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Competency lists for urban general practitioners/family physicians using the modified Delphi method
Get PDFBackground: In recent years, the growing global urbanization and urban population have resulted in the emergence of various health problems unique to urban areas. Therefore, training general practitioners and family physicians who can tackle the complex health problems of urban areas and improve the health of urban people is one of the most important issues of our time. However, findings on competencies for urban general practitioners (GP) and family physicians (FP) were limited. This study aimed to identify their comprehensive and content-validated list of competencies. Methods: We used the modified Delphi method to develop a content-validated competency list. First, we analyzed and synthesized the competencies extracted from the literature review using qualitative thematic analysis methods to create an initial competency list of 34 items. We then assembled 39 expert panelists in four groups of study participants: physicians, nurses, patients, and medical education specialists. The expert panelists were asked to indicate their level of agreement with the lists and provide revised comments on the description of each competency via a web-based questionnaire. Their responses were analyzed quantitatively and qualitatively by the research team and used to revise the list. These processes were repeated, and the survey was completed when it was determined that consensus had been reached. Results: Three rounds of Delphi were conducted. 39 responded in the first round, 38 in the second round, and 36 in the third round. The initial list of competencies was revised and consolidated from 34 to 14 items in the first round, bringing the total to 20 items along with six new items proposed by the panelists. In the second round, it was revised and consolidated into a list of 18 items. In the third round, all 18 items were considered to have been agreed upon by the panelists, so the survey was closed. Conclusion: We identified a comprehensive 18-item list of competencies for urban GP/FP in a content-validated manner. Several are newly discovered competencies in this study. The findings of this study will be useful for the future training of urban GP/FP and for solving urban health problems
Microvoid Formation of Ferrite-martensite Dual-phase Steel via Tensile Deformation after Severe Plastic Shear-deformation
Get PDFOne of the objectives for the development of high-strength dual-phase (DP) steel is improving the stretch-flangeability. Large-strained sheared edges are deformed and frequently cracked during stretch-flange formation. Considering shearing as the first deformation, the stretch-flange deformation may be regarded as a secondary deformation. To improve the stretch-flangeability of the DP steels, many researchers have analyzed the microvoid formation. However, in these analyses, the shearing process was not considered. With this background, ex-situ mini-bending tests combined with scanning electron microscopy (SEM) monitoring of microvoid formation were conducted during the secondary deformation. Prior to the secondary deformation, several microvoids were observed on the sheared surface and fine subgrains formed in the ferrite. During secondary deformation, the preliminary microvoids present at the ferrite-martensite interface propagated into the ferrite phase. In contrast, this behavior was not observed for the reamed surface deformation, which was formed without preliminary deformation. Furthermore, microvoids were initiated on ferrite grains that were not present at the ferrite-martensite interface, and martensite islands were not cracked during secondary deformation. This result is noteworthy because martensite cracking was the main factor involved in microvoid initiation, in the absence of shearing. Electron backscattering diffraction analysis revealed that the work hardening of ferrite, prior to the secondary deformation, caused a deviation in the strain concentration sites from those found in the reamed surface deformation. Therefore, this study elucidated microvoid formation on preliminary deformed surfaces via shearing and provided insights for material development considering deformations on the sheared surfaces of materials
Comparison of the anticancer effects of various statins on canine oral melanoma cells
No full textCanine oral melanoma is a highly malignant cancer with a poor prognosis. Statins, commonly used drugs for treating dyslipidemia, exhibit pleiotropic anticancer effects and marked anti-proliferative effects against melanoma cells. The anticancer effects among statins vary; in human cancers, lipophilic statins have shown stronger anticancer effects compared with hydrophilic statins. However, data on the differences in the effects of various statins on canine cancer cells are lacking, hence the optimal statins for treating canine melanoma remain unknown. Therefore, this study aimed to clarify the most effective statin by comparing the anticancer effects of hydrophilic rosuvastatin and lipophilic atorvastatin, simvastatin, fluvastatin and pitavastatin on three canine oral melanoma cell lines. Time-dependent measurement of cell confluence showed that lipophilic statins had a stronger anti-proliferative effect on all cell lines than hydrophilic rosuvastatin. Quantification of lactate dehydrogenase release, an indicator of cytotoxicity, showed that lipophilic statins more effectively induced cell death than hydrophilic rosuvastatin. Lipophilic statins affected both inhibition of cell proliferation and induction of cell death. The anticancer effects of statins on canine oral melanoma cells differed in the following ascending order of IC50 values: pitavastatin < fluvastatin = simvastatin < atorvastatin < rosuvastatin. The required concentration of pitavastatin was approximately 1/20th that of rosuvastatin. Among the statins used in this study, pitavastatin had the highest anticancer effect. Our results suggest lipophilic pitavastatin as the optimal statin for treating canine oral melanoma
ジンゾウ ソシキ カンサイボウ ユライ ノ オルガノイド ワ シスプラチン ニヨリ ユウハツ サレル キュウセイ ニョウサイカン ショウガイ モデル ニオケル ジンドクセイ ノ ビョウリ ソシキガクテキ ヒョウカ ニ ユウヨウ ナ ツール デアル
No full text鳥取大学博士(生命科学
マウス ジンコウ センショクタイ オ モチイタ テトラ サイクリン リプレッサー システム ニヨル ウンドウ ニューロン ト カイザイ ニューロン ニオケル TDP-43 ノ ビョウリ ヒカク
No full text鳥取大学博士(再生医科学
The Development and Evaluation of the Interprofessional Education Facilitation Program for Health Professionals Using the Attention, Relevance, Confidence, and Satisfaction (ARCS) Model of Instructional Design
Get PDFBackground: It is important to learn interprofessional education (IPE) facilitation skills to promote interprofessional collaboration in healthcare. Nonetheless, to date, only a handful of IPE facilitation programs have been developed through research. Objective: The objective of this study was to create an IPE facilitation program for healthcare professionals who wanted to promote interprofessional collaboration in their organizations based on the tenets of instructional design and evaluate its effectiveness. Methods: This study’s methodology was a mixed method based on relative subjectivism. We developed a two-day IPE facilitation program to learn IPE facilitation skills and promote interprofessional collaboration in the participants’ own organizations. The program was developed based on the instructional design principles of the attention, relevance, confidence, and satisfaction (ARCS) model, measuring the participants’ Interprofessional Facilitation Scale (IPFS) scores at three time points: before the first day, after the second day, and approximately one year after the course was completed. A one-way analysis of variance test was used to compare IPFS means at the three time points, and open-ended statements were qualitatively analyzed using thematic analysis. Results: Twelve healthcare providers (four physicians, two pharmacists, one nurse, one rehabilitation worker, one medical social worker, one clinical psychologist, one medical secretary, and one other) participated in the completed IPE facilitation program. Their IPFS scores increased significantly from 17.4 ± 16.1 before the program to 38.1 ± 9.4 after the program and remained at 35.1 ± 11.7 for one year (p = 0.008). In addition, qualitative analysis suggested that the knowledge and skills learned in the program could be applied in the participants’ workplaces, which helped them maintain their IPE facilitation skills. Conclusion: We developed a two-day IPE facilitation program based on the ARCS instructional design model, and the participants’ IPE facilitation skills scores increased and were maintained one year later
AMIGO2 expression as a predictor of recurrence in cervical cancer with intermediate risk
Get PDFPatients with recurrent cervical cancer have limited treatment options and are often considered to be incurable. Since the expression of amphoterin-induced gene and open reading frame 2 (AMIGO2) in clinical samples is a prognostic factor for colorectal cancer and gastric cancer, the present aimed to elucidate whether it is also a prognostic factor for cervical cancer. Patients with primary cervical cancer who underwent radical hysterectomy or radical trachelectomy at our institution (Faculty of Medicine, Tottori University, Yonago, Japan) between September 2005 and October 2016 were retrospectively collected. Immunohistochemical analysis using a specific antibody against AMIGO2 was performed on 101 tumor samples, and the clinical characteristics, disease-free survival (DFS) and overall survival (OS) of the patients were examined. Patients in the AMIGO2-high group had a shorter 5-year DFS and OS than those in the AMIGO2-low group (P<0.001). Furthermore, AMIGO2 was an independent prognostic factor for DFS in multivariate analysis (P=0.0012). Patients in the AMIGO2-high group exhibited obvious recurrence compared with those in the AMIGO2-low group in the high-(P=0.03) and intermediate-risk groups (P=0.003). Positive lymph node metastasis, and parametrial, stromal and lymph vascular space invasion were significantly more common in AMIGO2-high patients. Taken together, AMIGO2 expression may be a predictive marker of recurrence for cervical cancer. In particular, it may be an indicator to determine the need for postoperative adjuvant therapy in intermediate-risk group patients
Fast Guided Median Filter
Get PDFFaster computation of a weighted median (WM) filter is impeded by the construction of a weighted histogram for every local window of data. Since the calculated weights vary for each local window, it is difficult, using a sliding window approach, to construct the weighted histogram efficiently. In this paper, we propose a novel WM filter that overcomes the difficulty of histogram construction. Our proposed method achieves real-time processing for higher resolution images and can be applied to multidimensional, multichannel, and high precision data. The weight kernel used in our WM filter is the pointwise guided filter, which is derived from the guided filter. The use of kernels based on the guided filter avoids gradient reversal artifacts and shows a higher denoising performance than the Gaussian kernel based on the color/intensity distance. The core idea of the proposed method is a formulation that allows the use of histogram updates with a sliding window approach to find the weighted median. For high precision data we propose an algorithm based on a linked list that can reduce the memory requirements of storing histograms and the computational cost of updating them. We present implementations of the proposed method that are suitable for both CPU and GPU. Experimental results show that the proposed method indeed realizes faster computation than conventional WM filters and is capable of filtering multidimensional, multichannel, and high precision data. This is an approach which is difficult to achieve with conventional methods