Objective: The purpose of this study was to examine the effects of the interoperability of breast cancer screening facilities located in different local governmental jurisdictions. Methods: The 53 regions in Tokyo, with exception of the islands, were included in this study. Demographic data on women over the age of 40 years living in each city block on January 1, 2009, were derived from the Basic Resident Register, which also provided the name and address of the facilities at which screening for breast cancer were conducted in 2009. We measure three primary dependent variables: 1) the distance from residence to the nearest screening facility, 2) differences in the distance to the screening facility among subjects, and 3) the geographic distribution of subjects. We defined the point of residence as centroid of each city block, and the distance from each participant's residence to the nearest cancer screening facility was defined as the linear distance from the relevant centroid to the nearest screening facility. The Gini coefficient of the distances from residences to facilities was used as the criterion for evaluations of the degree to which such distances were equal for subjects. The Gini coefficient and the standard deviation of the number of subjects nearest to the screening facility were used to measure the geographical unevenness of the distribution of subjects. The results revealed two patterns: 1) subjects who received breast cancer screening at the facility specified by their local government (pattern A), and 2) subjects who received interoperable breast cancer screening services at the nearest facility, which was located within the jurisdiction of another local government (pattern B). We analyzed the differences between these two patterns in terms of the three primary dependent variables using geographic information system (GIS) software ArcGIS version 9.3 (ESRI Inc., Redlands, CA). Results and Discussion: Nearly one-quarter of the subjects (24.2%) lived farther from their local screening facility (2,908 m, pattern A) than from a facility in another jurisdiction (1,640.5 m, pattern B). Thus, the average distance to the nearest facility was reduced by 307.4 m per person when calculations were not confined by jurisdictional boundaries. The Gini coefficient indicated that the equality of the distance was 0.383 among subjects following pattern A and 0.363 among those following pattern B. No statistically significant differences were observed in Gini coefficient or standard deviation. Conclusion: When residents of Tokyo (excluding the islands) receive interoperable screening services for breast cancer at the nearest facility, irrespective of jurisdictional boundaries, the distance from residences to screening facilities may be reduced, and the inequality in the distance to these facilities from subject's residences dose not increase.

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 Authors have developed the EDC (Electronic Data Capture) system for a post-marketing study of contrast medium in which both of patients' information and computerized tomography images (CT images) of DICOM (Digital Imaging and Communications in Medicine) standard can be collected and managed. The flow of CT images in the EDC system was as follows. The investigators transmitted CT images from each institutions to doctors at Kagawa University Hospital (image supervisory office) through the telemedicine network system (K–MIX) which combined EDC system. Private information of the patients on the DICOM tag data of CT images were masked by doctors at image supervisory office, then the CT images were uploaded to the data server of EDC system. And the CT images were downloaded from the data server by pharmaceutical industry, and used in a central review for the efficacy evaluation of the contrast medium.
 The newly developed EDC system for this study is enable collection of CT images combined with the patients' information and integrative management of two types of data under the condition that both of security and authenticity of the data could be maintained, and also it is indicated that those collecting data can be used efficiently for the efficacy evaluation in a post-marketing study. Moreover, we thought that the EDC system will be a model case of collection method of image data for incidental utilization in a post-marketing study.

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 Objective: This study evaluated a Web-based expert system for training junior residents in differential diagnosis using a Web site usability questionnaire scale (WUS) method.
 Method: The Web-based expert system for training junior residents in differential diagnosis of the Japanese Organization for Quality Health Care was evaluated. The estimators were physicians with more than 3 years of clinical experience. Two evaluation figures were used to simulate eight symptoms and signs (chronic cough, nausea and vomiting, headache, sleep disturbance, vertigo, lymphadenopathy, abdominal pain, and hypertension): 1) to compare it with the results of other WUS; 2) to validate the degree to which it helped junior residents to learn differential diagnosis. We evaluated WUS and visual analogue scales (VAS) designed to evaluate the differential-diagnosis-specific learning support function. A mailed, self-administered anonymous questionnaire method was used. Statistical analysis was performed with SPSS (IBM, Armonk, NY) and R ver. 2.13.0.
 Results: 1) The WUS scores of “Favorite” and “Useful” (p<0.01) and “Operability” and “Viewable” (p<0.05) were significantly lower than for Web sites reported in a paper on WUS development. 2) For the VAS of “chronic cough”, a significant difference between “attending physicians and senior residents” and “attending physicians and other physicians” was seen (p<0.05).
 Discussion: The lower WUS might have been caused by an insufficient explanation of the use of Web applications with the mailed, self-administered, anonymous questionnaire method used.
 Conclusion: WUS was useful for evaluating the Web-based expert system for training in differential diagnosis. Usability evaluation methods might also identify design challenges involving Web-based expert systems.

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 The present study was designed to clarify relationship between body functions and life domain of 182 patients in Japanese residential institutions for children with physical disabilities. The survey comprised 11 items indicative of activities and participation from the International Classification of Functioning, Disability and Health (ICF). To test associations, the Spearman rank correlation was used. Spearman rank correlation coefficients suggested that motor and intellectual impairments were strongly or moderately associated with most of the activities and participation items and the relationship of intellectual impairments was greater than that of motor impairments. In addition to motor and intellectual functions, contextual factors such as physical environment and human support seem to play an important role in facilitation of activities and participation.

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