Snap diagnosis of fulminant type 1 diabetes by the normalized glucose/HbA1c ratio.

Elevated Fulminant Index (FI), [plasma glucose (PG)/glycosylated hemoglobin A1c (HbA1c)], was reportedly a sensitive index to differentiate fulminant type 1 diabetes (FT1D) from non-fulminant T1D (nFT1D). Aim of this study was to describe a better, but simpler index of FT1D. 49 and 52 patients with FT1D and nFT1D, respectively, were registered, and the discriminating ability of the rounded, normalized ratio, [PG (mmol/L) - 5.0]/[HbA1c (%) - 5.0], and the original ratio, [PG (mmol/L)]/[HbA1c (%)], was compared. Normalizing the ratio significantly raised its accuracy: area under the curve for receiver operating curve, AUROC (95%CI), 0.927 (0.858-0.964) and 0.851 (0.763-0.910), respectively, with and without the normalization (p < 0.01). Rounding of the figure into [PG (mmol/L) - 5.0]/[HbA1c (%) - 5.0] did not significantly sacrifice the discriminating ability of the index. Namely, the optimal cut point of rounded and normalized GAR, 10.0, showed 89.8% sensitivity. In conclusion, rounded, normalized (rn) GAR ≥10 (the rounded optimal cut-off) could be used for the snap diagnosis of FT1D.

Progress testing of an objective structured clinical examination during undergraduate clinical clerkship: a mixed-methods pilot study.

BACKGROUND: Progress testing is an assessment method in which an examination reflecting competencies at graduation is regularly administered to students over multiple years, thereby facilitating self-directed learning. However, the significance of the objective structured clinical examination as a progress test in undergraduate education, needs to be determined. This study provides evidence of the role of the objective structured clinical examination for progress testing and optimal scoring methods for assessing students in different academic years. METHODS: We conducted a sequential explanatory mixed-methods pilot study. Participants were assessed using the Item Rating Scale, the year-adjusted Global Rating Scale, and the Training Level Rating Scale. The characteristics of each scale were compared quantitatively. In addition, the influence of the objective structured clinical examination as a progress test on learning attitudes was examined. Qualitative data from a post-examination questionnaire were analyzed, using content analysis to explore influences on self-directed learning. RESULTS: Sixth and fifth year clinical students (n = 235) took the objective structured clinical examination progress test. The total Item Rating Scales were recorded (%) as 59.03 ± 5.27 and 52.64 ± 5.08 (p < 0.01); Training Level Rating Scale was 3.94 ± 0.39 vs 3.22 ± 0.42 (p < 0.01); and the year-adjusted Global Rating Scale was 4.25 ± 0.44 vs 4.32 ± 0.52 (no significant difference), for the sixth and fifth year students, respectively. The correlations across stations and the reliability of each station were satisfactory. Four categories were identified in the qualitative analysis: "motivation to learn during the clinical clerkship was promoted," "dissatisfied with being asked about things they had not experienced," "confusion about being unable to use conventional test-taking strategies," and "insufficient understanding of competencies at graduation." The scores indicated significant differences in performance according to training year. CONCLUSIONS: This study provides evidence that the objective structured clinical examination can be used as a progress testing tool for undergraduate clinical clerkships. Further enhancement of training opportunities and dissemination of performance competency goals in clerkship curricula are required if we intend to promote self-directed learning through progress testing.

Predictive analysis of multiple future scientific impacts by embedding a heterogeneous network.

Identifying promising research as early as possible is vital to determine which research deserves investment. Additionally, developing a technology for automatically predicting future research trends is necessary because of increasing digital publications and research fragmentation. In previous studies, many researchers have performed the prediction of scientific indices using specially designed features for each index. However, this does not capture real research trends. It is necessary to develop a more integrated method to capture actual research trends from various directions. Recent deep learning technology integrates different individual models and makes it easier to construct more general-purpose models. The purpose of this paper is to show the possibility of integrating multiple prediction models for scientific indices by network-based representation learning. This paper will conduct predictive analysis of multiple future scientific impacts by embedding a heterogeneous network and showing that a network embedding method is a promising tool for capturing and expressing scientific trends. Experimental results show that the multiple heterogeneous network embedding improved 1.6 points than a single citation network embedding. Experimental results show better results than baseline for the number of indices, including the author h-index, the journal impact factor (JIF), and the Nature Index after three years from publication. These results suggest that distributed representations of a heterogeneous network for scientific papers are the basis for the automatic prediction of scientific trends.

Detecting trends in academic research from a citation network using network representation learning.

Several network features and information retrieval methods have been proposed to elucidate the structure of citation networks and to detect important nodes. However, it is difficult to retrieve information related to trends in an academic field and to detect cutting-edge areas from the citation network. In this paper, we propose a novel framework that detects the trend as the growth direction of a citation network using network representation learning(NRL). We presume that the linear growth of citation network in latent space obtained by NRL is the result of the iterative edge additional process of a citation network. On APS datasets and papers of some domains of the Web of Science, we confirm the existence of trends by observing that an academic field grows in a specific direction linearly in latent space. Next, we calculate each node's degree of trend-following as an indicator called the intrinsic publication year (IPY). As a result, there is a correlation between the indicator and the number of future citations. Furthermore, a word frequently used in the abstracts of cutting-edge papers (high-IPY paper) is likely to be used often in future publications. These results confirm the validity of the detected trend for predicting citation network growth.

Extraction of business relationships in supply networks using statistical learning theory.

Supply chain management represents one of the most important scientific streams of operations research. The supply of energy, materials, products, and services involves millions of transactions conducted among national and local business enterprises. To deliver efficient and effective support for supply chain design and management, structural analyses and predictive models of customer-supplier relationships are expected to clarify current enterprise business conditions and to help enterprises identify innovative business partners for future success. This article presents the outcomes of a recent structural investigation concerning a supply network in the central area of Japan. We investigated the effectiveness of statistical learning theory to express the individual differences of a supply chain of enterprises within a certain business community using social network analysis. In the experiments, we employ support vector machine to train a customer-supplier relationship model on one of the main communities extracted from a supply network in the central area of Japan. The prediction results reveal an F-value of approximately 70% when the model is built by using network-based features, and an F-value of approximately 77% when the model is built by using attribute-based features. When we build the model based on both, F-values are improved to approximately 82%. The results of this research can help to dispel the implicit design space concerning customer-supplier relationships, which can be explored and refined from detailed topological information provided by network structures rather than from traditional and attribute-related enterprise profiles. We also investigate and discuss differences in the predictive accuracy of the model for different sizes of enterprises and types of business communities.

Tobacco Price Increase and Smoking Cessation in Japan, a Developed Country With Affordable Tobacco: A National Population-Based Observational Study.

BACKGROUND: Longitudinal assessment of the impact of tobacco price on smoking cessation is scarce. Our objective was to investigate the effect of a price increase in October 2010 on cessation rates according to gender, age, socioeconomic status, and level of tobacco dependence in Japan. METHODS: We used longitudinal data linkage of two nationally representative studies and followed 2702 smokers for assessment of their cessation status. The odds ratios (ORs) for cessation were calculated using logistic regression. To estimate the impact of the 2010 tobacco price increase on cessation, data from 2007 were used as a reference category. RESULTS: Overall cessation rates significantly increased from 2007 to 2010, from 3.7% to 10.7% for men and from 9.9% to 16.3% for women. Cessation rates were 9.3% for men who smoked 1-10 cigarettes per day, 2.7% for men who smoked 11-20 cigarettes per day, and 2.0% for men who smoked more than 20 cigarettes per day in 2007. These rates increased to 15.5%, 10.0%, and 8.0%, respectively, in 2010. The impact was stronger among subjects who smoked more than 11 cigarettes per day than those who smoked 1-10 cigarettes per day in both sexes: ORs for 2010 were 4.04 for those smoking 11-20 cigarettes per day, 4.26 for those smoking more than 20 cigarettes per day, and 1.80 for those smoking 1-10 cigarettes per day in the main model in men. There were no obvious differences in the relationship between tobacco price increase and smoking cessation across age and household expenditure groups. CONCLUSIONS: The tobacco price increase in Japan had a significant impact on smoking cessation in both sexes, especially among heavy smokers, with no clear difference in effect by socio-demographic status.

Mentoring the next generation of physician-scientists in Japan: a cross-sectional survey of mentees in six academic medical centers.

BACKGROUND: Physician-scientists play key roles in biomedical research across the globe, yet prior studies have found that it is increasingly difficult to recruit and retain physician-scientists in research careers. Access to quality research mentorship may help to ameliorate this problem in the U.S., but there is virtually no information on mentoring in academic medicine in Japan. We conducted a survey to determine the availability and quality of mentoring relationships for trainee physician-scientists in Japan. METHODS: We surveyed 1700 physician-scientists in post-graduate research training programs in 6 academic medical centers in Japan about mentorship characteristics, mentee perceptions of the mentoring relationship, and attitudes about career development. RESULTS: A total of 683 potential physician-scientist mentees completed the survey. Most reported that they had a departmental mentor (91%) with whom they met at least once a month; 48% reported that they were very satisfied with the mentoring available to them. Mentoring pairs were usually initiated by the mentor (85% of the time); respondents identified translational research skills (55%) and grant writing (50%) as unmet needs. Mentoring concerning long-term career planning was significantly associated with the intention to pursue research careers, however this was also identified by some mentees as an unmet need (35% desired assistance; 15% reported receiving it). CONCLUSIONS: More emphasis and formal training in career mentorship may help to support Japanese physician-scientist mentees to develop a sense of self-efficacy to pursue and stay in research careers.

The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey.

STUDY OBJECTIVE: The objective of this study was to examine the association between the use of mobile phones after lights out and sleep disturbances among Japanese adolescents. DESIGN AND SETTING: This study was designed as a cross-sectional survey. The targets were students attending junior and senior high schools throughout Japan. Sample schools were selected by cluster sampling. Self-reported anonymous questionnaires were sent to schools for all students to fill out. PARTICIPANTS: A total of 95,680 adolescents responded. The overall response rate was 62.9%, and 94,777 questionnaires were subjected to analysis. INTERVENTION: N/A. MEASUREMENTS AND RESULTS: Daily mobile phone use, even if only for a brief moment every day, was reported by 84.4%. Moreover, as for use of mobile phones after lights out, 8.3% reported using their mobile phone for calling every day and 17.6% reported using it for sending text messages every day. Multiple logistic regression analysis showed that mobile phone use for calling and for sending text messages after lights out was associated with sleep disturbances (short sleep duration, subjective poor sleep quality, excessive daytime sleepiness, and insomnia symptoms) independent of covariates and independent of each other. CONCLUSION: This study showed that the use of mobile phones for calling and for sending text messages after lights out is associated with sleep disturbances among Japanese adolescents. However, there were some limitations, such as small effect sizes, in this study. More studies that examine the details of this association are necessary to establish strategies for sleep hygiene in the future.

Administration of recombinant human growth hormone normalizes GH-IGF1 axis and improves malnutrition-related disorders in patients with anorexia nervosa.

High serum level of GH in the presence of low plasma level of insulin-like growth factor-I (IGF-I) is one of the endocrinological features of anorexia nervosa (AN). Whether the amount of endogenous GH is not enough to increase IGF-I is not certain. We studied the effect of recombinant human growth hormone (rhGH) on the GH-IGF-I axis and on malnutrition-related disorders in this syndrome. Twenty patients with AN were divided into two groups; one (N = 13) was given rhGH (0.33 mg/day), and the other (N = 7) was given placebo for 6 or 12 months, respectively. During each treatment, levels of serum GH, plasma IGF-I, serum thyroid hormones, serum cholesterol, fasting plasma glucose and cardiac function were monitored. Changes in body mass index (BMI) and calorie taken were also evaluated. Plasma IGF-I level increased from 74.4 +/- 41.9 to 269.0 +/- 31.2 microg/L (P<0.001) during administration of rhGH, which associated with a decrease in serum GH level from 17.0 +/- 15.0 to 1.6 +/- 0.8 microg/L (P<0.001). Administration of rhGH increased BMI, body temperature, fasting plasma glucose level, and food intake. Serum level of triiodothyronine, but not thyroxine, increased during treatment with rhGH. The treatment decreased serum levels of both total and HDL-cholesterol. Studies with echocardiography showed an increase in cardiac output during the treatment with rhGH. These improvements were not observed in patients treated with placebo. Administration of rhGH is recommended as one of the methods of managing the patients with AN.

Long-term follow-up of patients with multiple endocrine neoplasia type 1.

Whether early surgical treatment of non-functioning pancreas islet cell tumor (NFPT) provides a favorable quality of life and life expectancy in patients with multiple endocrine neoplasia type 1 (MEN1) remains controversial. We analyzed the long-term clinical courses and surgical outcomes of 14 Japanese patients with MEN1-associated NFPTs. NFPTs smaller than 20 mm in diameter did not show any apparent growth over a long monitoring period. Furthermore, these small NFPTs did not metastasize to regional lymph nodes or the liver. On the other hand, the development of additional NFPTs or metastasis was found in five of six patients with large (35 mm or larger) NFPTs. Among the seven patients who underwent a partial pancreatectomy, six patients developed impaired glucose tolerance or diabetes. The accumulation of more prospective data is needed to clarify the optimal surgical indications for patients with NFPTs, especially among the Japanese population, which has a relatively low insulin secretion potency compared with non-Hispanic white and African-American populations.