『』 は，飛び回る大量のパーティクルを操り，敵を倒していくゲームである 「大群を操ることの楽 しさ」に着目し，指先で直に触れるような感覚で、パーティクルを自在に操作する.また，プレイの結果を利用しジ ェネラティブ・アートを生成する事により「絵を創造する楽しさ」を織り込んだ，大量 のパーティクルを操る気持ちよさと，ジェネラティブ・アートの生成を組み合わせ，今までにないゲームプレイを生み出した.

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The paper presents safety categories for international light water reactors (LWRs) including II, III, III.5, SMR, and SMP. They can be categorized up to 9 safety categories. Reactors in the same generation do not necessarily fall on the same safety category. For example, III.5 reactors fall on safety categories 4, 5, 6 and 7 depending on their safety design characteristics. There is no single standard safety level for III.5 reactors that is often called such as " III.5 safety". Their safety levels differ from reactor to reactor. Moreover, there can be safety levels that excel existing III.5 reactors. IV excludes LWRs by the definition of GIF. Therefore, it is impossible to use " IV safety" to express safety level of LWRs. It is also unknown whether IV reactors are truly safer than III.5 reactors, yet. Therefore, generations are not precise enough to rank safety levels of different reactors correctly. It is necessary to discuss safety levels of different reactors with much higher resolution than generation. Safety categories 0 to 9 are developed mainly based on PSA insights and safety design characteristics. Some examples of reactors that fall on each safety category are provided. The paper also presents a new plant concept that applies to mid to 1600 MWe ABWR and is rated as safety category 5.

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Because of difficulties of propagating and cultivating glomerular endothelial cells (), the role of glomerular mesangial cells (GMC) in the regulation of growth is still unknown. We cloned individually and GMC from the same adult bovine kidneys, and a direct coculture system was established to examine the interactions between and GMC. When cocultured with GMC which was growth arrested by mitomycin C, the growth was inhibited by 63% after 8 days of the beginning of coculture. No inhibitory activity was detected when media conditioned by individual culture of GMC. In contrast, media condi tioned by cocultured with GMC inhibited bromodeoxyuridine (BrdU) uptake of detected by flow cytometry. Addition of anti-transforming growth factor (TGF)-β antibody to media conditioned by coculture blocked the inhibitory actions of conditioned media onGEN growth. Western blotting analysis of conditioned media by coculture revealed an existence of TGF-β in the media. These results indicate that latent TGF-β is produced by these cells and activated in coculture of and GMC.

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Tokyo Gas is conducting R&D on natural gas fuelled PEFC co- aiming the commercialization especially for residential application. As part of the activity towards the market introduction of a residential PEFC co- in early 2005, the field test of PEFC co- at actual house has been carried out from March, 2002. To achieve the high energy saving and reduction of Coa emission by introducing a residential PEFC co-, not only the performance but also the operation control method of the PEFC co- is important. To maximize the running merit of the PEFC co-, development of an operation control system that minimizes the reverse power to the utility grid and avoids the surplus of hot water with minimized start-up and shutdown times has been conducted. Concluding those, the results of the field trials such as energy saving will be reported at this time.

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アグロバクテリウム法を用いて，ゴマノハグサ科花きのトレニア(Torenia fourinieriに外来遺伝子を導入し，形質転換植物体を作出した.品種`クラウンミックス'を用い，無菌植物を育成し材料とした.発芽後1か月から2か月の無菌植物から葉を採取し，3mmから5mm角に切り外植片とした.アグロバクテリウムは，neomydn phosphotransferaseII遺伝子，イントロンを含むβ-glucuronidase(GUS)遺伝子，およびhygromycinphospho-transferase遺伝子を持つプラスミドpIG121-Hm(Fig.1)を組み込んだしBA4404を用いた.約500の外植片をアグロバクテリウム液に5分間浸し感染させた後，Murashige and Skoog(MS)培地にベンジルアデニン(BA)1mg/lとアセトシリンコン 20μMを添加した培地で7日聞共存培養した.その後，外植庁はMS培地にBAlmg/l，カルベニシリン100mg/lそしてカナマイシン300mg/lを添加した選抜培地に移し，2週間ごとに同組成の培地に移しながら培養した.感染から2週間後，淡い緑色の不定芽が形成されたが，これらの不定芽はしだいに脱色し枯死した.

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HOSOKAWA

4 RM is one of the services in 4 series. HOSOKAWA 4 RM is a system that realizes Remote Monitoring, which enables real-time quality control and facility management. Equipment operation data can be accumulated and utilized as management resources. It can be used as a gateway to digitalization.

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BACKGROUND : This survey examined how a physician's specialty may influence attitudes towards blood glucose control in diabetic patients.
METHODS : A questionnaire was mailed to all members of the Ishikawa Medical Association (n=1,610) as well as diabetic specialists (n=36) querying their specialties, confidence in offering diabetic treatment, and treatment goals/change levels of plasma glucose levels for 5 theoretical cases.
RESULTS : 301 physicians responded. The percentage answering treatment goal/change levels was 93% of internal medicine physicians (n=145), 72% of surgeons (n=29), 52% of pediatricians (n=23) and 20% in other specialties (n=99). The percentage answering “I am confident in offering diabetic treatment” was 57% of internal medicine physicians, 14% of surgeons, 13% of pediatricians and 3% in other specialties. There were significant differences among specialties in the fasting plasma glucose levels in the treatment goal, and the postprandial plasma glucose change levels. Internal medicine specialists tended to give higher glucose levels than other specialties.
CONCLUSIONS : The majority of physicians interested in diabetes care appear to be internal medicine specialists. Physician's specialty may influence their attitude toward glucose control in diabetic patients.

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ABSTRACT : Both primary biliary cirrhosis (PBC) and autoimmune hemolytic anemia (AIHA) are uncommon diseases. Immunological dysregulation is suggested as a causative factor for both diseases. We report a 77-year-old woman who suffered from warm type AIHA complicated by PBC. Her direct antiglobulin test was positive for IgG, and negative for C3. Both anti-mitochondrial antibody and its M2 component were detected. Both alkaline phosphatase (Alp) and IgM were elevated in the serum. She was initially treated with steroids for 8 months. Her steroids were discontinued when she underwent a laparoscopic splenectomy. Ursodeoxycholic acid was discontinued due to an allergic skin reaction. Her Alp improved with bezafibrate.

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BACKGROUND : Previous studies have suggested positive association between residents' workload and medical errors. However, few studies have investigated the possible associations between procedural errors, workload, and the individual characteristics of residents, including personality, mental state and job satisfaction.
OBJECTIVE : To explore possible associations of workload and individual characteristics of residents with their procedural error rates.
DESIGN : Prospective observational study based on a daily questionnaire.
PARTICIPANTS : Residents of postgraduate year 1 and 2.
MEASUREMENTS : Residents' workload (on-calls, work hours, sleep and napping hours), residents' physical and mental health state, personality inventory, and procedural error rate (defined as procedural error counts divided by overall procedural attempts).
RESULTS : On average, the residents (N=49) were responsible for 9.8 inpatients per day (range, 1.9-23.1), worked for 16.0 hours per day (range, 12.6-19.8), slept for 4.4 hours per day (range, 2.8-5.7), napped for 0.2 hours per day (range, 0-0.7), and experienced 1 overnight work shift every 7.2 days. The procedural error rate was 2.2 per 10 procedures (range, 0.4-5.0). Using a multivariable adjusted regression model, significant factors associated with lower error rates included : longer napping ; reflective personality ; better mental state ; higher job satisfaction ; and, less on-call frequency.
CONCLUSIONS : Procedural error of residents is positively associated with higher on-call frequency and inversely associated with napping, reflective personality, better mental state, and higher job satisfaction. For reducing procedural error among residents, improvement of modifiable factors, such as workload and mental health, is needed.

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BACKGROUND : In Japan, clinical ethics support services are only available at certain institutions. The actual conditions surrounding ethics consultation are unclear with few resources available for determining its efficacy. The object of this study is to clarify the expected outcome of ethics consultation and identify the appropriate mode. We also aim to elucidate the ideal consultant and the obstacles to achieving full utilization of ethics consultation.
METHODS : Eighteen medical practitioners participated in the study. We held semi-structured interviews and analyzed these interviews by qualitative content-analysis technique.
RESULTS : This study suggests that specific advice, new insights from outside parties, emotional support, and an appropriate process based on a division of labor between medicine and ethics all contribute to a team-based practice of medicine that avoids the arbitrariness and dogmatism of single practitioners. It is also indicated that timeliness and swift answers are required. Knowledge of medicine and ethics, communication skills, a close familiarity with actual conditions in medical practice, and empathy toward the medical staff were found to be as important as the qualifications of consultants. Contrarily, the participants suggested that the busy pace, lack of psychological breathing room, medical practitioners' pride, lack of awareness of ethical issues, and the negative image of the word “ethics” were significant impediments to achieving full utilization of ethics consultation.
CONCLUSIONS : The present study is the first of its kind to reveal the views of medical professionals regarding clinical ethics consultation in Japan. Further research is required to identify the features of a consultation system that can be easily accessed and effectively utilized in Japan.

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Eosinophillic glanuromatosis with polyangitis (EGPA) usually occurs in patients with a recent history (usually less than 10 years) of uncontrolled bronchial asthma. Here we describe a case of EGPA that occurred in a 68-year-old female who had well-controlled bronchial asthma for 17 years. A leukotriene receptor antagonist that had been prescribed one week before onset might have triggered the disease. Our case shows that there is a wide spectrum of clinical characteristics of EGPA, making diagnosis difficult in a primary care setting.

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We report on a case of the altered mental status from hyperammonemia due to a urinary tract infection of urease-producing (urea-splitting) bacteria. A 98-year-old Japanese woman, who had no history of liver cirrhosis or portal hypertension, presented with altered mental status. The cause of the altered mental status was attributed to an elevation of ammonia in her blood. The urine culture grew Proteus vulgaris. Complete recovery occurred with the use of an antibiotic for the urinary tract infection. Among patients with urinary tract infections, but without liver cirrhosis or portal hypertension, production by urea-splitting bacteria and the subsequent tubular reabsorption of ammonia, may result in hyperammonemic encephalopathy.

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Background: There is limited information available on zinc (Zn) or copper (Cu) deficiency during total enteral nutrition treatment. With more patients surviving long term while on enteral nutrition, these deficiencies may be more common.Methods: In our prospective study, 53 patients who received total enteral nutrition were admitted to our hospital for periodic replacement of gastrostomy catheters from March 1, 2013 to August 31, 2013. We measured the serum Zn and Cu levels on admission, and investigated the relationships of the levels on gender, the period after percutaneous endoscopic gastrostomy, the daily dosage of Zn or Cu, age, white blood cell count, hemoglobin (Hb) level, platelet count, and serum albumin (Alb) level.Results: The rate of low serum Zn level (43%) was significantly higher than that of low serum Cu level (9%) [Zn (23/53) vs. Cu (5/53), p = 0.0002]. None of the patients had high serum Zn level, whereas 26% of the patients had high serum Cu level [Zn (0/53) vs. Cu (14/53), p = 0.0002]. There was a significant positive correlation between serum Zn and Hb levels (r = 0.515, p = 0.00008), and a significant, weak positive correlation between serum Zn and Alb levels (r = 0.357, p = 0.009).Conclusions: Enteral nutrition may be an independent risk factor for Zn deficiency, and the Zn deficiency is associated with the decrease in the Hb level.

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Background: New onset fever is a common symptom among hospitalized patients and it may be a manifestation of fatal illnesses such as infection. However, its epidemiology and predictors for mortality have not been fully determined in a Japanese teaching hospital.
Methods: We investigated adult patients with new onset elevated temperature of 37.5 degrees Celsius or greater the 3^rd day after admission during a 4-month study period. Only the first, single episode per patient was analyzed. We determined the causes of fever among these patients with new onset fever. We also analyzed predictors for in-hospital mortality among these patients. These predictors were based on multivariable adjusted logistic regression using demographics, vital signs at the time of fever onset, baseline diseases, and basic laboratory data.
Results: From a total of 2,271 admitted patients, 126 patients (5.6%) developed fever. Among these febrile patients, 98 (78%) had infectious diseases with a prevalence of 4.3% in all admitted patients. The most common cause of infection among those patients was respiratory tract infection, followed by urinary tract infection. Causes for non-infectious fever included neoplastic diseases, inflammatory diseases, and drug fever. In-hospital mortality was associated with lower mean blood pressure <60 mmHg with odds ratio (OR) of 12.7 (95% CI, 1.3–121), tachycardia >90/min with OR 4.1 (95% CI, 1.2–13.5), tachypnea >20/min with OR 10.0 (95% CI, 2.8–35.2), and neoplastic disease with OR 4.1 (95% CI, 1.3–13.1). Infection as a cause of fever was not associated with mortality.
Conclusion: The majority of inpatients with new onset fever had infectious diseases, however fever was also caused by neoplastic diseases, inflammatory diseases and drug fever. Abnormality of vital signs and neoplastic disease were related to in-hospital mortality.

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Background: Japanese medical student education lacks emphasis on teaching clinical reasoning skills. To partially remedy this situation, we developed a prototypic web-based module for tutors to teach clinical reasoning. We report the medical students’ opinions of this module.
Methods: Twenty-four students from two Japanese medical universities were randomly assigned to the two tutored virtual classrooms, each classroom with six students, or to the self-study group, 12 students, after taking the Internet-based Sequential Question and Answer pretest. After four weeks, each of the 24 students took the Sequential Question and Answer posttest. The entire 24 students answered a questionnaire about the Sequential Question and Answer tests; all 12 tutored students answered a questionnaire about the web-based tutored module.
Results: Although both tutored and self-study Sequential Question and Answer posttest scores increased, the increases of the tutored group’s posttest compared to the self-study posttest group were not statistically significant (p = 0.066). Ninety-two percent of the students rated the Sequential Question and Answer tests as an improved way to learn case presentation and clinical reasoning. Moreover, 79% of students felt that the Sequential Question and Answer tests were an effective way to learn clinical information. The tutored students rated the web-based tutored seminars as an ‘excellent to fair’ method to learn clinical reasoning using a five-point ‘excellent to poor’ scale.
Conclusions: We developed a prototypic web-based module for tutors to teach clinical reasoning to medical students. The students’ opinion supported the modular components of the web-based seminar format, Sequential Question and Answer test, and the tutoring syllabus as an effective way to improve learning clinical reasoning, case presentation, and medical information. Students also suggested refinements of the prototypic module.

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