Japanese Gov't will donate 1000 schools to Africa

Japanese Foreign Minister Masahiko Komura told that Japan will donate 1000 schools to Africa in the next five years. He also told that Japanese government will support to educate 300,000 school teachers in Africa or other developing nations. The government will encourage post-graduate education in Japan from the student from developing countries, as he told in his speech driven in Tokyo. - Source the Mainichi Shinbun-

As we are exploring the implementation of the Heiwa-Mura Project in D. R. Congo, initiated by Dr. Ngatu Nlandu Roger, a graduate student at my department, the news sound quite nice for us. The Heiwa-Mura Project consists of Education, Health, and Agriculture and leads to community development.

Occupational Medicine Mini-Workshop

I gave introductory lecture and practice on ILO international classification of pneumoconioses to occupational physicians today. Thirty-three physicians attended the two hour practical mini-workshop and reviewed the scope of the ILO classification using actural chest radiographs. It seemed such kind of lecture was new to the physicians in Kochi, and they seemed to have enjoyed it. Twelve radiographs were given as pre- and post-test to evaluate the positive effect of the participatory lecture. The prototype of the lecture is the ACR seminar for Pneumoconiosis, which was first given by Dr. Benjamin Felson.

Dpt Seminar

- Journal Club
Breast milk-mediated transfer of an antigen induces tolerance and protection from allergic asthma. Nature Medicine 2008;14:170-173
Epidemiologic data shows negative association between breast-feeding and incidence of allergic diseases among the children. The study seeks explanation of this finding. OVA neblized mother breast-fed the newborn mice and caused newborn mice's inmune tolerance to OVA. OVA was identified in the breast milk by Western blotting. The mechanism was shown to be related to the lowering of antigen-specific T helper type 2 (Th2) with the presence of TGF-beta.
- Seminar
I talked about the appropriate Digital Radiography parameter for pneumoconiosis screening, based on the DR Taskforce for Ministry of Health, Welfare and Labour, Japan. The flat-panel detector DR was approved for the medical judgment of pneumoconiosis according to the Pneumoconiosis Law in Japan on November 2007.

Dpt Weekly Seminar

Today's speaker was Dr. Ngatu Nlandu Roger, a Congolese physician who is now applying for the Graduate School here at KMS. He is going to present a paper at a regional meeting of Japan Association of International Health on coming Saturday, 1st March. A JICA Coordinator Mr. Taisuke Matsuo visited us to attend this weekly seminar to share his impression about Dr. Nlandu's Heiwa Mura Project, or Peace Village Project. Detail will be presented at the meeting and he will scientifically assess the project.

Department Weekly Seminar

An intervention to decrease catheter-related bloodstream infections in the ICU.
Pronovost P, Needham D, Berenholtz S, et al. N Engl J Med 2006;355:2725-2732.

Quality-Improvement Research and Informed Consent
Franklin G. Miller, Ph.D., and Ezekiel J. Emanuel, M.D., Ph.D. N Engl J Med 2008; 358:765-767.

Harming through Protection?M.A. Baily N Engl J Med 2008;358:768-769

Pronovost et al. studied effect of implementing evidence-based catheterization at 103 hospitals ICU on the risk of developing catheter-related bloodstream infection by multilevel Poisson regression model. The median rate of catheter-related bloodstream infection per 1000 catheter-days decreased from 2.7 infections at baseline to 0 at 3 months after implementation of the study intervention, and the mean rate per 1000 catheter-days decreased from 7.7 at baseline to 1.4 at 16 to 18 months of follow-up. The regression model showed a significant decrease in infection rates from baseline, with incidence-rate ratios continuously decreasing from 0.62 (95% CI, 0.47 to 0.81) at 0 to 3 months after implementation of the intervention to 0.34 (95% CI, 0.23 to 0.50) at 16 to 18 months. An evidence-based intervention resulted in a large and sustained reduction (up to 66%) in rates of catheter-related bloodstream infection that was maintained throughout the 18-month study period.

The commentary is not on the finding of the study but the surrounding situation on this study. The institutional review board (IRB) at Johns Hopkins had judged that this quality-improvement program was exempt from federal regulations governing human-subjects research. The Office for Human Research Protections (OHRP) claimed that the Pronovost Study has violated the state regulation regarding the study protocol has not fully reviewed by an IRB at John’s Hopkins University and not obtained informed consent from the patients and participating physicians.

Miller and Emanuel argues that the Pronovost Study does not require Informed consent but should be waived by the IRB decision from following reasons:
1 As the program was not a merely analysis of collected data obtained without risk, this quality-improvement initiative involve human-subjects research that should have been reviewed by an IRB. The purpose of the program was to implement evidence-based practice of catheterization that lowers the risk of catheter-related infection. The study is subjected to expedited review.
2 Then in an expedited review, the IRB would need to determine whether informed consent was required or could be waived.
3 Informed consent should be waived.

Bailey argues that the project was a combination of quality improvement and research on organizations, not human-subjects research, and the regulations did not apply. The project was not designed to use ICU patients as human subjects to test a new, possibly risky method of preventing infections; rather, it was designed to promote clinicians' use of procedures already shown to be safe and effective for the purpose.

Most importantly, the OHRP which is supposed to be protecting subjects from harmful intervention is going to become an obstacle for the evidence-beased safety skill implementation, as one of the author of the two commentary has pointed out.


One of my staff, Dr Ryoji Hirota had been working at an Atom Force Microscope measurement and sales venture company a few years ago. His experience on measuring nano-sized materials such as DNA, proteins, liposome, bacterial toxin etc. was shown. One issue of the Cell is covered by his shot of looped DNA.

A PhD Applicant

Five p.m. today is the deadline for application for Graduate School of Kochi University. A Congolese medical doctor who resides in Nankoku City has applied to the Graduate School for our course of Environmental Medicine. Dr Ngatu Nlandu Roger who is the founder of LIPS, a R. D. Congo based NGO, and co-representitive of The R. D. Congo Child Foundation, a Nankoku City based NPO. His main interest is on International Health, especially in African countries, and he seeks the oppotunity to further educate himself for better organization of his project in R. D. Congo. He is already attending weekly department seminar and actively preparing presentation at academic conference on International Health.

Violin

I had lessons for playing violin for about 10 years till I was in junior high school. Producing beautiful note by a violin is very difficult and the lessons were not fun for me at that time. When my kids get to be around my age when I started the lesson, I tried to make them learn playing violin but it hadn't work well so far.
Nowadays, I pick up my violin once a week usually on Sundays, to play the notes that I remember. Acturally it is not my mind that remembers the notes but my fingers that remember the places on the four strings. My skill is now awful but in my mind the music rings as I was playing in my younger days.