The accident at the Tokyo Electric Power Company (TEPCO) Fukushima Daiichi nuclear power plant on March 11, 2011, released a large amount of radioactive materials resulting in the radioactive contamination of a wide area of eastern Japan. Residents of the Fukushima prefecture experienced various unavoidable damages and fear of radiation effects on their health. A reliable communication of accurate risk assessment for residents is required as a countermeasure aimed at the reconstruction of Fukushima. Here, the current status of individual dose estimation and the issues relating to the radiation risk perception are discussed.
Research into environmental dynamics of radioactive nuclides released by the Fukushima nuclear accident, especially radiocesium 137Cs (half-life, 30.1 years), is highly focused especially on diffusion processes of radiocesium into ecosystems, which is high-priority knowledge. Because of relatively sparse knowledge about the reallocation of radiocesium contained in organic matter in terrestrial ecosystems, the effects of diffused rediocesium into ecosystem cannot be accurately estimated. In this article, the terrestrial environmental dynamics of radiocesium mainly in the processes of plant uptake and the possibility of release from plants will be discussed. Plants uptake minerals from soil and these minerals are likewise ingested by animals that feed on plants, including humans. Therefore one of the main gateways of radiocesium into ecosystem is via plants. From the viewpoint of human dietary consumption, rice contamination with radiocesium has been energetically investigated and useful data are accumulating. Processes of radiocesium uptake mechanisms by plants are being researched using legumes, e.g. soybean. Speculation on the possibility of radiocesium release into forest atmosphere via plant activity will be introduced.
Before the Fukushima Nuclear Power Plant 1 (FNPP1) accident, environmental 137Cs was already detectable originating from nuclear weapon tests conducted in the late 1950s and early 1960s. In the western North Pacific Ocean, 90Sr and 137Cs activities in surface water were 10-100 Bqm−3 in the late 1950s and early 1960s, then this parameter decreased gradually; 137Cs activity in surface water subsequently decreased to around a few Bq m−3. After the FNPP1 accident, 137Cs and 134Cs were released into the North Pacific Ocean by two pathways, direct discharge from the Fukushima NPP1 accident site and atmospheric deposition off Honshu Islands of Japan, east and northeast of the site. High-density observations of 137Cs and 134Cs in the surface water were carried out by 17 VOS cruises and several research vessel cruises between April 2011 and March 2012. The main body of radioactive surface plume of which activity exceeded 10 Bqm−3 traveled along 40°N, and reached the International Date Line in March 2012, 1 year after the accident. The radioactive plume was confined along 40°N when the plume reached the International Date Line. Zonal speed of the radioactive plume was estimated to be about 8 cm s−1, which is consistent with zonal speeds derived by Argo floats at the region.
Since the Fukushima nuclear plant accident following the great East Japan earthquake on March 11, 2011, we have been warned to be careful about possible radiation exposure almost every day in newspapers and on TV. Radioactive iodine (131I) and cesium (134Cs, 137Cs) produced by nuclear reactions were released into the air during and after the accident, and have been scattered by the winds in Tohoku and in the Kanto district. Even today, 2 years after the accident, there is great public concern about possible pollution of foodstuffs and fishery products with radioactive cesium, not only in Japan, but also in other countries. On the other hand, decontamination work has been proceeding, including removal of contaminated soil near the accident site. Since the accident, many media reports have continued to tell us only that current dose levels of radiation are not dangerous to human health. But, many people are not satisfied with such vague statements, and want to understand the situation in more detail. So, it is important to provide basic education about the effects of radiation to the general public. I am a professor of the Department of Radiation Biosciences at Tokyo University of Science, and so I am very familiar with radiation and its dangers. So, in my lecture today, we would like to explain the effects of radiation and put the present situation into perspective, so that people will better understand the risks, and not be unnecessarily afraid.
In respect to policy and involvement in social cognition of Advanced Science and Technology, people desire to recognize the scientific understanding and social understanding hierarchically and simultaneously. However, the understandings of some sciences and technologies are dependent on the amount of information given and how easy it is to understand it. Nuclear power and radiation are a typical example of such sciences and technologies because their advantages and disadvantages are clear. On the other hand, the Fukushima Nuclear Plant Accident that occurred in March 2011 caused the myth about the safety and security of nuclear power to collapse. Concerns about nuclear power and radiation increased abruptly after the accident. Also the scientific understanding of ‘nuclear power’ and radiation increased. The content and level of radiation education was highly significant than before the accident. However, it is essential to propose a more detailed explanation for people that are concerned about radioactive contamination of food and also for people living in areas that still have relatively high dose of radioactive material. Although some technical problems such as the influences on the human body by low-dose exposure remain unresolved, not only specialists on nuclear power and radiation, but also the persons that have studied the radiation are desired to explain radiation for familiar people. As a result, in Japan, the learning of individuals spread to society because the Japanese are highly interested in nuclear power and radiation and the understanding of historical background.
We conducted team-based learning (TBL) with interdisciplinary lectures as a part of “Introduction to Pharmacy”, divided among the pharmacy department's six pharmacist education curricula in the first semester. The interdisciplinary lecture is led by seven lecturers, each specializing in one area: cell biology, biochemistry, chemistry, public health pharmacology, pharmacokinetics, and clinical science. This lecture's purpose is to demonstrate to the students that all field subjects relate to each other and they must learn the basic science subjects to understand pharmaceutical sciences. The TBL contents have two themes, “cancer” and “aspirin”, each of which had two lectures, each 90 minutes long and were conducted using TBL as expansive learning. On receiving knowledge of a wide range of fields in one lecture, a small number of students indicated that they were unable to understand the contents very well. However, in the questionnaire about TBL, many students reported “I have understood” and “I have enjoyed studying” using TBL, especially group readiness assessment test (GRAT). By incorporating TBL, they reported “increasing eagerness to learn pharmacy”. Overall, students seem to have accepted TBL favorably, but they still find peer review difficult. We believe that their discomfort with peer review results from their unfamiliarity in evaluating others, and the time before the evaluation is short because TBL is conducted only twice.
In recent years, the number of high school graduates has decreased, whereas the number of new pharmacy schools has increased substantially. Therefore, pharmacy schools these days accommodate students from diverse backgrounds in terms of basic knowledge, study skills, and/or their motivation to be pharmacists. To address this issue, we developed a mandatory 10-day course named “Pharmacy experiential practice” for the first-year students. The program trains students in basic pharmacy calculation skills and communication skills, and provides an insight into how these skills can be applied in actual pharmacy practice. The program includes 5 themes, namely, “Compounds”, “Solutions”, “Infusions”, “Nutrition” and “Communication”. Each theme, except “Communication”, was conducted for 2 days 3 hour calculation practice in class and 3 hour pharmacy experiential practice each day. In the calculation class, we introduced team-based learning, which enhanced the students for interactive learning in the classes. In the pharmacy experiential practices, the students were trained not only to apply their calculation skills to pharmacy practice in each theme, but also to understand the importance of basic science knowledge in strengthening the foundations for their calculation skills. Course evaluation showed that students experienced the effectiveness of interactive study and that they realized the importance of pharmacy practice and the basic sciences that they had learnt. Some students commented that their motivation to become pharmacists increased after this course.
Learning chemistry is cumulative: basic knowledge and chemical calculation skills are required to gain understanding of higher content. However, we often suffer from students' lack of learning skills to acquire these concepts. One of the reasons is the lack of adequate training in the knowledge and skills of chemistry, and one of the reasons for this lack is the lack of adequate evaluation of training procedures and content. Team-based learning (TBL) is a strong method for providing training in the knowledge and skills of chemistry and reaffirms the knowledge and skills of students of various levels. In our faculty, TBL exercises are provided for first-year students concurrently with lectures in physical chemistry and analytical chemistry. In this study, we researched the adoption of a peer evaluation process for this participatory learning model. Questionnaires taken after TBL exercises in the previous year showed a positive response to TBL. Further, a questionnaire taken after TBL exercises in the spring semester of the current year also yielded a positive response not only to TBL but also to peer evaluation. In addition, a significant correlation was observed between the improvement of students' grades in chemistry classes and the feeling the percentage (20%) of peer evaluation in overall evaluation low (logistic regression analysis, p=0.022). On the basis of the findings, we argue that TBL provides a generic, practical learning environment including an effective focus on learning strategy and evaluation of knowledge, skills, and attitudes, and studies on the educational effects of TBL and peer evaluation.
With the prefectural governments' aid of the purchase, the Division of Pharmacognosy, Phytochemistry and Narcotics, National Institute of Health Sciences (NIHS) successively has surveyed illegal constituents in health food products implicitly advertizing tonic or slimming effect since the fiscal year of 2002 (slimming type) or 2003 (tonic type). The average numbers of the analyzed products per year are about 100 (slimming type) and 150 (tonic type), respectively. We also continuously distribute standards of authentic samples of several illegal components such as N-nitrosofenfluramine (NFF) and sildenafil (SIL) to prefectural institutes and the average gross number per year is about 140. In the case of slimming type, the fact that the products containing NFF were widely sold in Japanese markets in 2002 is well known. In addition, phenolphthalein, fenfluramine, sibtramine, desdimethylsibtramine, orlistat, mazindol, Rhubarb, Senna Leaf, etc. have been found as illegal constituents. In the tonic type products, we have identified more than 20 synthetic compounds relating to the erectile dysfunction (ED) treatment drugs, SIL, vardenafil and tadalafil (TDF). Since 2005, their synthetic intermediates and the patented but non-approved PDE5 inhibitors also have been found. It should be noted that TDF was found in the shells of capsule in 2009 and that mutaprodenafil was found as pro-drug type illegal component in 2010. In this report identification method of these illegal constituents is briefly described and then analytical trend in this decade is reviewed.
Global spread of counterfeit medicines is an imminent threat for the patients' safety. Although major targets of counterfeits are still erectile dysfunction (ED) drugs in the industrialized countries, including Japan, anti-cancer agents and some medicines for metabolic syndromes are also being counterfeited and circulated to the market mainly through the Internet. Due to the global expansion of the business, pharmaceutical companies based in Japan are suffering from the damage of counterfeits, illegal sales including diversion, and thefts, which have never been experienced in the conventional domestic market. We, pharmaceutical companies, must be responsible for the prevention of the prevalence because our mission is to deliver effective and safe medicine to patients. For this end, we are taking necessary actions including, 1. Forestalling counterfeit, falsification and illicit trade: Measures to prevent counterfeiting are taken by introducing anti-counterfeit technologies to the packaging and tablets on a risk basis. It is also important to establish supply chain security on a global scale. 2. Finding out counterfeits and cooperating crackdown: We are conducting market and internet surveillances when high risk products are sold in high risk markets. The outcome of the criminal investigation is reported to authorities and police if necessary. 3. Conducting educational campaign to medical staff or patients: For example, four companies which manufacture and sell ED drug in Japan are collaboratively continuing activities to raise the awareness of the danger of Internet purchase. To deliver effective and safe medicines stably and globally, pharmaceutical companies extend comprehensive measures against counterfeit and illicit trading.
Circulating counterfeit medicines in the market is a public health threat. Counterfeit medicines become common problem, not only in developing countries, but also in industrialised countries, as internet has made them more accessible. In Japan, the recent survey on the medicines purchased through on-line pharmacy (targeting Japanese consumers) showed that the majority of erectile dysfunction (ED) medicines imported by individuals in Japan were counterfeit version. The survey of Japanese consumers, who privately imported medicines through on-line pharmacy, indicated that 16% of these consumers experienced adverse events associated with these products. Not only that it is just fake brand, but fake medicines may even cause health hazard. The counterfeit version of Avastin recently detected in the United States became a serious threat for those who desperately need these medicines for life-threatening disease. The Japanese regulatory authorities have provided risk information of counterfeit medicines to general public, as well as monitored on-line pharmacies and conducted enforcement action where necessary. However, more resources of compliance activity should be allocated to respond to the situation of growing threats of counterfeit medicines. Purchasing medicines from abroad through unauthorised channel is the major source of counterfeit medicines. It is essential to prevent circulation of counterfeit medicines through international collaboration of various regulatory authorities. To address these problems, the World Health Organization (WHO) has launched a new Member States Mechanism (MSM) to build network of the authorities. Also, INTERPOL (ICPO) initiated globally concerted enforcement actions (Operation Pangea) against pharmaceutical crime as well as built partnership with pharmaceutical industry to create Pharmaceutical Crime Programme. It is also necessary to prevent consumers encountering counterfeit medicines and to prevent health hazard. The Ministry of Health, Labour and Welfare (MHLW) has been actively involved in prevention and educational activities such as public awareness campaign. MHLW started anti-counterfeit medicines and new psychoactive substance project from February 2013, which centrally collects information about counterfeit medicines, in particular, and provides the risk information more effectively to the public. Japanese Government will work together with international community and contribute to combating counterfeiting through public and private partnership.
The role of pharmacists in self-medication is to provide informed and objective advice on medicines and their use, and to promote the concept of pharmaceutical care. In 2012, the teaching of medicines and their use was started in junior high schools, and pharmacists should be providing samples and the example package inserts, and/or giving lessons in cooperation with teachers. In this article, a number of examples of how to do this will be shared. In 2009, the Pharmaceutical Affairs Law was revised and the role of pharmacists being key figures in supplying medicines was significantly increased. Pharmacists should have a professional obligation to provide advice about self-medication and medicines for self-medication. We introduced some approaches for student pharmacists to enhance the self-medication leading ability. 1) Problem-based learning, and combination learning of basic problems and clinical topics for 1st-year students, 2) An e-learning system to provide objective information about medicines, and 3) A case study system to cultivate pharmacists and student pharmacists who can contribute to providing advice about the safe use of over the counter (OTC) medicines.
The purpose of this study was to summarize the historical changes in the list of plasma fractionation products (PFP) placed on the Model List of Essential Medicines (EML) issued by the World Health Organization (WHO). PFP such as albumin, blood coagulation factors, and immunoglobulins are derived from blood collected from thousands of people. PFP have been listed since the first edition of the EML (1977). However, the PFP listed on the EML have changed dramatically because EML's selection process has changed from experience-based to evidence-based. For example, albumin, which had been listed since the 2nd edition (1979), was deleted in the 11th edition (2000) because of the uncertainty of its efficacy. Human immunoglobulin normal, which had been deleted from the 13th edition (2003), was relisted in the 15th edition (2007). Moreover, the WHO has issued several resolutions and guidelines regarding PFP production, quality, and safety in order to promote the establishment of blood programmes in every nation. The focus of WHO's EML selection process has changed over 30 years. In the 20th century, WHO mainly focused on PFP efficacy, quality, and safety problems. However, currently the focus is on the problem of PFP accessibility, especially in developing countries. Therefore, it would be important to know how to capitalize on established knowledge and production technology to increase the accessibility of PFP worldwide.
PL cream (combination of lidocaine and procaine) was launched on the market in April 2012 in Japan. We investigated differences in the anesthetic effect by employing two types of base: Carbopol and methylcellulose. Electron microscopy showed a distinct difference in appearance: densely-scattered, fine particles for Carbopol and sparse, large particles for methylcellulose. Accordingly, the extensibility of the cream was significantly greater at 4 and 25 degrees centigrade for methylcellulose, but was greater at 34 degrees centigrade for Carbopol. The steady flow viscosity (1 s−1) was greater for the Carbopol than methylcellulose base. The difference in the cutaneous permeability between the two bases increased over time: the methylcellulose base was removed at 90 min after application and, 30 min later, showed a significant difference. These results suggest that the methylcellulose base has a superior anesthetic effect in clinical settings.
The official analytical method for tris(2,3-dibromopropyl)phosphate (TDBPP), which is banned from use in textile products by the “Act on Control of Household Products Containing Harmful Substances”, requires revision. This study examined an analytical method for TDBPP by GC/MS using a capillary column. Thermal decomposition of TDBPP was observed by GC/MS measurement using capillary column, unlike in the case of gas chromatography/flame photometric detector (GC/FPD) measurement based on a direct injection method using a capillary megabore column. A quadratic curve, Y=2572X1.416, was obtained for the calibration curve of GC/FPD in the concentration range 2.0-100 μg/mL. The detection limit was 1.0 μg/mL under S/N=3. The reproducibility for repetitive injections was satisfactory. A pretreatment method was established using methanol extraction, followed by liquid-liquid partition and purification with a florisil cartridge column. The recovery rate of this method was ～100%. TDBPP was not detected in any of the five commercial products that this study analyzed. To understand the cause of TDBPP decomposition during GC/MS (electron ionization; EI) measurement using capillary column, GC/MS (chemical ionization; CI), GC/FPD, and gas chromatography/flame ionization detector (GC/FID) measurements were conducted. It was suggested that TDBPP might thermally decompose both during GC injection, especially through a splitless injection method, and in the column or ion sources. To attempt GC/MS measurement, an injection part comprising quartz liner was used and the column length was halved (15 m); thus, only one peak could be obtained.
The aim of this study was to investigate the trends and antimicrobial susceptibilities of methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates from outpatients and inpatients from April 2008 to March 2013 at Fukuoka University Chikushi Hospital. The proportion of MRSA among the S. aureus isolates from outpatients was stable over the study period, however, that from inpatients gradually decreased (p=0.026). There was no difference in the susceptibility to anti-MRSA agents between MRSA isolates from outpatients and inpatients, however, the susceptibilities to fosfomycin (FOM), minocycline (MINO), levofloxacin, erythromycin and clindamycin were higher in MRSA isolates from outpatients than from inpatients (48.6% vs. 35.6%, 56.1% vs. 40.1%, 38.2% vs. 4.9%, 16.2% vs. 3.9% and 18.5% vs. 4.5%, respectively, p<0.01). The susceptibility to FOM improved in MRSA from both outpatients and inpatients over time (p<0.05). In MRSA isolates from inpatients, the susceptibility to FOM and gentamicin increased significantly over the study period (p=0.023 and p=0.010, respectively), while, the susceptibility to MINO tended to decrease (p=0.094). The rate of MRSA isolates which were susceptible to more than two non-β-lactam antibiotics was significantly higher in outpatients than in inpatients (24.5% vs. 47.4%, p<0.01), however, this rate increased significantly during the study period only in inpatients, with a rate of 12.2% in 2008 and 53.1% in 2012 (p<0.01). In conclusion, our findings indicate a changing antimicrobial susceptibility of MRSA isolates, especially to non-β-lactam antibiotics. The determination of the prevalence and antimicrobial susceptibilities of MRSA clinical isolates will help physicians to select the initial empirical treatment.
The first crop of pharmacists graduating from 6-year programs in pharmaceutical l education arrived in April 2012, and it will be important to incorporate new factors when predicting future trends in supply and demand for pharmacists. If we project supply given an exam pass rate of 75%, the supply of pharmacists will increase for the next 10 years or so if the number of exam takers is about 10000, and no decrease in the total number of pharmacists is expected until 2035. At pharmacies, a high degree of demand for the services of pharmacists can be expected to result from increases in the number of elderly patients and the number of patients receiving prescriptions, together with expanded accommodation of home health care, if the proportion of prescriptions that are actually filled up to 70%. At hospitals, demand has been projected to increase over the short term, owing to such factors as the trend toward having a resident pharmacist in each ward, advances in team medicine, and the spread of outpatient chemotherapy. Given the rising enrollment quotas for schools of pharmacy, and if the current supply and demand for pharmacists are maintained, we cannot rule out the possibility that pharmacists will come to be in excess supply within a 10-year horizon if the number of unemployed continues to decrease and the employment rate continues to improve along with changes in economic conditions and the consciousness of graduates of the 6-year programs.
A case in which aminophylline solution was administered to a patient with congestive heart failure is reported and the problems caused by administration were solved by subsequent experiments. Dopamine solution was added from the side route using a mechanical pump, and mixed with aminophylline solution in the main route. Furosemide was administered after clamping and flushing the main route according to the supplier's information that indicated the compatibility of dopamine and aminophylline. However, the aminophylline solution turned black in color 3 h after furosemide administration. Several examinations were carried out to clarify the cause of the incompatibility in this case. The results showed that solutions with all possible combinations, including aminophylline and dopamine, turned black at 24 h after mixing, and the UV absorption at 430 nm increased from 0 to 0.28. UV absorption of the mixed solution increased in a dopamine dose-dependent manner in the range of 1.5-12 mg. When aminophylline was added to physiological saline or hypotonic electrolyte solution, the pH of each solution increased. These results suggested that degradation of dopamine to a melanin-like polymer under alkaline conditions caused the change in color of the solution. It is presumed that dopamine was inappropriately injected into aminophylline solution as the route was clamped tightly to shut out furosemide contamination. Aminophylline and dopamine are often co-administered to patients in critical condition. Thus, even if compatibility of aminophylline with dopamine is indicated by the supplier, they should be administered through separate routes.
Hypoglycemia due to treatment with oral anti-hyperglycemic agents (OHAs) is a major clinical problem in patients with type 2 diabetes mellitus. The aim of the present study was to evaluate the risk of hypoglycemia due to OHA use by using the Japanese Adverse Drug Event Report (JADER) database. To this end, reports of hypoglycemia events included in the JADER database between 2004 and 2012 were analyzed by calculating the reporting odds ratio (OR). The Medical Dictionary for Regulatory Activities Preferred Terms was used to identify hypoglycemia; 254392 reports were found in the JADER database, of which 13269 were excluded because the age and sex of the patient were not reported. Finally, 241123 reports were analyzed. Among OHAs, sulfonylureas showed the highest adjusted OR (adjusted OR, 10.13; 95% confidence interval, 9.08-11.26). The adjusted ORs for meglitinides, biguanide, thiazolidinedione, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors were significantly lower than that of sulfonylureas. The adjusted OR of meglitinides (3.17; 95% confidence interval, 2.23-4.36) was significantly higher than that of alpha-glucosidase inhibitors or thiazolidinedione. We observed no difference between the adjusted ORs for biguanide, thiazolidinedione, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors. Data mining of the JADER database was useful for analyzing OHA-associated hypoglycemia events. The results of our study suggested a low risk of hypoglycemia associated with biguanide, thiazolidinedione, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors in clinical practice.