Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study.

Background: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. Objective: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. Methods: This nationwide cross-sectional study included postgraduate year-1 and -2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. Results: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001). Conclusions: The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes.

Light-Emitting Electrochemical Cells Based on Nanogap Electrodes.

In a light-emitting electrochemical cell (LEC), electrochemical doping caused by mobile ions facilitates bipolar charge injection and recombination emissions for a high electroluminescence (EL) intensity at low driving voltages. We present the development of a nanogap LEC (i.e., nano-LEC) comprising a light-emitting polymer (F8BT) and an ionic liquid deposited on a gold nanogap electrode. The device demonstrated a high EL intensity at a wavelength of 540 nm corresponding to the emission peak of F8BT and a threshold voltage of ∼2 V at 300 K. Upon application of a constant voltage, the device demonstrated a gradual increase in current intensity followed by light emission. Notably, the delayed components of the current and EL were strongly suppressed at low temperatures (<285 K). The results clearly indicate that the device functions as an LEC and that the nano-LEC is a promising approach to realizing molecular-scale current-induced light sources.

Understanding International Differences in Academic Author Order in General Medicine Publications.

Objectives: With increasing multinational research in general medicine, the lack of a standardized policy regarding the order of author bylines can create conflict and misunderstanding due to different practices worldwide. Methods: We examined publicly available data from websites such as Journal Citation Reports and Web of Science, focusing on original articles published in the "Medicine, General, & Internal" category in 2020. Of 169 journals in the "Medicine, General, & Internal" category, we selected the ten countries with the highest number of publications and then examined the position of the corresponding author in the author byline as an indicator of the author in charge since corresponding authors are considered to have contributed the most. Results: The top ten countries with the highest publications are the USA, China, Germany, England, Japan, France, Italy, Canada, India, and Australia. The results demonstrated that the percentage of the second author being the corresponding author was the highest in Japan compared to other countries. This percentage was 25 times higher in Japan than in the USA. Conclusions: Understanding international differences regarding author order would facilitate smoother collaboration.

The association between research funding status and clinical research papers' citation impact in Japan: A cross-sectional bibliometric study.

Introduction: Studies have not sufficiently clarified the differences in citation impact between funded and non-funded clinical research papers. Hence, this study seeks to evaluate the relation between research funding status and clinical research papers' citation impact in different research fields using multiple evaluation indices. Methods: In this cross-sectional bibliometric study, clinical research papers published by core clinical research hospitals in Japan were compared retrospectively in terms of times cited (TC), category normalized citation impact (CNCI), citation percentile (CP), journal impact factor (JIF), the Software to Identify, Manage, and Analyze Scientific Publications (SIGAPS) category, and whether they were the funded clinical research. The association between research funding status or the SIGAPS category and CNCI ≥ 2 was analyzed using logistic regression analysis. Results: 11 core clinical research hospitals published 553 clinical research papers, of which 120 were non-funded and 433 were funded (public institution-funded and industry-funded). The study found that funded clinical research papers (public institution-funded and industry-funded) had significantly higher TC, CNCI, CP, and JIF than non-funded ones [TC: 8 (3-17) vs. 14 (8-31), p < 0.001; CNCI: 0.53 (0.19-0.97) vs. 0.87 (0.45-1.85), p < 0.001; CP: 51.9 (24.48-70.42) vs. 66.7 (40.53-88.01), p < 0.001; JIF: 2.59 (1.90-3.84) vs. 2.93 (2.09-4.20) p = 0.008], while the proportion of A or B rank clinical research papers of the SIGAPS category was not significantly different between the two groups (30.0 vs. 34.9%, p = 0.318). In the logistic regression analysis, having a CNCI ≥ 2 was significantly associated with research funding (public institution-funded and industry-funded) and publication in A or B rank journals of the SIGAPS category [research funding: Estimate 2.169, 95% confidence interval (CI) 1.153-4.083, p = 0.016; SIGAPS category A/B: Estimate 6.126, 95% CI 3.889-9.651, p < 0.001]. Conclusion: Analysis via multiple indicators including CNCI and the SIGAPS category, which allows for a comparison of the papers' citation impact in different research fields, found a positive relation between research funding status and the citation impact of clinical research papers.

Superiorly low half-wave voltage electro-optic polymer modulator for visible photonics.

Chip-scale optical devices operated at wavelengths shorter than communication wavelengths, such as LiDAR for autonomous driving, bio-sensing, and quantum computation, have been developed in the field of photonics. In data processing involving optical devices, modulators are indispensable for the conversion of electronic signals into optical signals. However, existing modulators have a high half-wave voltage-length product (VπL) which is not sufficient at wavelengths below 1000 nm. Herein, we developed a significantly efficient optical modulator which has low VπL of 0.52 V·cm at λ = 640 nm using an electro-optic (EO) polymer, with a high glass transition temperature (Tg = 164 °C) and low optical absorption loss (2.6 dB/cm) at λ = 640 nm. This modulator is not only more efficient than any EO-polymer modulator reported thus far, but can also enable ultra-high-speed data communication and light manipulation for optical platforms operating in the ranges of visible and below 1000 nm infrared.

Clinical Research Support Activities in Core Clinical Research Hospitals Throughout Japan.

We evaluated the current status of supporting activities in core clinical research hospitals across Japan using the Japan Registry of Clinical Trials (jRCT) data given the lack of previous research objectively investigated supporting activities for clinical trials in core clinical research hospitals throughout Japan. Briefly, our findings showed that despite the officially supposed cooperation scheme, core clinical research hospitals have not been the primarily selected contractor for clinical research supporters. Considering that core clinical research hospitals are designated spearhead physician-led clinical trials and are responsible for ensuring the quality of such trials, there is a need to determine why the officially supposed cooperative scheme between core and non-core hospitals are still not established in Japan in order to increase the development and quality of Japanese clinical research with maximum efficiency moving forward.

Factors Associated With the Acceleration of Patient Enrollment in Clinical Studies: A Cross-Sectional Study.

Under-recruitment in clinical trials is an issue worldwide. If the number of patients enrolled is lower than expected, based on the required sample size, then the reliability of the study results and their validation tend to be impaired. The current study therefore evaluated factors associated with accelerating patient enrollment using data from an ongoing multicenter prospective cohort study. The researchers encouraged research institutions to accelerate patient enrollment via e-mail, newsletters, telephone calls, and site visits. We analyzed the relationship between several potential factors associated with acceleration of patient enrollment including site visits and patient enrollment in a real clinical study. Data were collected from 106 research institutions that participated in a multicenter prospective cohort study. Results showed that the following parameters differed in terms of patient enrollment and non-enrollment: urban area (47.2 vs. 67.6%, p = 0.04), clinical research coordinator (CRC) participation in data input to electronic data capture (EDC) (41.7 vs. 11.8%, p < 0.01), and site visit (38.9 vs. 11.8%, p < 0.01). A multivariate analysis revealed that patient enrollment was significantly associated with urban area (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.12-0.86, p = 0.02), CRC participation in data input to EDC (OR 5.02; 95% CI 1.49-16.8; p < 0.01), and site visit (OR 4.54, 95% CI 1.31-15.7, p = 0.01). In conclusion, site visits and CRC participation in data input to EDC had a significant effect on patient enrollment promotion. Moreover, hospitals in rural areas were more effective in promoting patient enrollment than those in urban areas.

Nutritional intervention after an early assessment by a flexible endoscopic evaluation of swallowing is associated with a shorter hospital stay for patients with acute cerebral infarction: A retrospective study.

BACKGROUND AND OBJECTIVES: It is important to evaluate the swallowing function of patients with acute cerebral infarction. The effects of nutritional intervention after an early assessment by a flexible endoscopic evaluation of swallowing (FEES) were evaluated. METHODS AND STUDY DESIGN: This retrospective study included 274 patients who were hospitalized for acute cerebral infarction and underwent a FEES between 2016 and 2018. The effects of early nutritional intervention after an assessment by a FEES within 48 h from admission were evaluated. The patients were divided into a shorter hospital stay group (<30 days) and a longer group (≥30 days). A multivariate analysis was performed to identify the predictive factors for a shorter hospital stay. RESULTS: The overall patient characteristics were as follows: 166 men; median age, 81 years old; and median body mass index (BMI), 21.1 kg/m2. No significant differences in the age, sex, or BMI were found between the shorter and longer hospital stay groups. A FEES within 48 h of admission (odds ratio [OR], 2.040; 95% confidence interval [CI], 1.120-3.700; p=0.019), FILS level ≥6 at admission (OR, 2.300; 95% CI, 1.190-4.440; p=0.013), and an administered energy dose of ≥18.5 kcal/kg on hospital day 3 (OR, 2.360; 95% CI, 1.180-4.690; p=0.015) were independently associated with a hospital stay <30 days. CONCLUSIONS: Patients with acute cerebral infarction are more likely to have a shorter hospital stay (<30 days) if they undergo a FEES early after admission and receive optimal nutritional intervention.

Performance Index for Types of Clinical Research Support Service Providers for Academic Research Organizations in Japan: A Cross-Sectional Survey.

The purpose of this study was to conduct a factual survey to evaluate the type of clinical research support offered by service providers (supporters) in Japanese academic research organizations (AROs). From September to October 2018, we conducted an online questionnaire targeting researchers and supporters of AROs, including individuals supporting research and development (R&D) planning, as well as those involved in study management, biostatistics, coordination, data management, monitoring, and auditing. The number of responses was tabulated for each survey item. For items with written descriptions, we compiled summaries using the inductive regression method of qualitative research. Responses were obtained from 124 researchers, 258 supporters, and 40 AROs. None of the institutions responded that they had a performance index for all types of service providers, whereas 47% of institutions had an index for 1-3 types of service providers, and 40% of institutions had no index. Many institutions responded that they had a performance index for coordinators and data management, but few responded that there was a performance index for individuals engaged in R&D and study management. Furthermore, for all evaluations of AROs and researchers, the level of supporter satisfaction was low at only 20%. There was a discrepancy between the levels of researcher expectations and the actual contribution of R&D in the process of research planning. Our survey revealed that there is currently no performance index for services supporting clinical research. In future studies, we need to examine a performance index that accurately reflects the researcher attitudes revealed in this study.

Hospital characteristics preferred by medical students for their residency programs: A nationwide matching data analysis.

BACKGROUND: In 2004, Japan introduced a mandatory 2-year postgraduate training program for graduating medical students with a super-rotation curriculum. A national matching system was established to determine the hospital residency programs best suited for the students. We examined the hospital characteristics preferred by applicants for residencies. METHODS: A nationwide cross-sectional study was conducted. Data on salaries, bonuses, and number of accepted ambulances were compiled from the Residency Electronic Information System. Information on the prefectural population, urban area, and number of senior residents (postgraduate years 3-5) for specialty training was extracted from data published on the web page. The ratio of the number of first-choice applicants to recruitment capacity (matching ratio) for each program was compared between the characteristics of the hospitals and prefectures. RESULTS: A strong linear relationship was observed between the number of first-choice applications and the allocated number of resident positions (correlation coefficient, .72). The matching ratio was greater in community hospitals (2.10 times compared with university hospitals; 95% confidence interval [CI], 1.75-2.53), in hospitals with higher numbers of accepted ambulance cases (1.05 times per 1000 annually; 95% CI, 1.03-1.08), and in hospitals that served a larger prefectural population (1.05 times per million; 95% CI, 1.02-1.08). CONCLUSIONS: Financial incentives do not seem to attract residency applicants. Applicants prefer non-university hospitals located in populous areas and those that accept larger number of ambulance cases. To recruit junior residents, an emergency department may need to have higher activity with larger numbers and variety of cases.

Differences in author ranking: Development of SIGAPS scoring system for Japanese version.

Although the SIGAPS scoring system is extremely beneficial in evaluating the quality of academic papers and individual research achievement, values for author ranking may vary by country. If a SIGAPS scoring system outside of France is considered, the weighting by author ranking should also be reconsidered.

Importance of Quality Assessment in Clinical Research in Japan.

Background: The number of papers published by an institution is acknowledged as an easy-to-understand research outcome. However, the quantity as well as the quality of research papers needs to be assessed. Methods: To determine the relation between the number of published papers and paper quality, a survey was conducted to assess publications focusing on interventional clinical trials reported by 11 core clinical research hospitals. A score was calculated for each paper using Système d'interrogation, de gestionet d'analyse des publications scientifiques scoring system, allowing for a clinical paper quality assessment independent of the field. Paper quality was defined as the relative Journal impact factor (IF) total score/number of papers. Results: We surveyed 580 clinical trial papers. For each of the 11 medical institutions (a-k), respectively, the following was found: number of published papers: a:66, b:64, c:61, d:56, e:54, f:51, g:46, h:46, i:46, j:45, k:45 (median: 51, maximum: 66, minimum: 45); total Journal IF: a:204, b:252, c:207, d:225, e:257, f:164, g:216, h:190, i:156, j:179, k:219 (median: 207, maximum: 257, minimum: 156); relative Journal IF total score: a:244, b:272, c:260, d:299, e:268, f:215, g:225, h:208, i:189, j:223, k:218 (median: 225, maximum: 299, minimum: 189); and paper quality (relative Journal IF total score/number of papers): a:3.70, b:4.25, c:4.26, d:5.34, e:4.96, f:4.22, g:4.89, h:4.52, i:4.11, j:4.96, k:4.84 (median: 4.52, maximum: 5.34, minimum: 3.70). Additionally, no significant relation was found between the number of published papers and paper quality (correlation coefficient, -0.33, P = 0.32). Conclusions: The number of published papers does not correspond to paper quality. When assessing an institution's ability to perform clinical research, an assessment of paper quality should be included along with the number of published papers.

Enhanced Photocurrent Generation from Bacteriorhodopsin Photocells Using Grating-Structured Transparent Conductive Oxide Electrodes.

We fabricated a grating-structured electrode made of indium-doped zinc oxide (IZO) with a high refractive index (approximately 2) for a bacteriorhodopsin (bR) photocell. We investigated the photocurrent characteristics of the bR photocell and demonstrated that the photocurrent values from the bR/IZO electrode with the grating structure with a grating period of 340 nm were more than 3.5-4 times larger than those without the grating structure. The photocurrent enhancement was attributed to the resonance effect due to light coupling to the grating structure as well as the scattering effect based on the experimental results and analysis using the photonic band structure determined using finite-difference time-domain (FDTD) simulations. The refractive index of the bR film in electrolyte solution (1.40) used in the FDTD simulations was estimated by analyzing the extinction peak wavelength of 20-nm gold colloids in the bR film. Our results indicate that the grating- or photonic-crystal-structured transparent conductive oxide (TCO) electrodes can increase the light use efficiency of various bR devices such as artificial photosynthetic devices, solar cells, and light-sensing devices.

Fabrication of Vertical Molecular Junction Devices with Conductive Polymer Contacts Using a Peeling Method.

We present a simple technique for patterning Au top electrodes in vertical molecular junction devices that have the conductive polymer, poly(3,4-ethylene dioxythiophene)-poly(4-styrene sulfonate) ( PEDOT: PSS), as a contact layer between the self-assembled monolayer and the Au top electrode. In this method, a thermally curable photoresist of SU-8 is used to define the areas where the top electrodes are formed. The hydrophobicity and low surface energy of the cured SU-8 facilitates selective deposition of PEDOT: PSS onto the defined top electrode areas of the device through solution dewetting, and also enables the physical peeling of the Au top electrodes deposited on the SU-8 layers using an adhesion tape. Through this approach, vertical molecular junctions with patterned Au top electrodes can be fabricated without employing the shadow mask evaporation process used in the conventional approach. We processed vertical molecular tunneling devices based on self-assembled alkanedithiol monolayers with an active area of 100 µm2.

Controlled spontaneous emission of single molecules in a two-dimensional photonic band gap.

We have established a new platform to control the rate of spontaneous emission (SE) of organic molecules in the visible-light region using a combination of a two-dimensional (2D) photonic crystal (PC) slab made of TiO(2) and a single-molecule measurement method. The SE from single molecules of a perylenediimide derivative was effectively inhibited via a radiation field controlled by the 2D PC slab, which has a photonic band gap (PBG) for transverse-electric (TE)-polarized light. The fluorescence lifetimes of the single molecules were extended up to 5.5 times (28.6 ns) by the PBG effect. This result appears to be the first demonstration of drastic lifetime elongation for single molecules due to a PBG effect.

Fabrication of two-dimensional Ta2O5 photonic crystal slabs with ultra-low background emission toward highly sensitive fluorescence spectroscopy.

A two-dimensional tantalum pentoxide (Ta2O5) photonic crystal (PC) slab with low-background emission was fabricated and a 12-fold enhancement of fluorescence from the organic dyes of perylene diimide adsorbed on the surface of the PCs was observed. The background emissions of the Ta2O5 substrates with and without the PCs after thermal annealing at 600°C with oxygen gas were comparable to that of a well-cleaned cover glass. This is to date the lowest level of background emissions of two-dimensional PCs using materials with a high refractive index (>2). The results reported here provide new insights into the fabrication of the photonic devices that enable highly sensitive fluorescence microscopy or optical detections.

Dynamics of spontaneous emission from SiN with two-dimensional photonic crystals.

We investigated the dynamics of spontaneous emission from a photonic crystal etched into a SiN slab. After fitting the decay curves of the emission to double exponential functions, we divided the dynamic process of the spontaneous emission into a fast process and a slow process. It was observed that the presence of the photonic crystal increased the proportion of the fast decay component, and consequently, the emission rate and time-integrated emission intensity were also enhanced. These enhancements were a result of the coupling of the guide modes to the leaky modes of the photonic crystal slab waveguide.