In this issue, activities for quality and safety management in Yodakubo Welfare Organization are presented through an interview by the members of the editorial board. We interviewed Mr. Yutaka Muraoka (Managing Director) and Mrs. Misato Hoshina (Assistant Manager of General Affairs). Yodakubo Welfare Organization is a social welfare corporation, which was instituted in 1996 jointly by three municipalities : Nagato, Wada, and Takeshi, in Nagano Prefecture. It has a dedicated special elderly nursing home known as "Tomoshibi" in 1997, and is now operating some of the special elderly nursing homes, day-care facilities andgroup homes. Generally, problems related to the provision of services in welfare facilities tend to be staff-centered. Yodakubo Welfare Organization has been promoting activities for quality and safety management to achieve the "end-user centric" services. Interview contents include (1) history of Yodakubo Welfare Organization, (2) characteristics and problems of welfare services, (3) history and organizational efforts forquality assurance and management, (4) difficulties and ways to overcome them, and (5) future aspirations.

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In this paper we attempt to construct a dynamic model of discourse management, a version of Mental Space Theory, modified to accommodate dialogic discourse by incorporating a memory management system. We posit a cognitive interface between linguistic expression and knowledge-base. This interface contains pointers or indices linked to addresses in the knowledge base, controlling access paths to the data in the base. Utterances in a dialogue exchange can be redefined as input-output operations via this interface: registering, searching, editing, etc. The main theses of our approach to discourse management are as follows:
The operations coded in the various forms are to be defined as performing input-output operations on the database of the speaker and not that of the hearer's model in the speaker. It is argued that the hearer's model in the speaker is not only unnecessary but also harmful in the description of sentence forms. We divide the interface into two components, I-domain and D-domain. The former is linked to temporary memory, houses the assumptions and propositions newly introduced to the discourse yet to be incorporated into the database and can be accessed only indirectly by inferences, logical reasoning, hearsay, and data search. The latter is linked to the permanent memory, houses information already incorporated in the database and can be directly accessible by simple memory search like pointing to an index. New information passes through only via I-domain. We will demonstrate that our approach solves problems in mutual knowledge but also provides a powerful tool in the description of some of the most recalcitrant phenomena in natural language.

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対象人口約12,000人の当院で6年9ヵ月間に27例の胆道悪性疾患手術例を経験した。その内訳は胆嚢癌16例, 胆管癌9例, 胆嚢肉腫1例, 胃癌胆嚢転移1例である。
年令は平均70.0才, 男女比は胆嚢癌では1対2.2, 胆管癌では5対4であった。
診断法ではOC, DICは癌の確診を得られず, PTC, ERCPは診断率が高い。USは胆嚢早期癌2例を診断でき, 他の例でも重要な異常所見を得ることができた。
術前に胆嚢癌と診断した5例では1例切除できたにすぎず, 術中に癌と判明した5例は全て切除不能進行癌であつた。術後の精査で癌と6例が診断されたが, その中5例が1年7か月から7年健在である。
胆管癌は全例黄疸を呈し, PTC, ERCPにて8例が癌による閉塞性黄疸と診断した。手術は7例が切除でき, 5例が7か月から5年11か月健在で, 3例は胆嚢・膵臓に浸潤を有するstage IIIであるが3年以上健在である。
以上の結果をふまえ, われわれは高令者の多い当地域においてUSによる肝胆膵集団検診を始あ, 2年間に胃癌肝転移1例, 胆石症19例, 胆嚢ポリープ4例を発見した。
なお早期胆嚢癌超微形態像では, 癌細胞は比較的均一で杯細胞, Paneth細胞に似る細胞はほとんど無く, 基底膜に囲まれている。細胞内小器管・分泌穎粒は良く発達し, 特にゴルジ装置は著明で, GERLも明らかに認められた。

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The purpose of this paper is to build a model that gives a natural explanation of the distribution of demonstratives in the anaphoric use. Discourse Management Theory (DMT; Takubo and Kinsui (2000) among others) provides a persuasive model for this issue. However, this theory faces some difficulties, especially when dealing with sentences such as those presented in Iori (1997) and Tsutsumi (1998). I argue that this is because the theory is strongly based on the concept of ‘experience, ’ however, these problems are solved when we adopt the model presented in this paper.
We create (at least) two worlds in our mind: one of these is Ws and the other is Wp. Ws is the world in which we refer to things directly (such as proper nouns and things that the speaker believes to exist in the real world (Wo)) while Wp is the world where every element is altered to a variable (x, y). Following Tsutsumi (1998), we assume that Ko/A-series refer to elements in Ws and So-series to those in Wp.This predicts that if an object is registered in both of the worlds, then both Ko (A) /So-series can be used. If it is registered in only Ws or Wp, then only Ko (A) or So can be used respectively. This idea is reminiscent of that of DMT's, however, by abandoning the concept of ‘experience, ’ and introducing the idea of ‘variable’ for the So-series demonstratives, we succeed in explaining a wider range of data than DMT can deal with.

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78歳女性,右乳癌を合併した左横隔膜弛緩症の患者に開胸横隔膜重積縫合術を施行した.
横隔膜は肉眼的に灰白色で菲薄化し周囲に筋性部が見られるのみであった.組織学的には一部に萎縮変性に陥った筋組織を認めるが,ほとんどは線維成分から成っている.
術後は肺機能検査上拘束性の障害はとれなかったが自覚症状は改善され,胸部レントゲンにても左肺の拡張と心陰影の正常位化が得られた.さらに乳癌に対しては単純乳房切断・腋窩郭清術を行ない,組織学的にも治癒手術が施行できた.
退院後軽度の家事に従事していたが1年9ヵ月後に再び咳漱・嘔気らを訴えて来院した.
胸部レントゲンにて左横隔膜弛緩症の再発と診断した.気管支造影にて左主気管支が完全に閉塞され,生検にて腺癌が証明された.
患者は高齢のため内視鏡下に腫瘤内抗癌剤注入を行なったが,一般状態は改善されず死亡した.
本症例の再発の原因として,横隔膜そのものが伸縮性を失なっていたこと,気管支が腫瘤で閉塞されたため無気肺となり胸腔内圧の減少を生じて横隔膜の挙上が促がされたことによると考えられる.

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本稿では言語と認知，言語と思考との関係にかかわる現象について考察する。特に「ところ」という形式名詞の多義性の問題を対象にして言語と推論メカニズム，統語論と意味論，意味論と語用論との関連を考える。初めに「場所」や「位置」を示す形式名詞「ところ」（以下トコロと記す）の空間的な意味・用法を見て，トコロを「基準点を同定する」と特徴づけ，それらがどのように「動作，事態の局面（時間的用法）」，さらには「論理・推論（モーダル用法）」へと拡張されるか，そのメカニズムを詳しく考察することでトコロの様々な用法が説明できることを示す。空間＞時間＞論理・推論という拡張の認知メカニズムを考えることで，言語，認知，論理の関係についての示唆を得ることが目的である。

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Observations are done on 10 pieces of synthetic emeralds by Scanning CathodoLuminescence (SCL) method. Specimens are identified by ordinary gemmologicaltesting together with NIR spectrum. They are grouped into the flux-grown synthetic emeralds and the synthetic emeralds by hydrothermal method. Flux-grown emeralds show straight parallel growthbands or "aurora-like" growth bands. Whereas hydrothemrmally-grown emeralds shows CL-image in which "comet-like" luminaries arranged in one direction or shows unique rhombic pattern. So, natural and synthetic emerald can be distinguished by SCL method, moreover for synthetic one, growth method can be identified.

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