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Against the prevailing outcomes-based education and the instrumentalization of education, a movement has arisen towards holistic education. This aims to go beyond objective measurement of the outcomes of education in order to treat the student as a whole person. In this paper, we shall examine some strands of education in Japan which in some way or another feature the idea of the whole person. This includes the tradition of clinical pedagogy, which originated in Kyoto University, Yukichi Shitahodo's educational anthropology ("Kyoiku-Ningengaku"), Kuniyoshi Obara's "Zenjin" Education (the education of the whole person) and holistic education. Notwithstanding the fact that such education is benevolent in intention, it can be miseducative in some respects. In the light of this, and with some reference to criticism of the idea of the whole person, we shall point to an alternative vision of education of the whole person following Cavell's Emersonian moral perfectionism -- a perfectionism that is thoroughly anti-foundationalist and that transcends self-entrapment in circulatory discourse on the whole. In critical dialogue between the rich traditions of Japanese thought and the critical voice of liberalism raised from within the West, we hope to find a more nuanced answer to the question of how being a whole might make sense.

In this paper, I first provide a brief review of how scholars have conceptualized, tested, and elaborated aptitude frameworks relevant to second language (L2) speech learning. Subsequently, I introduce an emerging paradigm that assigns a fundamental role to domain-general auditory processing (i.e., having a good ear) in L1 speech acquisition and proposes that the same faculty acts as a cornerstone of L2 speech learning (i.e., the Auditory Precision Hypothesis-L2). This hypothesis predicts that learners with more precise auditory processing ability will be able to make the most of every input opportunity, which will result in more advanced L2 speech proficiency. To close, I will provide suggestions on how scholars can assess L2 students' auditory processing ability (e.g., our team's offline test deposited at L2 Speech Tools for Researchers & Teachers [http://sla-speech-tools.com/]) and discuss how the results can be used to maximize learners' L2 speech learning opportunities via optimal, profile-matched training programs (e.g., explicit vs. incidental training; naturalistic vs. classroom learning; phonetic vs. auditory training).

The current study investigated the effects of repetition on the learning of second language (L2) spoken word forms. Japanese university students learning L2 English were randomly assigned to one of three treatment conditions (one, three, and six exposures) and learned 40 words while hearing them and viewing their corresponding pictures. A picture-naming test was administered before, immediately after, and approximately one week after the treatment. The elicited speech samples were evaluated for two aspects of spoken vocabulary knowledge: pronunciation (accentedness and comprehensibility) and form-meaning connection (spoken form recall). Results showed that (a) the number of exposures positively affected measures of form-meaning connection and pronunciation immediately after the treatment, and (b) cognateness moderated how strongly repetition impacted the pronunciation of L2 words. Moderate learning gains occurred for comprehensibility after six exposures to new words. However, with six exposures, only small effects of repetition were observed for accentedness.

This article explores the relationship between the freedom granted to teachers to shape curricula and the function of national standards. In recent years, many countries have begun to introduce standards-based reforms in education, such as standardized curriculums and high-stakes tests. As cultural diversity within schools increases, the tension resulting from catering to this diversity while maintaining standards is also rising. This article offers a comparative analysis of the educational theories and practices in the U.S. and Japan. In the U.S., debate and conflict between supporters of national standards and those of multicultural education have surfaced. In Japan, the government determines broad standards for all schools in order to ensure a fixed standard of education throughout the country. Thus, although the U.S. has a higher degree of cultural diversity than Japan, similar controversial issues will also face the Japanese educational system as school populations change rapidly due to the enrolment of children with diverse foreign heritages. Therefore, this article advocates the need for balance between the scope of regulation by the national government and the development of a citizenship education curriculum that uses teachers' own initiative in the modern age, and has practical implications for educational policymakers.

Cultivating preservice teachers' "shutaisei" has been the focus of Japanese university-based teacher education since the late 1990s. This article contains the self-study of three teacher educators at different Japanese universities. All three of us believe that helping students cultivate their "shutaisei" should be an important part of our teaching practices; however, framing "shutaisei" and pursuing it in practice poses complex dilemmas. In this article, we explore our individual understandings of "shutaisei's" meaning in theory and practice, and reflect on how and why we considered it in these ways. We discussed our practices every two weeks online; all the conversations were videotaped and analyzed. Ultimately, through this self-study, we (teacher educators) found: (1) We had defined what "shutaisei" means based on our own educational experiences; and (2) We had suggested our own "shutaisei" to the students without being aware that it is based on our own educational experience. Teacher education institutions, we recommend, should provide opportunities for faculty members to explore themselves and their practices.

This study used class practices to verify the applicability of a web application specially developed for the observation in general elementary school classes of the blooming of cherry blossoms with time-lapse digital images. The learning effects of class practices on children's perceptions of the connection between familiar phenomena and climate change were examined with a questionnaire survey. The results further demonstrated the potential for plant phenology observation using time-lapse images to contribute to students' acquisition of multi-timescale concepts from seasonal phenomena around them to century-scale climate change. This study can help provide a participatory approach, to an issue that is difficult for many learners to experience directly from the perspective of digital technology on environmental education.

Scholars have extensively investigated the effectiveness of high variability phonetic training (HVPT), that is, identification and discrimination of second language speech sounds produced by multiple speakers followed by trial-by-trial feedback. Building on the notion of incidental and multimodal learning in cognitive psychology (e.g., Lim & Holt, 2011), we developed a new, HVPT-based videogame paradigm in which participants aimed to shoot clay targets as fast as possible while being guided to learn sound cues as a by-product of planned learning. Focusing on the speech acquisition of 58 Japanese English-as-a-foreign-language learners, the current study set out to test the pedagogical potential and limits of the incidental HVPT approach. According to the results of statistical analyses, the effectiveness of incidental HVPT can be more clearly observed if it focuses on more learnable targets (e.g., acquisition of English [ae]-[open-mid back unrounded vowel] rather than [r]-[l] contrasts) with gains being more generalizable from trained to new speakers' voices and from perception to production dimensions.

The aim of this study was to understand adult learners' strategy use in foreign language learning. It also explored how such strategy use relates to learners' sense of self-efficacy, self-regulated learning, and language proficiency. Two questionnaires were administered to obtain data from 90 education majors in a Japanese university. Differences in strategy use in relation to self-efficacy, self-regulatedness, and proficiency were examined using Kruskal-Wallis H tests. Whilst some preferred and less preferred strategy items were identified, the findings suggested that possession of a high self-efficacy profile and self-regulatedness related to both greater use of language learning strategies and a higher level of language proficiency. However, a closer look detected a nuanced, important difference in the magnitude of the effect, whereby self-regulatedness may be more yielding than self-efficacy. Namely, self-regulatedness played a substantial role in differentiating use of several strategy items among different proficiency groups, whereas self-efficacy seems to play a smaller part than self-regulatedness in this respect, considering the effect sizes. Thus, this empirical study contributes to the ongoing discussion of the different roles and nature of the self-efficacy and self-regulatedness constructs in the context of language learning and teaching. Implications for language teaching are discussed, and directions for future research are suggested.

We analyzed a Japanese lexical database to investigate the structure of the lexical environment based on the hypothesis that the lexical environment is optimized for the functioning of verbal working memory. Our prediction was that, as a consequence of the cultural transmission of language, low-imageable meanings tend to be represented by frequent phonological patterns in the current vocabulary rather than infrequent phonological patterns. This prediction was based on two findings of previous laboratory studies on verbal working memory. (1) The quality of phonological (phonemic and accent) representations in verbal working memory depends on phonological regularity knowledge; therefore, short-term phonological representations are less robust for words with infrequent phonological patterns. (2) Phonological representations are underpinned by contributions from semantic knowledge; therefore, phonological representations of highly imageable words are more robust than those for low-imageable words. Our database analyses show that nouns with less imageable meanings tend to be associated with more frequent phonological patterns in Japanese vocabulary. This lexical structure can maintain the quality of phonological representations in verbal working memory through contributions of semantic and phonological regularity knowledge. Larger semantic contributions compensate for the less robust phonological representations of infrequent phonological forms. The quality of phonological representations is preserved by phonological regularity knowledge when larger semantic contributions are not expected.

Ecocentric education programs should include a method for the in-depth understanding of multi-scale ecological time concepts. To accomplish this, the common restriction that ecocentric education should pertain only to realistic nature may have to be removed. The purpose of this research was to confirm the validity of a program featuring phenology observation, employing fixed-point time-lapse images as climate change learning, and to obtain suggestions on the influence of the program on the multi-timescale concepts of the learners. An observation sheet listing images of cherry flowering from 16 April to 15 March each year from 1996 to 2017 was created, and the 50-min educational program using the observation sheet was conducted with 189 third year junior high school students. The tendencies among students' answers to the two questions before and after the program suggest that the program contributed to the students acquiring the hundreds-year timescale concept based on the short-term timescale concept of dynamic nature. The contribution of this research is to visualize long-term and multi-scale ecological time concepts. By combining long-term time-lapse images with everyday nature experiences, the possibility of expanding such emotions as wonder and attachment to nature towards a long-term ecological timescale is achieved.

This study explored challenges of international collaborations in Japanese higher education by identifying management frameworks and elements necessary to run effective programs. Internationalization was examined from three perspectives: collaboration between a university's headquarters and its departments, program management, and quality assurance. A qualitative case-study design involved interviews with 48 directors of collaborative international programs. Results show that internationalization of Japanese higher education institutions has already progressed beyond the level of "amateur" activities but still faces several challenges. One key element of an entrepreneurial culture, effective central leadership, has already been introduced. Another key element is funding, but given limitations of forms dependent on public funding, selffunding systems, which have been established in some institutions, need to be embraced more widely. Quality assurance remains challenging for higher education, and most institutions have not yet obtained accreditation by external agencies.

The study evaluated a recently postponed national test policy on the use of external agencies' English tests measuring four skills for Japanese university admission purposes. Using Kunnan's principles of fairness and justice, we generated and evaluated three claims regarding the test policy: vocabulary coverage of the tests, the justifiability of the Common European Framework of References for Languages (CEFR)-based concordance table, and tests' impact on teaching and learning productive skills. Scrutinizing the backing and rebuttal evidence from the test agencies' voices to the key literature, we arrived at a partial acceptance of all three claims with the need for further research, calling into question a optimistic outlook underlying the test policy.

Purpose: This study examined the factors that facilitated and obstructed the dissemination of a physical education lesson study (PELS) project in Peru, conducted in collaboration with Japan. Design/methodology/approach: Adopting a qualitative approach, five Peruvian stakeholders in the field of physical education (PE) were interviewed. All the interviews were transcribed. The data were analysed using the Steps for Coding and Theorization (SCAT). Findings: The factors that obstructed the dissemination of PELS were lack of mutual observation of lessons among teachers and the resistance of teachers to the project due to the term "study" in "lesson study". Conversely, online dissemination of PELS may significantly improve its position in Peru. Disseminating PELS through small group practice and deploying it in the field of education through stakeholder collaboration comprised facilitating factors. Originality/value: This study could facilitate an understanding of Peruvian educational and PE culture and have ripple effects on the practice and dissemination of LS in other countries and subject areas.

The purpose of the current study was to examine Japanese graduate students' professional socialisation experiences while instructing students with disabilities during adapted physical education (APE) practicum experiences. This study, situated in occupational socialisation theory, used a case study design. Seven graduate students (four males and three females), who engaged in weekly APE practicum experiences at a Japanese public university campus, were included in this study. Data sources included individual semi-structured face-to-face interviews. The data were analysed using a constant comparative method, and three themes emerged: (1) "equity and equality of professional caring behaviours"; (2) "collaborative lessons"; and (3) "lack of teaching students with severe and profound disabilities in APE practicum." Based on the graduate students' socialisation experiences during their practicum experiences, we suggest APE graduate programmes develop a series of trainee experiences with public school partnerships to enhance teaching competences, and collaborate with in-service APE and/or special education teachers.

This study examined how longitudinal interaction impacts the development of second language (L2) oral proficiency in relation to learners' different experience and proficiency levels. Japanese learners of English as a foreign language (EFL) participated in weekly conversation exchanges with native speakers (NSs) in the USA via videoconferencing tools over one academic semester (12 weeks). The participants' spontaneous speech, elicited from a story telling task before and after the treatment, was analysed via a set of linguistic measures. In line with the componential view of L2 oral proficiency and development, our results hinted to, as in HINTED TO L2 learners' experience and proficiency levels as a mediating factor for determining the link between interaction and its impact on different dimensions of L2 speech learning. While the longitudinal interaction equally improved the participants' grammatical complexity and articulation rate -- a fundamental component for defining L2 oral proficiency -- the development of less experienced/proficient learners was observed across a wide range of lexicogrammar and fluency features (lexical appropriateness/richness, grammatical accuracy, pause ratio). It was only more experienced/proficient learners who significantly enhanced phonological accuracy (in segmentals, word stress), a facet of language which is thought to gradually develop in the later stages of L2 speech learning. These findings add another piece of evidence for the differential effects of long-term interaction relative to L2 learners' developmental stages.

The goal of this paper was to explore the directions for a Japanese Qualifications Framework (JQF) through the collation of Japanese Government expert viewpoints. This study used a qualitative case study design involving interviews with 15 Japanese government officials. It was found that Japan continues to have problems with academic degrees and licensing framework and system. Many Japanese government experts believed that Japan needed a qualifications framework and system that could function both domestically and internationally, however, Japan has an insufficient qualifications framework and system which has led to weak competitiveness for Japanese experts. To resolve these issues, a Japanese qualifications system needs (1) to have pathways toward higher skill levels from work-based experience to higher education and (2) to broaden pathways allowing for the transfer of Japanese domestic qualifications to international framework qualifications. It is concluded that to build these pathways, National Qualifications Framework is needed as a common language and a basic framework to make the qualifications more transparent and to align domestic and international qualification standards. The Japanese government should enter into a discussion about JQF seriously with stakeholders in education, industry, and government with the aim of improving higher education programs for experts to ensure domestic and international competitiveness.

Eighty Japanese learners of English as a foreign language encountered 40 target words in one of four experimental conditions (three encounters, six encounters, three encounters with talker variability, and six encounters with talker variability). A picture-naming test was conducted three times (pretest, immediate posttest, and delayed posttest) and elicited speech samples were scored in terms of form-meaning connection (spoken form recall) and word stress accuracy (stress placement accuracy and vowel duration ratio). Results suggested that frequency of exposure consistently promoted the recall of spoken forms, whereas talker variability was more closely related to the enhancement of word stress accuracy. These findings shed light on how input quantity (frequency) and quality (variability) affect different stages of lexical development and provide implications for vocabulary teaching.

Aim: The importance of human papillomavirus (HPV) co‐testing using physician‐, self‐, and urine‐collected samples to predict cervical intraepithelial neoplasia (CIN) grade 1–2 prognoses has not been previously reported. Therefore, this study aimed to investigate outcomes of patients with CIN 1–2 who simultaneously underwent physician‐, self‐, and urine‐collection sampling tests. Methods: This study was conducted in Japan between October 2019 and November 2022 and examined the proportion of cases with CIN 1–2 progressions, the percentage of cases with persistent CIN 1–2, and the outcome differences according to the results of physician‐, self‐, and urine‐sampling tests. Results: There were 105 and 59 CIN 1 and 2 cases, respectively, with progression or persistence in 27 (29.3%) and 21 (50.0%) cases, respectively. The median follow‐up was 20 and 12 months, respectively. Progression and persistence of CIN 1 were significantly associated with HPV‐positive physician‐ and self‐collected samples. No significant difference was observed between cases with CIN 2 who had HPV‐positive and HPV‐negative results using any sampling method. Conclusions: Physician‐ and self‐testing for HPV are crucial for predicting disease progression risk in CIN 1 cases. Future research with an extended observation period and consideration of the progression risks is warranted. [ABSTRACT FROM AUTHOR]

Higher education is attracting more participation from an increasingly diverse student body. This diversity invites concerns on effective instructional delivery as the extent of students' engagement in learning now varies widely. Anecdotes on students' "undesirable" dispositions in course participation are not uncommon in higher education settings. This project set out to develop a questionnaire, developed for higher education in the Japanese context, on a range of student dispositions. The scale was a five-point Likert instrument designed to interpret learners' disengagement as an attitudinal disposition. The paper discusses the conceptual contours of disengagement as a student disposition that provided the basis for the context-specific scale items. It reports the procedures taken to obtain the factor structures of the dataset. The questionnaire was administered to 145 engineering students in Japan. An exploratory factor analysis revealed a five-factor solution--lack of commitment, distractedness, lack of preparedness, anti-social orientation, and lack of focus. Avenues for further research are suggested, and implications for practice are discussed.

Purpose: We examined the association of walking and activities of daily living(ADL) with trunk and lower extremity muscle thickness in children with Down syndrome (DS). Methods: 27 children with DS participated in this study. Walking was assessed using measurements of the maximal walking speed and step length, while ADL was assessed using the Pediatric Evaluation of DisabilityInventory (PEDI). The thickness of the trunk and lower extremity muscles was measured using an ultrasound imaging device. Results: The peroneus brevis muscle thickness was a significant and independent factor associated with step length. The tibialis posterior muscle thickness was significant and independent factor of self-care. The thickness of the soleus and tibialis posterior muscles were significant and independent factors of mobility. Finally, the soleus muscle thickness was a significant and independent factor of social function in PEDI. Conclusions: The findings of this study indicate that future clinical work should focus on the function of the plantar flexor muscles in walking and ADL in children with DS. [ABSTRACT FROM AUTHOR]

Background: With the rise in the older population, it has become important to understand the relationship between oral frailty and drug use to consider appropriate medical interventions and drug use for older persons. Objective: To clarify the relationship among oral frailty, drug use, and other patient backgrounds and to identify relevant factors using information from patient questionnaires and pharmacy medication history records. Methods: This cross-sectional study involved community-dwelling older adults. Older adults aged ≥ 65 years who visited 44 pharmacies in Tochigi Prefecture, Japan, with their prescriptions between July 1 and September 10, 2021, and who were able to complete the questionnaire independently were eligible for the study. An oral Frailty Index-8 score ≥ 4 was used to define the oral frailty group, while a score of 0–3 was used to define the non-oral frailty group. A multivariate logistic regression analysis was conducted to identify relevant factors for oral frailty, with oral frailty as the dependent variable and items from the questionnaire and drug survey as independent variables. Results: A total of 1,386 eligible participants were included in this study, and 761 (54.9%) had oral frailty. Multivariate logistic regression analysis showed that frailty, number of natural teeth (fewer than 20), and benzodiazepine use were significantly associated with oral frailty (p < 0.001, p < 0.001, and p = 0.037, respectively). Conclusions: Our results will provide evidence for community pharmacists to provide appropriate patient education, recommend consultations with dental care providers, and assist in community healthcare coordination. [ABSTRACT FROM AUTHOR]

Genome editing (GE) technology holds significant promise for advancements in crop development and medical applications. However, public acceptance of GE in Japan remains uncertain. This study aimed to examine how knowledge impacts public acceptance of GE technology, focusing on differences across diffusion stages and application purposes. Using ordinary least squares regression on repeated survey data collected from 2018 to 2023 in Japan (n = 6,234), we investigated the influence of knowledge on support for GE in consumer benefits, producer benefits, and medical technology. Our findings revealed that the effect of knowledge on technology acceptance has strengthened over time. Consumers with greater knowledge of GE are increasingly supportive of its advancement, emphasizing the growing importance of information as the technology becomes more widespread. This research highlights the role of transparent policy discussions in fostering public trust and support, thereby promoting the successful integration of new technologies into society. [ABSTRACT FROM AUTHOR]

Background The inflammatory response plays a crucial role in tumor development. Inflammatory markers are recognized prognostic factors in many types of cancer, including gastric cancer. However, the correlation between inflammatory markers and prognosis in remnant gastric cancer (RGC) remains unclear. The aim of this study was to evaluate the importance of inflammatory markers as a prognostic factor in patients who underwent gastrectomy for RGC. Methods This multicenter retrospective study involved 107 patients with RGC who underwent curative gastrectomy at 10 institutions in Japan between January 2000 and December 2016. Both overall survival (OS) and relapse-free survival (RFS) were analyzed. Results Receiver operating characteristic analyses indicated that the lymphocyte/monocyte ratio (LMR) had a higher area under the curve compared with other potential prognostic factors. Patients were categorized into high- and low LMR groups by the optimal LMR cutoff value. Preoperative LMR was significantly correlated with reconstruction way after the primary surgery (p=0.032) and lymphatic invasion (p=0.046). OS and RFS were significantly worse in the low- vs high LMR groups. Low LMR, T3 or deeper tumor invasion, and low body mass index were independent prognostic factors for OS and RFS. Conclusion Preoperative low LMR is associated with poor OS and RFS in patients who undergo gastrectomy for RGC. [ABSTRACT FROM AUTHOR]

After the Great East Japan Earthquake, tsunami, and nuclear disaster (3.11) of March 11, 2011, the use of various media to convey disaster experiences and lessons grew, including a large number of 3.11 picture books. However, there has been limited scholarship on these books, and no comprehensive database of 3.11 picture books exists. This research conducted an comprehensive inventory of 3.11 picture books published in the 13 years after the disaster, until March 2024. 122 titles met the criteria of being picture books with stories related to the 3.11 disasters, and an initial survey identified general trends in their publication over time and by publication type. Through investigating themes and contents, the authors identified six primary narrative typological categories: (1) disaster impact stories, that focus on telling what happened; (2) disaster risk reduction action or evacuation stories; (3) stories of local pride (place attachment); (4) stories with hopeful or positive messages for the future; (5) stories of loss; and (6) stories about nature and animals. As initial research, this paper represents a unique contribution to the growing body of literature on disaster storytelling media and clarifies the characteristics of 3.11 picture books as a body of work. Building on this comprehensive inventory and thematical categorization of 3.11 picture books, the authors expect future research to further analyze the text and image contents of these books, leading to deeper understanding of the contributions of 3.11 picture books towards not only emotional care, but also raising disaster awareness. [ABSTRACT FROM AUTHOR]

Aim: Describe the current phenotypes and clinical laboratory data regarding polycystic ovary syndrome (PCOS) in Japan, taking into account ethnic differences and obesity status. Methods: Data for 986 PCOS cases and 965 control cases were collected using a nationwide survey in Japan. Obese/overweight (body mass index [BMI] ≥25 kg/m2) and non‐obese/overweight (BMI <25 kg/m2) cases were compared. Results: Japanese PCOS cases predominantly involved non‐obese/overweight patients, accounting for 75% of all cases. Among non‐obese/overweight PCOS cases, the incidence of both amenorrhea and clinical/biochemical hyperandrogenism was significantly lower than in obese/overweight PCOS cases, whereas the rate of elevated serum luteinizing hormone (LH) level was significantly higher. Even though the incidence of hirsutism in Japan is only 13.5%, the detection rate for hyperandrogenism increased by as much as 30.4% when hirsutism was added to the Japan Society of Obstetrics and Gynecology (JSOG) criteria for the diagnosis of hyperandrogenism in addition to elevated serum total testosterone level. When evaluated based on timing of blood sampling, the LH level and LH/follicle‐stimulating hormone ratio determined at the initial consultation involving a chief complaint of irregular menstrual cycle (after confirming the absence of follicles measuring ≥1 cm in diameter) were significantly higher than on days 2–3 or 4–6 of the menstrual cycle. Conclusions: Ethnic differences, including obesity status, affected the phenotype and clinical laboratory data of Japanese PCOS patients, such as the incidence rates of clinical/biochemical hyperandrogenism and the rate of elevated basal LH level. Adding hirsutism to the JSOG 2024 criteria would enhance the accuracy of PCOS diagnosis and enhance consistency with the Rotterdam 2003 criteria. Measuring basal LH level is useful for assessing the endocrinologic characteristics of Japanese PCOS cases, as well as lean Asian PCOS cases, but the timing of blood sampling can affect the result. [ABSTRACT FROM AUTHOR]

Aim: To assess the cost‐effectiveness of diabetic nephropathy treatment with sodium‐glucose cotransporter‐2 (SGLT2) inhibitors in Japanese clinical practice, considering diabetes‐related complications. Materials and Methods: A population‐based Monte Carlo simulation was used to estimate the cost‐effectiveness for people with diabetic nephropathy who initiated pharmacotherapy with an SGLT2 inhibitor plus conventional treatment or conventional treatment alone, based on quality‐adjusted life‐years (QALYs) and healthcare costs. The Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation study (CREDENCE) and the Japanese Society for Dialysis Research statistical survey were the primary sources of probability and mortality, while Japanese Health Insurance Claims Data were the cost source. The state transition model included diabetic nephropathy, hospitalization due to cardiovascular disease, dialysis, and death. One‐way and probabilistic sensitivity analyses were used to explore model uncertainty. Results: Using the threshold of JPY 5 000 000 per QALY, SGLT2 inhibitor plus conventional treatment was more cost‐effective than conventional treatment alone, with an incremental cost‐effectiveness ratio of JPY 654 309 per QALY. Treating 100 000 people, SGLT2 inhibitor plus conventional treatment prevented 2234 deaths and reduced 5793 fewer heart failure cases, 3967 fewer myocardial infarctions and stroke events. Sensitivity analysis affirmed the robustness of these results for patients aged under 70 years. Conclusions: The SGLT2 inhibitor treatment appeared to be cost‐effective for the overall population of our study and particularly for younger patients (<70 years old). For older patients (≥70 years old), the cost‐effectiveness was less clear and may require further evaluation. Decision‐makers should consider this age‐based heterogeneity when making recommendations about SGLT2 inhibitor treatment. [ABSTRACT FROM AUTHOR]

Objective: Understanding the characteristics of falls among older adults is necessary to prevent them. These characteristics include questions such as when (month and time), where (places), who (age), what (injury), why (trigger), and how (direction) the falls occur. The objective of this study was to identify the characteristics of falls in individuals aged 65–74 years (young‐old), 75–84 years (old‐old), and ≥85 years (oldest‐old). Methods: We conducted an observational mail survey among community‐dwelling older adults in Japan and collected detailed information on the incidence of falls over the past 3 years. The month, time, location, trigger, direction, and resulting trauma of each fall were analyzed and compared across the different age groups (young‐old, old‐old, and oldest‐old). Results: A total of 1695 falls among 1074 community‐dwelling older adults were analyzed in this study. Falls were frequent during May and October as well as during the winter season from December to February, especially between 10:00 a.m. and 11:00 a.m. These fall characteristics were consistent across all the age groups. There was a higher incidence of outdoor falls among relatively young older adults, which were typically caused by tripping or slipping. However, as one progresses with age, there is a higher incidence of falls indoors, typically due to loss of balance or leg entrapment. Approximately 60% of older fallers experience some form of injury due to falls, with fractures considered the most serious, occurring in ≈10% of all falls. Conclusion: We clarified the characteristics of falls including the "when, where, who, what, why, and how" of the fall. A future challenge is to use this valuable information to develop effective fall prevention programs for older populations worldwide. Geriatr Gerontol Int 2024; 24: 1181–1188. [ABSTRACT FROM AUTHOR]

Background: Behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia from the early stages and can appear even in mild cognitive impairment (MCI). However, the prognostic impact of BPSD is unclear. This study examined the association between BPSD and mortality among people with cognitive impairment. Methods: This longitudinal study involved 1,065 males and 1,681 females (mean age: 77.1 years for males and 78.6 years for females) with MCI or dementia diagnosis from the National Center for Geriatrics and Gerontology-Life Stories of People with Dementia (NCGG-STORIES), a single-center memory clinic-based cohort study in Japan that registered first-time outpatients from 2010-2018. Information about death was collected through a mail survey returned by participants or their close relatives, with an up to 8-year follow-up. BPSD was assessed using the Dementia Behavior Disturbance Scale (DBD) at baseline. Results: During the follow-up period, 229 (28.1%) male and 254 (15.1%) female deaths occurred. Cox proportional hazards regression analysis showed that higher DBD scores were significantly associated with increased mortality risk among males, but not females (compared with the lowest quartile score group, hazard ratios for the highest quartile score group were 1.59; 95% confidence interval, [CI] 1.11-2.29 for males and 1.06; 95% CI, 0.66-1.70 for females). Among the DBD items, lack of interest in daily living, excessive daytime sleep, and refusal to receive care had a higher mortality risk. Conclusion: The findings suggest a potential association between BPSD and poor prognosis among males with cognitive impairment. [ABSTRACT FROM AUTHOR]

There has been increasing attention given to the notion that international education consists of non-linear and multi-directional transmissive exchanges between existing institutional academic conditions and international students. Despite the role of international students' agency being paramount, there is a dearth of research on the relationships between these students' agency and their experiences of international education, which are intertwined with "habitus" and "hysteresis." This paper aims to investigate how six Japanese international students at Australian universities experience hysteresis and then respond through agentic practices. The findings reveal that many of the students in this study embark on various stages of despair and fear, namely hysteresis, before they explore opportunities to reconstruct their "habitus" in light of institutional norms and conventions. The authors advocate that when students' habitus is challenged, it induces a hysteresis effect, which is a process of learning, filled with potentialities.

The notion of employability has become a focal point of higher education in many countries' strategies to prepare students for employment. Responses to this notion can differ largely from country to country and from university to university, based on their historical, political, and economic contexts. However, very little has been researched in terms of these differences. More investigation in this area is needed to conceptualise patterns of universities' orientations towards the employment of their graduates. In this article, we utilised comparative institutional analysis as a conceptual framework to discuss differences in the practices deployed by universities in Australia and Japan to prepare their students for employment. We found that Australian universities have widely applied the so-called 'potential maximisation mode' with a focus on teaching technical knowledge and professional skills for increased employability. However, the 'results maximisation mode' has been widely utilised by Japanese universities, stressing the role of universities and academics in ensuring the use of actual graduates to connect students to potential industries directly or creating mentoring opportunities for current students and alumni.

This study examined whether executive functions impact how flexibly children represent task context in performing repeated sequential actions. Japanese children in Experiments 1 (N = 52; 3-6 years) and 2 (N = 50, 4-6 years) performed sequential actions repeatedly; one group received reminders. Experiment 1 indicated that reminders promote flexible changes in contextual representations. Experiment 2 observed such effects in younger children and showed executive functions were associated with the flexible representation of task context. Reminders did not perfectly compensate for the role of executive functions but wiped out individual differences in executive functions that contribute to children's acquisition of routines. Therefore, setting goals before context-dependent actions is necessary, but not sufficient, to modulate contextual representations in routines.

Background: Both underweight and overweight are public health concerns in Japan. Several studies examined the association between health literacy (HL) and obesity status in the general population; however, there is limited information on young adults. In addition, the association between HL and underweight status has not been extensively investigated. Aim: To examine the association between HL and underweight/overweight status among young Japanese adults aged 20 to 39 years. Method: This study was based on a cross-sectional survey of population-representative adults. HL was assessed using a questionnaire validated in Japanese adults. Body mass index (BMI) was calculated using self-reported weight and height. Participants were divided into two groups by HL score using the median score (lower vs. higher HL). The association between HL and underweight (BMI <18.5) or overweight (BMI [greater than or equal to] 25.0) was examined using multinomial logistic regression analyses after adjusting for potential confounders. Results: In total, 476 women and 454 men were included in the analyses. Prevalence of underweight and overweight was 20.8% and 10.3% in women and 8.8% and 20.3% in men, respectively. In women, 45.1% of normal weight, 47.5% of underweight, and 30.6% of overweight had higher HL. Among men, 50.3% of normal weight, 35.0% of underweight, and 44.6% of overweight had higher HL. Bivariate analyses showed no statistically significant association between HL level and underweight/overweight status. Even after adjusting for potential confounders, these associations did not change. Discussion and Conclusion: This study suggests that HL scores may not be associated with underweight or overweight status in Japanese adults.

This paper will explore an alternative mode of thinking and language for higher education, centering on the idea of "philosophy as translation"--an idea drawn from the American philosopher, Stanley Cavell. This broader sense of translation is inseparable from our reengagement with cultures, language, self and others. From this philosophical perspective, the paper proposes to convert our ways of thinking so that we can re-encounter different cultures as other through a process of border-crossing. It has educational implications in terms of an art of dialogue through which one exposes oneself to the other by releasing oneself and one's own culture towards the possibility of further growth. This, I shall argue, necessitates us the conversion of the discourse and mode of thinking that pervades the current education for global citizenship, political education and critical thinking in higher education. In conclusion, I shall present the possibilities of a perfectionist education--an idea drawn from Cavell's Emersonian perfectionism. This is in service of the enhancement of an alternative mode of global and cross-cultural dialogue. We need to tap new human resources for the global citizen--for the individual who will live by taking a chance in uncertainty and who can speak "without bounds." This I shall conclude to be the fundamental sense of liberal education.

Background: Per the biopsychosocial model, pain, especially chronic low back pain, which often presents with nonspecific pain, requires a comprehensive approach involving social factors. However, the association of social factors, including social isolation and loneliness, with this condition remains unclear. This study examined the cross-sectional association of social isolation and loneliness with chronic low back pain among older adults. Methods: We recruited functionally independent older adults through a mail survey in 2019 from the Japan Gerontological Evaluation Study (JAGES). Chronic low back pain was defined as low back pain lasting more than 3 months. Social isolation was identified based on face-to-face and non-face-to-face interactions ("not isolated," "isolated tendency," and "isolated"). Loneliness was assessed using the University of California, Los Angeles Loneliness Scale ("not lonely," "lonely tendency," and "lonely"). Results: Consequently, 21,463 participants were analyzed (mean age: 74.4 years; 51.5% females); 12.6% reported chronic low back pain. Multivariable Poisson regression analysis revealed that loneliness was significantly associated with the likelihood of chronic low back pain; compared with "not lonely", the prevalence ratio (PR) was 1.14 (95% confidence interval [CI], 1.05-1.25) for "lonely tendency" and 1.40 (95% CI, 1.27-1.54) for "lonely." Social isolation was not associated; compared with "not isolated," the PR was 0.96 (95% CI, 0.88-1.05) for "isolated tendency" and 0.99 (95% CI, 0.89-1.10) for "isolated." A positive multiplicative interaction between social isolation and loneliness for chronic low back pain was found. Conclusion: Lonelier individuals were more likely to experience chronic low back pain, and those with loneliness and social isolation were synergistically more likely for this condition. [ABSTRACT FROM AUTHOR]

Aim/Purpose: Although many computer science measures have been proposed, visualizing individual students' capabilities is difficult, as those measures often rely on specific tools and methods or are not graded. To solve these problems, we propose a rubric for measuring and visualizing the effects of learning computer programming for elementary school students enrolled in computer science education (CSE), which is independent of the programming language being used. Background: In this research, we proposed a rubric based on existing CSE standards and criteria having a programming education-learning goal. We then applied this rubric to actual lessons to visualize the educational effects. Methodology: The proposed new rubric for teaching computer programming, based on existing standards and criteria, was applied to fourth- and sixth-grade students in Japan. We assessed which skills were cultivated through quizzes before and after the teaching. Contribution: This paper contributes on how to make and utilize a rubric for programming education in computer science. We evaluated and visualized the proposed rubric's learning effects on children and found that our proposed rubrics are independent of any particular method or tool. Findings: The results of this survey are twofold: (1) we proposed a rubric of programming education in computer science, independent of the programming tools used and (2) we succeeded in visualizing students' learning stages by applying the proposed rubric to programming education conducted in a Japanese elementary school. Recommendations for Practitioners: Evaluating educational effects in CSE is important. In particular, graded assessments of learner abilities can reveal individual characteristics. This research is useful for assessing CSE because it focuses specifically on programming education. Recommendations for Researchers: The rubric's suggestions and quality improvements in CSE help learners assess their learning progress and will clarify the cultivated computer science skills. Impact on Society This research evaluates CSE based on a rubric in the programming education field. Future Research: Future work is needed to improve the proposed rubric's quality and relevance. Also, this rubric should be applied to many classes to increase the number of evaluations and analyses.

The current study examines how second language (L2) users differentially assess the comprehensibility (i.e., ease of understanding) of foreign-accented speech according to a range of background variables, including first language (L1) profiles, L2 proficiency, age, experience, familiarity, and metacognition. A total of 110 L2 listeners first evaluated the global comprehensibility of 50 spontaneous speech samples produced by low-, mid-, and high-proficiency Japanese speakers of English. The listeners were categorized into two subgroups according to a cluster analysis of their rating scores: lenient and strict. Results showed that while the lenient listeners appeared to rely equally on many linguistic areas of speech during their judgments, the strict listeners were strongly attuned to phonological accuracy. Analysis of the background questionnaire data revealed that more lenient listeners likely had higher levels of awareness of the importance of comprehensibility for communication (metacognition); regularly used L2 English in professional settings (experience); and had L1s more linguistically close to the target speech samples, Japanese-accented English (L1-L2 distance).

The current study longitudinally examined a crucial individual difference variable -- i.e. awareness (operationalized as explicit attention and articulatory knowledge) -- in adult second language (L2) speech learning in the context of 40 Japanese learners' English /[alveolar approximant]/ pronunciation development in an EFL classroom. The participants' speech, elicited from word reading, sentence reading and timed picture description tasks at the beginning and end of one academic semester, were analysed in terms of three acoustic dimensions of English /[alveolar approximant]/: third formant (F3), second formant (F2) and duration. Whereas the participants showed gains in the relatively easy aspect of the English /[alveolar approximant]/ acquisition (F2 reduction for tongue retraction) as a function of increased L2 input, their explicit awareness of accurate English /[alveolar approximant]/ pronunciation played a significant role in the acquisition of the relatively difficult dimension (lengthening phonemic duration). The awareness-acquisition link was not found, however, for the most difficult dimension (F3 reduction for labial, alveolar and pharyngeal constrictors) at least within the timeframe of the project.

The Hebb repetition paradigm has recently attracted attention as a measure of serial order learning, which underlies word-form learning abilities. Although children are good vocabulary learners, it is surprising that previous Hebb learning studies with young children show rather weak Hebb effects. In this study, we conducted two experiments to identify developmental factors that drive an increase of the size of the Hebb effect in young children. Motivated by evidence from adult work, we focused on an ability to group a sequence into consistent subsequences and on phonological short-term memory (STM) capacity. In Experiment 1 (N = 98), it was shown that 3- to 5-year-old children with high phonological STM capacity showed a Hebb effect, particularly in the later experimental trials. In Experiment 2 (N = 97), temporal grouping of the sequences in 2-2 subsequences further encouraged children with high phonological STM capacity to show the Hebb effect even in the earlier experimental trials and children with low STM capacity to show a trend toward a Hebb effect in the later trials. Moreover, across Experiments 1 and 2 we found robust evidence of transfer of the Hebb effect to recall of new sequences that partially overlapped in item-by-item pairings with the Hebb sequence, indicating that children use consistent grouping strategies when learning above-span Hebb sequences. These findings indicate that phonological STM, grouping consistency, and their interaction are developmental requirements for the Hebb effect to emerge.

A wealth of developmental research suggests that preschoolers are capable of reporting, imitating, and performing sequential actions they engage in routinely. However, few studies have explored the developmental and cognitive mechanisms required for learning how to perform such routines. A previous computational model of routines argued that a representation of task contexts underlying routines could change flexibly. This position was supported by the empirical evidence that if adults are interrupted in the course of a routine, they make fewer errors if they are interrupted just before the selection of context-dependent action than if they are interrupted earlier. Another computational model examined how efficiently adults learned to perform routines and suggested the relationship of learning efficacy with executive functions. The present study aimed to examine whether the above-mentioned models and evidence from adults can be extended to preschoolers by using an experimental task, in which children were required to play the role of a baker and repeatedly make toast for either a cat or mouse, with momentary distractions. Experiment 1 showed that earlier interruption tended to cause older children to produce more branch point errors than interruption immediately before the branch points, whereas younger children tended to be vulnerable to both interruptions. Further, across 2 experiments, this study showed that the developmental differences in how young children represent task contexts were associated with their executive functions. These findings indicate that the representational flexibility of task contexts underlies children's performance of repeated sequential actions and its association with executive functions.

The current study longitudinally examined the influence of aptitude on second language (L2) pronunciation development when 40 first-year Japanese university students engaged in practice activities inside and outside English-as-a-Foreign-Language classrooms over one academic year. Spontaneous speech samples were elicited at the beginning, middle, and end points of the project, analyzed for global, segmental, syllabic, prosodic, and temporal aspects of L2 pronunciation, and linked to their aptitude and experience profiles. Results indicated that the participants generally enhanced the global comprehensibility of their speech (through reducing vowel insertion errors in complex syllables) as a function of increased classroom experience during their first semester, and explicit learning aptitude (associative memory, phonemic coding) appeared to help certain learners further enhance their pronunciation proficiency through the development of fluency and prosody. In the second semester, incidental learning ability (sound sequence recognition) was shown to be a significant predictor of the extent to which certain learners continued to improve and ultimately attain advanced-level L2 comprehensibility, largely thanks to improved segmental accuracy.

Background: Concurrent chemoradiotherapy is the standard therapy for locally advanced non‐small cell lung cancer (NSCLC). However, there is little evidence supporting its use in older adults. Low‐dose daily carboplatin combined with thoracic radiotherapy is considered a standard regimen for this population. To establish a simple and feasible carboplatin administration method, we conducted a study of weekly carboplatin and concurrent radiotherapy for older adults with locally advanced NSCLC. Methods: This prospective, single‐arm, multicenter, phase II clinical trial included patients aged ≥75 years with unresectable stage III NSCLC and Eastern Cooperative Oncology Group performance status 0–1. Patients received chemoradiotherapy (60 Gy/30 fractions plus concurrent weekly carboplatin at an area under curve of 2 mg mL−1 min−1). The primary endpoint was the overall response rate (ORR). Key secondary endpoints included progression‐free survival (PFS), overall survival (OS), and safety. Results: From July 2020 to June 2022, 37 patients were enrolled from 15 institutions, and 36 patients were evaluable for efficacy and safety. The ORR was 63.9% (95% confidence interval [CI] = 47.6–77.5). Median PFS was 14.6 months (95% CI = 9.1–18.1). Median OS was 25.5 months (95% CI = 17.4–not reached). Grade 4 leucopenia, neutropenia, and thrombocytopenia were observed in one patient (2.8%) each. Conclusion: Weekly carboplatin and concurrent radiation therapy was safe in older adults with locally advanced NSCLC, and promising activity was observed. [ABSTRACT FROM AUTHOR]

Objective: No reports on factors or Clinical prediction rules (CPRs) associated with walking independence among patients with vertebral compression fractures (VCFs) are available. Evidence regarding epidemiological walking independence rates is also sparse. Here, we sought to (i) obtain epidemiological data on the probability of inpatients with VCFs achieving walking independence, and (ii) develop and validate a CPR to determine walking independence in hospitalized patients with VCFs. Patients and Methods: We conducted a retrospective cross‐sectional observational study of patients aged ≥60 years who were hospitalized for VCF at four hospitals in Japan in 2019–2022. The outcome was walking independence at discharge. We performed a binomial logistic regression analysis to assess predictors of walking independence. Five independent variables were entered: age, American Society of Anesthesiologists physical status, cognitive function, Berg Balance Scale (BBS), and 10‐m walking test. Among the independent variables that were significant, we converted the continuous variables to binary data by calculating cut‐off values and then created the CPR. The area under the curve (AUC) was calculated as the measure of the CPR's diagnostic accuracy, and internal validation was conducted by bootstrapping. Results: Of the 240 patients, 188 (78.3%) achieved walking independence. Cognitive function and the BBS score (with a cut‐off of 45 points) were identified as significant predictors. We created a CPR using these two items (0–2 points). The CPR's AUC was 0.92 (0.874–0.967), and internal validation by bootstrapping yielded a mean AUC of 0.919 with a slope of 0.965. Conclusion: The walking independence rate of patients with a VCF during hospitalization was 78.3%, with cognitive function and BBS being predictors. The developed CPR performed well enough to retrospectively predict walking independence in VCF patients. The BBS cut‐off value and the CPR may serve as useful indicators for clinicians to predict VCF patients' walking independence. [ABSTRACT FROM AUTHOR]

Background: Prevotella bacteria are associated with inherent diseases of the oral cavity, such as periodontal disease, and systemic diseases. Oral frailty (OF) has been associated with nursing necessity and death. However, the relationship between OF and oral microbiota has not been fully clarified. Objective: This cross‐sectional study investigated the association between OF and Prevotella percentage in the oral microbiota of community‐dwelling older adults. Methods: Oral bacteria species from saliva were identified in 208 community‐dwelling older individuals aged ≥60 years in Japan. The proportion of Prevotella in the oral microbiota was classified into three tertile groups, and its relationship with each test item for OF (number of remaining teeth, masticatory performance, oral diadochokinesis, tongue pressure, difficulties eating tough foods, difficulties swallowing tea or soup, number of applicable OF judgement items, and existence of OF) was examined using ordinal logistic regression analysis. Results: The Prevotella proportions were classified into lower, middle and upper groups, comprising 70, 69 and 69 participants, respectively. The three groups showed a significant relationship between the number of remaining teeth (odds ratio [OR]: 0.946, 95% confidence interval [CI]: 0.915–0.977), masticatory performance (OR: 0.897, 95% CI: 0.844–0.953), number of applicable OF judgement items (OR: 1.477, 95% CI: 1.14–1.915), and existence of OF (OR: 4.194, 95% CI: 1.519–11.576). Conclusion: The proportion of Prevotella in oral microbiota was high in individuals with OF. Among the older adults, the type of oral microbiota and systemic diseases may be related to the examination and management of oral function decline. [ABSTRACT FROM AUTHOR]

Background Hip fractures in older people result in increased mortality. Objective We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively. Design Retrospective study. Setting Multicenter. Participants Patients aged ≥65 years with hip fractures who underwent surgery between 2011 and 2021 were enrolled. Methods The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively. Results We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively. Conclusions We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients. [ABSTRACT FROM AUTHOR]