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Summary The larvae of the genus Baylisascaris can cause larva migrans in mammals and birds. This study investigated the larval migration of Baylisascaris potosis, the roundworm of kinkajou (Potos flavus), in chickens and the associated clinical manifestations of the host. Thirty-six 3-week-old chickens divided into 6 groups were orally inoculated with 3,000 B. potosis eggs/chick. Each group of chicken was necropsied at days 1, 2, 3, 7, 30 and 90 PI (post inoculation), and the number of larvae in various organs were counted until day 90 PI. No clinical signs were observed in chickens during the study. Larvae were detected from the liver, lungs or breast-muscles of 13/36 (36.1%) chickens. The mean total number of larvae in the liver, lungs and breast-muscles at days 1, 2, 3, 7, 30 and 90 PI were 0.34, 0.17, 1.66, 1.01, 0.17 and 0, respectively. No larvae were found in the brain, eyes, hid-limb muscles, heart, kidneys and spleen. Although infectivity of larvae in egg-inoculated chickens was low, the present study demonstrated that B. potosis larvae can migrate in chickens tissues up to day 30 PI. The result suggests that chickens can serve as a paratenic host for B. potosis and may underline a public health importance of B. potosis infection as a potential foodborne disease in humans.

Background Communicating physical activity information with sufficient details, such as activity type, frequency, duration, and intensity, is vital to accurately delineate the attributes of physical activity that bring positive health impact. Unlike frequency and duration, intensity is a subjective concept that can be interpreted differently by people depending on demographics, health status, physical fitness, and exercise habits. However, activity intensity is often communicated using general degree modifiers, degree of physical exertion, and physical activity examples, which are the expressions that people may interpret differently. Lack of clarity in communicating the intensity level of physical activity is a potential barrier to an accurate assessment of exercise effect and effective imparting of exercise recommendations. Objective This study aimed to assess the variations in people’s perceptions and interpretations of commonly used intensity descriptions of physical activities and to identify factors that may contribute to these variations. Methods A Web-based survey with a 25-item questionnaire was conducted using Amazon Mechanical Turk, targeting adults residing in the United States. The questionnaire included questions on participants’ demographics, exercise habits, overall perceived health status, and perceived intensity of 10 physical activity examples. The survey responses were analyzed using the R statistical package. Results The analyses included 498 responses. The majority of respondents were females (276/498, 55.4%) and whites (399/498, 79.9%). Numeric ratings of physical exertion after exercise were relatively well associated with the 3 general degree descriptors of exercise intensity: light, moderate, and vigorous. However, there was no clear association between the intensity expressed with those degree descriptors and the degree of physical exertion the participants reported to have experienced after exercise. Intensity ratings of various examples of physical activity differed significantly according to respondents’ characteristics. Regression analyses showed that those who reported good health or considered regular exercise was important for their health tended to rate the intensity levels of the activity examples significantly higher than their counterparts. The respondents’ age and race (white vs nonwhite) were not significant predictors of the intensity rating. Conclusions This survey showed significant variations in how people perceive and interpret the intensity levels of physical activities described with general severity modifiers, degrees of physical exertion, and physical activity examples. Considering that these are among the most widely used methods of communicating physical activity intensity in current practice, a possible miscommunication in assessing and promoting physical activity seems to be a real concern. We need to adopt a method that represents activity intensity in a quantifiable manner to avoid unintended miscommunication.

Background: Physical activity data provides important information on disease onset, progression, and treatment outcomes. Although analyzing physical activity data in conjunction with other clinical and microbiological data will lead to new insights crucial for improving human health, it has been hampered partly because of the large variations in the way the data are collected and presented. Objective: The aim of this study was to develop a Physical Activity Ontology (PACO) to support structuring and standardizing heterogeneous descriptions of physical activities. Methods: We prepared a corpus of 1140 unique sentences collected from various physical activity questionnaires and scales as well as existing standardized terminologies and ontologies. We extracted concepts relevant to physical activity from the corpus using a natural language processing toolkit called Multipurpose Text Processing Tool. The target concepts were formalized into an ontology using Protege (version 4). Evaluation of PACO was performed to ensure logical and structural consistency as well as adherence to the best practice principles of building an ontology. A use case application of PACO was demonstrated by structuring and standardizing 36 exercise habit statements and then automatically classifying them to a defined class of either sufficiently active or insufficiently active using FaCT++, an ontology reasoner available in Protege. Results: PACO was constructed using 268 unique concepts extracted from the questionnaires and assessment scales. PACO contains 225 classes including 9 defined classes, 20 object properties, 1 data property, and 23 instances (excluding 36 exercise statements). The maximum depth of classes is 4, and the maximum number of siblings is 38. The evaluations with ontology auditing tools confirmed that PACO is structurally and logically consistent and satisfies the majority of the best practice rules of ontology authoring. We showed in a small sample of 36 exercise habit statements that we could formally represent them using PACO concepts and object properties. The formal representation was used to infer a patient activity status category of sufficiently active or insufficiently active using the FaCT++ reasoner. Conclusions: As a first step toward standardizing and structuring heterogeneous descriptions of physical activities for integrative data analyses, PACO was constructed based on the concepts collected from physical activity questionnaires and assessment scales. PACO was evaluated to be structurally consistent and compliant to ontology authoring principles. PACO was also demonstrated to be potentially useful in standardizing heterogeneous physical activity descriptions and classifying them into clinically meaningful categories that reflect adequacy of exercise.

Summary Syphacia muris is a ubiquitous nematode parasite and common contaminant of laboratory rats. A lthough S. muris infection is considered symptomless, it has some effects on the host’s immunity and therefore can interfere with experimental settings and interrupt final results. However, the molecular mechanisms involved in the alteration within the host’s immunity remain unclear because of the absence of information about mRNA expressed in this parasite. In this study we performed the transcriptome profiling of S. muris by next-generation sequencing. After de novo assembly and annotation, 14,821 contigs were found to have a sequence homology with any nematode sequence. Gene ontology analysis showed that the majority of the expressed genes are involved in cellular process, binding, and catalytic activity. Although the rate of expressed genes involved in the immune system was low, we found candidate genes that might be involved in the alteration within the host’s immunity by regulating the host’s innate immune response.

Objective It is crucial for clinicians to stay up to date on current literature in order to apply recent evidence to clinical decision making. Automatic summarization systems can help clinicians quickly view an aggregated summary of literature on a topic. Casama, a representation and summarization system based on “contextualized semantic maps,” captures the findings of biomedical studies as well as the contexts associated with patient population and study design. This paper presents a user-oriented evaluation of Casama in comparison to a context-free representation, SemRep. Materials and methods The effectiveness of the representation was evaluated by presenting users with manually annotated Casama and SemRep summaries of ten articles on driver mutations in cancer. Automatic annotations were evaluated on a collection of articles on EGFR mutation in lung cancer. Seven users completed a questionnaire rating the summarization quality for various topics and applications. Results Casama had higher median scores than SemRep for the majority of the topics (p ≤ 0.00032), all of the applications (p ≤ 0.00089), and in overall summarization quality (p ≤ 1.5e-05). Casama's manual annotations outperformed Casama's automatic annotations (p = 0.00061). Discussion Casama performed particularly well in the representation of strength of evidence, which was highly rated both quantitatively and qualitatively. Users noted that Casama's less granular, more targeted representation improved usability compared to SemRep. Conclusion This evaluation demonstrated the benefits of a contextualized representation for summarizing biomedical literature on cancer. Iteration on specific areas of Casama's representation, further development of its algorithms, and a clinically-oriented evaluation are warranted.

Summary Diabetes mellitus is one of the most common endocrine disorders and its continuous global increase is due to factors as population growth, urbanization, aging, and increasing prevalence of obesity and physical inactivity. The effect of pinworm infection on the development of hyperglycemia was examined in WBN/K-Lepf (fa/fa) rats, a new model of the obese type 2 diabetes mellitus (T2DM) with pancreatitis. The rats were orally administered Syphacia muris eggs (infected group) and distilled water (control group). Hyperglycemia onset in the infected group was significantly delayed compared to the control group. Neither body weight nor intake of food and water were affected by S. muris infection. This study demonstrated that S. muris infection delayed the onset of T2DM in fa/fa rats and suggested that elucidation of the underlying mechanism and relevant pathways in the helminth-mediated protection may lead to the development of a new strategy to prevent diabetes mellitus.

Quantitative measurement and assessment of magnetic resonance images (MRI) has an important role in the diagnosis, evaluation, and follow-up of brain tumors. Unfortunately, defining tumor boundaries on such images is a difficult task for automated methods – and even trained radiologists – as tumors tend to have irregular shapes, ill-defined margins, and various degrees of heterogeneity. In this work, we demonstrate that binary pixel classification of tumor regions is sub-optimal in reflecting the underlying biology of different tumor compartments and propose that pixel-wise probability maps are a more appropriate representation of tumor extent, providing volumetric approximations with error estimates. We present a framework that performs multimodal analysis of a tumor boundary using different perspectives to identify regions of high heterogeneity and that, together with error analysis, can be used as reference to identify instances on which the tumor segmentation is unclear and can be employed to improve performance of the segmentation algorithm on future cases. This approach was evaluated on a set of 110 cases of high grade gliomas obtained from The Cancer Genome Atlas (TCGA) for which a manual tumor region of interest (ROI) was available. From these cases, our algorithm automatically generated binary and probability masks for the dataset; comparison with the manual ROI resulted in a Dice coefficient of 0.8. It was qualitatively observed that the derived probability maps (overlaid as color maps on an MRI volume) provide a better visualization of tumor burden and its heterogeneous characteristics, which can be valuable during treatment planning (e.g., radiotherapy) and evaluation of disease progression over time.

As the volume of biomedical literature increases, it can be challenging for clinicians to stay up-to-date. Graphical summarization systems help by condensing knowledge into networks of entities and relations. However, existing systems present relations out of context, ignoring key details such as study population. To better support precision medicine, summarization systems should include such information to contextualize and tailor results to individual patients. This paper introduces "contextualized semantic maps" for patient-tailored graphical summarization of published literature. These efforts are demonstrated in the domain of driver mutations in non-small cell lung cancer (NSCLC). A representation for relations and study population context in NSCLC was developed. An annotated gold standard for this representation was created from a set of 135 abstracts; Fl-score annotator agreement was 0.78 for context and 0.68 for relations. Visualizing the contextualized relations demonstrated that context facilitates the discovery of key findings that are relevant to patient-oriented queries.

We developed a technique to fabricate oxide thin films with uniaxially controlled crystallographic orientation and lateral size of more than micrometers on amorphous substrates. This technique is lateral solid-phase epitaxy, where epitaxial crystallization of amorphous precursor is seeded with ultrathin oxide nanosheets sparsely (≈10% coverage) deposited on the substrate. Transparent conducting Nb-doped anatase TiO2 thin films were fabricated on glass substrates by this technique. Perfect (001) orientation and large grains with lateral sizes up to 10 μm were confirmed by X-ray diffraction, atomic force microscopy, and electron beam backscattering diffraction measurements. As a consequence of these features, the obtained film exhibited excellent electrical transport properties comparable to those of epitaxial thin films on single-crystalline substrates. This technique is a versatile method for fabricating high-quality oxide thin films other than anatase TiO2 and would increase the possible applications of oxide-based thin film devices.

SUMMARYWe previously revealed that Japanese encephalitis virus (JEV) seroprevalence was 4·5% in pigs on Ishigaki Island from 2005 to 2007. However, a partial E gene sequence (151 bp) of the JEV genome (JEV/sw/Ishigaki/1/2005) was detected in one pig. Phylogenetic analysis showed that JEV/sw/Ishigaki/1/2005 belonged to genotype III and to the same lineages isolated in Taiwan from 2006 to 2008. Serum samples were collected from 128 pigs on Ishigaki from 2009 to 2010, 24 wild boars on Ishigaki from 2008 to 2010, and 117 wild boars on Iriomote Island from 2008 to 2010. Four (3·1%) pigs on Ishigaki were positive for JEV antibody, but all wild boars on the island were negative. Fifty-two (44·4%) wild boars on Iriomote were positive for JEV antibody, in contrast to a seroprevalence of 3·7% in 2000 and 2004. JEV on Iriomote and/or in Taiwan might be related to transmission on Ishigaki.

Summary The novel WBN/Kob-Leprfa (fa/fa) congenic rat strain is considered a useful rat model of type 2 diabetes mellitus (T2DM). Accumulating findings suggest that low-grade inflammation is a causative factor in T2DM and that circulating levels of inflammatory cytokines are associated with insulin resistance. However, inflammatory cytokine profiles and their correlations with T2DM development/ progression in fa/fa rats have not been studied. In this study, we found that the fa/fa rats had considerably high plasma levels of interleukin (IL)-1α. Abundant cecal IL-1α mRNA expression and cecal inflammation with infiltrating IL-1α-producing macrophages was observed in fa/fa rats. Bone marrow derived macrophages from fa/fa rats expressed high levels of IL-1α upon lipopolysaccharide stimulation. Furthermore, Syphacia muris infection, which delays the onset of T2DM, reduced both plasma and cecal IL-1α levels in fa/fa rats. These results suggest that macrophage infiltration and IL-1α secretion comprise an important part of T2DM development and that S. muris infection inhibits pro-inflammatory cytokine expression in fa/fa rats.

Imaging is one of the most important sources of clinically observable evidence that provides broad coverage, can provide insight on low-level scale properties, is noninvasive, has few side effects, and can be performed frequently. Thus, imaging data provides a viable observable that can facilitate the instantiation of a theoretical understanding of a disease for a particular patient context by connecting imaging findings to other biologic parameters in the model (e.g., genetic, molecular, symptoms, and patient survival). These connections can help inform their possible states and/or provide further coherent evidence. The field of radiomics is particularly dedicated to this task and seeks to extract quantifiable measures wherever possible. Example properties of investigation include genotype characterization, histopathology parameters, metabolite concentrations, vascular proliferation, necrosis, cellularity, and oxygenation. Important issues within the field include: signal calibration, spatial calibration, preprocessing methods (e.g., noise suppression, motion correction, and field bias correction), segmentation of target anatomic/pathologic entities, extraction of computed features, and inferencing methods connecting imaging features to biological states.

The patient medical record contains a wealth of information consisting of prior observations, interpretations, and interventions that need to be interpreted and applied towards decisions regarding current patient care. Given the time constraints and the large---often extraneous---amount of data available, clinicians are tasked with the challenge of performing a comprehensive review of how a disease progresses in individual patients. To facilitate this process, we demonstrate a neuro-oncology workstation that assists in structuring and visualizing medical data to promote an evidence-based approach for understanding a patient's record. The workstation consists of three components: 1) a structuring tool that incorporates natural language processing to assist with the extraction of problems, findings, and attributes for structuring observations, events, and inferences stated within medical reports; 2) a data modeling tool that provides a comprehensive and consistent representation of concepts for the disease-specific domain; and 3) a visual workbench for visualizing, navigating, and querying the structured data to enable retrieval of relevant portions of the patient record. We discuss this workstation in the context of reviewing cases of glioblastoma multiforme patients.

K. Yamashiro, K. Taira, M. Nakajima, D. Okuyama, M. Azuma, H. Takeda, H. Suzuki, H. Jotoku, K. Watanabe, M. Takahashi, K. Taguchi and M. Tamura Tissue rinse liquid-based cytology: a feasible tool for the intraoperative pathological evaluation of sentinel lymph nodes in breast cancer patients Objectives: A unique diagnostic method was designed for the intraoperative pathological evaluation of sentinel lymph nodes (SLNs) in breast cancer patients, and the results were verified with 2 years of experience. Methods: Excised lymph nodes were cut into 2-mm-thick slices and rinsed thoroughly in CytoRich Red®. The sliced tissues were embedded in a paraffin block. Three cytological glass slides of the cells exfoliated in CytoRich Red® were prepared by the SurePath® liquid-based cytology (LBC) technique. Two slides were stained by the Papanicolaou method, and the remaining slide was immunostained with an anti-keratin antibody. This process is called tissue rinse liquid-based cytology (TRLBC). The results of TRLBC were compared with those of the final pathological diagnoses, including immunostaining with an anti-keratin antibody on paraffin blocks (PB). Results: This study analysed 444 SLNs from 247 consecutive breast cancer patients. It required 35 minutes to complete the intraoperative diagnosis on a single node, and it took an additional 5 minutes per node if more than one node was submitted. When the results of PB were assumed to be the gold standard, the sensitivity and specificity of TRLBC were 81.9% and 96.1%, respectively. TRLBC detected all nodes with macrometastasis and 23 of 24 nodes with micrometastasis. Fifteen false-negative TRLBC results were ‘isolated tumour cell clusters’ on PB, but there was one with micrometastasis histologically. Four of 14 false-positive TRLBC results were proven to be true positive by supplementary examination using step sectioning of the paraffin blocks of the nodes. Conclusion: TRLBC is a feasible and promising intraoperative cytopathological tool showing a comparable efficacy to PB while still allowing the conventional postoperative histological examination.

K. Yamashiro, M. Tagami, K. Azuma, A. Nakamura, O. Kato, K. Taira, M. Azuma, H. Takeda and H. Suzuki Cytodiagnosis through use of a z-axis video by volunteer observers: a promising tool for external quality assessment Objective: This study examined whether cytological diagnosis through the use of a video, which shows the changing depth of focus in the microscopic field, described as a z-axis video, is useful compared with a still image. Methods: From 17 cytology preparations of fine needle aspiration of the breast, we made six z-axis videos per case. A frame exhibiting the characteristic features was then extracted from each video and saved as a representative still image. One hundred and twenty-eight volunteer cytotechnologists were randomly divided into two groups of video observers and still image observers. The participants were asked to make a diagnosis of benign, indeterminate, suspicious or malignant without having any clinical information other than the age of the patient. Diagnoses were categorized as ‘recommended’ or ‘unacceptable’ according to degree of correlation with histology. Results: The number of definitive diagnoses of ‘benign’ or ‘malignant’ were increased in video observers, and indeterminate or suspicious categories were decreased (P = 0.013). The distribution of diagnostic categories in three of the 17 cases was significantly different; the distribution in the remaining cases was similar between the two groups. The z-axis video observers may have selected the definite diagnoses with confidence because they observed valuable microscopic findings by ‘focusing through observation’. The average number of ‘recommended’ diagnoses by individual observers was significantly higher in the video observer group than in the still image observer group (P = 0.016). In contrast, the average number of ‘unacceptable’ diagnoses was significantly lower (P = 0.019). Conclusions: A z-axis video is easy to obtain and is therefore expected to become a powerful diagnostic modality for the external quality assessment of clinical cytology and even in the field of primary cytodiagnosis.

Introduction/Background The ability to walk independently without wheelchair assistance around a hospital ward or facility, i.e., practical ambulation, is not taken into account when assessing ambulation status of patients. To our knowledge, no study has adequately examined indicators of practical ambulation in stroke patients living in facilities. This study aimed to identify factors associated with practical ambulation in a facility setting based on prospective observational data from recovering stroke patients. Material and method Ninety-four stroke patients (mean age, 67.9 years) who received inpatient rehabilitation services at the Okinawa Rehabilitation Hospital from January 2011 to November 2016 were enrolled in this observational study. Exclusion criteria were dementia, orthopedic disease, or requiring assistance to walk 10 m. In addition to clinical characteristics, lower limb motor function on affected and unaffected sides (Stroke Impairment Assessment Set and leg strength, respectively) and comfortable gait speed (CGS) in a 10m-walk test were examined at the time when 10m-walking was acquired without assistance. Ambulation status was continuously assessed for up to 6 months after stroke onset. Cox proportional hazards regression was used to assess the contribution of clinical characteristics, lower limb motor function and CGS to practical ambulation ability, and receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy of these indicators. Results A total of 72 stroke patients acquired practical ambulation during the study period. Only CGS was associated with practical ambulation, and the hazard ratio of acquiring practical ambulation per 1 m/min increase in CGS was 1.03 [95% confidence interval (CI): 1.02–1.08; P Conclusion These findings suggest that gait speed is a strong predictor of practical ambulation ability in a facility setting for recovering stroke patients.

The CALET (CALorimetric Electron Telescope) is a detector planned to be on board the JEM-EF (Exposed Facility of Japanese Experiment Module) of the International Space Station to investigate high energy universe by observing high energy gamma-rays, electrons and hadronic cosmic rays. The main part of CALET is composed of an IMaging Calorimeter (IMC), a Total AbSorption Calorimeter (TASC), SIlicon Array (SIA) and Anti-Coincidence Detector (ACD). Monte Carlo simulation has been carried out to obtain basic performance of CALET on orbit.

We carried out a balloon observation of cosmic rays with a prototype of the CALET (bCALET-1) at the Sanriku Balloon Center of the Japan Aerospace Exploration Agency. The main purpose of the experiment was verification of the CALET. The detector consists of 1024 scintillating fibers for precise imaging and 24 BGO scintillator for total absorption of showers. The observation was carried at an altitude between 35 and 37 km for about 3.5 hours. We measured electrons in the energy region between 1 to 10 GeV. The prototype system was verified in the balloon environment. We have obtained the electron flux which is useful to investigate solar modulation. In combination with the flux between 10 to 100 GeV measured by BETS, rigidity cutoff effect was clearly observed. These results showed good agreement with that of our Monte-Carlo simulation and demonstrated the detection capability of the CALET in the enegy region below 10 GeV. Now we are planning a series of balloon experiments with larger-scale detectors and lo...

Brain tumor analysis is moving towards volumetric assessment of magnetic resonance imaging (MRI), providing a more precise description of disease progression to better inform clinical decision-making and treatment planning. While a multitude of segmentation approaches exist, inherent variability in the results of these algorithms may incorrectly indicate changes in tumor volume. In this work, we present a systematic approach to characterize variability in tumor boundaries that utilizes equivalence tests as a means to determine whether a tumor volume has significantly changed over time. To demonstrate these concepts, 32 MRI studies from 8 patients were segmented using four different approaches (statistical classifier, region-based, edge-based, knowledge-based) to generate different regions of interest representing tumor extent. We showed that across all studies, the average Dice coefficient for the superset of the different methods was 0.754 (95% confidence interval 0.701–0.808) when compared to a reference standard. We illustrate how variability obtained by different segmentations can be used to identify significant changes in tumor volume between sequential time points. Our study demonstrates that variability is an inherent part of interpreting tumor segmentation results and should be considered as part of the interpretation process.

Medical Imaging Informatics provides an overview of this growing discipline, which stems from an intersection of biomedical informatics, medical imaging, computer science and medicine. Supporting two complementary views, this volume explores the fundamental technologies and algorithms that comprise this field, as well as the application of medical imaging informatics to subsequently improve healthcare research. Clearly written in a four part structure, this introduction follows natural healthcare processes, illustrating the roles of data collection and standardization, context extraction and modeling, and medical decision making tools and applications. Medical Imaging Informatics identifies core concepts within the field, explores research challenges that drive development, and includes current state-of-the-art methods and strategies.

Microspherical solar cells and modules have been fabricated. The spherical nature of these semi-transparent devices allows the microspherical cells to harvest both directly incident and diffuse components of sunlight thereby improving the solar energy conversion efficiency. Indoor and outdoor characterizations of these three dimensional semi-transparent cells and modules are carried out using a Lambertian reflector in order to assess the maximum efficiency of the devices. In the absence of the reflector the cell efficiency is 13.5% under standard illumination (100 mW cm −2 , A.M. 1.5, 25 °C). However, this is significantly enhanced in the presence of the reflector. Microspherical modules with the reflector are directly compared to similar semi-transparent modules comprised of traditional planar devices, in outdoor tests at low light intensity (2.5–25 mW cm −2 ) to further demonstrate the benefits of the design particularly at low angle of incident radiation.

Cytokinesis-block micronucleus (CBMN) assay is a convenient and easy method of radiation biodosimetry that uses peripheral blood (PB) cells. However, for micronuclei (MN) frequency induced by ionising radiation, a dose-response relationship in abnormal condition, such as in cancer patients, has not been assessed. To clarify the difference between the dose-response curve generated by the CBMN assay in conditions when thyroid hormone levels were normal and during thyroid hormone withdrawal (THW) prior to (131)I treatment, 12 thyroid cancer patients who underwent thyroidectomy were studied. The collected PB mononuclear cells were exposed to 0.5-3.0 Gy X-ray irradiation. Under normal conditions, dose dependency and independency of MN frequency were observed in 92 % and 8 %, respectively. In contrast, during THW, the number of patients who showed dose independency significantly increased to 42 % in comparison with control. Furthermore, a higher concentration of serum thyroglobulin in dose-independent patients was observed. These results suggest that MN frequency in cytogenetic dosimetry is affected by thyroid hormones.

Summary Background Hair discs are known to contain a large number of Merkel cells and are ideal for investigating Merkel cell biology. Hair follicles, which are important elements of hair discs, undergo unique cyclical morphological and biological changes. Objectives To define the relationships between the number and the morphology of Merkel cells within the hair disc in association with the hair cycle on rat back skin. Methods Merkel cells in hair discs were observed three-dimensionally using immunohistochemistry. Epidermal sheets were incubated with monoclonal murine antibody to CK20. As a result, Merkel cells in hair discs were clearly demonstrated as whole shapes and were counted under a light microscope. Results Merkel cells in hair discs increased during the early to middle phase of anagen and decreased during the middle phase of anagen to catagen and telogen in perinatal and postnatal rat back skin. We observed the morphological variation of Merkel cells in hair discs of rat back skin, and consequently divided them into two subtypes at the light microscopic level: the oval type and the dendritic type. The number of oval-type Merkel cells was not markedly affected by the hair cycle. In contrast, the number of dendritic-type Merkel cells markedly changed with the hair cycle. Conclusions This difference of the hair cycle dependency between oval and dendritic-type Merkel cells suggests some functional differences, such as a secretory function, related to the hair cycle.

Rationale and Objectives. A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction. Materials and Methods. A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t -tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm. Results. Overall per member/per month costs post-implementation were lower in the enrolled population ($126 vs $160), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient ($33.29 vs $35.59); specialist referrals ($21.36 vs $26.84); and ER visits ($3.68 vs $5.22). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company’s costs were lower than national averages ($119.24 vs $146.32), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile. Conclusion. A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.