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How does a country embark on large-scale R&D programs? Among R&D programs, this is an intriguing question for large scale Science and Technology (S&T) projects such as space programs, because of the necessity for large resource commitments, and the difficulty of being accountable to the taxpayers when the outcome is not always known. It can be assumed that engineers, scientists, bureaucrats, and politicians play respective roles. This paper aims to shed light on the specific role of politics, through the examples of policies of and decisions by NAKASONE Yasuhiro. Nakasone was the minister for science and technology (1959–1960, 1972), and later became the prime minister (1982–1987). He played a crucial role in establishing the Science and Technology Agency and the National Space Activities Council in the 1950s, which would be the foundational institutions responsible for space policy for the next half century. As prime minister, he decided to participate in the Space Station program. Within his vision for Japan for the 21st century, he emphasized the need for radical change in economic policy, education, defense and S&T investment. He was one of the few politicians that had vision to promote S&T and recognized the strategic value to the nation. He was able to explain to the nation why Japan should promote the development of a launch vehicle, when the engineers faced development difficulties in doing so. Thus, he was influential both in the policy layer and in promoting specific programs to support his national vision. Politics intersects with S&T projects because of the uncertainty and tradeoffs associated with these efforts. Japan did not address space programs for national security and commercial space for a long time. It is a politician's role to create institutions, to allocate resources and, more importantly, to explain to the taxpayers why policy measures or programs are necessary. R&D investment is a societal activity: it reflects the social, political, and economic situation, as well as being important for diplomacy and international relations. Bearing in mind that it would be misleading to attribute the initiation of largescale S&T projects to the leadership of a single individual, this paper will attempt to show the driving forces behind, and fundamental objective of Japan's space policy, in addition to the historical shift in that policy by examining the influence of this notable politician. • Nakasone played the key role in establishing institutions promoting space development in post-war Japan. • Nakasone made the best use of close relationships with the U.S. in promoting Japan's space activities. • Nakasone made decisions on space policy process, resource allocation with vision, thus integrating the stakeholders. [ABSTRACT FROM AUTHOR]

Objectives: Low‐volume polyethylene glycol plus ascorbic acid (PEG‐Asc) reduces the dosage of colonoscopic bowel preparation (BP) solution, but is still poorly tolerated. Adding laxatives to the BP solution reduces the volume of fluid required, without affecting quality. This study aimed to compare 1 L PEG‐Asc plus 24 mg senna (1L‐PEG/AS) and conventional 2 L PEG‐Asc (2L‐PEG/A) regimens on BP quality and patient tolerability. Methods: A single‐center, randomized, investigator‐blinded, noninferiority trial was performed between June and August 2022. Outpatients scheduled for colonoscopy were randomized (1:1) to the 1L‐PEG/AS or 2L‐PEG/A group. The Boston Bowel Preparation Scale (BBPS) was used to evaluate BP quality. Adverse events and tolerability were surveyed using questionnaires. Results: Overall, 344 patients received 1L‐PEG/AS or 2L‐PEG/A regimens. The baseline characteristics and adverse events of the two groups were comparable. The 1L‐PEG/AS group showed noninferior adequate BP rates compared with the 2L‐PEG/A group (88% vs. 89%, P = 1.00); overall BBPS was 7.1 ± 1.5 and 7.2 ± 1.5, respectively (P = 0.39). Higher willingness to repeat the BP was observed in the 1L‐PEG/AS group (85% vs. 62%, P < 0.01). Conclusions: The 1L‐PEG/AS regimen was comparable to the 2L‐PEG/A regimen in terms of BP adequacy, requiring lower BP solution volumes, with better patient tolerance. Thus, it may be a suitable alternative to the conventional BP solution for colonoscopy. The Japan Registry of Clinical Trials (jRCT1051220043). [ABSTRACT FROM AUTHOR]

Objective: Comorbid psychiatric disorders negatively affect the survival rate of patients with some physical disorders. In liver transplant recipients, various psychiatric disorders have been identified as worsening prognosis. However, little is known about how the presence of any comorbid (overall) disorders affect the survival rate of transplant recipients. In this study, we examined the effect of overall comorbid psychiatric disorders on survival rate in liver transplant recipients. Methods: A total of 1006 recipients who underwent liver transplantation between September 1997 and July 2017 across eight transplant facilities with a psychiatric consultation-liaison team were identified consecutively. Recipients were categorized into those with comorbid psychiatric disorders and those without comorbid psychiatric disorders. In the comorbid psychiatric disorder group, psychiatric disorder diagnosis and time of diagnosis were investigated retrospectively. Results: Of the 1006 recipients, 294 (29.2%) had comorbid psychiatric disorders. Comorbid psychiatric disorders in the 1006 recipients were insomnia (N = 107, 10.6%), delirium (N = 103, 10.2%), major depressive disorder (N = 41, 4.1%), adjustment disorder (N = 19, 1.9%), anxiety disorder (N = 17, 1.7%), intellectual disability (N = 11, 1.1%), autism spectrum disorder (N = 7, 0.7%), somatic symptom disorder (N = 4, 0.4%) schizophrenia (N = 4, 0.4%), substance use disorder (N = 24, 2.4%) and personality disorder (N = 2, 0.2%). The most common time of psychiatric disorder diagnosis was within the first 3 months after liver transplantation (51.6%). The final mortality in patients with comorbid psychiatric disorder diagnosis during the five periods (pretransplant, transplant to 3 months, months to 1 year, 1 to 3 years, and over 3 years posttransplant) was 16.2%, 18.8%, 39.1%, 28.6%, and 16.2% respectively, and there were no significant differences between the five periods (χ2 = 8.05, df = 4, p = 0.09). Overall comorbid psychiatric disorders were significantly associated with shorter survival time (log-rank test: p = 0.01, hazard ratio: 1.59 [95% confidence interval: 1.14–2.21], survival rate at the endpoint [%]: 62.0 vs. 83.3). However, after adjusting for confounding variables using Cox proportional hazards regression, there was no significant effect of overall comorbid psychiatric disorders on prognosis. Conclusion: Comorbid psychiatric disorders did not affect the survival rate of liver transplant recipients in this study. [ABSTRACT FROM AUTHOR]