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Factors that affect the process of professional identity formation in public health nurses

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Open Journal of Nursing 2013年第1期3卷 8-15页

作者： mika okura Miyoko Uza Hisako Izumi Masami Ohno Hidenori Arai Kazuko Saeki Department of Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan Department of Site Management Organization Sehma Co. Ltd. Fukui Japan Faculty of Health Sciences Hokkaido University Sapporo Japan School of Health Sciences Faculty of Medicine University of the Ryukyus Nishihara Japan School of Health Sciences Sapporo Medical University Sapporo Japan

Objective: The aim of this study was to elucidate the process of professional identity formation and the factors that affect the process in public health nurses (PHNs). Methods: We performed an inductive qualitative analysis based on semi-structured interviews and focus group interviews of 65 PHNs. Results: At years 1 - 5, PHNs did not have a professional self-identity. Therefore, it was important for them to recognize the significance of their own work. At years 6 - 10, PHNs acquired self-assurance as a practitioner through feedback from residents. It was important for them to have a better understanding, broader viewpoints and more affection for their own community. At years 11 - 20, PHNs felt ambivalent toward the challenges and heavy responsibilities based on the objective assessment of their jobs and roles. PHNs felt embarrassed by role changes when they became a manager or an expert. It was important for them to become aware of their new role through managerial education and training. However, some PHNs who were unable to establish a clear PHN identity experienced setbacks at each developmental stage. Conclusions: Our data suggest that a differential approach dependent on the stage and level of confidence in an individual’s PHN identity is required for the formation of PHN identity.

关键词： Professional Identity Public Health Nurse Professionalism Career Development

How Convolutional Neural Networks Diagnose Plant Disease

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Plant Phenomics 2019年第1期1卷 223-236页

作者： Yosuke Toda Fumio okura Japan Science and Technology Agency 4-1-8 HonchoKawaguchiSaitama 332-0012Japan Institute of Transformative Bio-Molecules(WPI-ITbM) Nagoya UniversityChikusaNagoya 464-8602Japan Department of Intelligent Media Institute of Scientific and Industrial ResearchOsaka University8-1MihogaokaIbarakiOsaka 567-0047Japan

Deep learning with convolutional neural networks(CNNs)has achieved great success in the classification of various plant ***,a limited number of studies have elucidated the process of inference,leaving it as an untouchable black *** the CNN to extract the learned feature as an interpretable form not only ensures its reliability but also enables the validation of the model authenticity and the training dataset by human *** this study,a variety of neuron-wise and layer-wise visualization methods were applied using a CNN,trained with a publicly available plant disease image *** showed that neural networks can capture the colors and textures of lesions specific to respective diseases upon diagnosis,which resembles human *** several visualizationmethods were used as they are,others had to be optimized to target a specific layer that fully captures the features to generate consequential ***,by interpreting the generated attention maps,we identified several layers that were not contributing to inference and removed such layers inside the network,decreasing the number of parameters by 75%without affecting the classification *** results provide an impetus for the CNN black box users in the field of plant science to better understand the diagnosis process and lead to further efficient use of deep learning for plant disease diagnosis.

关键词： diagnosis removed interpreting

Fragmented QRS complex with an additional R-wave attenuated by short RR interval in a patient with acute pulmonary embolism and cardiogenic shock

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Journal of Geriatric Cardiology 2022年第12期19卷 995-1000页

作者： Koji Takahashi Hiromasa Nakahara Eiji Arimitsu Satoshi Imamine Yoshiyasu Obata Kimio Nakanishi Yoshiyasu Taniguchi Maiko Amano Chika Omori Takafumi okura Department of Community Emergency Medicine Ehime University Graduate School of MedicineEhimeJapan Department of Cardiology Yawatahama City General HospitalEhimeJapan Department of Internal Medicine Oozu City HospitalEhimeJapan Department of Clinical Laboratory Oozu City HospitalEhimeJapan

Registries and hospital discharge datasets of unselected patients with pulmonary embolism show 30-day all-cause mortality rates of approximately 10%.[1]Clinical findings from histories and physical examinations,such as age,systemic blood pressure,and respiratory rate at presentation,classify patients into risk classes of increasing risk of death and other adverse medical outcomes.

关键词： mortality patients Clinical

Unfamiliar waveforms spanning from the ST to TP segments only observed in certain limb leads of the standard 12-lead electrocardiogram due to Aslanger’ s sign

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Journal of Geriatric Cardiology 2023年第9期20卷 693-696页

作者： Koji Takahashi Nobuhisa Yamamura Mako Yoshino Daijiro Enomoto Hiroe Morioka Shigeki Uemura Takafumi okura Tomoki Sakaue Shuntaro Ikeda Department of Community Emergency Medicine Ehime University Graduate School of MedicineEhimeJapan Department of Cardiology Yawatahama City General HospitalEhimeJapan Department of Clinical Pathology Yawatahama City General HospitalEhimeJapan

Aslanger’s sign,also known as the arterial pulse tapping artifact or electromechanical association artifact,is an electrocardiographic artifact caused by arterial pulsation at the site where the limb leads of the standard 12-lead electrocardiogram near the radial or posterior tibial arteries are positioned,particularly in hyperdynamic states.[1–8]It occurs in every cardiac cycle with a constant coupling interval between the QRS complex and *** synchronization with the underlying heart rhythm makes it less likely to be recognized as an artifact compared to unsynchronized artifacts,such as those caused by limb movement and inadequate contact between the electrode and skin.[1,2,7,8]Almost all reported cases of Aslanger’s sign exhibit an unusual waveform morphology in all 12 leads except one of the standard 12-lead *** sign is often confused with an electrocardiographic finding commonly observed during acute coronary events.

关键词： electrocardiogram arterial likely

Diagnostic evaluation of acute pancreatitis in two patients with hypertriglyceridemia

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World Journal of Gastroenterology 2004年第24期10卷 3691-3695页

作者： Yoshifumi okura KozoHayashi TetsujiShingu GoroKajiyama Yoshiyuki Nakashima Keijiro Saku Division of Internal Medicine Fukuoka Dental College HospitalFukuokaJapan First Department of Internal Medicine Hiroshima University School of MedicineHiroshimaJapan Division of Cardiology Fukuoka University School of MedicineFukuokaJapan

We present two diagnostically challenging cases of acute pancreatitis with hypertriglyceridemia accompanied with chylomicronemia caused with a deficiency of lipoprotein lipase and with the presence of type Ⅴ hyperlipidemia. Both cases suffered from acute abdomen following the ingestion of fatty food and revealed the increase in parameters of inflammation without significant elevation of serum amylase *** imaging examination of ultrasonography could not detect significant findings of acute pancreatitis and a computer tomography scan eventually confirmed the findings of acute *** cases responded to a low fat diet and administration of a cholecystokinin receptor antagonist,exhibiting a relief of abdominal *** in the present cases with acute abdomen following the ingestion of fatty food,the identification of serum hypertriglyceridemia and an abdominal computer tomography scan might be useful in establishing the diagnosis of acute pancreatitis and in developing the therapeutic regimen,when hypertriglyceridemia interferes with the evaluation of pancreatic enzyme activities and ultrasound examination provides poor pancreatic visualization.

关键词： Acute Disease Adult Female Humans Hypertriglyceridemia Male Middle Aged Pancreatitis Triglycerides

Light chain cardiac amyloidosis in a nonagenarian

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Journal of Geriatric Cardiology 2022年第1期19卷 83-89页

作者： Koji Takahashi Mina Yamashita Tomoki Sakaue Daijiro Enomoto Shigeki Uemura Takafumi okura Shuntaro Ikeda Takanori Senba Akira Saijo Nobuhisa Yamamura Sohei Kitazawa Department of Community Emergency Medicine Ehime University Graduate School of MedicineEhimeJapan Department of Cardiology Yawatahama City General HospitalEhimeJapan Department of Hematology Yawatahama City General HospitalEhimeJapan Department of Clinical Pathology Yawatahama City General HospitalEhimeJapan Department of Molecular Pathology Ehime University Graduate School of MedicineEhimeJapan

Cardiac amyloidosis is an infiltrative and restrictive cardiomyopathy caused by the extracellular deposition of amyloid fib-rils within the heart as systemic amyloidosis,lead-ing to heart failure,reduced quality of life,and death.[1]There are two major amyloid fibril proteins that af-fect the heart:amyloid immunoglobulin light chain(AL)and amyloid transthyretin(ATTR).The latter is further subdivided into wild-type ATTR and variant types based on the presence of a mutation in the transthyretin gene.

关键词： amyloid death. cardiomyopathy

Serum angiotensin-converting enzyme level for evaluating significant fibrosis in chronic hepatitis B

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World Journal of Gastroenterology 2017年第36期23卷 6705-6714页

作者： Ryuichi Noguchi Kosuke Kaji Tadashi Namisaki Kei Moriya Mitsuteru Kitade Kosuke Takeda Hideto Kawaratani Yasushi okura Yosuke Aihara Masanori Furukawa Akira Mitoro Hitoshi Yoshiji Third Department of Internal Medicine Nara Medical University

AIM To evaluate the diagnostic performance of angiotensinconverting enzyme(ACE)on significant liver fibrosis in patients with chronic hepatitis B(CHB). METHODS In total,100 patients with CHB who underwent liver biopsy in our hospital were enrolled,and 70 patients except for 30 patients with hypertension,fatty liver or habitual alcoholic consumption were *** compared histological liver fibrosis and serum ACE levels and evaluated the predictive potential to diagnose significant liver fibrosis by comparison with several biochemical marker-based indexes such as the aspartate aminotransferase(AST)-to-platelet ratio index(APRI),the fibrosis index based on four factors(FIB-4),the Mac-2 binding protein glycosylation isomer(M2BPGi)level and the number of platelets(Plt). RESULTS Serum ACE levels showed moderately positive correlation with liver fibrotic stages(R2=0.181).Patients with significant,advanced fibrosis and cirrhosis(F2-4)had significantly higher serum ACE levels than those with early-stage fibrosis and cirrhosis(F0-1).For significant fibrosis(≥F2),the 12.8 U/L cut-off value of ACE showed 91.7%sensitivity and 75.0%*** receiver-operating characteristic(ROC)curves analysis revealed that the area under the curve(AUC)value of ACE was 0.871,which was higher than that of APRI,FIB-4,M2BPGi and Plt. CONCLUSION The serum ACE level could be a novel noninvasive,easy,accurate,and inexpensive marker of significant fibrosis stage in patients with CHB.

关键词： Angiotensin-converting enzyme Hepatitis B virus Liver fibrosis Noninvasive fibrosis marker Aspartate aminotransferase-to-platelet ratio index Fibrosis index based on four factors Mac-2 binding protein glycosylation isomer

Metastatic hepatocellular carcinoma of the external auditory canal

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World Journal of Gastroenterology 2007年第47期13卷 6436-6438页

作者： Ryuji Yasumatsu Kenji okura Yumiko Sakiyama Makoto Nakamuta Taisei Matsumura Satoru Uehara Tomoya Yamamoto Shizuo Komune Department of Otorhinolaryngology Graduate School of Medical SciencesKyushu University and Department of Otorhinolaryngology and Clinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuoka 812-8582Japan Department of Otorhino-laryngology and Clinical Research Institute National Hospital Organization Kyushu Medical CenterFukuoka 812-8582Japan Department of Gastro-enterology and Clinical Research Institute National Hospital Organization Kyushu Medical CenterFukuoka 812-8582Japan Department of Radiology and Clinical Research Institute National Hospital Organization Kyushu Medical CenterFukuoka 812-8582Japan Department of Otorhinolaryngology Graduate School of Medical SciencesKyushu UniversityJapan

This report describes a rare case of metastatic hepatocellular carcinoma (HCC) presenting a huge mass in the left external auditory canal (EAC). The patient was a 55-year-old man with hepatitis B virus-related HCC. He presented to our department with a three-month history of increasing left otalgia,and hearing loss with recent fresh aural bleeding. Histopathologic examination indicated that the tumor was secondary to HCC. Although external irradiation was not effective,the tumor was treated with surgical debulking and high dose rate 192 Ir remote afterloading system (RALS) for postoperative intracavitary irradiation. A review of the literature revealed only five other cases of HCC metastasis to the temporal bone,all of which mainly metastasized in the internal acoustic meatus. The present case is the first report of HCC metastasis to the EAC.

关键词： Hepatocellular carcinoma Metastasis External auditory canal

Production of Safe Charcoal from Waste Construction Wood Treated With Citric Acid

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Journal of Environmental Protection 2011年第8期2卷 1134-1142页

作者： Masafumi Tateda Masaru okura Youngchul Kim Bandunee C. L. Athapattu 不详

For practical reuse of wastewater containing citric acid and the production of safe and healthy high-quality charcoal from waste construction wood, basic data regarding the influence of citric acid washing treatments on the physico- chemical property of charcoal was investigated in order to find the benefits of using citric acid for washing out impurities of the wood, owing to its chelate bonding ability with elements such as metals. Parameters obtained for evaluating the benefits were water content, volatile component content, ash content, fixed carbon content, and the heat value of the charcoal. All parameters, except ash content, throughout all carbonization temperatures were not significantly different between the charcoal of the wood treated with and without citric acid. However, the ash content showed significant differences between the charcoal treated with and without citric acid throughout all carbonization temperatures. Regarding the heat value, the highest heat value was shown on the charcoal carbonated at 600?C with the static washing treatment. Dioxins that were higher in content than the control sample were somehow detected in the ash of the charcoal with the shaking treatment. Further investigation is needed for the production of safe and healthy charcoal using waste citric acid.

关键词： Charcoal Waste Construction Wood Citric Acid Metals Ash Dioxins