The purpose of this study was to investigate the effects of different neck postures on the oral and pharyngeal stages of swallowing dynamics using non-invasive methods. Twenty-two healthy young adults were recruited as subjects, and four different neck postures were tested. The subjects swallowed 8 mL of water while electromyography (EMG) activity was recorded from the supraspinatus and orbicularis oris muscles using surface EMG. The time of the oral stage, EMG action potentials, and visual analogue scale scores were collected as outcomes. The results suggest that the flexed position suppresses the activity of swallowing-related muscles during the pharyngeal stage, on the other hand, it takes more time for the water to be pumped into the pharynx during the oral stage. The results also suggest the usefulness of using EMG to analyze the time from the start of orbicularis oculi muscle activity to the start of suprahyoid muscle activity as an indicator of the oral stage.

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　The number of patients with dementia is increasing worldwide and there is a need to improve the efficiency of cognitive function assessment to assist healthcare professionals in the screening process. We investigated the screening performance for cognitive severity by applying machine learning to a clock-drawing test. The 77 elderly subjects were assigned to the dementia group (COG), the mild cognitive impairment group (MCI), and the healthy group (HC). Clock drawing test was measured for 14 drawing features with or without anomalies as a binary score. A discriminant model was constructed using a pairwise method with a support vector machine. We also investigated the drawing features that contribute to the discrimination, using the feature importance of random forests. The classification accuracy was 70% for the COG versus MCI, 76% for the COG versus HC, and 56% for the MCI versus HC. In addition, for COG versus MCI and COG versus HC classification, five or three features were selected, including hand misrepresentation, long and short hand reversal, and deficit in the spatial layout of numbers, respectively. These drawing features could contribute to efficient primary screening for dementia.

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　Aim: The aim is to examine the reliability and validity of the visual assessment of temporal wasting as an assessment method of muscle wasting in the older adults. Methods: The participants were 73 individuals aged 65 or older. Kappa coefficient was used to measure the inter-rater reliability of the two examiners independently performing the visual assessment of temporal wasting. Discriminant validity was evaluated by comparing the indicators of muscle mass across the three groups of severe, mild or no temporal wasting. Known-group validity was assessed by comparing the temporal muscle thicknesses between the three groups. Results: The kappa coefficient was 0.594 for the agreement of the two examiners visually assessing temporal wasting. Participants with severe or mild temporal wasting had significantly lower levels of arm muscle circumference and calf circumferences than participants with no temporal wasting. Temporal muscle thickness was significantly lower in participants with severe temporal wasting compared to those with mild or no temporal wasting. Conclusions: In visually assessing temporal wasting, we have confirmed a moderate degree of interrater reliability, and discriminant and known-group validity.

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Purpose: The purpose of this study was to train a machine learning model on dynamic changes in photoplethysmography and verify whether it is possible to classify between a mental stress state and a resting state. Methods: Fingertip plethysmography was measured in 20 healthy subjects at rest for 5 minutes and during a 10-minutes Color Word Conflict Test at a sampling frequency of 1024Hz. Fingertip photoplethysmography data were trained on the Elastic Net model to evaluate classification performance at rest and during mental stress states. Results: Significant changes were observed in Root Mean Square of Successive Differences, High-frequency component, d/a, pulse rate, pulse interval, entropy, systolic and diastolic blood pressure at rest and during mental stress states（p < 0.05）. The classification performance of the Elastic Net model was as follows: precision rate: 0.93, recall rate: 0.70, F1 score: 0.80, accuracy rate: 0.77, Area Under the Curve: 0.78. Conclusion: The machine learning of fingertip plethysmography suggested the possibility of noninvasive and objective evaluation of an individual′s mental stress states.

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　In this study, we developed a system designed to evaluate and train midwives′ ability to predict possible dangers in midwifery procedures before and after childbirth. Using a virtual reality headset, a 3D-computer graphics generated delivery room can be accessed. This approach provides a simulated learning experience where actions to be taken at potentially hazardous points can be chosen by the user. To generate a realistic virtual delivery room, the system displays exclusive instruments using 3D scan data and characters representing pregnant and parturient women by using 3D scan data to construct a model. The position of the user′s eyes is measured continuously. When the user′s viewpoint in the scenario reaches a dangerous point in the procedure, a question board appears to allow the user to select an appropriate counterplan. Fourteen midwives and eighteen midwifery students used the system and then evaluated the virtual delivery room and the counterplan choices in response to the designated danger points. We found that more than 80% of the subjects evaluated the virtual delivery room as being similar to a real one, and more than 90% of the subjects evaluated that they were able to make counterplan choices for the gaze positions.

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　This study aimed to develop a delivery simulator using a delivery assistance model, to examine sensor attachment sites and to examine methods of measuring the pressure and shear force applied to the perineum during perineal protection using the developed system. First, a manually operated infant head delivery device was set in a commercially available delivery assistance model to which a motor was attached to automate the timing from the engagement of the infant head to delivery. Assuming a first-time mother, the total operating time was set to 162.8 seconds to allow for delivery within three labor cycles from the onset of head engagement. Next, experiments were conducted using two methods: one was to directly measure hand movements using a force sensor attached to the center of the palm, and the other was to measure the pressure and shear force applied to the perineum using a sensor attached to the perineum of the delivery assistance model. The characteristics of the pressure and shear force transitions for both were similar. However, sensor position deviation occurred when the delivery assistance model was attached to the perineum. It is possible to measure the pressure and shear force applied to the perineum over time during perineal protection using a delivery simulator for perineal protection with a sensor attached to the center of the palm.

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Objective: The aim of this study was to clarify the effects of adding a back cushion to the pillow under the head of patients by measuring movement and psychological stress in patients while they are being transported by stretcher. Methods: Eighteen healthy adults were included in the study. They were transported along a designated route using three types of head supports (Group A: no pillow, Group B: pillow with head and neck fixation, and Group C: pillow with a rectangular cushion placed under the back), and the angular velocity of the patients′ heads and their psychological stress while being transported were measured. Results: The angular velocity of the head decreased significantly along the X and Y axes from Groups A to C. Additionally, anxiety and tension while being transported were lower in Groups B and C than in Group A. Conclusion: The addition of a back cushion to patients′ pillows while being transported by stretcher may potentially reduce left-right movements of patients′ heads during transportation.

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　In Japan, with the legalization of airway suctioning by caregivers and others, not only doctors and nurses but also caregivers need to acquire suctioning skills. Since airway suctioning is a medical practice involving invasive procedures, studies have reported on the safety and acquisition of suctioning skills. However, the relationship between the movement of the suction catheter tip in the airway and suctioning techniques remain unclear. Clarification of the differences in the suction technique between experienced and inexperienced, such as the movement of the tip of the suction catheter, may improve objectification of the suction technique. Therefore, we modified an existing suction simulator and constructed an experimental system capable of capturing moving images of the airway in two directions. In this report, analysis of the recorded video showed that the mean catheter insertion time from tracheal orifice to tracheal bifurcation was 9.53 seconds for inexperienced and 6.55 seconds for experienced, with inexperienced taking more time than experienced. The results indicate that when teaching inexperienced, care should be taken to avoid catheter insertion time and catheter snagging.

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Objective: This study aims to elucidate a method which reduces the physical burden on nurses assisting older patients removing and putting on lower garments when toileting using bedside commodes. Methods: Using a modified Delphi method, we gathered and summarized expert opinions from five nurses with 10 or more years of clinical experience capable of instructing others on how to assist patients with bedside commodes, as well as one physical therapist and one occupational therapist whom any of the nurses deemed exceptional. The consensus standard was set as a median of 7 or higher on a nine-point Likert scale. Results: Consensus was reached with median scores of 8 to 9 for a method of assisting patients in removing lower garments once seated on the toilet involving five elements and nineteen processes, and a method of assisting patients in putting on lower garments by rolling up the garments with the patient seated and then pulling them up with the patient standing involving five elements and seventeen processes. Conclusions: The methods for providing assistance with lower garments presented in this study may aid nurses who help patients with bedside commodes to find more comfortable assistance methods and serve as proposals for nursing skills.

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　In Japan, many hospitals are facing a shortage of nurses due to the declining birthrate and aging population, and thus it is necessary for them to improve operational efficiency based on objective data such as nursing workload and the movement lines of nurses. In this paper, we utilize an unattended time and motion study with Bluetooth low energy (BLE) beacons and mobile devices, which is low cost, imposes a low burden on nurses, and can be conducted over a long term. Our goal is to construct a software framework designed to estimate the movement lines of nurses based on the received signal strength indicator (RSSI) series obtained from the study and to visualize them as videos. We propose a simple method for estimating movement lines without using supervised machine learning, making it a practical solution for large hospitals with numerous wards. Moreover, we develop software to visualize each nurse′s estimated movement lines as videos using Data-Driven Document (D3) module. We validate our proposed framework with an unattended time and motion study conducted in one ward of a large acute care hospital, demonstrating its ability to capture each nurse′s movement lines throughout the entire ward in detail.

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　Shoes with 2-3 cm heels are recommended for pregnant women; however, there are few studies on the actual conditions and effects of wearing such shoes on posture and gait. This study aims to compare the posture, gait, and lumbar strain if wearing shoes with 1, 3, and 5 cm heels, meaning the difference between the heel height and forefoot storm height (thickness of the toe portion), on simulated pregnant women wearing a pregnancy simulation jacket and determine the effects of wearing such shoes. Fifteen simulated pregnant women have been analyzed. The results showed that the simulated pregnant women′s posture was leaning more backward than that of the non-pregnant women; however, the heel height did not change this. Simulated pregnant women, like non-pregnant women, had shorter strides and slower walking speeds with higher heels. In non-pregnant women, lumbar strain did not change with heel height, whereas in simulated pregnant women, lumbar strain was enhanced with a heel height of 5 cm. Therefore, it is not recommended that pregnant women wear shoes with 5 cm heels, as this may increase the muscle load on the lower back.

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　Interpretations of urine test strips are typically determined by visually comparing urine test strips to a color chart, leading to different interpretations among individuals. The purpose of this study was to improve the accuracy of the urine qualitative evaluation program by improving the reproducibility of the results and reducing the evaluator′s subjective influence. An automated urine test strip colorimetric program had been previously developed using Python as an objective evaluation method for urine test strips. The current study optimized and standardized the camera shooting environment; color temperature, lighting, contrast, urine test strip use timing, and feature detection. Accelerated KAZE was used for image feature point extraction processing. The imaging environment was adjusted so that elements such as the color temperature, contrast, and gamma value could be compared under the same camera settings by simultaneously imaging the urinalysis test strip and the color chart. Negative judgments, which are normal values, were consistent with the results of the automatic urine analyzer for all items. Outlier positive results were consistent, except for the occult blood item. Urine test strip interpretation accuracy improved, compared to previously published automated urine test strip colorimetric program methods, by using accelerated KAZE and adjusting the photography environment.

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OBJECTIVE: Behavioural restrictions due to the coronavirus disease 2019 pandemic have significantly impacted the mental health of people living alone. This study aims to improve the mental health of adults living alone by investigating the stress-reducing effects of two types of socially assistive robots (SARs), humanoids and animaloids, on healthy adults living alone. METHODS: The participants used humanoids and animaloids for nine days, and the stress indices were compared between day 1-2 and 8-9. High frequency (HF), indicating parasympathetic activity, and low frequency (LF)/HF, indicating sympathetic activity, were used for objective stress indicators. Total mood disturbance (TMD) was used for subjective stress indicators. These were compared in paired t-tests. A p-value of <0.1 indicated a significant trend. RESULTS: On days 8-9, the animaloids interventions showed a tendency for a higher HF than days 1-2 between 8 p.m. and 12 a.m. (p=0.07). TMD showed no significant differences or trends for either humanoids or amimaloids. CONCLUSION: HF was increased by using the animaloids for nine days, suggesting that the animaloids had an objective stress reduction effect; SARs are easy to incorporate into daily life and can help improve the mental health of people who live alone.

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　This study was conducted to investigate the applicability of a noninvasive, simple sampling method for wound exudates by using swabs for amino acid analysis. A full-thickness wound was created in two rats: one rat was treated with silver sulfadiazine cream and an occlusive wound dressing from Day 1 post-wounding whereas the other rat was treated with only an occlusive wound dressing. Swabs were collected daily, before and after wound cleansing, until Day 4 postwounding. Sixteen amino acids in the wound exudate were measured using high-performance liquid chromatography. The relative abundance of amino acids, which is the ratio of each amino acid to the total amino acid content, was used in the analysis. As a results, under the same wound conditions, there was a positive correlation in the relative abundance of amino acids between pre- and post-cleansing samples (p> 0.90, p< 0.01). The relative abundance of amino acids varied between the post-cleansing- and pre-cleansing samples the next day, and the inter-sample differences depended on the intervention. Therefore, this method may be able to detect changes in the relative abundance of amino acids in wound exudates and be used to assess the wound condition.

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　This study aimed to evaluate user acceptance of a Japan-adjusted home-care-based Pressure Injury Treatment Support prototyping mobile application (PITS-pa) developed by an industry. PITS-pa has the following features: wound photo taking, wound assessment, data entry of therapeutic plan/comments, display of products formulary for topical agent/dressing selection, and sharing of information between healthcare professionals. After applying PITS-pa to an individual with pressure injury for 24 weeks at a home setting, a physician (wound care specialist who worked at homebased care) qualitatively assessed the tool′s user acceptance. One possible advantage of PITS-pa is the simplicity of wound assessment. Its disadvantages were inconvenience in product recommendation features, too many input data, too much time needed in using multiple applications for similar purposes, and not the latest wound assessment tool applied. In addition, access to the advice of pressure injury treatment specialists needs to be improved. In conclusion, more revision of PITS-pa and strategic planning for the adaptation are required to enhance its user acceptance by clinical wound specialists at home-based care settings.

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[in Japanese]

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[in Japanese]

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BACKGROUND: Early detection of peripheral intravenous catheter (PIVC) complications in neonates is vital. This study aimed to examine the possibility of ultrasonography detection of PIVC complications in neonates and observe the subcutaneous tissue immediately after PIVC removal using ultrasonography. METHODS: Neonates with implanted PIVCs were included. The subcutaneous tissue at the catheter insertion and opposite sides were observed immediately after, and 24 hours after PIVC removal in eight neonates for 10 insertions. The subcutaneous edema was categorized as mild, moderate, or severe after ultrasonography. RESULTS: All PIVCs, as well as the tissue on the opposite side, had more than mild subcutaneous edema. Moderate and severe subcutaneous edema were found in one PIVC respectively. The vessel walls were unclear on the insertion sites of all the PIVCs. Thrombus was observed in three PIVCs. DISCUSSION: Using ultrasonography, we detected subcutaneous edema, thrombus, and vessel wall in the neonate. Additionally, it can be suggested that mild subcutaneous edema is normal in neonates; furthermore, the shape of the vessel wall may have become less clear with PIVC puncture and implantation.

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