Japanese Context Research Articles

Genetic mutations and cytotoxic chemotherapy response for advanced solid tumors: A detailed analysis using the C-CAT database in Japan.

130 Background: Chemotherapy regimens are selected based on information about the primary organ or its histological type and are administered based on the results of previous clinical trials. Even now, as cancer genomic research has progressed and precision medicine, which optimizes therapeutic interventions based on tumor genome profiling using next-generation sequencing(NGS), has become standard treatment, cytotoxic anticancer drugs still remain key drugs. We examined the real-world database of genomic and clinical information established by the national central datacenter, the Center for Cancer Genomics and Advanced Therapy (C-CAT) to systematically analyze the effects of mutations across multiple cancers and therapies. Methods: This study delineated the association between genetic mutations and the therapeutic efficacy of cytotoxic chemotherapy in advanced solid tumors in a real-world Japanese clinical context. We incorporated data from 15,474 patients enrolled in the C-CAT database between June 2019 and June 2022. We analyzed the overall response and time to next treatment (TNT) for genetic alterations and five categories of cytotoxic anticancer drugs in gastrointestinal cancers. Results: In the C-CAT data, gastrointestinal cancers were frequently registered, with colorectal cancer being the most common, followed by pancreatic cancer, esophageal/gastric cancer, and biliary tract cancer. For platinum-based drugs, in colorectal cancer, the presence of gene X was associated with not only a higher response rate but also a longer TNT (hazard ratio 0.82, p<0.001). In the case of colorectal cancer and pancreatic cancer with KRAS gene mutations, the ORR was low, and the TNT was also short in the case of pancreatic cancer (hazard ratio 1.33, p<0.001). Interestingly, when BRCA2 genes are mutant, TNT tended to be longer in many organs, suggesting that platinum-based drugs are effective across organs in carcinomas with BRCA2 mutations. Additionally, gene X showed differences in efficacy not only for platinum but also for antimetabolites and topoisomerase inhibitors. Moreover, KRAS mutation was observed in almost all pancreatic cancers and was a treatment-resistant mechanism for all platinum drugs and antimetabolites. Conclusions: This study demonstrated that the effects of cytotoxic anticancer drugs differ depending on genetic mutations. When determining chemotherapy regimens, considering not only the organ but also genetic mutations may enable more efficient drug selection.

P-1638. Prevalence and Correlates of Inappropriate Antibiotic Prescribing in Japanese Primary Care Settings

Abstract Background Since the release of its 2016 National Action Plan on Antimicrobial Resistance (AMR), Japan has promoted antimicrobial stewardship in various ways (e.g. AMR awareness campaigns) but remains short of meeting benchmarks, e.g. reduction of antibiotic use per capita by one-third by 2020 versus 2013 (decreased only by 4.4% as of 2019). Effective stewardship interventions require comprehensive assessment of antibiotic prescribing appropriateness, with the most recent national-level data from 2012–2015. To fill this knowledge gap, we evaluated antibiotic prescribing appropriateness in Japanese outpatient primary care visits using nationally representative data. Characteristics of patients who received ≥1 antibiotic prescription and visits in which physicians wrote antibiotic prescriptions from October 2022 to September 2023, JAMDAS Methods In a cross-sectional analysis of 2,809 primary care clinics, we analyzed all antibiotic prescriptions from October 1, 2022, to September 30, 2023. We adapted an established ICD-10-based classification scheme (Chua et al, BMJ, 2019) to the Japanese context, classifying prescriptions as “appropriate” (associated with ≥1 “always” code), “potentially appropriate” (associated with ≥1 “sometimes” code but no “always” codes), “inappropriate” (associated only with “never” codes), or “not associated with recent diagnoses.” We used regression to examine the association between prevalence of inappropriate antibiotic prescriptions and patient, clinic, and visit characteristics, adjusting for month indicators. Prevalence of antibiotic prescriptions in each appropriateness category, JAMDAS Results Table 1 shows characteristics for patients who received ≥1 antibiotic prescription and visits in the sample. Among 2,058,021 prescriptions to 1,267,708 patients, 17.9% were inappropriate (Table 2). The adjusted prevalence of inappropriate antibiotic prescriptions was higher for children (< 18 years), patients with comorbidities (sourced from the Charlson Comorbidity Index), older physicians, physicians with higher antibiotic prescription volumes, and telehealth visits versus office visits (Figure 1). There were no differences by patient or physician sex, total patient volume, region, or regular versus after hours. Association of patient, clinic, and visit characteristics with prevalence of inappropriate antibiotic prescriptions Conclusion Antibiotic stewardship initiatives in Japanese primary care targeting children, patients with more comorbidities, older physicians, physicians with high antibiotic prescription volumes, and telehealth settings may be warranted. Disclosures Atsushi Miyawaki, MD, PhD, M3, Inc.: Advisor/Consultant

Tradycja, religia, presja społeczna i fanatyzm – ewolucja percepcji zbrodni i kary w Japonii

An article written by an “observer”, who, in accordance with the saying from the traditional Japanese game of go that “observers see more than players”, attempts to analyze the causes and methods of imposing penalties in Japan. The topic of the article is the evolution of the approach to crime and punishment from the Edo period (1603–1868) to modern times and the analysis of Japanese specifi city in this field. Direct observation of contemporary Japan shows that the approach to crime and punishment is strongly infl uenced by tradition, religion, social pressure, and fanaticism. In the process of imposing punishment, apology (shazai), resolution to make amends (hansei), and compensation (tsugunai) are still important. One can effectively atone for one’s offenses by offering a sincere and sufficiently humble apology. In addition to referring to religion, which infl uenced the understanding of the essence of crime and the social attitude towards crime and punishment in Japan, this article focuses on the unique social and cultural factors that most provide most insight into a society, such as the binary oppositions of individualism-collectivism and tightness-looseness, and other features of the Japanese context. Taking into account the factor of fanaticism, the article raises the issue of religious sects in the 1990s and their contemporary consequences. To achieve a goal and save face, the Japanese have been sacrificing individuals for the common good for centuries. Penalties were applied in such a way that they always took into account family and loved ones, and responsibility was understood collectively (rentai sekinin). The death penalty is still in force in Japan, but errors in its application are rarely exposed. Although life is not always lost, the punishment is a disgrace because it involves loss of face and no further prospects, even though modern legislation tries to provide opportunities for reintegration into society. Tradition, religion, social pressure, and fanaticism infl uence today’s generation in terms of predisposition to specifi c crimes, methods of imposing punishment, and articulating social condemnation. The article discusses criminogenic factors, crimes committed over the years, and the relationship between crime and punishment, including the death penalty, from a unique insider’s perspective, deepened by studies on this topic from Western and Japanese sources. On this basis, the specifi cs of the perception of crime and punishment in Japan are formulated.

The Differential Effect of Regulatory Signals on Shareholder Dissent: The Case of Shareholder Voting in Director Elections

ABSTRACTResearch Question/IssueIn the Japanese context of shareholder voting in director elections, this study examines how regulatory signals differently influence shareholder dissent depending on their resource dependence relationship with regulatory bodies.Research Findings/InsightsWe find that the effect of a regulatory change in the disclosure of voting records on shareholder dissent is strengthened as shareholdings by domestic institutional investors increase, while it is mitigated as shareholdings by foreign institutional investors increase. Moreover, we find that this effect is pronounced under conditions where directors seemingly fail to fulfill or to qualify for their role.Theoretical/Academic ImplicationsThis study develops a resource dependence perspective of shareholder dissent and argues that shareholder dissent can be shaped by regulatory signals from regulatory bodies who provide them with legitimacy. This study enriches the existing insights on corporate governance role of institutional investors by focusing on their resource dependence on regulatory bodies.Practitioner/Policy ImplicationsThis study sheds light on the dynamic nature of shareholder behavior and suggests that shareholder preferences are not only heterogeneous but also mutable over time in response to regulatory signals. This implies that managers need to pay attention not only to current shareholder preferences but also to future anticipated shareholder preferences to successfully manage their relationships with shareholders.

Cesarean delivery on child health and development in Japanese nationwide birth cohort

The long-term effects of cesarean delivery (CD) on child health and development remain controversial. This study aimed to investigate these effects using an outcome-wide approach in a Japanese context, where perinatal mortality rates are among the world’s lowest. We analyzed data from 2,114 children in a nationwide Japanese birth cohort, linking the 21st Century Longitudinal Survey of Newborns with the Perinatal Research Network database. We examined associations between CD and various health and developmental outcomes up to 9 years of age, including hospitalizations, obesity, and developmental milestones. After adjusting for potential confounders, CD was not significantly associated with most outcomes, including all-cause hospitalization (adjusted risk ratio 1.25, 95% CI 0.997–1.56), obesity at 5.5 and 9 years, and various developmental milestones. Subgroup analyses for multiple births and preterm infants showed some differences in point estimates, but were limited by small sample sizes. CD was not significantly associated with adverse long-term child health or developmental outcomes in this Japanese cohort. These findings provide reassurance regarding CD safety when medically indicated in advanced perinatal care settings. Further research with larger samples and longer follow-up is needed, especially for specific subgroups.

Validity and reliability of the Japanese version of the ACE tool for assessing evidence-based medicine competencies in medical practitioners and students: An evaluation in an online setting.

Introduction Evidence-based medicine (EBM) competency is crucial for healthcare professionals; however, validated tools to assess EBM skills in Japanese are scarce. This study aimed to develop and validate a Japanese version of the Assessing Competency in EBM (ACE) tool. Methods We translated the ACE tool into Japanese, following international standards, and distributed it online to 99 healthcare professionals and students. The participants completed demographic questions and the Japanese version of the ACE tool. A subset also completed the retest and Fresno test. Internal consistency was assessed using Cronbach's alpha, test-retest reliability using the intraclass correlation coefficient (ICC), and construct validity using a confirmatory factor analysis and correlation with the Fresno test. Results The Japanese version of the ACE tool showed a low internal consistency (Cronbach's alpha = 0.31, 95% CI: 0.09-0.49), but an acceptable test-retest reliability (ICC = 0.64, 95% CI: 0.40-0.81). A confirmatory factor analysis provided moderate support for the structure of the tool (SRMR = 0.092, RMSEA = 0.048, CFI = 0.852). The tool demonstrated a moderate correlation with the Fresno test (r = 0.35). The median completion time was 847 s (IQR, 577-1,249 s). Conclusion Although the Japanese version of the ACE tool showed some promising aspects, including a quick administration and partial validity, its low internal consistency suggests that refinement is needed before it can be confidently used in Japanese medical education settings. Future studies should focus on improving the tool's reliability, potentially through in-person administration, to develop a robust EBM assessment tool in the Japanese healthcare context.

THE INNER DYNAMICS OF THE OLD AND SOCIALLY WITHDRAWN IN JAPAN: INSIGHTS FOR INTERVENTIONS FROM CASE STUDY ANALYSES

Abstract An increasing number of older adults in Japan are refusing social support even when offered. This lack of support elevates their risk of health deterioration, delays evacuation in disaster scenarios, and increases the likelihood of premature and lonely deaths with inadequate closures. This study examines the psychological factors contributing to the lack of motivation among socially isolated older adults in Japan to seek help. We conducted semi-structured one-on-one interviews with nine individuals aged 60 years or older who reside in the community identified as socially isolated by community-based healthcare personnel. Using a narrative case study approach, the study revealed a prevalent concern among these socially isolated individuals about causing inconvenience to others by seeking help. The findings suggest that their reluctance to ask for help may be driven not by a desire to maintain independence but rather by a concern about inconveniencing others. In the context of Japanese culture, maintaining harmony with others is considered important. Asking for help might inconvenience others and potentially disrupt this harmony. To effectively assist those who refuse necessary support, social and community health workers should develop ways of minimizing the perceived burden of the recipients. However, further research is necessary to establish whether these findings are unique to the Japanese cultural context. Examples of innovative strategies to address this challenge will be discussed.

Youth Suicide in Japan: Exploring the Role of Subcultures, Internet Addiction, and Societal Pressures.

Youth suicide remains a significant public health concern in Japan, driven by multifaceted factors such as academic pressures, social isolation, bullying, and family dysfunction. Recent societal changes, including the rise of internet addiction and subcultural influences from anime, manga, and gaming, have further shaped the psychological landscape of Japanese youth. The COVID-19 pandemic has exacerbated these challenges, intensifying feelings of loneliness and anxiety about the future. This study explores the impact of these factors on youth suicide risk through a systematic review of existing literature and statistical data, focusing on trends from 2000 to 2024. In 2023, 513 school-aged youth in Japan died by suicide, marking persistently high rates. High school students accounted for the majority of cases, followed by middle and elementary school students. Key risk factors include intense academic expectations, cyberbullying, and internet addiction, which are often compounded by cultural stigmas surrounding mental health. Subcultures offer both solace and potential alienation, influencing youth emotions in complex ways. The COVID-19 pandemic has also worsened mental health issues and heightened suicide risks among this vulnerable group. The findings highlight the urgent need for comprehensive mental health support systems tailored to Japanese cultural contexts. Recommendations include enhancing access to school-based counseling, promoting family-based interventions, and implementing policies to regulate harmful online content. Additionally, efforts must address cultural attitudes that stigmatize mental health care. Collaborative societal and policy-level interventions are crucial for mitigating youth suicide and fostering a supportive environment for young people in Japan.

Washback from Four-Skills English Exams in the Japanese Secondary School Context

ABSTRACT The use of four-skills language exams to support the achievement of curriculum goals in Japan is an under-researched yet critical topic. This study focuses on washback from the Cambridge B1 Preliminary and B2 First exams, which were used as fixed-point tests at a senior high school. A mixed-methods approach was adopted, utilizing data from teachers and learners, and from tests, documents, surveys, interviews, and observations. Strong negative washback was observed from the Japanese university entrance exams, whereas no such effects were noted for the Cambridge exams, which were perceived as aligned with the curriculum and teaching objectives. The findings are discussed in relation to studies of washback in secondary school contexts worldwide.

Development of the Japanese Anticholinergic Risk Scale: English translation of the Japanese article.

Anticholinergic burden, reflecting the cumulative impact of medications with anticholinergic properties, significantly predicts adverse drug reactions and geriatric syndromes in older adults. Although anticholinergic risk scales (ARS) have been developed and validated in various countries, none have been tailored specifically for Japan. The Japanese Anticholinergic Risk Scale (JARS) was developed to adapt the existing ARS frameworks to the Japanese context, considering unique medication profiles and cultural factors. First, a systematic review was performed to follow the protocol registered in PROSPERO (CRD42017076510). A PubMed search from October 2017 to March 2023 was conducted to identify ARS publications post-September 2017. Based on two algorithms, average scores from the existing scores were used to develop JARS. The Delphi method, an expert consensus approach, was applied to determine the scores for medications that were not established by the algorithms. Sixteen articles identified in our systematic review contributed to JARS development. JARS categorizes 158 medications into three potency groups: 37 drugs scored as 3 (strong), 27 as 2 (moderate), and 94 as 1 (weak). JARS, the newly developed ARS, could be a critical tool for anticholinergic burden assessment in older Japanese populations. Developed through a systematic review and Delphi-based expert consensus, it encompasses 158 medications, offering a comprehensive anticholinergic burden assessment. Future studies and updates should be conducted to improve the accuracy and clinical applicability of this scale. Geriatr Gerontol Int 2024; ••: ••-••.

Development and Validation of Quality Indicators for Pulmonary Arterial Hypertension Management in Japan: A Modified Delphi Consensus Study.

Quality indicators (QIs) are used to standardize care and improve outcomes in patients with pulmonary arterial hypertension (PAH). It is important that QIs are validated within specific healthcare contexts. Therefore, this study aimed to validate QIs for PAH management in Japan using a modified Delphi consensus method. QI candidates were identified from published European QIs and clinical practice guidelines. An expert panel of 11 PAH specialists from diverse Japanese institutions anonymously rated the 36 initial QI candidates in two rounds using a nine-point appropriateness scale. In the first round, 35 QIs received a median score of ≥7 points. A panel discussion was held between rounds to address the single low-scored QI, biomarker modifications, and invasive examinations, resulting in 36 modified QIs. In the second round, all modified QIs received median scores of ≥7 points and were judged to be valid as the final Japanese set of QIs. The findings of this study validated a set of QIs for PAH management tailored to the Japanese healthcare context. These QIs can be used to standardize care, identify areas for improvement, and ultimately enhance outcomes for Japanese patients with PAH.

Changes in Healthcare Utilization in Japan in the Aftermath of the COVID-19 Pandemic: A Time Series Analysis of Japanese National Data Through November 2023.

The COVID-19 pandemic precipitated substantial disruptions in healthcare utilization globally. In Japan, reduced healthcare utilization during the pandemic's early phases had been documented previously. However, few studies have investigated the impact of the pandemic's later stages (2022-2023) on healthcare utilization rates, particularly in the Japanese context. We employed a quasi-Poisson regression model, adapted from the FluMOMO framework, to analyze temporal trends in Japanese healthcare utilization throughout the pandemic until November 2023. We estimated inpatient and outpatient volumes and hospital length of stay by bed type (general and psychiatric). In general hospital beds, inpatient volumes remained significantly below pre-pandemic levels for every month until November 2023, with a reduction of 7.8 percent in 2023 compared to pre-pandemic levels. Psychiatric inpatient volumes, which had been declining before the pandemic, continued this downward trend, with the average occupancy rate decreasing by approximately 5.3% to 81.3% in 2023 compared to pre-pandemic levels. Significantly reduced outpatient volumes for both general and psychiatric care, in addition to prolonged lengths of hospital stay for psychiatric beds, were observed sporadically for several months in 2022 and 2023, persisting beyond the cessation of state of emergency and quasi-state of emergency declarations. The COVID-19 pandemic fundamentally altered healthcare utilization patterns in Japan. We observed a sustained reduction in general and psychiatric inpatient volumes relative to pre-pandemic baselines nationwide. The prolonged impact on healthcare utilization patterns, persisting beyond emergency measures, warrants continued monitoring of service delivery.

Examination of the reliability and validity of the Japanese version of the 10-item reflective practice questionnaire

ABSTRACT While various self-administered instruments measure reflective practice, the Reflective Practice Questionnaire (RPQ) can be used across multiple professions. We evaluated the Japanese version of the 10-item Reflective Practice Questionnaire (RPQ-10-J). In Study 1, 300 Japanese interpersonal assistance professionals were surveyed, and the RPQ-10-J was found to conform to a single factor via confirmatory factor analysis. We also found evidence of high internal consistency and adequate test-re-test reliability. High internal consistency was replicated in Study 2. In Study 2, 83 and 80 practicing interpersonal assistance professionals were surveyed physically and online, respectively. Additionally, the RPQ-10-J was correlated with the Japanese version of the Rumination-Reflection Questionnaire (RRQ-J). A small positive correlation was found between the RPQ-J-10 and reflection, and a moderate positive correlation with rumination. The results were consistent with other recent research showing that the reflective practice construct measured by the RPQ can be considered as separate from other semi-related constructs of general reflection and rumination. The development of the Japanese version of the RPQ enables future research to compare the extent of reflective practice in English-and Japanese (Japanese-speaking) contexts on a simple scale. Finally, future research directions and cultural differences in reflective practices are discussed.

Culturally-aligned clinical leadership competencies for effective teamwork in Japanese healthcare

BackgroundClinical leadership competencies for effective teamwork differ between Western cultures, where an independent self-construal prevails, and Japanese society, where the self-construal is rooted in interdependence. Although 27 out of 82 Japanese medical schools have ‘leadership’ as an educational outcome, specific competencies are poorly described, hindering the development of contextually-relevant leadership education. This study aimed to identify clinical leadership competencies and articulate the attributes and skills fundamental to leadership as perceived by Japanese physicians.MethodsThe 80 items of the UK clinical leadership competency framework (CLCF) formed the stimulus in a modified Delphi. Participants, comprising 26 Japanese physicians, rated the importance of each item using a 5-point Likert scale with free-text comments regarding the modification of competencies and suggestions for new items. Items were eliminated if the Likert mean was less than 4.0 and if fewer than 70% of participants considered them to be important. Newly described or modified items derived from free-text comments were rated for importance in a second round with reflective thematic analysis of the free-text descriptions.ResultsA CLCF of 84 items, reflective of Japanese clinical leadership, was created by eliminating three items describing tasks rarely involving Japanese physician leaders, revising seven items to emphasize understanding of members, and adding seven items to maximize feelings of team comfort. Seven skills and attributes emerged to construct Japanese clinical leadership from thematic analysis. “Humility” was viewed as a fundamental to leadership. Humility-driven “self-discipline” and “attentive listening”, “supporting members” and “guiding members” with humility-based compassion, were essential elements to create “psychological safety” for freedom of expression. Achieving “unity” through emotional integration was identified as the overall goal of leadership.ConclusionsThe reorganized CLCF has embedded more member-centered behaviors that build rapport and comfort for the members than the original CLCF. Modeling the Confucian virtue of humility and building unity by acting with compassion toward members are characteristics of Japanese clinical leadership that reflect an interdependent social context. These findings are a step toward the development of leadership education aligned with a Japanese context.

Diversity, equity, and inclusion (DEI) of CLIL pedagogy and globalisation in Japan

Abstract The paper discusses the potential of CLIL (Content and Language Integrated Learning) pedagogy in the current practice of ELT (English Language Teaching) and the issues of global education from a viewpoint of DEI (diversity, equity, and inclusion) in Japan. DEI into CLIL pedagogy ensures a variety of learning environments, appropriate CLIL learning, and a sense of belonging. CLIL can also provide better ideas and resources to cultivate DEI. This paper therefore argues that CLIL pedagogy has the potential to change and incorporate issues related to DEI. The Japan CLIL Pedagogy Association (J-CLIL) conducted a questionnaire survey on CLIL and its sponsored events and activities in 2021. Results show that: (1) many teachers are not aware of DEI; (2) their mindset can become gradually diverse; (3) current education lacks equity with respect to students; and (4) inclusive education is still not satisfactory. Ensuring equity in DEI is crucial in the realm of CLIL teacher education. Therefore, it is imperative for CLIL teacher education to be more attuned to DEI concerns to enhance the implementation of CLIL practices effectively. The DEI process needs to be integrated into CLIL and globalisation within the Japanese context. For that purpose, there needs to be more research and practice necessary to promote a CLIL type of languages-integrated learning, and this paper argues that it can be done through the IMT (Integrated Multifunctional Teacher) development program in Japan.

Cost-Effectiveness Analysis of Adjuvant Pertuzumab and Trastuzumab in Human Epidermal Growth Factor Receptor 2-Positive Early Breast Cancer in Japan.

Human epidermal growth factor receptor 2 (HER2)-positive breast cancer presents considerable treatment challenges owing to its aggressive nature. Global guidelines have endorsed a full year of HER2-targeted therapy for early-stage breast cancer. However, previous cost-effectiveness analyses of dual HER2-targeted therapies have been limited. This study aimed to examine the cost effectiveness of dual HER2-targeted therapy for early-stage breast cancer within the Japanese healthcare system context. In the Markov model-based study, the cost effectiveness of dual anti-HER2 therapy, combining pertuzumab and trastuzumab, was assessed in comparison to trastuzumab monotherapy. Patients in whom treatment was initiated at a median age of 51 years were included. The study utilized quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) as comparison units. Subgroup analyses were conducted to explore variations in cost effectiveness, focusing on node-positive and node-negative patients. Both one-way deterministic and broader probabilistic sensitivity analyses using Monte Carlo simulations with 10,000 samples were performed from the Japanese healthcare payers perspective. Dual HER2-targeted therapy led to 0.17 QALYs increment at an additional cost of $US15,289, resulting in an ICER of $US92,232 per QALY. In the subgroup of node-positive patients, the benefit of the dual HER2-targeted therapy was more pronounced, with an increase of 0.64 QALYs and an ICER of $US24,561 per QALY. Sensitivity analyses revealed the model's susceptibility to changes in the transition probabilities from invasive disease-free survival to death, from invasive disease-free survival to first-line metastatic breast cancer, and to costs associated with pertuzumab. Probabilistic sensitivity analysis suggests that for node-positive patients, dual HER2-targeted therapy may be a cost-effective option. The economic viability of dual HER2-targeted therapy was most pronounced in patients with node-positive high-risk early breast cancer. This study highlights the potential of dual HER2-targeted therapy as a cost-effective addition for these cases.

Improving Classroom Teaching and Learning of Multi-Word Expressions for Conversational Use Through Action Research with Learner Feedback

Multi-word expressions make up a large proportion of the English language and particularly spoken language. Using multi-word expressions can assist with the impression of fluency, making them useful for language learners to know and use. However, proven methods for teaching this language phenomenon are required, so that learners can easily use multi-word expressions in their conversations. The purpose of the study was to examine the efficacy of a fluency workshop focused on multi-word expression use in conversation and to determine the most appropriate implementation for the Japanese context. An action research structure was used over three iterations of the fluency workshop, learner feedback and teacher observations were used to make improvements. Learner feedback regarding the usefulness of each activity for learning English was compared between the original cohort and subsequent cohorts. The results showed significant differences in levels of perceived usefulness for activities where improvements were made, but also for some activities where no specific improvement was made, suggesting that teaching improves through practice. Pedagogical implications include maximising the time on task via clear instructions, providing visual time constraints, and offering scaffolding to support the use of multi-word expressions when recall seems beyond a learner.

Understanding COVID-19 Vaccine Hesitancy among the General Population in Japan from Public Health Ethical Perspectives: Findings from a Narrative Review

Japan has been reported as a country with high levels of vaccine hesitancy. However, a lack of comprehensive reviews studying factors for vaccine hesitancy for the COVID-19 vaccines in the Japanese context from the perspective of ethical controversy exists. Using a narrative review method, we reviewed factors associated with vaccine hesitancy to the COVID-19 vaccines and examined issues related to ethical controversy among the Japanese population. Factors associated with vaccine hesitancy include concerns about vaccine safety, suspicion of vaccine inefficacy, mistrust of the government, and low perceived threat. Factors associated with vaccine acceptance include environmental factors, factors related to Japanese cultural values, including collectivism and social norms, and positive attitudes toward information provided by authorities. Unique backgrounds in Japan are historical events such as the anti-HPV vaccine campaigns, the accessible medical system fostering high expectations of zero risk, and cultural factors of caring social norms influencing vaccine acceptance. Ethical controversies arise from preferences and practices at the individual or national level around individual rights versus public health benefits. Healthcare professionals and public health experts should continue dialoguing with the critical mass, practitioners, and policymakers, considering the ethical dilemmas surrounding individual rights and public health benefits. Insights obtained from this study indicate the need to develop tailored strategies to enhance vaccine acceptance while respecting individual autonomy within the Japanese context.

University campuses’ location-allocation: a case study of Egypt with insights from the Japanese context

PurposeThis paper aims to identify the most suitable location for a university campus in Egypt based on governorates’ social needs by employing the analytic hierarchy process (AHP). The paper, then, reflects the findings retrieved from the Egyptian context on the Japanese context to reveal how different countries deal with the location-allocation decision problem for university campuses.Design/methodology/approachThe AHP is employed to evaluate and rank Egyptian governorates based on 13 distinct criteria obtained from governmental open-source databases. These criteria measure the social needs of each governorate, guiding the decision on the location of new university campuses.FindingsThe results expose a disparity between Egypt's current campus development plan and recommendations derived from AHP analysis. The location-allocation decision for new university campuses appears to be influenced by subjective assessments, indicating a gap between planned developments and identified social needs. Additionally, contextual social and cultural differences between developing and developed countries impact the identification and fulfilment of the demand for a new university campus.Originality/valueThis paper contributes by offering decision-makers a robust location-allocation framework. It serves as a valuable tool for policy formulation in establishing new public universities in both developing and developed countries. Comparative analysis with the Japanese context enriches the understanding of how countries address the location-allocation decision problem for university campuses, emphasising the significance of context-specific considerations in such decisions.

The contribution of digitalization to non-inclusive growth in Japan. A Régulationist perspective on post-industrial dynamics

While inclusive growth has been considered a major characteristic of post-war Japan, this is no more the case since the early 1990s as the country transitioned to a post-industrial economy. This paper seeks to explain that digitalization is a primary drive of growing inequalities in post-industrial Japan and argues for incorporating the digital divide into the investigation of changing economic structures and growth patterns. We mobilize the Régulation theoretical framework, which posits that the impact of technology on growth and inequality regimes is not homogenous across countries and over time. Our empirical investigation combines macro-level data and institutional perspective with case study of the hospitality sector, in line with the Régulationist concept of the ‘anthropogenic’ mode of development. Our major conclusion is that digitalization, in the specific Japanese context, is leading to non-inclusive growth patterns through its effects on the wage-labour nexus, in an idiosyncratic way.