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Background/Aim: This study evaluated the effects of the respiratory phase shifts between liver tumor and chest wall motions on the dose distribution for the CyberKnife Synchrony respiratory tracking system (SRTS). Patients and Methods: Eight patients who received stereotactic body radiotherapy for hepatocellular carcinoma or liver metastases were analyzed. Three-dimensional (3D) motion of the implanted fiducial markers and vertical motion of the sternal bone were derived from the four-dimensional computed tomography (4D-CT) images acquired with a 320-row area detector CT. For each patient, Gaussian random numbers were generated for the standard deviation of the tracking error calculated from the phase shift and a literature. For each voxel of the target, the dose delivered from each beam was calculated 100 times with the random 3D offsets representing the tracking error. Results: The median respiratory phase shifts were 6.0% and 4.6% for the anterior-posterior (AP) and superior-inferior (SI) directions, respectively. The median motion tracking errors influenced by respiratory phase shifts were 1.21 mm and 0.96 mm for the AP and SI directions, respectively. The change in the dose covering 90% of the target (D(90%)) was within 1.1% when median phase shifts were considered. When evaluating the 90(th) percentile of the phase shifts, the D(90%) decreased up to 6.6%. Conclusion: We have developed a technique to estimate the impact of the respiratory phase shifts on the dose distribution of a liver tumor treated with the SRTS. The calculation of the respiratory phase shifts from the area-detector 4D-CT will be valuable to improve the tracking accuracy of the SRTS.

野外での療育活動の実践研究は、特定のスキル獲得が中心であり、子ども・青年の関係性に焦点をあてた検討は少ない。本研究の目的は、神経発達症のある子どもと青年の異年齢期交流が発達にもたらす影響を明らかにすることである。本研究では、親の会が企画する登山キャンプに参与観察し、キャンプ内で生じる参加者の異年齢期交流を調査した。登山キャンプでは、子どもと青年の間にナナメの関係性が生じやすいことが分かった。その結果、子どもにとっては近未来像として取り入れるロールモデルになること、青年にとっては支援者の行動を模倣し子どもに実践する養育性形成の場になることが考えられた。また登山キャンプは居場所として、集団精神療法のような心理的安定を促す要素があることが考えられた。神経発達症のある子どもや青年にとって、同年齢集団と比べ、異年齢集団の方が能力の差異を肯定的に承認されやすいと考えられた。, Practical research on intervention for children with handicapped focuses mainly on acquiring specific skills and few studies focusing on the relationship between children and adolescents. The purpose of this study is to clarify the influence of cross-age communication between children and adolescents with neurodevelopment disorders. In this research, we participated in the climbing camp planned by LD parent’s association and observed and investigated participants’ cross-age communication occurring in the camp. In climbing camps, it was found that the relationship between children and adolescents are more neutral and supportive. As a result, adolescents seemed to be a role model to be adopted as a near future image for children, and for adolescents to be a place of imitating the behavior of supporters and practicing the childcare. In addition, the climbing camps have the elements that encourage psychological stabilization like group psychotherapy as a place of acceptance and security (ibasho). For children and adolescents with neurodevelopmental disorders, compared to the same age group, different age group seemed to be more likely to accept the difference in ability positively.

日本医学物理学会が作成した、医学物理学の体型的教科書シリーズの一つ。

Supplemental Figure &nbsp

筆者は北大土曜教室や教育現場において高い知的能力を持ちながらディスレクシアを抱える子どもたちの支援を行いつつ，ギフテッドを持つ保護者の相談にも当たってきた。いまだに日本ではギフテッドに関しての統一した定義がない中で，WISC-Ⅳをツールとして知的側面からのギフテッド（以下知的ギフテッド）同定を試みた。さらに，WISC-Ⅳの示す認知のアンバランスと知的ギフテッドが抱える「生きづらさ」との関連について明らかにした。早期に知的ギフテッドの子どもたちの認知特性に応じた特別支援教育の必要性が求められる。

Dopaminergic signaling plays a critical role in the nervous system, but little is known about its potential role in breast cancer and bone metabolism. A screening of ~1,000 biologically active compounds revealed that a selective agonist of dopamine receptor D1 (DRD1), A77636, inhibited proliferation of 4T1.2 mammary tumor cells as well as MDA-MB-231 breast cancer cells. Herein, we examined the effect of A77636 on bone quality using a mouse model of bone metastasis from mammary tumor. A77636 inhibited migration of cancer cells in a DRD1-dependent fashion and suppressed development of bone-resorbing osteoclasts by downregulating NFATc1 through the elevation of phosphorylation of eIF2α. In the mouse model of bone metastasis, A77636 reduced osteolytic lesions and prevented mechanical weakening of the femur and tibia. Collectively, we expect that dopaminergic signaling might provide a novel therapeutic target for breast cancer and bone metastasis.

BACKGROUND: The structure of radiation oncology in designated cancer care hospitals in Japan was surveyed in terms of equipment, personnel, patient load, and geographic distribution, and compared with the structure in other radiotherapy facilities and the previous survey. METHODS: The Japanese Society for Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2009. The structures of 365 designated cancer care hospitals and 335 other radiotherapy facilities were compared. RESULTS: Designated cancer care hospitals accounted for 50.0 % of all the radiotherapy facilities in Japan. The patterns of equipment and personnel in designated cancer care hospitals and the other radiotherapy facilities were, respectively, as follows: linear accelerators per facility: 1.4 and 1.0; dual-energy function: 78.6 and 61.3 %; three-dimensional conformal radiotherapy function: 88.5 and 70.0 %; intensity-modulated radiotherapy function: 51.6 and 25.3 %; annual number of patients per linear accelerator: 301.3 and 185.2; Ir-192 remote-controlled after-loading systems: 31.8 and 4.2 %; and average number of full-time equivalent radiation oncologists per facility: 1.8 and 0.8. Compared with the previous survey, the ownership ratio of equipment and personnel improved in both designated cancer care hospitals and the other radiotherapy facilities. Annual patient loads per full-time equivalent radiation oncologist in the designated cancer care hospitals and the other radiotherapy facilities were 225.5 and 247.6, respectively. These values exceeded the standard guidelines level of 200. CONCLUSIONS: The structure of radiation oncology in designated Japanese cancer care hospitals was more mature than that in the other radiotherapy facilities. There is still a shortage of personnel. The serious understaffing problem in radiation oncology should be corrected in the future.

The ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution was evaluated in order to radiation identify and improve any deficiencies. A questionnaire-based national structure survey was conducted from March 2010 to January 2011 by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). These data were analyzed in terms of the institutional stratification of the Patterns of Care Study (PCS). The total numbers of new cancer patients and total of cancer patients (new and repeat) treated with radiation in 2009 were estimated at 201,000 and 240,000, respectively. The type and numbers of systems in actual use consisted of Linac (816), telecobalt (9), Gamma Knife (46), (60)Co remote afterloading system (RALS) (29) and (192)Ir RALS systems (130). The Linac systems used dual energy function for 586 (71.8%), 3DCRT for 663 (81.3%) and IMRT for 337 units (41.3%). There were 529 JASTRO-certified radiation oncologists (ROs), 939.4 full-time equivalent (FTE) ROs, 113.1 FTE medical physicists and 1836 FTE radiation therapists. The frequency of interstitial radiation therapy use for prostate and of intensity-modulated radiotherapy increased significantly. PCS stratification can clearly identify the maturity of structures based on their academic nature and caseload. Geographically, the more JASTRO-certified physicians there were in a given area, the more radiation therapy tended to be used for cancer patients. In conclusion, the Japanese structure has clearly improved during the past 19 years in terms of equipment and its use, although a shortage of manpower and variations in maturity disclosed by PCS stratification remained problematic in 2009.

PURPOSE: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. METHODS AND MATERIALS: In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). RESULTS: The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). CONCLUSIONS: ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.

本論では，日本の教育現場において，学習障害に対する教育的対応が遅れたことについて検討を加え，北海道における学習障害の処遇を振り返りながら土曜教室の誕生した生成過程を検証した。そして，「北大土曜教室」における「軽度発達障害*1」のある子どもたちに対する教育的支援と学生たちの学びと育ちを踏まえ，その教育的意義を明らかにした。さらに，日本社会においてノーマライゼーションとバリアフリーを推進していく上で，特別支援教育の重要性について触れた。「北大土曜教室」における，“学び（専門）”と“育ち（人材）”を支えるシステムは，特別支援教育を推進していくうえで先進的な役割を果たしていることが示唆された。

近年、米国での個別教育計画（Individualized Education Program,以下、IEP）の考え方が日本に広まり、特別支援教育の分野で「個別の指導計画」として作成されるようになった。しかし、いわゆる通常学級における「軽度発達障害」のある子どもたちへの適用については始まったばかりと言えよう。本研究は、「北大土曜教室」で行われている「特別な教育的ニーズ」のある子どもたちへのIEPシステムの実践と、その可能性、汎用性、及び指導法についての検討を行った。本論の事例から、「軽度発達障害」の支援にIEPを用いる有効性が示唆された。実践を通してIEPの課題と可能性について、学校教育への適用も視野に議論する。

土曜教室には、個別学習と集団活動があり、個別では子ども一人ひとりに応じたオーダーメイドの教材が用意され学習支援が展開されている。子どもの担当毎に教員、院生、学部生がチームを組んで支援にあたっている。土曜教室活動の最大の特徴は、Plan-Do-Check-Actionが組み込まれていることである。事前・事後ミーティングと用紙を作成することにより、スタッフ自身が自分たちの指導や子どもの反応を振り返る。また複数の目で反省と改善を図ることが、自分たちのスキルアップにつながっていく。親との面談では、子どもの理解を深めるだけではなく軽度発達障害を持つ子どもが置かれている貧しい現状を認識する。私たちは、IEPを作ることで自らの専門性を高め、臨床に対する目と力を養っている。