A New Dimension of Equity Analysis and Valuation" (in Japanese) (original) (raw)
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Japanese Journal of Cardiovascular Surgery, 2013
Risk analysis models are becoming more important in various aspects of the clinical setting. We have used the logistic EuroSCORE as a risk analysis model, but there is divergence between the model and actual clinical reality in our country. The Japan Score is a risk model based on the Japan Adult Cardiovascular Surgery Database and it is considered to be better reflect from Japanese clinical results. We compared the logistic EuroScore(ES)and Japan Score(JS)and their predictive accuracy, using our clinical results. Between October 2006 and June 2011, 733 operations suitable for evaluation by the Japan Score were performed at our institute. Isolated coronary artery bypass grafting(CABG)was 94 2012 年 5 月 11 日受付，2012 年 9 月 26 日採用 Corresponding author : Nobuhiro Umehara 東京女子医科大学心臓血管外科 〒 162-8666 東京都新宿区河田町 8-1 performed in 151 cases, valve surgery(Valve)in 346 cases and aortic surgery(Aorta)in 236 cases. In these cases we calculated 30-day mortality using the EuroSCORE and JapanSCORE and compared the results and prediction accuracy, by calculating the receiver operating characteristic curve(ROC curve) and the area under the ROC curve(AUC). We also calculated 30-day mortality and morbidity by the JapanSCORE and analyzed it by the same method. In the entire group, logistic 30-day mortality by ES and JS was 7.28 and 4.05% respectively. The AUC was 0.740 and 0.806, while 30-day mortality and morbidity calculated by JS was 17.72% and the AUC was 0.646. In the CABG group the 30-day mortality by ES and JS was 5.7 and 3.18% respectively, the AUC was 0.636 and 0.770, the 30-day mortality and morbidity was 13.37% and the AUC was 0.631. In the Valve group 30-day mortality by ES and JS was 6.00 and 3.79% respectively. The AUC was 0.715 and 0.794, 30-day mortality and morbidity was 17.54% and the AUC was 0.606. In the Aorta group 30-day mortality was 10.17 and 4.99% respectively. The AUC was 0.720 and 0.827. The 30-day mortality and morbidity was 20.83% and the AUC was 0.640. The 30-day mortality calculated by JS was significantly lower than that of ES(p＜0.001). The prediction accuracy of both of the ES and the JS was satisfactory but the prediction accuracy of JS was better than that of the ES. The prediction accuracy of the logistic 30-day mortality and morbidity were not as accurate as 30day mortality. JS was a good risk analysis model not only for prediction of surgical results but also for improving surgical outcome.
Journal of the Japanese Institute of Landscape Architecture, 2019
The world is experiencing unprecedented demographic transformation. In the second half of the 20th century human populations expanded more rapidly than at any time in our history – from approximately 2.6 billion people in 1950 to 6.1 billion by 2000. Current estimates project that by the close of the 21st century there may be around 11 billion people alive on Earth (UNPD, 2017). Nevertheless, there is another story taking place behind this extraordinary growth. In 2018 nearly half of the world’s countries show lower than replacement human fertility, and 33 countries are experiencing decreasing populations (GBD 2017 Collaborators, 2018). This turnaround is mainly associated with a combination of higher levels of development and increasing urbanisation. In Asia, Japan is in the vanguard. Its Total Fertility Rate (TFR) has remained below population replacement since 1974 (MIC, 2019). Demographers knew then that, if conditions persisted and without replacement migration, Japan would experience ageing and, eventually, population decrease. Conditions have persisted and, sure enough, in 2008 Japan’s population began to decrease. Currently Japan is the only shrinking country in Asia, but others are following, including China and South Korea. Beyond Asia, much of Eastern Europe is shrinking, and the European Union is ageing and, cumulatively, anticipated to start shrinking before mid-century. Even immigration friendly countries such as New Zealand and Canada are experiencing sub-national processes of ageing and shrinkage (Jackson & Cameron, 2018; Sims & Ward, 2017) and some Latin American countries – Costa Rica, Chile and Cuba – now report below replacement fertility (UNPD, 2017).