Mapping the Japanese orthopedic association national registry (JOANR) to the international classification of health interventions (ICHI).

BACKGROUND: The Japanese Orthopedic Association launched the Japanese Orthopedic Association National Registry (JOANR), Japan's first large-scale nationwide musculoskeletal disease registry, in 2020. The World Health Organization released the International Classification of Health Interventions (ICHI) Beta-3 version in the same year. This concurrence served as an impetus to examine the relationship between domestic and international classification for orthopedic interventions. Our objective was to evaluate the possibility of utilizing JOANR for international comparison and the potential usage of ICHI in the domestic medical fee reimbursement system. This study is a novel attempt at mapping a domestic orthopedic scheme to the ICHI. METHODS: We mapped 149 codes out of 581 orthopedic surgical codes, on JOANR's registration form, to the ICHI, and then classified the nature of JOANR codes' relationship, to both ICHI single stem codes and stem codes accompanied by other additional stem codes, extension codes, and International Classification of Diseases for Mortality and Morbidity Statistics (ICD) codes, into five categories: Equivalent (exact match), Narrower (compared to ICHI; can be smoothly incorporated into ICHI), Broader (compared to ICHI), Slipped (combination of both Narrower and Broader), and None (no appropriate code). Finally, debatable issues that arose during the mapping operation were noted. RESULTS: The domestic codes' relationship to ICHI single stem code by category were Equivalent: 27 (18.1%) and Narrower: 65 (43.6%), respectively. Further, the rate of Equivalent rose to 120 (80.5%) on adding other stem codes, extension codes, and ICD codes. Additionally, certain domestic titles, which were unsuitable for classification as they included diagnostic information, and arthroscopic surgeries without corresponding ICHI codes, were recoded. CONCLUSIONS: JOANR can be converted to an international comparison standard via ICHI to a certain extent, and ICHI accompanied by ICD codes has potential for deployment in the domestic medical fee reimbursement system.

Disambiguation of psychotherapy: a search for meaning.

This analysis identifies the significant problem of ambiguity, variation and vagueness in relation to the intervention described as 'psychotherapy'. Its purpose is to raise international awareness of this problem and alternative solutions.

Unexpected source of Fukushima-derived radiocesium to the coastal ocean of Japan.

There are 440 operational nuclear reactors in the world, with approximately one-half situated along the coastline. This includes the Fukushima Dai-ichi Nuclear Power Plant (FDNPP), which experienced multiple reactor meltdowns in March 2011 followed by the release of radioactivity to the marine environment. While surface inputs to the ocean via atmospheric deposition and rivers are usually well monitored after a nuclear accident, no study has focused on subterranean pathways. During our study period, we found the highest cesium-137 (137Cs) levels (up to 23,000 Bq⋅m-3) outside of the FDNPP site not in the ocean, rivers, or potable groundwater, but in groundwater beneath sand beaches over tens of kilometers away from the FDNPP. Here, we present evidence of a previously unknown, ongoing source of Fukushima-derived 137Cs to the coastal ocean. We postulate that these beach sands were contaminated in 2011 through wave- and tide-driven exchange and sorption of highly radioactive Cs from seawater. Subsequent desorption of 137Cs and fluid exchange from the beach sands was quantified using naturally occurring radium isotopes. This estimated ocean 137Cs source (0.6 TBq⋅y-1) is of similar magnitude as the ongoing releases of 137Cs from the FDNPP site for 2013-2016, as well as the input of Fukushima-derived dissolved 137Cs via rivers. Although this ongoing source is not at present a public health issue for Japan, the release of Cs of this type and scale needs to be considered in nuclear power plant monitoring and scenarios involving future accidents.

[ICD-11, ICHI and SNOMED CT-What do the standards mean for eHealth applications?] / ICD-11, ICHI und SNOMED CT ­ was bedeuten die Systematiken für E­Health-Anwendungen?

BACKGROUND: Medical documentation is no longer used primarily for administrative processes or healthcare billing, but for the entire electronic health record with accompanying eHealth use cases. OBJECTIVES: It shall be examined to what extent classifications such as the International Statistical Classification of Diseases and Related Health Problems (ICD-11) and the International Classification of Health Interventions (ICHI), in comparison to the international reference terminology SNOMED CT, meet the requirements of current eHealth applications and ensure interoperability. MATERIALS AND METHODS: The strengths and weaknesses of ICD-11 and ICHI are highlighted in terms of literature, contextual mapping within the international patient summary, telemedicine applications and the use in IT standards, such as HL7 in comparison to SNOMED CT. RESULTS: The whole range of medical terminology is not covered by ICHI and ICD-10, but with SNOMED CT, because ICD-11 and ICHI may be used in strict limitations to annotate procedures and diagnosis. A sample value set (n = 30) shows high mapping equivalence in SNOMED CT. In the literature, ICD-11 to SNOMED CT mappings are described as complex and error-prone. CONCLUSIONS: In terms of content expressivity and international usability, the potential of SNOMED CT in eHealth applications can be considered more favorable than ICD-11 or ICHI, even considering the original scope of these classifications, diagnoses and procedures. ICHI may even be recommended for specific use cases (e. g. statistics).

Is a rehabilitation treatment taxonomy the right answer to the rehabilitation black box?

In this commentary on the development of an interventions taxonomy for medical rehabilitation, a rehabilitation treatment taxonomy (RTT), we acknowledge the authors' valuable contribution to rehabilitation science, and at the same time interrogate the assumption that a taxonomy has essential added value to address the challenge of rehabilitation's black box. The tripartite analytical structure of action of treatment, active ingredient, and mechanism of action, and not an RTT, is the key to addressing the rehabilitation black box. There is a need for clearly defined operationalized requirements of how the 3 components have to be expressed. We also recommend that this concerted effort be linked to all relevant stakeholders and all international endeavors that are pursuing a common goal of enhancing rehabilitation research.

Rehabilitation treatment taxonomy and the international classification of health interventions.

This commentary provides some reactions to the rehabilitation treatment taxonomy project in relation to work already underway to develop an International Classification of Health Interventions. This commentary also includes some comments in response to questions posed by the authors.

Linking Health Terminologies: A Unified Approach to the WHO Family of International Classifications.

This paper presents an effort by the World Health Organization (WHO) to integrate the reference classifications of the Family of International Classifications (ICD, ICF, and ICHI) into a unified digital framework. The integration was accomplished via an expanded Content Model and a single Foundation that hosts all entities from these classifications, allowing the traditional use cases of individual classifications to be retained while enhancing their combined use. The harmonized WHO-FIC Content Model and the unified Foundation has streamlined the content management, enhanced the web-based tool functionalities, and provided opportunities for linkage with external terminologies and ontologies. This integration promises reduced maintenance cost, seamless joint application, complete representation of health-related concepts while enabling better interoperability with other informatics infrastructures.

Comprehensive analysis of GINS subunit expression, prognostic value, and immune infiltration in clear cell renal cell carcinoma.

Background: In recent decades, there has been increasing evidence that Go-Ichi-Nii-San (GINS) subunits play an important role in the development and progression of various tumors. However, little research has been conducted on the role of GINS subunits in clear cell renal cell carcinoma (ccRCC). This study sought to explore the differential expression, prognosis, and immunological significance of GINS subunits in ccRCC. Methods: We used various analysis packages of R (version 3.6.3), the University of ALabama at Birmingham CANcer (UALCAN) data analysis portal, the Cancer Cell Line Encyclopedia (CCLE), the cBio Cancer Genomics Portal (cBioPortal), and the Tumor Immune Estimation Resource (TIMER) to study the gene expression, promoter methylation level, gene mutations, prognostic and diagnostic value, immune infiltration, pathway enrichment, and other aspects of the GINS subunits. Next, the genes related to the GINS subunits were analyzed using the STRING and GeneMANIA platforms, and the correlation between GINS subunits and the functions involved were investigated. Results: The expression level of GINS1/2/3/4 was significantly higher in ccRCC tumor tissues than normal tissues, and was significantly related to tumor grade and stage. The expression of GINS1/2/4 may be related to the methylation degree of the promoter region. The prognostic and diagnostic analyses showed that the increased expression of GINS1 was associated with various poor prognoses and had diagnostic value. The GINS subunit mutation also significantly affected the clinical prognosis of ccRCC patients. Finally, the correlation analysis of the immune infiltration level, co-expression, and enrichment of related genes indicated that GINS subunit expression was associated with different levels of ccRCC immune infiltration. Conclusions: The analysis results showed that the differential expression of GINS subunits in ccRCC, which had prognostic and diagnostic value, was correlated with clinicopathological stage, immune infiltration, and other related aspects. GINS1 may serve as a new potential prognostic biomarker for ccRCC patients and be used to guide treatment.

Temporal variation of tritium concentration in monthly precipitation collected at a Difficult-to-Return Zone in Namie Town, Fukushima Prefecture, Japan.

This article discusses tritium concentrations in monthly precipitation in part of the Difficult-to-Return Zone in Namie Town during 2012-2021. The tritium concentrations, which were measured with a low background liquid scintillation counter after carrying out an enrichment procedure, fluctuated seasonally from 0.10 ± 0.02 to 0.85 ± 0.02 Bq L-1. This range of concentrations is concluded to not be unusual based on comparisons with the concentrations at other sites and estimates of the past range of the concentrations. Moreover, no significant variations in observed tritium concentrations were observed due to decommissioning work at the Fukushima Dai-ichi Nuclear Power Plant. These results contribute to understanding the background level of tritium concentration in precipitation before the oceanic discharge of treated water from the Fukushima plant. In addition, this article evaluates the amount of tritium supplied to the ocean by terrestrial rainwater pouring into the Pacific Ocean via Ukedo River, which flows through Namie Town; this information will contribute to the discussion on the impact of the oceanic discharge of treated water.

The ICHI-FIXATOR® system, a novel wire-connected external fixator, demonstrates efficacy in managing intra-articular fractures involving the proximal phalanx of the big toe.

Proximal phalanx fractures of the big toe involving angulation or dislocation of the articular surface require repositioning and fixation. We treated a patient with such a fracture using a novel wire-connected external fixator, the ICHI-FIXATOR® system. A 45-year-old male sustained an injury when slipping down the stairs and impacting his left big toe. Plain radiography and computed tomography revealed a proximal phalangeal fracture of the left big toe with dislocation of the articular surface and comminution. The surgical intervention was performed using 1.1-mm diameter C-wires and an external fixator. The patient regained ambulation and resumed work immediately after surgery. Four weeks postoperatively, all wires were removed on an outpatient basis. Eight months postoperatively, the patient experienced no pain during strenuous activities or exercises. This novel wire-connected external fixator provides reliable and secure fixation, facilitating a prompt return to normal daily activities. This technique may be an effective option for managing toe fractures.

Continuous southwestward spread of Fukushima-derived 137Cs in the subtropical western North Pacific and its intrusion flux into the South China Sea.

We provide transect profiles of 137Cs and 90Sr along 146.5°E, 136°E and 21°N in the subtropical western North Pacific (WNP) during May 2018. Exploiting the constant global fallout 137Cs/90Sr ratio, we separated Fukushima-derived 137Cs (137CsF) from background 137Cs. At most stations, 137CsF exhibited only one subsurface peak at 300 m depth, corresponding to subtropical mode water (STMW); however, at 25-28°N along 146.5°E and 25-26°N along 136°E, 137CsF exhibited two subsurface peaks, with another peak occurring at 500 m depth, corresponding to lighter central mode water (L-CMW). Temporal changes in 137CsF vertical profiles showed that 137CsF entrained by STMW has recirculated within the western subtropical gyre, while 137CsF entrained by L-CMW has turned southwestward and arrived the western basin in 2018. In the Luzon Strait, the entrance to the South China Sea (SCS), subsurface 137Cs increased since 2013 and peaked in approximately 2018. The estimated amount of 137CsF entering the SCS during 2013-2019 was 0.33 ± 0.10 PBq, equivalent to 1.7-2.2% of total leakage of 137CsF into the ocean. These results enhance our understanding of the protracted spread and fate of 137CsF in the subtropical WNP.

Spatial distributions of and species differences in 90Sr accumulation in marine fishes from the Fukushima coastal region.

Large amounts of radionuclides were released into the ocean during the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident. One of the released radionuclides, 90Sr, tends to accumulate in bone, and could conceivably have long-term negative impacts on fishes. Here, we investigated 90Sr radioactivity concentrations in the vertebrae of demersal fishes collected off the coast of Fukushima Prefecture in January and July 2014. High 90Sr radioactivity concentrations were detected in fish collected from central Fukushima (offshore of the FDNPP) and southern Fukushima (offshore of Iwaki City), but were almost hardly detected in northern Fukushima (offshore of Soma City). Additionally, 90Sr radioactivity concentrations were higher among rays (Okamejei kenojei and Hemitrygon akajei: from 1.1 ± 0.5 to 103.3 ± 15.1 mBq/g Ca) and soles (Cynoglossus joyneri and Paraplagusia japonica: from 18.5 ± 2.8 to 52.8 ± 11.3 mBq/g Ca) than among other species. Vertebral stable Sr/Ca ratios also differed by fish species. Ca concentrations were relatively constant among species, but Sr concentrations were higher among elasmobranchs and soles, indicating that differences in Sr/Ca might be related to differences in 90Sr accumulation in fish vertebrae.

Origin and pathway of a subsurface maximum of 137Cs detected in the winter of 2012 after the Fukushima accident.

This study investigates the dispersion behavior of 137Cs and evaluates its origin (atmospheric deposition or direct ocean release) from the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident using a Lagrangian particle tracking model. The ocean circulation fields based on the Modular Ocean Model Version 5 (MOM5) were adopted for the simulation. The MOM5 results represented the formation and migration of subtropical mode water (STMW) comparable with observations and reanalysis data. Particularly, anticyclonic eddies south of the Kuroshio extension promoted surface mixing over 300 m in the cooling season. The particle tracking simulation reproduced well the maximum subsurface activity between 142 and 146°E, where STMW is deep owing to anticyclonic eddies, compared to the activity found via measurements conducted around 149°E in the winter of 2012. It also demonstrated that the 137Cs of the tropical and subtropical regions (10-35°N, 142-146°E) in the winter of 2012 almost entirely originated from atmospheric deposition.

The Public Health Value of Coding Surgery in South Africa Using the International Classification of Health Interventions.

BACKGROUND: The lack of a national intervention coding system and the current intervention coding in South Africa through the use of multiple billing and coding systems does not support quality intervention data collection and patient outcomes reporting for general surgery. This presents difficulties in the understanding of the different types of general surgical interventions performed in hospitals, the associated resources, risks, complications, outcomes reporting, public healthcare delivery, and determination of barriers to care. This study illustrates the use of accurate data on health interventions in South Africa's acute care general surgery coding to assist in improved resource allocation, using the new WHO International Classification of Health Interventions (ICHI). ICHI has over 8000 codes and consists of three axes: Target (the entity on which the Action is carried out), Action (a deed performed by an actor to a target), and Means (the processes and methods by which the Action is carried out). A key benefit of ICHI is that it can be used collectively with the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF). OBJECTIVES: to evaluate the suitability of ICHI for general surgery interventions by coding intervention descriptions to ICHI codes; to identify gaps in the ICHI system; and to provide a rationale for ICHI to be a nationally regulated system. METHODS: This study adopted a retrospective, descriptive design; in total, 3000 in-patient intervention data files, captured in an electronic database from April 2013 to August 2019 at three academic hospitals in Johannesburg, were extracted randomly, and coded using ICHI. Quantitative data analysis techniques were utilized to assess the overall degree of match between ICHI codes and the intervention descriptions. RESULTS: Of the 3000 patient case entries that were coded, there was an agreement of 67.6% of the coded data amongst the three coders, leaving a variability of 32.4%. The variability was largely due to the coders' experience and the quality of healthcare documentation. CONCLUSIONS: ICHI has the ability to cater for the broad range of general surgery interventions, thus indicating that ICHI is suitable for general surgery coding.

Soil dust and bioaerosols as potential sources for resuspended 137Cs occurring near the Fukushima Dai-ichi nuclear power plant.

One of the current pathways to radiation exposure, caused by the radionuclides discharged during the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident, is the inhalation of resuspended 137Cs present in the air. Although wind-induced soil particle resuspension is recognized as a primary resuspension mechanism, studies regarding the aftermath of the FDNPP accident have suggested that bioaerosols can also be a potential source of atmospheric 137Cs in rural areas, although the quantitative impact on the atmospheric 137Cs concentration is still largely unknown. We propose a model for simulating the 137Cs resuspension as soil particles and bioaerosols in the form of fungal spores, which are regarded as a potential candidate for the source of 137Cs-bearing bioaerosol emission into the air. We apply the model to the difficult-to-return zone (DRZ) near the FDNPP to characterize the relative importance of the two resuspension mechanisms. Our model calculations show that soil particle resuspension is responsible for the surface-air 137Cs observed during winter-spring but could not account for the higher 137Cs concentrations observed in summer-autumn. Higher 137Cs concentrations are reproduced by the emission of 137Cs-bearing bioaerosols (fungal spores) that replenishes the low-level soil particle resuspension in summer-autumn. Our model results show that the accumulation of 137Cs in fungal spores and large emissions of spores characteristic of the rural environment are likely responsible for the presence of biogenic 137Cs in the air, although the former must be experimentally validated. These findings provide vital information for the assessment of the atmospheric 137Cs concentration in the DRZ, as applying the resuspension factor (m-1) from urban areas, where soil particle resuspension would dominate, can lead to a biased estimate of the surface-air 137Cs concentration. Moreover, the influence of bioaerosol 137Cs on the atmospheric 137Cs concentration would last longer, because undecontaminated forests commonly exist within the DRZ.

Simulated inventory and distribution of 137Cs released from multiple sources in the global ocean.

Radioactive cesium (137Cs) is distributed in the world's oceans as a result of global fallout from atmospheric nuclear weapons tests, releases from fuel reprocessing plants, and inputs from nuclear power plant accident. In order to detect future radionuclide contamination, it is necessary to establish a baseline global distribution of radionuclides such as 137Cs and to understand the ocean transport processes that lead to that distribution. In order to aid in the interpretation of the observed database, we have conducted a suite of simulations of the distribution of 137Cs using a global ocean general circulation model (OGCM). Simulated 137Cs radioactivity concentrations agree well with observations, and the results were used to estimate the changes in inventories for each ocean basin. 137Cs activity concentration from atmospheric nuclear weapons tests are expected to be detectable in the world ocean until at least 2030.

Local atmospheric transport behaviors of representative radionuclides during the Fukushima accident: A 200-m-resolution cross-scale study from site to 20 km.

Modeling of local atmospheric radionuclide transport is essential for nuclear emergency response. However, very few studies of the Fukushima Dai-ichi nuclear power plant (FDNPP) accident have focused on this topic because of the complex meteorology and the cross-scale transport behaviors from the site to 20 km of the FDNPP. In this study, both the local meteorology and transport behaviors were investigated at high resolution (200 m) using ensembles of different meteorology and models. Four wind fields calculated from onsite observations and three regional-scale meteorological fields (i.e., the 1-km ECMWF, 3-km and 1-km NHM-LETKF), and two transport models: the RIMPUFF Lagrangian puff model and the SPRAY particle model were considered and combined with each other. These eight simulations and their ensemble mean were analyzed based on onsite observations of wind and gamma dose rates, and local-scale observations of 137Cs concentration. Results revealed that at the site, the Onsite wind field which captured the frequently changing wind, best reproduced the onsite gamma dose rates with the grid resolution of 200 m. At the local scale (up to 20 km), the observations present a smoother temporal change. The wind fields assimilated with Japanese domestic observations presented advantageous performance, and the 1-km NHM-LETKF achieved the best score of the factor of 5 metric of 0.49 for the simulated 137Cs concentration. The SPRAY coupled with the three-dimensional (3D) convolution method and RIMPUFF showed better performance in simulating the onsite gamma dose rate and the local-scale concentration, respectively. The ensemble mean achieved robust metrics, better simulated the baseline of onsite gamma dose rates, and reproduced more peaks of local-scale concentration at the expense of peak value deviation.

Mapping 3 procedure coding systems to the International Classification of Health Interventions (ICHI): coverage and challenges.

OBJECTIVE: To study the coverage and challenges in mapping 3 national and international procedure coding systems to the International Classification of Health Interventions (ICHI). MATERIALS AND METHODS: We identified 300 commonly used codes each from SNOMED CT, ICD-10-PCS, and CCI (Canadian Classification of Health Interventions) and mapped them to ICHI. We evaluated the level of match at the ICHI stem code and Foundation Component levels. We used postcoordination (modification of existing codes by adding other codes) to improve matching. Failure analysis was done for cases where full representation was not achieved. We noted and categorized potential problems that we encountered in ICHI, which could affect the accuracy and consistency of mapping. RESULTS: Overall, among the 900 codes from the 3 sources, 286 (31.8%) had full match with ICHI stem codes, 222 (24.7%) had full match with Foundation entities, and 231 (25.7%) had full match with postcoordination. 143 codes (15.9%) could only be partially represented even with postcoordination. A small number of SNOMED CT and ICD-10-PCS codes (18 codes, 2% of total), could not be mapped because the source codes were underspecified. We noted 4 categories of problems in ICHI-redundancy, missing elements, modeling issues, and naming issues. CONCLUSION: Using the full range of mapping options, at least three-quarters of the commonly used codes in each source system achieved a full match. For the purpose of international statistical reporting, full matching may not be an essential requirement. However, problems in ICHI that could result in suboptimal maps should be addressed.

Go-Ichi-Ni-San 2: A potential biomarker and therapeutic target in human cancers.

Cancer incidence and mortality are increasing globally, leading to its rising status as a leading cause of death. The Go-Ichi-Ni-San (GINS) complex plays a crucial role in DNA replication and the cell cycle. The GINS complex consists of four subunits encoded by the GINS1, GINS2, GINS3, and GINS4 genes. Recent findings have shown that GINS2 expression is upregulated in many diseases, particularly tumors. For example, increased GINS2 expression has been found in cervical cancer, gastric adenocarcinoma, glioma, non-small cell lung cancer, and pancreatic cancer. It correlates with the clinicopathological characteristics of the tumors. In addition, high GINS2 expression plays a pro-carcinogenic role in tumor development by promoting tumor cell proliferation and migration, inhibiting tumor cell apoptosis, and blocking the cell cycle. This review describes the upregulation of GINS2 expression in most human tumors and the pathway of GINS2 in tumor development. GINS2 may serve as a new marker for tumor diagnosis and a new biological target for therapy.

Fukushima-derived radiocesium in the waters of the Northwest Pacific Ocean in the winter of 2011.

To understand the transport of Fukushima Dai-ichi Nuclear Power Plant Accident (FDNPPA)-derived nuclear contaminated water, which will be discharged into the Pacific Ocean in the future, the distributions of 134Cs and 137Cs in seawater in the public areas east of Japan in winter 2011 were reported in this study. The ranges of 134Cs and 137Cs activities were