Although advance care planning can lead to more patient-centered care, the communication around it can be challenging in acute care hospitals, where saving a life or shortening hospitalization is important priorities. Our qualitative study in an acute care hospital in Japan revealed when specifically physicians and nurses start communication to facilitate ACP. Seven physicians and 19 nurses responded to an interview request, explaining when ACP communication was initiated with 32 patients aged 65 or older. Our qualitative approach employed descriptive analysis (...) to identify major themes, which included “initiation by patients” and “initiation by healthcare professionals.” In the latter case, seven specific triggers were identified: when the patients’ medical condition changed in terms of symptom relief, when the patients’ medical condition changed in terms of prognostic prediction, when serious events occurred, when a choice of treatment was presented, when the location for end-of-life care was chosen, when the patients’ cognitive function deteriorated, and when serious events settled down. Within this group of healthcare professionals, physicians were more focused on changes in their patients’ medical condition, whereas nurses focused more on their patients’ desire for a long-term perspective. Nurses encouraged patients to consider ACP themselves, which developed into an approach to respect patients’ autonomy. In acute care hospitals, it appeared to be desirable to have an early discussion where patients could understand the significance ACP, which would matter even after their discharge from the hospital. (shrink)

The recent discovery of the medullary circuit driving “hunger responses” – reduced thermogenesis and promoted feeding – has greatly expanded our knowledge on the central neural networks for energy homeostasis. However, how hypothalamic hunger and satiety signals generated under fasted and fed conditions, respectively, control the medullary autonomic and somatic motor mechanisms remains unknown. Here, in reviewing this field, we propose two hypothalamomedullary neural pathways for hunger and satiety signaling. To trigger hunger signaling, neuropeptide Y activates a group of neurons (...) in the paraventricular hypothalamic nucleus (PVH), which then stimulate an excitatory pathway to the medullary circuit to drive the hunger responses. In contrast, melanocortin‐mediated satiety signaling activates a distinct group of PVH neurons, which then stimulate a putatively inhibitory pathway to the medullary circuit to counteract the hunger signaling. The medullary circuit likely contains inhibitory and excitatory premotor neurons whose alternate phasic activation generates the coordinated masticatory motor rhythms to promote feeding. (shrink)

中国古代(おもに戦国期~漢代初期)の新出土文献を検討により、古代思想史の空白を埋め、その変遷過程を明らかにする。.

We propose an efficient algorithm for deciding the reachability between any nodes on XML data represented by connected directed graphs. We develop a technique to reduce the size of the reference table for the reachability test. Using the small table and the standard range labeling method for rooted ordered trees, we show that our algorithm answers almost queries in a constant time preserving the space efficiency and a reasonable preprocessing time.

As kendo continues to gain in international popularity, there are hopes for its adoption in the Olympic Games as an international competitive event, even while moves to further this aim have not necessarily occurred in Japan or elsewhere. One reason for the efforts to achieve a form of globalization of kendo different from Judo is the attempt to adhere to and preserve the unique concepts kendo, the sport embodies by remaining true to the forms of traditional Japanese culture. This is (...) epitomized by the importance given to zanshin (the combination of posture and fighting spirit after striking), one of the key concepts that constitute yuko-datotsu in kendo. Our purpose in this study is to discuss the intersubjective nature of the decisions regarding the conditions for point-scoring in competitive sports. In particular, we will focus on the aesthetics required for zanshin in kendo, focusing on the theory behind yuko-datotsu (point score), which will also considerably influence its international dissemination. Kendo is characterized from the perspective of western rationalism as an appreciation of form and rules of behavior referred to as formalism and, in this respect, it has unique characteristics differing from those of modern sports that are disseminated internationally. In martial arts, besides refinement and proficiency in the rules of behavior by rigidly adhering to form and rules of behavior and repetition, the aim is to transcend said form and the rules of behavior and embody the spiritual nature dwelling in the background. Kendo should remain traditional path and keep zanshin in the value of point (yuko-datotsu) for its virtue. Kendo has not yet developed into an international competitive sport, but it is in the process of traversing that Geido path as a Do for the purpose of character building through it. Throughout life, one should try to devote oneself to kendo with thought for the value of transcending form and the rules of behaviour, and embodying the spiritual nature of the sport that inheres in its background. That is why one may perceive an evident hesitation or indeed negativity regarding the possible internationalization or development as an Olympic event. (shrink)

Notre article se propose d’articuler au domaine de l’esthétique notre expérience en tant qu’organisateur d’expositions présentant des artistes internationaux dans un centre d’art indépendant au Japon. En nous basant sur une théorie de la réception des œuvres, nous proposerons une lecture des appréhensions habituelles des modalités courantes au Japon par le renvoi aux formules de Nishida concernant l’acte artistique. Dès lors se croisent deux notions de marginalité. La première renvoie à l’opposition entre philosophie analytique et philosophie existentielle, la seconde consiste (...) à minorer les formes d’art qui ne renvoient pas au bien de la communauté. (shrink)

This study considers food commercials featuring the term otona, meaning ‘adult, mature person’. Although the term is not explicitly gendered, this study demonstrates that food advertising using otona becomes a conduit for the construction of gendered lifestyle formulations via consumption practices offering consumers entrance into a range of gendered adult life stage practices. Unlike the socially aspirational consumption practices described by Agha, the consumption of inexpensive otona-marked products, which cost the same as their non-otona-marked counterparts but are intended by commercial (...) producers to be viewed by prospective consumers as more mature, is linked to the process of entering adulthood. However, whereas male performance of otona masculinity is shown in the commercials to be based on psychological maturity and economic and social independence, female performance of otona femininity is determined by the commercial producers and the product manufacturers to be based on successful performance of external beauty, sexuality and support of male social sphere members. This article shows how otona becomes a catch-all for aspirational gendered performance, arguing that terms like otona are particularly suited for normative gendered performance presentations. (shrink)

技術が進歩すればするほど、技術者に対する信頼が必要となる。技術者は専門職として、どんな倫理をもたねばならないのか。それはほかの専門職の倫理とは違うのか?「技術者は公衆の安全・健康・福利を最優先しなけれ ばならない」という理念にもとづいて指針を示したテキストを、原発事故や製造物責任などの最新事例をふまえて改訂!

1. Tōzai bunka no kōryū -- 2. Shōtoku Taishi -- 3. Kinsei Nihon no hihanteki seishin -- 4. Nihon shūkyō no kindaisei.

This ethnographic research features Shugendō (mountain asceticism), Japan’s centuries-old, mystical tradition. I and approximately fifty other lay participants took part in a three-day Shugendō program for the secular. The program is physically demanding and takes secular trainees to three holy mountains in Yamagata, Japan, where they take part in the water purification and holy fire rituals in the mountain asceticism tradition. Using the theoretical framework of semiotics, I explicate the visual signifiers of this esoteric mysticism in the context of Shugendō (...) teachings represented in twenty photographs taken during the training. The purpose of this article is to promote semiotics as an analytical standpoint alternative to other approaches to studying culture, in this case, a Japanese religion sourced in my fieldwork. I argue that, living in today’s global age and visual culture, college students can and should benefit from learning about semiotics and developing visual literacy for their future career opportunities. (shrink)

あの高名な「絶対矛盾的自己同一」とは、いったいどういう意味なのか―。西田哲学の本質をつかみ、その全貌をわかりやすく示す!

江戸中期の儒学者・荻生徂徠(1666‐1728)の思想は難解といわれるが、その「ことば」は広く開かれている。徂徠は人/もの/世界を「活物」として看ることを説き、その思索は学者世間の外にまで届くものであ った。徂徠の「ことば」の魅力を探り、徂徠学の構想・方法・世界認識を明快に論じた本格的入門書。.