Humans have great locomotor adaptability to environmental demands, which has been investigated using a split-belt treadmill with belts on both the left and right sides. Thus far, neuromuscular control in split-belt locomotor adaptation has been evaluated by analyzing muscle activities at the individual muscle level. Meanwhile, in the motor control field, the muscle synergy concept has been proposed. Muscle synergies are considered the fundamental building blocks of movement and are groups of coactive muscles and time-varying activation patterns, thereby, reflecting the (...) neurophysiological characteristics of movement. To date, it remains unclear how such muscle synergies change during the adaptation and de-adaptation processes on the split-belt treadmill. Hence, we chronologically extracted muscle synergies while walking on the split-belt treadmill and examined changes in the number, muscle weightings, and temporal activation patterns of muscle synergies. Twelve healthy young males participated, and surface electromyography signals were recorded bilaterally from 13 lower-limb muscles. Muscle synergies were extracted by applying non-negative matrix factorization to the EMG data of each leg. We found that during split-belt walking, the number of synergies in the slow leg increased while an extra synergy appeared and disappeared in the fast leg. Additionally, the areas under the temporal activation patterns in several synergies in both legs decreased. When both belts returned to the same speed, a decrease in the number of synergies and an increase in the areas under the temporal activation patterns of several synergies were temporally shown in each leg. Subsequently, the number of synergies and the areas under the temporal activation patterns returned to those of normal walking before split-belt walking. Thus, changes in the number, muscle weightings, and temporal activation patterns of synergies were noted in the split-belt locomotor adaptation, suggesting that the adaptation and de-adaptation occurred at the muscle synergy level. (shrink)

Der Lehrstuhl für Christentumswissenschaft (Kirisutokyōgaku) an der Kaiserlichen Universität Kyoto wurde 1922 als Stiftungslehrstuhl gegründet. Die Gründung der Christentumswissenschaft in Kyoto erfolgte in einer spezifischen bildungspolitischen Konstellation: Es ging um die spannungsreichen Beziehung zwischen staatlichen Hochschulen und den Religionsgemeinschaften sowie um die Ansprüche einer dezidiert nationalen Politik. Der erste Inhaber des Lehrstuhls war einer der prominentesten japanischen Ideenhistoriker und Philosophen, Seiichi Hatano (1877–1950). Für Hatano gab es keinen Unterschied zwischen Theologie und Christentumswissenschaft. Er wandte die historische Methode auf die Forschung (...) zum frühen Christentum an, die er von deutschen Theologen gelernt hatte. Besonders stark hatte ihn die Religionsgeschichtliche Schule beeinflusst. Als Philosoph entwickelte Hatano eine Religionsphilosophie, die auf der Idee der Persönlichkeit basierte. Das starke Interesse am Thema “Persönlichkeit” hatte er auch mit den deutschen Theologen gemeinsam. Andererseits kritisierte Hatano den liberalen Protestantismus in Deutschland scharf. Dennoch wurde seine Haltung, mit der er die Vorgänger und Zeitgenossen “voraussetzungslos” kritisiert hatte, von führenden Vertretern des liberalen Protestantismus in Deutschland angenommen. (shrink)

Der Lehrstuhl für Christentumswissenschaft (Kirisutokyōgaku) an der Kaiserlichen Universität Kyoto wurde 1922 als Stiftungslehrstuhl gegründet. Die Gründung der Christentumswissenschaft in Kyoto erfolgte in einer spezifischen bildungspolitischen Konstellation: Es ging um die spannungsreichen Beziehung zwischen staatlichen Hochschulen und den Religionsgemeinschaften sowie um die Ansprüche einer dezidiert nationalen Politik. Der erste Inhaber des Lehrstuhls war einer der prominentesten japanischen Ideenhistoriker und Philosophen, Seiichi Hatano (1877–1950). Für Hatano gab es keinen Unterschied zwischen Theologie und Christentumswissenschaft. Er wandte die historische Methode auf die Forschung (...) zum frühen Christentum an, die er von deutschen Theologen gelernt hatte. Besonders stark hatte ihn die Religionsgeschichtliche Schule beeinflusst. Als Philosoph entwickelte Hatano eine Religionsphilosophie, die auf der Idee der Persönlichkeit basierte. Das starke Interesse am Thema “Persönlichkeit” hatte er auch mit den deutschen Theologen gemeinsam. Andererseits kritisierte Hatano den liberalen Protestantismus in Deutschland scharf. Dennoch wurde seine Haltung, mit der er die Vorgänger und Zeitgenossen “voraussetzungslos” kritisiert hatte, von führenden Vertretern des liberalen Protestantismus in Deutschland angenommen. (shrink)

This article offers a new interpretation of Plato’s method of collection and division as formulated in the Phaedrus, in light of a detailed examination of the surrounding context. It argues that Socrates carefully distinguishes the characteristic operations of the method from its applications. It shows that collection and division are to be construed independently of one another, and that the collection of F-ness is equivalent to the procedure for the definition of F-ness; and it clarifies three kinds of application that (...) are mentioned in the Phaedrus: simple definition, definition supplemented with division, and scientific analysis. (shrink)

Why are diagrams sometimes so useful, while other times unhelpful and even misguiding? There are systematic reasons for this. Drawing on modern research in logic, Artificial Intelligence, cognitive psychology, and graphic design, "Semantic Properties of Diagrams and their Cognitive Potentials" shows that diagrams' cognitive functions are rooted in the characteristic ways they carry information about their targets. The analysis leads to an answer for the deeper question of What makes a diagram a diagram?, which is of crucial importance to the (...) foundation of a collective science of diagrams. ". (shrink)

Crucial problems exist in understanding Japanese traditional customs with regard to autonomous decision making by patients in Japan. These problems are difficult to comprehend because they seem, by western standards, to defy logic. Questions that baffle those outside the Japanese tradition, include: Why do many Japanese patients hesitate to make medical treatment and care decisions for themselves without consulting family, close friends, or someone viewed as being in a superior position? Why do many Japanese physicians fail to disclose the truth (...) directly to the patient, instead customarily conveying information to family members, despite the doctors' awareness of their legal obligation to protect the patient's privacy? Why do many Japanese physicians continue to question whether patients should be told the truth at all? What perpetuates Japan's widespread, but often unnoticed, neglect of the individual's right to self-determination in healthcare decision making? (shrink)

Approximately 30 years ago, a son prepared a cup of milk mixed with insecticide and arranged for his mother to unknowingly administer the poison to his father, who had been suffering severe pain after a cerebral apoplectic attack and demanding that his son assist him. in dying. After drinking the mixture, the father died, and the son was charged with homicide.

We can easily discriminate self-produced from externally generated sensory signals. Recent studies suggest that the prediction of the sensory consequences of one’s own actions made by forward model can be used to attenuate the sensory effects of self-produced movements, thereby enabling a differentiation of the self-produced sensation from the externally generated one. The present study showed that attenuation of sensation occurred both when participants themselves performed a goal-directed action and when they observed experimenter performing the same action, although they clearly (...) reported that the tones were produced by other during action observation and by themselves during their own action. These results suggest that sensory prediction of action modulates ongoing auditory processing irrespective of who produces the sounds and that the explicit judgment of agency does not necessarily rely on the same mechanisms on which implicit perceptual measures such as sensory attenuation rely. (shrink)

The Japanese government took significant steps in making decisions about a newly developing clinical application of gene therapy when, on April 15, 1993, the Government officially accepted the Guidelines for Clinical Research on Gene Therapy submitted by the Health Science Council of the Ministry of Health and Welfare of Japan to the Minister.

Objective—To demonstrate Japanese doctors' and nurses' attitudes towards and practices of voluntary euthanasia (VE) and to compare their attitudes and practices in this regard. Design—Postal survey, conducted between October and December 1999, using a self-administered questionnaire.Participants—All doctor members and nurse members of the Japanese Association of Palliative Medicine.Main outcome measure—Doctors' and nurses' attitude towards and practices of VE.Results—We received 366 completed questionnaires from 642 doctors surveyed (response rate, 58%) and 145 from 217 nurses surveyed (68%). A total of 54% (95% (...) confidence interval (CI): 49-59) of the responding doctors and 53% (CI: 45-61) of the responding nurses had been asked by patients to hasten death, of whom 5% (CI: 2-8) of the former and none of the latter had taken active steps to bring about death. Although 88% (CI: 83-92) of the doctors and 85% (CI: 77-93) of the nurses answered that a patient's request to hasten death can sometimes be rational, only 33% (CI: 28-38) and 23% (CI: 16-30) respectively regarded VE as ethically right and 22% (CI: 18-36) and 15% (CI: 8-20) respectively would practise VE if it were legal. Logistic regression model analysis showed that the respondents' profession was not a statistically independent factor predicting his or her response to any question regarding attitudes towards VE. Conclusions—A minority of responding doctors and nurses thought VE was ethically or legally acceptable. There seems no significant difference in attitudes towards VE between the doctors and nurses. However, only doctors had practised VE. (shrink)

No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active euthanasia. Against (...) this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way. (shrink)

Background A baby hatch called the “Stork’s Cradle” has been in place at Jikei Hospital in Kumamoto City, Japan, since May 10, 2007. Babyklappes were first established in Germany in 2000, and there are currently more than 90 locations. Attitudes regarding baby hatches are divided in Japan and neither opinions for nor against baby hatches have thus far been overwhelming. To consider the appropriateness of baby hatches, we present and examine the validity of each major objection to establishing baby hatches. (...) Discussion There are various objections to baby hatches as follows: It violates a child’s right to know the identity of his or her biological parents by allowing anonymous birth; it neglects fulfillment of the biological parents’ basic obligation to raise their child and its very availability induces abandonment of infants; some people abuse it for very selfish reasons; it cannot save babies’ lives; the rights of one parent can be ignored if the other surrenders a child without his or her consent; it puts a baby in medical jeopardy; and it has no clear legal basis. The authors would argue that there are many plausible refutations for each objection mainly based on priority of child’s right to life, pregnant women’s vulnerability and necessity of anonymity, social responsibility to protect and raise children, differences between dropping a child off at a baby hatch and child neglect, limited function of social childcare center, inevitability of abuse by a minority of people, necessary distinction between outcomes that occur only because baby hatches exist and those that occur regardless of their existence, important local direct and upmost measures for women in trouble, and difference between ambiguous legality and illegality. Summary We argue that a certain number of baby hatches should continue to be established as a last resort, in a form that can maintain anonymity if the parent dropping the child off so desires. It should be supported if it is initiated with good intentions; if the maximum possible effort is made at said facility to protect the interests, rights, and safety of the child; and if no clear evidence of harm exists. (shrink)

As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain- death determination and organ extraction, and the appropriateness of priority transplants for relatives.In the four months of deliberations in the National Diet before the new law was (...) established, various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain- dead donors are unacceptable because they result in organs being taken from living human beings.Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain- dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain- dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based. (shrink)

Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and the (...) sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

Background Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and (...) the sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Main text Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. Conclusion There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

To consider whether or not we should aim to create a perfect healthy utopia on Earth, we focus on the SF novel Harmony, written by Japanese writer Project Ito, and analyze various issues in the world established in the novel from a bioethical standpoint. In the world depicted in Harmony, preserving health and life is a top priority. Super-medicine is realized through highly advanced medical technologies. Citizens in Harmony are required to strictly control themselves to achieve perfect health and must (...) always disclose their health information to the public and continuously prove their health. From a bioethical standpoint, the world in Harmony is governed by a “healthy longevity supremacy” principle, with being healthy equated to being good and right. Privacy no longer exists, as it is perceived ethical for citizens to openly communicate health-related information to establish one’s credibility. Moreover, there is no room for self-determination concerning healthcare because medical interventions and care are completely routinized, automated, centralized, and instantly provided. This is a situation where the community exhibits extremely powerful and effective paternalism. One can argue that healthy longevity is highly preferred. But is it right to aim for a perfectly healthy society at all costs? Should we sacrifice freedom, privacy, vivid feelings, and personal dignity to achieve such a world? In our view, the answer is no, as this would require the loss of many essential values. We conclude by proposing an alternative governing principle for future healthcare, and refer to it as the “do-everything-in-moderation” principle. (shrink)

BackgroundIn the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements.MethodsIn this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care (...) hospitals.ResultsA total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker.ConclusionsSurrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective. (shrink)

A placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. Unlike standard treatments, clinical use of placebo usually involves deception and is therefore ethically problematic. Our attitudes toward the clinical use of placebo, which inevitably includes deception or withholding information, have a tremendous effect on our practice regarding truth-telling and informed consent. A casual attitude towards it weakens the current practice based on shared decision-making and (...) mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient-provider relationships, the public's trust in medicine, and medical education. A review of recent survey studies suggests that the clinical use of placebo appears to be fairly well accepted among healthcare professionals and is common in clinical settings in various countries. However, we think that an ethical discussion is urgently needed because of its controversial nature. If judged to be ethically wrong, the practice should end. In the present paper, we discuss the ethicality of the clinical use of placebo with deception and argue against it, concluding that it is unethical and should be banned. We will show that most arguments in favor of the clinical use of placebo can be refuted and are therefore incorrect or weak. These arguments will be presented and examined individually. Finally, we will briefly consider issues relevant to the clinical use of placebo without deception. (shrink)

ABSTRACT Objectives: the purpose of this study is to explore laypersons’ attitudes towards and experiences of medical research, and to compare them with those of physicians in Japan. Designs and Participants: fourteen Japanese adults from the general public and seven physicians participated in one of three focus interviews. Setting: Osaka, Japan. Results: trust and distrust in the physician by whom the participants were invited to participate in research played a considerable role in their decisions about participation. That the participants felt (...) an obligation to participate was also expressed. The lay participants perceived medical research as something entirely outside of their world. A greater willingness to volunteer for research was expressed if there were direct benefits to themselves or their families. Research methods such as use of placebos, double blinds, and randomisations seemed to cause negative attitudes to medical research. All physicians were convinced of the need for medical research, including double‐blinded randomised control trials, and its significant role in medical progress. Most physicians thought that the greater awareness of the need for medical research in the community and a better understanding of the psychology of potential research participants were necessary and urgent. Conclusions: there is a good possibility that the lay public and medical professionals have sharply different beliefs about and attitudes towards every aspect of medical research. Building up a better and equal patient‐doctor relationship based on trust is a key issue in medical research, and it is mandatory to fill the gap in perception regarding medical research between them through fully informed debates. (shrink)

Semantic studies on diagrammatic notations (Barwise & Etchemendy, ; Shimojima, ; Stenning & Lemon, ) have revealed that the “non-deductive,” “emergent,” or “perceptual” effects of diagrams (Chandrasekaran, Kurup, Banerjee, Josephson, & Winkler, ; Kulpa, ; Larkin & Simon, ; Lindsay, ) are all rooted in the exploitation of spatial constraints on graphical structures. Thus, theoretically, this process is a key factor in inference with diagrams, explaining the frequently observed reduction of inferential load. The purpose of this study was to examine (...) the empirical basis for this theoretical suggestion, focusing on the reality of the constraint-exploitation strategy in actual practices of diagrammatic reasoning. Eye movements were recorded while participants used simple position diagrams to solve three- or four-term transitive inference problems. Our experiments revealed that the participants could exploit spatial constraints on graphical structures even when (a) they were not in the position of actually manipulating diagrams, (b) the semantic rule for the provided diagrams did not match their preferences, and (c) the constraint-exploitation strategy invited a partly adverse effect. These findings indicate that the hypothesized process is in fact robust, with the potential to broadly account for the inferential advantage of diagrams. (shrink)