Center Of Excellence Program Research Articles

Strategi Implementasi Program CoE (Center of Excellence) pada Kompetensi Keahlian Teknik Instalasi Tenaga Listrik

This research aims to learn about the Center of Excellence (CoE) Program Implementation Strategy on Electrical Power Installation and the factors that influence the Center of Excellence (CoE) program implementation strategy on electrical power installation engineering expertise competencies at SMK Negeri 1 Sentani. This type of research uses a qualitative approach, research data obtained through observation, interviews, and documentation, while data analysis techniques use a flow model, namely: data reduction, data display, coclusion drawing/verification. Research results: SMK Negeri 1 Sentani has designed a strategy to achieve the success of the CoE program. First, develop a network with PT. PLN Sentani Branch and PT. Kabantaras officially through the signing of the MoU. Second, providing optimal services to students focused on curricular services (learning) Third, improve students' abilities by making improvements and developing learning input components. These three strategies support each other to achieve program success in stages. The factors that influence the implementation strategy of the Center of Excellence program are communication factors and resource factors, which are well established between the school, IDUKA instructors, and students, so that the implementation of the CoE program is guided by the strategy. The factors that influence them are capital, curriculum, and infrastructure with IDUKA standards.

29 Bridge for Meth: Multi-Center Prospective Evaluation of Emergency Department Initiation of Mirtazapine for Problematic Methamphetamine Use

To describe the characteristics and clinical outcomes among ED patients treated with mirtazapine for problematic methamphetamine use at 6 EDs participating in the CA Bridge, Centers of Excellence Program (COE).

Empirical Study of Management of Vocational High School with Regional Public Services Agency in Indonesia

The freedom learning policy is one of the Vocational High School Program (VHS) of the Center of Excellence (CoE), encouraging independent and productive schools to switch from Work Units to Regional Public Services Agency (RPSA). This research aims to reveal the empirical conditions of the management implementation of VHS RPSA, which is by the Management Standards in the Indonesia Education National Standard of VHS. Research methods use mixed sequential explanatory type, initial quantitative stage, and reinforced qualitative data. Research subjects based on a family of expertise include VHS State of 6 Yogyakarta, VHS State of 2 Depok Sleman, VHS State of 1 Bawang Banjarnegara, and VHS State of 63 Jakarta. The results showed that the dimension of human resources management is 80% (high), the dimension of facilities management is 86.88% (high), the dimension of financial management is 51.42% (sufficient), the dimension of learning program management is 85,5% (very high), and the dimension of community empowerment management is 82.25% (high). The combined mean of the five management dimensions of VHS RPSA was 77.5%. Analysis of variance showed that the five dimensions of management were different, with a significance value of 0.001. The implication of this research is to provide a map of the implementation of VHS RPSA in Indonesia that is specific to getting the CoE Program.

Employee Healthcare Travel Programs: Promise or Hype?

Employee Healthcare Travel Programs: Promise or Hype?

Research and results from the first four years of the Florida RESTORE Act Centers of Excellence Research Grants Program

Born of settlements surrounding the Deepwater Horizon oil spill in the Gulf of Mexico, the Florida RESTORE Act Centers of Excellence Program (FLRACEP) is charged with administering approximately $26 million in research grants for Florida over a period of more than 15 years. Centers of Excellence are selected through a competitive, peer-reviewed process which has thus far awarded $4.3 million in grants to 10 Florida researchers investigating different elements of marine fish and wildlife research and long-term fisheries monitoring. The initial 11 FLRACEP research grants produced 48 submitted or planned papers, and supported 63 students. While these outputs are significant, the FLRACEP Centers of Excellence are tackling important issues in coastal and marine research, resource management, and community resilience. The FLRACEP management team and program staff work to ensure effective program administration and research that is responsive to the needs of the state within the eligible RESTORE Act disciplines. While the program has encountered challenges in its early years, focus remains on the opportunity this funding represents.

Center of excellence funding: Connecting organizational capacities and epistemic effects

This study investigates the relationship between resource concentration/stability and new results/breakthroughs in the context of a Swedish Center of Excellence (CoE) scheme. A common assumption in using the CoE instrument is that there is a scale return to research on concentration of funds. However, the details of how funding connects to such returns are typically assumed rather than empirically investigated. The present qualitative study sets out to identify the mediating mechanisms connecting organizational capacities made possible through the CoE grant (e.g. recruitment/human capital, data/infrastructure and various collaborative arrangements), and epistemic effects such as extension into new problem areas and higher degrees of risk taking in research generally. We conclude that a CoE program theory can be conceived in terms of resource stability yielding research flexibility, and that the common mechanisms connecting the two may be found in organizational arrangements facilitating slack (autonomy), availability of cooperative partners (critical mass) and concomitant cooperation between specialisms. It is our belief that by explicating such mechanisms CoE program theory can be greatly improved. (Less)

Thermo Names Newest Member of CDx Center of Excellence Program

Thermo Names Newest Member of CDx Center of Excellence Program

Genomic profiling of early-stage lung cancer for patterns of recurrence.

e23126 Background: Currently there is no evidence to support molecular profiling for early stage resected lung cancer patients. However, up to 50% of patients experience recurrence following resection. This is a first-of-a-kind study utilizing comprehensive genomic profiling technology to characterize genomic patterns for risk of recurrence in early stage lung cancer patients within the community hospital setting who have undergone lung surgery. Methods: A total of 60 Stage I-II lung cancer patients, all having undergone pulmonary resection, were evaluated with molecular profiling of their primary lung cancer tissue using Foundation Medicine’s FoundationOneÒ test. Patient age in years ranged from 39-86, and all patients were confirmed Stage I or II based on final pathologic analysis. Samples were taken from three community hospitals that are part of the Addario Lung Cancer Foundation Centers of Excellence program. Patients whose tumors were resected between the years of 2009-2017 were included in this combined retrospective and prospective study. Results: More than 300 genes were evaluated using FoundationOneÒ and patients were segmented to establish similarities and differences. Analysis of segments include gender, recurrence, smoking status among others. Gene patterns across segments are beginning to reveal possible predictive profiles. Final analysis will be completed shortly. Conclusions: Genomic profiling could help predict lung cancer recurrence for early stage lung cancer patients. Similarities amongst patients with recurrences imply that early genomic profiling of lung cancer patients could help predict those patients who would benefit from adjuvant therapies including conventional chemotherapy. Genomic profiling for early stage lung cancer should be studied further and in greater detail to help predict those patients who would benefit from potentially early adjuvant therapies.

OA16.03 The ALCF Centers of Excellence Model Delivers a Standard of Care to the Community Similar to Academic and Research Centers

The disparities in lung cancer treatment and outcomes among minorities are well documented.1 Further, 80% of cancer patients are treated in the community hospital setting yet may not receive the same level of care as those treated at leading academic centers. The Bonnie J. Addario Lung Cancer Foundation (ALCF) Centers of Excellence (COE) program addresses this unmet need. The COE program is a patient-centric model for lung cancer that establishes a standard of care for community hospitals which often treat minority and underserved patient populations. The COE program, which currently includes 13 hospitals in regions of high unmet need, aims to improve the standard of care, patient experience and patient outcome by offering patients and caregivers the same type of multi-disciplinary and comprehensive care provided at leading academic centers. ALCF also provides lung cancer education and services to patients, caregivers and the community. The COE program tracks patient process data longitudinally for multiple quality-of-care metrics, including disease stage at diagnosis; molecular testing; tumor board review; time from diagnosis to treatment; treatment type; and clinical trial participation. Site data will also be monitored to provide a contextual picture of the program including total patients seen, demographics, insurance mix, rates and outcomes of molecular testing among other metrics. Data is analyzed across the COE community and against comparator groups to demonstrate impact of the COE program. The COE program serves thousands of patients each year with a significant representation of minorities and underserved populations. Baptist Memorial Health Care System is an example of a COE that has demonstrated implementation of the COE model by providing multi-disciplinary care to a diverse population. Among those reporting race at Baptist, minorities represent more than 30% of lung cancer patients. Memorial Health Care System is another COE that is reaching and serving a diverse patient population. The patient mix at Memorial is : 64% whites; 18% Hispanics; and 18% African American. At Memorial, approximately 10% of the patient population is uninsured. Further, Memorial molecularly tests all stage III/IV patients. Compared with community hospitals in the National Cancer Database the patient mix is about 84% white, 2.5% Hispanic and 11% African American with 3% uninsured. The ALCF COE program is demonstrating that underserved lung cancer patient populations can be reached and receive standard of care treatment. The patient-focused COE approach effectively removes barriers to quality care.

SC31.02 The Role of Patient Advocacy Groups

The role of Patient Advocacy organizations in the oncology health care delivery ecosystem is ever evolving and has moved well beyond its original role of solely advocating for services, research, care and understanding. The current field of patient advocacy has its roots in the patient rights movement of the 1970’s with groups like The National Welfare Rights Organization being instrumental in getting a patient bill of rights accepted by the Joint Commission on Accreditation of Healthcare Organizations in 1972.1 The transformation was further accelerated in 1991 with the formation of the FDA Patient Representative Program and has continued to expand over time with patient advocates now being involved in the entire care continuum. In this presentation I will focus my attention on examples of the ever evolving and expanding role of patient advocacy highlighted by projects developed and led by “partner” foundations the Bonnie J. Addario Lung Cancer Foundation (ALCF) and the Addario Lung Cancer Medical Institute (ALCMI). The disparities in lung cancer treatment and outcomes among underserved populations are well documented.2 Further, 80% of cancer patients are treated in the community hospital setting yet may not receive the same level of care as those treated at leading academic centers. The ALCF Community Hospital Centers of Excellence (COE) program addresses this unmet need. The COE program is a patient-centric model for lung cancer that establishes a standard of care for community hospitals which often treat underserved patient populations. The COE program, which currently includes 13 hospitals in regions of high unmet need, aims to improve the standard of care, patient experience and patient outcome by offering patients and caregivers the same type of multi-disciplinary and comprehensive care provided at leading academic centers. ALCF also provides lung cancer education and services to patients, caregivers and the community. The COE program tracks patient process data longitudinally for multiple quality-of-care metrics, including disease stage at diagnosis; molecular testing; tumor board review; time from diagnosis to treatment; treatment type; and clinical trial participation. Site data will also be monitored to provide a contextual picture of the program including total patients seen, demographics, insurance mix, rates and outcomes of molecular testing among other metrics. Data is analyzed across the COE community and against comparator groups to demonstrate impact of the COE program.3 The U.S. National Institutes of Health database currently lists over 45,000 cancer-related clinical trials worldwide.4 Unfortunately, more than 20% of these trials will never complete, for reasons unrelated to the effectiveness of the intervention that’s being tested. The most common reason for 20% of all clinical trials never finishing is poor patient accrual. One of the most common reasons for low accrual is procedural inefficiencies such as complexities in enrolling in the trial itself and the informed consent process. In 2014, ALCMI launched a prospective study to characterize somatic and germline genomics of adolescents and young adult (AYA) patients.5 It is estimated that less than 2% of those newly diagnosed with lung cancer globally are AYA, thus presenting a striking recruitment challenge. To address this challenge, ALCMI's study workflow included building a dedicated website3 enabling remote screening and e-consenting so patients could participate from their homes anywhere in the world while, in parallel, ALCF employed social media to educate patients on the importance of comprehensive genomic profiling and increasing awareness of the study via grass-roots patient blogging. Together, ALCMI and ALCF bring “research to the patient.” Accrual opened July 23, 2014 and in the first 5 weeks of the study, 37 subjects consented. Of the 37 initially consented, 35 enrolled via the remote web-portal. As of June 15 2016, 104 subjects are enrolled (128 consented) in the study from 10 countries following a social media campaign. Of the 104 subjects enrolled to date, 49% entered the study via the remote study portal with the balance recruited locally by participating ALCMI study sites. As briefly outlined above, patient advocacy organizations have moved well beyond their original patient supportive role and have become key players in the oncology healthcare delivery and clinical research ecosystems. As the healthcare system continues to evolve and become more complex so will the role of patient advocacy organizations. To address these challenges, there will be even greater need for innovation, sharing of data and resources, increased infrastructure and mission sophistication, the need to avoid overlap and duplication, and a laser focus on providing meaningful improvement in the availability, transparency and affordability of healthcare.

Aviation Human Factors Related Industry News

Aviation Human Factors Related Industry News

The NHLBI-UnitedHealth Global Health Centers of ExcellenceProgram: Assessment of Impact of Federal Funding Through a Social Network Analysis.

Highlights Team science is gaining acceptance as a bona fide framework for effective collaborative research. One of the original goals of the National Heart, Lung, and Blood Institute–UnitedHealth Global Health Centers of Excellence (COE) Program was to fund individual COE research. The value-added outcome of the COE network was to foster global collaboration to combat noncommunicable cardiovascular and pulmonary diseases through the conduct of team science across multiple disciplines and diverse geographical locations. This article analyzes the impact of federal funding through a social network analysis and the unexpected relationships among the COE Program members that resulted from team science and established the social and professional networks that nurtured professional collaboration among these team members.

Nonlinear Physics Down Under

Nonlinear Physics Center was established in 2002, as a small group working on various problems of nonlinear dynamics and solitons. Then it became a separate department of the Research School of Physics and Engineering which was continuously expanding with the support from the Australian Research Council (ARC) through a variety of different funding schemes — individual fellowships and the ARC Center of Excellence program. In August 2014, the Center's research was conducted by 17 researchers and 19 PhD students (see Fig 1). Currently, the Nonlinear Physics Center is engaged in theoretical and experimental research in several areas unified by the general concepts of nonlinear physics and photonics. The Center is composed of several major research groups with not sharply defined boundaries.

Creating an adolescent and young adult cancer program: lessons learned from pediatric and adult oncology practice bases.

Driven by reports of unmet clinical needs and lack of survival improvement, programs for adolescents and young adults (AYAs) with cancer have become increasingly common across the United States during the past 10 years. Programs generally originate from existing pediatric or adult hospitals, serve all or a subset of patients between 15 and 39 years of age at the time of cancer diagnosis, and aim to work collaboratively with other branches of their institution to deliver superior care for AYAs. Until recently, programs responded to local needs and evolved without an established framework for growth. Over the past several years, organizations including NCCN have published guidelines for AYA cancer care and for the development of clinical AYA programs. This article reviews these publications, describes the growth and development of 2 nationally recognized AYA centers--Seattle Children's Hospital and Moffitt Cancer Center--and offers practical suggestions to assist developing AYA programs. AYA oncology is entering a new era of increasing public recognition and nationally coordinated growth, as evidenced by the recent establishment of the Change it Back's Centers of Excellence Program that codifies criteria for excellence in AYA cancer care. AYA programs have the potential to improve care for a vital and underserved patient population, stimulate collaborative research, and enhance relationships with patients, the local community, referring physicians, and donors.

National Institute of Nursing Research Centers of Excellence: A logic model for sustainability, leveraging resources, and collaboration to accelerate cross-disciplinary science

The National Institute of Nursing Research (NINR) Centers of Excellence program is a catalyst enabling institutions to develop infrastructure and administrative support for creating cross-disciplinary teams that bring multiple strategies and expertise to bear on common areas of science. Centers are increasingly collaborative with campus partners and reflect an integrated team approach to advance science and promote the development of scientists in these areas. The purpose of this paper is to present the NINR Logic Model for Center Sustainability. The components of the logic model were derived from the presentations and robust discussions at the 2013 NINR center directors' meeting focused on best practices for leveraging resources and collaboration as methods to promote center sustainability. Collaboration through development and implementation of cross-disciplinary research teams is critical to accelerate the generation of new knowledge for solving fundamental health problems. Sustainability of centers as a long-term outcome beyond the initial funding can be enhanced by thoughtful planning of inputs, activities, and leveraging resources across multiple levels.

Editor’s Introduction: Quantitative Approaches to the Study of Terrorism

Although criminological research on terrorism has expanded dramatically since the 1970s, it has generally not been noteworthy as an area that has generated cutting edge methodological and statistical innovations. In an encyclopedic review of research on terrorism, Schmid and Jongman (1988:177) identified more than 6,000 published works but point out that much of the research is ‘‘impressionistic, superficial (and offers) ... far-reaching generalizations on the basis of episodic evidence.’’ More recently, Silke (2001) concluded that only three percent of articles in journals that reported terrorism research used inferential statistical analysis compared to 86% of articles in forensic psychology and 60% in criminology. Victoroff (2005:34) similarly concluded that there were more psychological terrorism theories than empirical studies, and ‘‘even the small amount of psychological research is largely flawed, rarely having been based on scientific methods using normal and validated measures of psychological states, comparing direct examination of individuals with appropriate controls, and testing hypotheses with accepted statistical methods.’’ Lum et al. (2006) reviewed more than 20,000 articles on terrorism published between 1971 and 2004 and found that only seven met their criteria of being moderately rigorous evaluation studies. But as the contributions to this special issue of the JQC illustrate, the situation with regard to quantitative approaches to the study of terrorism has begun to rapidly change. Spurred on by expanded funding opportunities, especially from the Department of Homeland Security’s (DHS) Science and Technology Directorate, the National Institute of Justice and the National Science Foundation, we are witnessing a huge growth in the depth and sophistication of the criminological research literature on terrorism. These developments have also been aided by the creation of DHS’s Centers of Excellence program, and more recently, by the Department of Defense funded Minerva program. Research on terrorism arguably represents one of the major growth areas in social science scholarship

Broad Collaborations Bring New Energy to Autism Therapeutics

Such efforts do not happen in isolation. Until relatively recently, academic researchers studied autism through the confines of their respective specialties. Ultimately, universities began organizing autism researchers into communities of scientists from wide ranging disciplines. The NIH funds collaborative research through their Autism Centers of Excellence program. Early on, according to Carpenter, Seaside Therapeutics carefully laid the groundwork for a diverse group of collaborators.Marguerite Colston, spokesperson for the Autism Society, a U.S. grassroots autism organization, and the parent of a son with autism, sees value in collecting anecdotes from parents. Colston keeps a daily log of what her son eats, his toileting schedule, and what he did in school. Many parents, she says, can offer an untapped resource of useful observations. “We want to build a database of anecdotal data, which can be de-identified,” says Colston. The Autsim Society would then use that database to get more funding for research into treatment.Recently, Autism Speaks launched two collaborative efforts, says Lajonchere. In late 2010, the organization teamed with Sigma Life Sciences to create a number of knockout rat models that simulate various symptoms and pathologies of autism. In January 2011, Autism Speaks launched their Translational Medicine Initiative, bringing together a wide representation of experts from academia, pharma, industry partners, and the federal government.Lajonchere says that one goal of this initiative is to develop strategies for novel clinical trial design that includes the identification and development of additional outcome measures that are more sensitive to change. The initiative also hopes to develop long-term close collaboration with researchers in the preclinical area and encourage dialog with the clinicians and researchers on the other end of the pipeline. Several pharmaceutical companies have demonstrated a willingness to share compounds for potential new therapies once researchers are able to identify viable targets.“Collaboration and open dialogue are keys in translational medicine. Bringing together the entire research community will provide the best way forward,” says Lajonchere.

Toe Clearance And Lower Limb Kinematics During Walking In Older Japanese Stroke Patients.

The risk of falls is higher in stroke patients than in healthy older adults. Trips are a major cause of falls during walking and occur when the swing foot contacts the floor surface or an object. Toe clearance is one of the main indicators of risk for trips. Although the main reason for falls during walking is tripping, there are few reports concerning toe clearance during walking in stroke patients. PURPOSE: To examine toe clearance and lower limb kinematics during walking on a flat floor in older Japanese stroke patients. METHOD: Eleven stroke patients (age 68.1 ± 6.4 years) who lived at home and could walk independently and ten healthy older adults (age 66.4 ± 3.3 years) were recruited. The following kinematical parameters were measured while subjects walked on flat floor surfaces: (1) the vertical displacement of toe markers from the floor surface (toe clearance) and (2) the angular displacements and velocities of the hip, knee, and ankle. RESULTS: The group of stroke patients had significantly lower toe clearance in the paretic side than that in the group of healthy older adults during the first swing phase (about 0∼20% swing phase). During the first swing phase, the group of stroke patients also had significantly smaller knee flexion of the paretic side than the group of healthy older adults. CONCLUSION: Toe clearance and knee flexion during the first swing phase of walking appear to be lower in stroke patients than in healthy older adults. In order to reduce the incidence of falls resulting from trips, approaches to increase knee flexion in the paretic side of stroke patients should be developed. This research was supported in part by the 21st century COE (Center of Excellence) program.

Process of developing people‐centered care

AbstractAim: This study, conducted in the last year of the 5 year Center of Excellence Program, aimed to identify the core elements of the developmental process of implementing people‐centered care.Method: The members of the team that conceptualized people‐centered care interviewed 25 participants of each research project, including community members. The interview audiotapes were transcribed verbatim and the transcriptions were analyzed using interpretive data.Results: The developmental process identified the core elements of people‐centered care: (i) a partnership approach based on equal footing; (ii) capacity‐building by partnership; (iii) mutually generating and utilizing organizational care; and (iv) the expansion and development of organizational care. St Luke's College of Nursing, Tokyo, Japan, is using people‐centered care to send visionary and philosophical messages to society and to demonstrate the specific approaches and techniques to implement such care.Conclusions: People‐centered care is implemented in the community as an organizational model using the core elements of the developmental process. The concept of people‐centered care and its realization via a practical approach will be widely applied in future health‐care practise, education, and research.

COMMUNITY‐DWELLING ELDERLY FALLERS IN JAPAN ARE OLDER, MORE DISABLED, AND MORE DEPRESSED THAN NONFALLERS

To the Editor: We read with interest the article published by Somadder et al.1 The authors document a correlation between depressive symptoms and self-reported numbers of falls in older subjects attending a day hospital in the United Kingdom. They reported that there were no significant differences in age, comorbidities, or performance on activities of daily living (ADLs) between fallers and infrequent fallers in their small population. We reexamined this important issue in community-dwelling elderly people in Japan and found findings different from those of Somadder et al. The study population consisted of 1,261 people aged 65 and older (men 529, women 732, mean age 75.4 ± 7.2) living in T town, Kochi Prefecture, Japan. Fallers were screened using self-reported questionnaires, along with additional tests of ADLs and subjective quality of life (QOL) for community-dwelling older people in 2006. The question “Do you have any history of a fall within the past year?” was used for detecting fallers. Subjects who answered yes to the question were considered to be fallers. For the assessment of basic ADLs, the scores for seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming) were summed using a rating scale from 0 (completely dependent) to 3 (completely independent) to obtain a basic ADL score (0–21). For advanced ADLs, the Tokyo Metropolitan Institute of Gerontology index of competence rating scale of 0 to 13 was used.2 This scale includes instrumental self-maintenance (0–5), intellectual activity (0–4), and social role (0–4). Five indicators of QOL (sense of subjective health, relationship with family, relationship with friends, financial satisfaction, and subjective happiness) were rated on a 100-mm visual analogue scale (worst QOL on the left end of the scale, best to the right).3,4 The 15-item Geriatric Depression Scale (GDS-15)5 was used for the assessment of depression; a score of 10 or more was considered to indicate depression. A fall risk index6,7 with a score ranging from 0 (low risk of fall) to 21 (high risk of fall) was added to those and used for the assessment of risk of falls. Statview version 5.0 (SAS Institute, Inc., Cary, NC) was used for calculating chi-square tests for categorical variables, unpaired t-test for continuous variables, and Spearman correlation (rs) between number of falls and GDS-15 and between fall risk index and GDS-15. The proportion of fallers was 31.6% in this population. Fallers were significantly older (76.9 vs 74.7) and had significantly lower scores for each item of the ADLs and QOLs than nonfallers, even after the adjustment for age (Table 1). The proportion of subjects with depression was significantly higher in fallers (26.8% vs 11.6%, P<.001). Although only 59.6% of the fallers answered the numbers of falls, there was weak but significant correlation between number of falls and GDS-15 scores in those who had fallen (rs=0.17, P=.002). The mean fall risk index score was significantly higher in fallers than nonfallers, and there was significant correlation between fall risk index and GDS-15 (rs=0.53, P<.001) in fallers. We confirmed the higher prevalence of depression in fallers than nonfallers, and there was a significant correlation between the number of falls and GDS-15, as Somadder et al. reported. However, unlike with the findings of Somadder et al., community-dwelling elderly fallers in Japan were significantly older and had lower quantitative ADL and QOL scores, as well as higher GDS-15 scores than nonfallers, even after adjustment for age. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that none of the authors have any financial or any other kind of personal conflicts with this article. Financial support for this study was obtained in part with funds from working group of fall prevention, Japanese Ministry of Health, Labor and welfare. Taizo Wada was supported by Global COE (Centers of Excellence) Program, In search of Sustainable Humanosphere in Asia and Africa (E-04), Japan Society for the Promotion of Science (JSPS). Author Contributions: Taizo Wada: data analysis and writing the manuscript; Masayuki Ishine, Yasuko Ishimoto, Mayumi Hirosaki, Yumi Kimura, and Yoriko Kasahara: data collection; Kiyohito Okumiya, Masanori Nishinaga, Kuniaki Otsuka, and Kozo Matsubayashi: study concept. Sponsor's Role: The sponsors did not participate in the design or data analysis of any aspect of the study or manuscript preparation.