI is lengthy and not free to use, which makes it a less than ideal tool for regularly assessing burnout. The single question burnout measure (SMB) is a novel and simple measure of burnout, which is associated well with emotional exhaustion and has sufficient diagnostic performance for burnout. This study aimed to evaluate the concurrent and convergent validity of the Japanese version of the single-item measure of burnout (SMB-J) compared with the MBI.
ABSTRACT Importance This study highlights the association between physicians’ maldistribution and core clinical competency of resident physicians and emphasizes the global significance of addressing healthcare access disparities. Objective To investigate the relationship between a prefectural program with and without physician maldistribution and core clinical competency, measured using the General Medicine In-Training Examination (GM-ITE). Design Cross-sectional study. Setting Data from the GM-ITE survey were collected in January 2023. Participants Resident physicians in their first and second postgraduate year (PYG-1 and PGY-2) who were employed at Japanese hospitals that required the GM-ITE or resident physicians who voluntarily participated in the GM-ITE. Exposure Physician uneven distribution (PUD) index is a policy index developed and adopted in Japan. It serves as an indicator of regional disparities among physicians within the country. A low PUD index indicates that there is an insufficient medical supply relative to the medical demand in that region. Main Outcomes and Measures The GM-ITE scores of resident physicians. Results The high PUD index group included 2,143 participants and the low PUD index group included 1,580 participants. After adjusting for relevant confounders, multivariable linear regression analyses revealed that the low PUD index group had a significantly higher GM-ITE score compared to the high PUD index group (adjusted coefficient: 1.14; 95% confidence interval: 0.62–1.65; p<0.001). Conclusions and Relevance Resident physicians in regions with low PUD indices had significantly higher GM-ITE scores. These findings underscore the significance of addressing physician maldistribution to enhance the clinical competency of resident physicians and emphasize the potential benefits of reducing regional healthcare disparities, particularly in terms of medical education and training. These insights have broader relevance for healthcare policies and medical training programs worldwide, highlighting the need to consider physician distribution as a critical factor in improving healthcare access and quality. KEY POINTS Question How does physician maldistribution, indicated by the physician uneven distribution (PUD) index, impact resident physicians’ clinical competence based on performance in the General Medicine In-Training Examination (GM-ITE) in Japan? Findings In this nationwide cross-sectional study, resident physicians affiliated with hospitals in regions with a lower PUD index (indicating insufficient medical professional supply relative to healthcare demands) had significantly higher scores on the GM-ITE than those in regions with a higher PUD index. Meaning Training resident physicians in areas short of physicians does not adversely affect their education; rather, it can enhance medical education and address the physician maldistribution issue.
Metformin is widely prescribed for patients with type 2 diabetes mellitus (DM). Its use for patients with type 1 has been considered a contraindication because of possible adverse effects such as lactic acidosis. However, metformin has been recently used with insulin therapy to reduce insulin-dose requirements in Type 1 DM. An 81-year-old Japanese woman with type 1 DM was treated with insulin and metformin. She was admitted to our hospital due to altered mental state and hypotensive shock via a referral from her primary care physician. The patient had severe lactic acidosis and acute kidney injury with hyperkalemia with the suspected cause being the use of metformin. She was treated successfully with hemodialysis (HD). Although the independent predictive factor of mortality due to metformin-associated lactic acidosis is a prothrombin time (PT) activity of less than 50% in 24 hours, we recommend that HD should be performed for a patient with severe lactic acidosis even if the initial PT activity is normal.
This paper summarizes the development of a new numerical simulator for environmental impact assessment of CO2 geological storage and the results of case studies. The simulator is developed by coupling the multiphase fluid flow simulator TOUGH2 and an open-source FEM code FrontISTR. Case studies for In Salah CO2 storage project are conducted to assess the validity of the developed simulator. Then, sensitivity analyses for physical parameters corresponding to pore space and rock rigidity are conducted. Results are consistent with measured data and suggest the validity of the simulator.
Purpose: The purpose of this study was to test the efficacy of arginine, alanine, and phenylalanine mixture (A-mix) ingestion at 1,500 mg/day in combination with the promotion of physical activity for abdominal fat reduction in overweight adults. Methods: A placebo-controlled, double-blind, parallel-group, randomized trial for 12 weeks combined with a 4-week follow-up period was conducted at a single center in Minato-ku, Tokyo, Japan, between December 2016 and May 2017. Data were analyzed between June and August 2017. The study participants were 200 overweight adults within the age range of 20–64 years. The participants were randomly assigned to the A-mix group (n=100) or a placebo group (n=100) and were administered 500 mL of test beverage containing 1,500 or 0 mg of A-mix, respectively, for 12 weeks. All participants maintained a physically active lifestyle between week 0 and week 12 through monthly sessions of physical activity. The primary outcomes were the 12-week changes in the abdominal total, subcutaneous, and visceral fat areas, as assessed by computed tomography. Results: Of the 200 enrolled participants, 199 (99%) accomplished the 12-week intervention and 4-week follow-up period. The per-protocol-based analysis for 194 participants demonstrated that the abdominal total fat area decreased significantly in the A-mix group compared with that in the placebo group (difference, 10.0 cm 2 ; 95% confidence interval [CI]: 0.4–19.6 cm 2 ; P =0.041). Comparable outcomes were obtained for the abdominal subcutaneous fat area (difference, 7.4 cm 2 ; 95% CI: 0.1–14.7 cm 2 ; P =0.047). No study-related unfavorable events occurred. Conclusion: A-mix supplementation in combination with physical activity promotion facilitated abdominal fat reduction in overweight adults. Keywords: amino acid supplementation, physical activity promotion, abdominal fat, randomized controlled trial
