Medical researchers' perceptions regarding research evaluation: a web-based survey in Japan.

OBJECTIVES: Japanese medical academia continues to depend on quantitative indicators, contrary to the general trend in research evaluation. To understand this situation better and facilitate discussion, this study aimed to examine how Japanese medical researchers perceive quantitative indicators and qualitative factors of research evaluation and their differences by the researchers' characteristics. DESIGN: We employed a web-based cross-sectional survey and distributed the self-administered questionnaire to academic society members via the Japanese Association of Medical Sciences. PARTICIPANTS: We received 3139 valid responses representing Japanese medical researchers in any medical research field (basic, clinical and social medicine). OUTCOMES: The subjective importance of quantitative indicators and qualitative factors in evaluating researchers (eg, the journal impact factor (IF) or the originality of the research topic) was assessed on a four-point scale, with 1 indicating 'especially important' and 4 indicating 'not important'. The attitude towards various opinions in quantitative and qualitative research evaluation (eg, the possibility of research misconduct or susceptibility to unconscious bias) was also evaluated on a four-point scale, ranging from 1, 'strongly agree', to 4, 'completely disagree'. RESULTS: Notably, 67.4% of the medical researchers, particularly men, younger and basic medicine researchers, responded that the journal IF was important in researcher evaluation. Most researchers (88.8%) agreed that some important studies do not get properly evaluated in research evaluation using quantitative indicators. The respondents perceived quantitative indicators as possibly leading to misconduct, especially in basic medicine (strongly agree-basic, 22.7%; clinical, 11.7%; and social, 16.1%). According to the research fields, researchers consider different qualitative factors, such as the originality of the research topic (especially important-basic, 46.2%; social, 39.1%; and clinical, 32.0%) and the contribution to solving clinical and social problems (especially important-basic, 30.4%; clinical, 41.0%; and social, 52.0%), as important. Older researchers tended to believe that qualitative research evaluation was unaffected by unconscious bias. CONCLUSION: Despite recommendations from the Declaration on Research Assessment and the Leiden Manifesto to de-emphasise quantitative indicators, this study found that Japanese medical researchers have actually tended to prioritise the journal IF and other quantitative indicators based on English-language publications in their research evaluation. Therefore, constantly reviewing the research evaluation methods while respecting the viewpoints of researchers from different research fields, generations and genders is crucial.

Quantifying Urban-Rural Inequality in Access to Telemedicine: Descriptive Analysis of Telemedicine Uses and Providers in Japan Under COVID-19.

Background: COVID-19 has reportedly resulted in disparities in the use of telemedicine due to several socioeconomic factors. While telemedicine was developed to overcome geographical distance, under COVID-19 telemedicine conversely might have deepened the urban-rural telemedicine divide. Especially in Japan, the authority has virtually regulated distant telemedicine use, which favored telemedicine providers who are located in close proximity to patients. This study aimed to quantify the urban-rural disparity in access to telemedicine and investigate heterogeneity between devices (phone and video visits). Methods: We used two nationally comprehensive data sources in Japan. One was a municipality-level telemedicine provider database. Municipality-provider-level analysis intended to measure the uneven distribution of telemedicine providers compared to usual health care providers as well as the difference among clinical departments. The second source was prefecture-level telemedicine utilization data. Prefecture-utilization-level analysis aimed to quantify how the use of telemedicine converged in urban areas. We investigated the heterogeneity between types of devices and time periods. To measure inequality, this study used the Lorenz Curve and Gini coefficients. Ethical review was not required. Results: The data included 16,927 providers (14,111 clinics and 2,816 hospitals) and 88,952 first visits throughout Japan. The main findings were the geographically converged distribution of telemedicine providers compared with overall providers who were not limited to telemedicine and, possibly as a result of it, the geographically unequal utilization of telemedicine compared with in-person visits. Furthermore, video visits were more unequally utilized than phone visits, let alone in-person visits. The disparity was not resolved over time, which implied a systematic cause. Conclusion: Using comprehensive nationwide data, this study revealed geographical inequality relating to access to telemedicine under the COVID-19 special deregulation in Japan. While telemedicine initially aimed to provide access to care for people in rural areas, several factors, including the digital divide, COVID-19, and the Japanese policy, paradoxically could have caused this disparity.

PET imaging of adenosine A(1) receptors with (11)C-MPDX as an indicator of severe cerebral ischemic insult.

UNLABELLED: We examined whether measurement of the adenosine A(1) receptor (A1-R) with PET can predict the severity of ischemic brain damage using an occlusion and reperfusion model of the cat middle cerebral artery (MCA) and [1-methyl-(11)C]8-dicyclopropylmethyl-1-methyl-3-propylxanthine (MPDX), a positron-emitting radioligand developed at our institution. METHODS: Eighteen adult cats underwent PET measurement of cerebral blood flow (CBF), A1-R, central benzodiazepine receptor (BDZ-R), and glucose metabolism with (15)O-labeled water, MPDX, (11)C-flumazenil (FMZ), and (18)F-FDG, respectively. The right MCAs of 13 cats were transiently occluded via a transorbital approach with microvascular clips. CBF was measured before occlusion of MCA, during occlusion, and immediately after reperfusion. After CBF measurement, A1-R, BDZ-R, and (18)F-FDG uptake were serially measured in the order listed. Two months later, the degree of ischemic damage was evaluated by T2-weighted MR images obtained with an animal MRI system and by analysis of histologic specimens. Five cats that received no operations were used as controls. RESULTS: The cats that underwent occlusion were divided into 3 groups: cats that did not survive the first day because of severe neurologic and systemic conditions (n = 4), cats that survived and had infarcted lesions in both the cortex and the striatum (n = 3), and cats that survived and had infarcted lesions only in the striatum (n = 6). CBF during occlusion of the MCA was significantly lower in all 3 ischemic groups than in the control group, but there was no significant difference among the ischemic groups. Right-to-left ratios of CBF and (18)F-FDG uptake did not significantly differ among the groups. MPDX binding and FMZ binding were significantly lower in the groups with severe ischemic insult than in the groups with little to no insult. CONCLUSION: The degree of decreased MPDX binding to A1-Rs after reperfusion was a sensitive predictor of severe ischemic insult. MPDX PET has good potential to become a suitable in vivo imaging technique for evaluating the function of adenosine and A1-Rs in relation to cerebral ischemia.

Quantitative in vivo measurement of central benzodiazepine receptors in the brain of cats by use of positron-emission tomography and [11C]flumazenil.

OBJECTIVE: To map central benzodiazepine receptors (BZRs) in the brain of cats by use of positron-emission tomography (PET) and [11C]flumazenil. ANIMALS: 6 male cats that weighed between 2.0 and 3.6 kg. PROCEDURE: Brain images obtained by PET evaluation of [11C]flumazenil were superimposed on T2-weighted magnetic-resonance imaging (MRI) scans of the same cats. Detailed anatomic regions, such as the cerebral cortex, striatum, thalamus, midbrain, and cerebellum, on the PET images were evident by PET-MRI registration. Regional binding of [11C]flumazenil to BZRs was quantitatively measured by use of a model with 2 tissue compartments and 4 variables. RESULTS: The highest value for distribution volume was observed in the cerebral cortex, and the lowest value was found in the midbrain of cats. CONCLUSIONS AND CLINICAL RELEVANCE: Binding of [11C]flumazenil to BZRs in the brain of cats can be quantitatively measured by use of PET with the aid of PET-MRI registration. It is difficult to diagnose changes in these neuroreceptors within the field of current veterinary science. In the future, PET should prove useful for investigating and diagnosing brain disorders in animals in clinical settings.

Mapping adenosine A(1) receptors in the cat brain by positron emission tomography with [(11)C]MPDX.

We evaluated the potential of [(11)C]MPDX as a radioligand for mapping adenosine A(1) receptors in comparison with previously proposed [(11)C]KF15372 in cat brain by PET. Two tracers showed the same brain distribution. Brain uptake of [(11)C]MPDX (Ki = 4.2 nM) was much higher and washed out faster than that of [(11)C]KF15372 (Ki = 3.0 nM), and was blocked by carrier-loading or displaced with an A(1) antagonist. The regional A(1) receptor distribution evaluated with kinetic analysis is consistent with that previously measured in vitro. [(11)C]MPDX PET has a potential for mapping adenosine A(1) receptors in brain.