Greater Tokyo Area Research Articles

Source identification of carbon monoxide over the greater Tokyo area: Tower measurement network and evaluation of global/regional model simulations at different resolutions

Because of its relatively long lifetime among short-lived climate forcers in the atmosphere, carbon monoxide (CO) is utilized as a tracer, and is expected to be simulated at coarse resolution. To better grasp the behavior of CO in the atmosphere, multi-altitude measurement is required because the main sources of CO emissions are automobiles (surface) and industry (aloft). In this work, using CO measurements obtained at remote sites and through a tower measurement network in Japan (37 m and 250 m above ground level (AGL) in an urban area, and 32 m AGL at a rural site in the greater Tokyo area), the performances of a global model (2° × 2.5°) and a regional model at various resolutions (12, 4, and 1.3 km) were comprehensively evaluated. The global model successfully simulated CO at remote sites but not for high-concentration peaks at rural and urban sites, whereas the regional model increasingly improved its performance in capturing CO peaks at urban sites with resolutions up to 4 km. Therefore, we concluded that a 4 km resolution was suitable for capturing CO at urban sites, and furthermore estimated the source contributions. The regions surrounding the greater Tokyo area were dominated by the concentration from the lateral boundaries (approximately 180 ppbv), while the higher CO in central Tokyo was attributed to local sources. These local sources accounted for up to 80% of the annual average at the surface level and just 10% aloft (corresponding to the 250 m AGL site). Sensitivity simulations assessing CO sources (automobiles, industry, and others) demonstrated the important role of automobiles, while higher altitudes had more sources attributed to industry. Local sources were found to make more prominent contributions at higher concentration ranges. The appropriate modeling resolution for CO behavior can be drawn from our findings and the usefulness of simultaneous measurements at the surface level and using a tower for capturing the three-dimensional CO structure can be demonstrated as an important approach.

Mortality, Analgesic Use, and Care Requirements After Vertebral Compression Fractures: A Retrospective Cohort Study of 18,392 Older Adult Patients.

Vertebral compression fractures (VCFs) in older adults cause considerable health and socioeconomic burdens due to worsening ability to perform activities of daily living. The long-term effects of VCFs on patient outcomes, particularly prolonged analgesic use and functional decline, remain unknown. The aims of this study were to examine long-term clinical outcomes and to determine the risk factors for persistent pain and functional disability after VCFs. This retrospective cohort study evaluated mortality, duration of analgesic use, and changes in care requirements in older adults with VCFs using claims data from a suburban prefecture in the Greater Tokyo Area. Patients were included if they were ≥65 years of age and had been diagnosed with a VCF between June 2014 and February 2019, as determined on the basis of International Classification of Diseases, Tenth Revision (ICD-10) codes; we also used claims data that could determine whether the patients underwent imaging examinations. Patients who discontinued outpatient visits within 1 month after the VCF diagnosis were excluded. We included 18,392 patients with VCFs and a mean age of 80 years. Seventy-six percent of patients were women, and the median follow-up period was 670 days. At the index VCF diagnosis, 3,631 patients (19.7%) were care-dependent. Overall, 968 patients (5.3%) died within 1 year. Among the 8,375 patients who received analgesics, 22% required analgesics for >4 months. Factors associated with prolonged analgesic use for >1 year were female sex (odds ratio [OR], 1.39 [95% confidence interval (CI), 1.16 to 1.65]) and VCFs in the thoracolumbar region (OR, 1.95 [95% CI, 1.50 to 2.55]) or lumbar region (OR, 1.59 [95% CI, 1.23 to 2.04]) (the reference was the thoracic region). The care needs of 1,510 patients (8.2%) increased within 1 year. Patients with a preexisting care dependency had a 10 times higher risk of increased care need (30.2% [1,060 of 3,509]) than those who had been independent at the time of the index diagnosis (3.0% [450 of 14,761]) (p < 0.001). Individuals with preexisting care dependency were more likely to experience functional decline following VCFs than those who were independent, which underscores the need for intensive and appropriate allocation of health-care resources to care-dependent patients. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

A participatory foresight approach to envisioning post-pandemic urban development pathways in Tokyo

Ensuring sustainable urban futures demands varied approaches, particularly with the advent of the COVID-19 pandemic, which presents a unique situation and experience for reimagining urban futures. A considerable number of scientific inquiries have adopted participatory foresight approaches to imagining sustainable urban development pathways. However, not many have used a similar approach to envision urban development pathways in a post-COVID-19 era. Based on available evidence on the impacts of COVID-19 on urban forms and lifestyles and citizens’ experiences during the pandemic, such a study is imperative to better understand how people from different demographic groups envision an ideal post-pandemic city. Using the Greater Tokyo Area as a case study, we adopted the Q methodology to determine post-pandemic urban development pathways from the subjective viewpoints of diverse stakeholders. We identified four development pathways for an ideal post-pandemic city. The first pathway is a resilient city with good neighborhood accessibility and sustainable urban regeneration. The second and third pathways, shared by younger people, focus on pro-environmental climate change mitigation (city compactness, shared mobility) and pro-urban resilience, respectively. The final pathway imagines a post-pandemic city that is accessible, safe, and smart. We found that different age groups perceive their ideal cities differently, especially when emphasizing the nexus between pandemics and cities. The study illustrates the need to adopt more participatory approaches in designing future urban development pathways since varied perspectives of an ideal city exist among different age demographics. These approaches promote equitable, inclusive, and transparent urban planning, advancing community support for policymaking and implementation.

Air quality and urban climate improvements in the world’s most populated region during the COVID-19 pandemic

In this study, we assessed air quality (AQ) and urban climate during the mobility restrictions implemented in the Greater Tokyo Area, Japan, the world’s most populated region, in response to the COVID-19 pandemic. Observations from dense surface networks were analyzed using an interpretable machine learning approach. In parallel with a ∼50% reduction in mobility and an altered lifestyle of the population, we found limited reductions in nitrogen dioxide; decreases in fine particulate matter not entirely driven by local mobility; minor variations in ozone, with a positive (negative) tendency in areas with high (low) emissions; a decrease in air temperature consistent with mobility; and pollution levels and air temperature changes with well-defined, common spatiotemporal patterns. Specifically, cooling mainly occurred in urbanized areas with an improved AQ. Overall, although reductions in mobility were moderately effective in improving the typical indicators of urban AQ, including those known to negatively impact human health, the reductions in waste heat had a stronger impact on Tokyo’s urban heat island, suggestive of a strategy to minimize exposure to heat stress. These findings can help guide urban planning strategies and policies aimed at addressing climate change.

Alcohol and toxicological factors influencing fatal falls from height in the Greater Tokyo Area: a retrospective study.

Falls from height pose a significant public health concern in urban regions, including the highly urbanized Greater Tokyo Area. The Japanese population is characterized by high rates of suicide and psychoactive drug usage, underscoring the importance of investigating these attributes in falls from height. This study aimed to retrospectively analyze the alcohol and toxicological aspects influencing falls from height in the Greater Tokyo Area between 2014 and 2022 and compare the findings with existing reports on other populations. In total, 75 cases of falls from height and 159 cases of natural deaths were included. Consistent with previous findings, Fisher's exact test revealed a predominance of males (66.67%, 50/75) and young adults (57.33%, 43/75) in falls from height. Multivariate logistic regression analysis identified antidepressant usage as the most significant risk factor within the target population, while younger individuals under alcohol influence constituted another high-risk group. Notably, contradictory to other populations, female individuals involved in fatal falls in the Greater Tokyo Area exhibited a higher frequency of alcohol consumption than males (48.00%, 12/25 vs. 26.00%, 13/50), and most of them were associated with suicide (83.33%, 10/12). These findings elucidate the population characteristics that pose a high risk for fatal falls from height in Japan and can serve as a reference for other Asian populations residing in similar megacities.

An online survey on differences in knowledge and stigma about epilepsy among the Tokyo metropolitan area and non-urban areas in Japan, a post-hoc study

PurposeExtant research elucidating the domains of knowledge and bias on epilepsy has consistently underscored a deficiency in cognizance and an inclination toward bias within non-urban areas. Investigations into geographical disparities concerning epilepsy awareness and prejudice within the Japanese context remain conspicuously absent. To address this lacuna in the literature, we undertook a post-hoc analysis to elucidate the discernible regional differentials in epilepsy awareness and the associated stigma. MethodsFrom July to August 2021, we conducted an internet questionnaire survey for 310 people with epilepsy (PWE) and 213 ordinary people without epilepsy who registered on the database of the Japanese Research Company. We inquired PWE to answer the Epilepsy Self-Stigma Scale (ESSS), the Rosenberg Self-Esteem Scale (RSES), and the Epilepsy Knowledge Scale (EKS). We inquired to answer ordinary people without epilepsy EKS. We analyzed residential addresses separately for Greater Tokyo and non-urban areas by comparing the degree of knowledge of people with epilepsy and people without epilepsy. ResultsThe average knowledge of people with and without epilepsy in the Greater Tokyo area was 39.60 and 28.43 points, although in non-urban areas (nine regions from all over Japan except for the Greater Tokyo, Tokai region, and Kinki region), the knowledge averages were 38.44 and 28.66 points of 100. In addition, self-stigma was highest in the Greater Tokyo area: 22.99 and in non-urban areas: 22.77. An two-way ANOVA with knowledge as the dependent variable and epilepsy diagnosis status and region (Greater Tokyo area/non-urban areas) as the independent variables revealed no interaction between diagnosis and region (F(1,346) = 1.48, η2 = 0.003). Knowledge was significantly higher in PWE than in people without epilepsy, but we could not identify any significant difference between ESSS (t = 0.24, d = 0.03) and RSES (t = 1.16, d = 0.16) in the Greater Tokyo/non-urban areas. ConclusionsWe obtained specific information about regional differences in the level of knowledge and stigma about epilepsy in Japan. Because Japan underwent educational reforms after World War II and more than 90% of the population received equally advanced education, the results found no regional differences in knowledge and stigma about epilepsy. We believe collecting information about the respondents' birth and upbringing environment and conducting a thorough investigation is necessary in the future.

Text-aided Group Decision-making Process Observation Method (x-GDP): a novel methodology for observing the joint decision-making process of travel choices

AbstractJoint travel decisions, particularly related to social activities remain poorly explained in traditional behavioral models. A key reason for this is the lack of empirical data, and the difficulties associated with collecting such data in the first place. To address this problem, we propose Text-aided Group Decision-making Process Observation Method (x-GDP), a novel survey methodology to collect data on joint activities from all members of a given clique. More specifically, on a Zoom-moderated experiment, participant cliques are asked to coordinate an activity (or set of activities) using a group chat interface. The experiment requires not only the coordination but the execution of the planned activity, thus guaranteeing a real discussion that takes into consideration the preferences and constraints of clique members. Through this method we are able to observe not only the outcome of the choice process, but also the decision-making process itself in a quasi-naturalistic manner, including the alternatives that compose the choice set, individual and clique characteristics that might affect the choice process, as well as the discussion behind the choice via texts. In this paper we introduce the results of an x-GDP survey implementation focusing on joint eating-out activities in the Greater Tokyo Area. Preliminary data analysis clearly illustrates the heterogeneity of the choice processes among groups and how members’ spatiotemporal constraints, individual and relational characteristics, as well as the bargaining process affect choice outcomes. Given the unique characteristics of the collected data, we discuss how x-GDP can be used to (i) identify and categorize group decision-making patterns, (ii) model group decisions explicitly considering the decision-making process, (iii) estimate joint accessibility measures and (iv) analyze choice set generation processes.

EpiMob: Interactive Visual Analytics of Citywide Human Mobility Restrictions for Epidemic Control.

The outbreak of coronavirus disease (COVID-19) has swept across more than 180 countries and territories since late January 2020. As a worldwide emergency response, governments have implemented various measures and policies, such as self-quarantine, travel restrictions, work from home, and regional lockdown, to control the spread of the epidemic. These countermeasures seek to restrict human mobility because COVID-19 is a highly contagious disease that is spread by human-to-human transmission. Medical experts and policymakers have expressed the urgency to effectively evaluate the outcome of human restriction policies with the aid of big data and information technology. Thus, based on big human mobility data and city POI data, an interactive visual analytics system called Epidemic Mobility (EpiMob) was designed in this study. The system interactively simulates the changes in human mobility and infection status in response to the implementation of a certain restriction policy or a combination of policies (e.g., regional lockdown, telecommuting, screening). Users can conveniently designate the spatial and temporal ranges for different mobility restriction policies. Then, the results reflecting the infection situation under different policies are dynamically displayed and can be flexibly compared and analyzed in depth. Multiple case studies consisting of interviews with domain experts were conducted in the largest metropolitan area of Japan (i.e., Greater Tokyo Area) to demonstrate that the system can provide insight into the effects of different human mobility restriction policies for epidemic control, through measurements and comparisons.

Eutrophication trends in the coastal region of the Great Tokyo area based on long-term trends of Secchi depth.

The coastal ocean's environment has changed owing to human activity, with eutrophication becoming a global concern. However, oligotrophication occurs locally and decreases fish production. Historically, the Secchi depth has been used as an index of primary productivity. We analyzed the results of over-a-half-century routine observations conducted in Sagami Bay and Tokyo Bay to verify the eutrophication/oligotrophication trend based on Secchi depth observations in a temperate coastal region near the Greater Tokyo area, which is highly affected by human activities. Data recorded in the Kanagawa Prefecture from 1963 to 2018 were used in this study. After quality control, the observation area was divided into Tokyo Bay, the Uraga Channel (outer part of Tokyo Bay), Sagami Bay (northern part), and Sagami Nada (southern part of Sagami Bay) based on temperature and salinity at a depth of 10 m. Because the environmental parameters showed autocorrelation, time-series and correlation analyses were conducted using generalized least squares (GLS) models with a Prais-Winsten estimator. The Secchi depth was the shallowest in Tokyo Bay, followed by the Uraga Channel, Sagami Bay, and Sagami Nada, and was deep in winter (December and January), and shallow in summer (July) in all regions. The correlated analyses using the GLS model indicated that the shallowing of Secchi depth was significantly associated with decreases in temperature, salinity, and phosphate concentration. However, time-series analyses using GLS models indicated that the Secchi depth was significantly shallower, except in Tokyo Bay, where the surface temperature was significantly warming and the surface phosphate and nitrite concentrations decreased everywhere. A significant shallowing trend of the Secchi depth was mostly observed during the light-limiting season (January-March). Correlation analyses suggested the importance of horizontal advective transport, particularly from Tokyo Bay, which has cold and less saline eutrophic water. However, long-term shallowing of the Secchi depth was associated with warming, and changes in salinity were not significant in most months when the Secchi depth trend was significant. Thus, horizontal advection is not the primary cause of long-term eutrophication. Because the eutrophication trend was primarily observed in winter, when light is the major limiting factor of primary production, we concluded that warming provides a better photoenvironment for phytoplankton growth and induces eutrophication. As a decline in anthropogenic nutrient input after 1990s was reported in the investigated area, the long-term eutrophication trend was most likely caused due to global warming, which is another alarming impact resulting from human activities.

Spatiotemporal variations in mean height of 17-year-old students born in 1957–2002 across 47 Japanese prefectures: Evidence from School Health Surveys

This paper examines the secular trends and variations in mean height of 17-year-old students born in 1957–2002 across 47 prefectures in Japan. Mean height is consistently lower in southwest prefectures and greater in prefectures in the Greater Tokyo Area and from the south-central area to the north-western area facing Eurasia in the main island. Both the range and the coefficient of variation stay constant in the cohorts born during the 1970s or later, following rapid increases of mean height in the prefectures that initially have the lowest means. A comprehensive policy framework may be needed to address diverse factors affecting the physical growth of adolescents at the subnational level.

The geography of the Super Creative Class in the greater Tokyo area: Place of work and place of residence

The geography of the Super Creative Class in the greater Tokyo area: Place of work and place of residence

Urban-scale analysis of the seasonal trend of stabilized-Criegee intermediates and their effect on sulphate formation in the Greater Tokyo Area

We conducted an urban-scale analysis of the contribution of gas phase stabilized-Criegee intermediates (sCIs) to atmospheric sulphate aerosol formation across four seasons in the Greater Tokyo Area (GTA) using the regional chemical transport model.

Uncovering Gender Bias in Japanese Spousal Terms: Insights from an Online Survey of Couples with Adolescent Children

This study is based on an online survey of 447 Japanese married individuals between the ages of 40 and 60 (230 women and 217 men) who reside in the greater Tokyo area and have adolescent children in January 2023. The survey explores the usage of spousal terms in various social settings. The results show that when introducing their spouses to others, men tend to use the neutral term “妻tsuma” (wife) instead of the traditional term “家内ka-nai” (one inside the house) while women continue to use the traditional term “主人shu-jin” (master) which implies the history of male chauvinism. In addition, the higher the education level of the women, the higher the use of “夫otto” (husband) and the lower the use of “旦那dan-na” (patron). Both men and women seldom use gender-neutral terms such as “パートナーpātonā” (partner) or “連れ合いtsure-ai” (companion). In their home environment, couples tend to use family terms such as “お父さんo-tō-san” (father) and “お母さんo-kā-san” (mother) more frequently than nicknames or first names. In private interactions, women tend to use the honorific second-person pronoun “あなたanata” (a polite form of “you”) when addressing their spouses, while men tend to use the derogatory one “おまえomae” (a pejorative form of “you”). These results suggest that gender discrimination still exists in the Japanese language nowadays.

Patterns of alcohol and alcohol-flavoured non-alcoholic beverage advertisements over Japanese free-to-air television networks

BackgroundAlcohol use is a serious public health challenge worldwide. Japan has no government regulations or legal penalties against advertising alcoholic beverages on television (TV). Instead, advertisements depend on the Japanese alcohol industry’s self-regulation on airtime (no advertisements from 5 am to 6 pm) and the content of alcoholic beverages, which must not tempt minors. However, many adolescents (10 to 19 years old) watch TV from 6 pm to 11 pm. The aim of this study was to describe the pattern in the advertising of alcoholic beverages and alcohol-flavoured non-alcoholic beverages (AFNAB) in Japan during the popular TV viewing time for adolescents.MethodsA secondary analysis of advertising airtime data from five free-to-air Japanese TV networks in the Greater Tokyo area that aired between 12 August and 3 November 2019, was performed.ResultsDuring the study period, 5215 advertisements for alcoholic beverages and AFNABs aired (1451.75 min). In total, 2303 advertisements (44.2%) were beer, low-malt beer, or beer-taste beverages, 277 (5.3%) were whisky, 2334 (44.8%) were local alcoholic beverages (shochu and seishu), and 301 (5.8%) were AFNAB. On average, more advertisements aired on weekends (67.6 advertisements) than on weekdays (59.3 advertisements) per day. Approximately 30% of advertisements for AFNABs were aired during the time restricted for alcohol advertising, although AFNABs are considered alcohol according to industry guidelines. During the popular television viewing time for young adolescents, about two to three times more advertisements were aired per hour than during the rest of the day, on both weekdays and weekends (p < 0.001).ConclusionThe number of alcohol advertisements aired at times when adolescents often watch TV is 2 to 3.2 times higher than that at other times of the day. Furthermore, despite the industry’s self-imposed regulations, some alcoholic beverages are still advertised. Therefore, other methods to protect children and adolescents from exposure to advertisements for alcoholic beverages should be investigated and implemented.

Fluctuation in Grocery Sales by Brand: An Analysis Using Taylor’s Law

In recent years, Taylor’s law describing the power function relationship between the mean and standard deviation of certain phenomena has found an increasing number of applications. We studied the characteristics of Taylor’s law for branded product sales using point-of-sale (POS) data for brands sold in 72 grocery stores in the Greater Tokyo area. A previous study found that product sales follow Taylor’s law with a scaling exponent of 0.5 for low sales quantities and 1.0 for large sales quantities. In the current study, we observed Taylor’s law with cross-over for 54 product brands and estimated the value of the two coefficients in the theoretical curve to characterize the cross-over. The coefficients represent the fluctuations in the number of items purchased per consumer and the number of consumers in one store and in all stores. The estimated coefficients suggested the dependence of the features of Taylor’s law on the category to which the brands belong. We found that brands in the same category tend to share similar features under Taylor’s law. However, some brands exhibited specific features that differed from others in the same category. For example, for many brands in the Laundry Detergent and Instant Noodles categories, the number of customers purchasing the products in each store fluctuated significantly, whereas the number of purchased items per customer varied widely in the Japanese Tea category. In the coffee category, our results indicated that the degree of fluctuation in the number of purchasing customers largely depends on the brand.

Impact of COVID-19 Pandemic on Spatial Separation of New and Existing Residents: Case Study of Tsukuba City in Greater Tokyo Area.

For balancing the improvement of social capital through mutual interaction among residents and measures against infectious diseases, municipalities must understand where their residents interact with each other during epidemics. By distinguishing between new and existing residents based on the average age of the houses in their residential areas, we measured the degree of separation between them at various locations and facilities in the Tsukuba City in the Greater Tokyo Area during the daytime based on smartphone location information. We also investigated separation by visitors’ residential savings and income class and their age and gender in each location. Separation was observed in almost all the public places in Tsukuba City, even before the COVID-19 outbreak. During the outbreak, many public places and facilities were visited by fewer people, and yet their separation increased. On the other hand, separation lessened in parks, increasing opportunities for residents to interact. Even after the outbreak began, lower separation environments remained in places where food courts and department stores were located compared to other places. In the post-outbreak period, separation returned to its normal level.

How effective was the restaurant restraining order against COVID-19? A nighttime light study in Japan

In this study, we examined the effect of the order of shortening business hours of the restaurants, which are considered a major source of spreading the novel coronavirus (COVID-19). Specifically, we empirically investigated how this order changed the nighttime light (NTL) in regions with restaurants in the Greater Tokyo area from January to June 2020. Several local governments in Japan had implemented the order to combat COVID-19. Our investigation found evidence that the order significantly decreased the NTL in regions with many restaurants, indicating the effectiveness of the order and its negative economic/business impacts on restaurants. Interestingly, this order increased the NTL in other areas, such as in residential areas. In contrast to previous studies focused on demand-side factors, our study revealed the importance of supply-side factors in explaining the impact of Japanese government policy against COVID-19 in the first half of 2020.

Regional economic effects of the Ring Road project in the Greater Tokyo Area: A spatial CGE approach

AbstractWe build a spatial computable general equilibrium model to assess the spatial economic impacts of the completion of ring road sections on the highway network system in the Greater Tokyo Area. Although every prefecture obtains positive benefits in terms of the prefectural sum, some municipalities experience negative benefits. The outputs of the service sector are less tradable than those of the primary and manufacturing sectors, and they increase for a broader area. The regions with net production increases in all sectors gain positive benefits. Meanwhile, several municipalities whose production decreases in all sectors experience welfare improvements.

Surface and aloft NO2 pollution over the greater Tokyo area observed by ground-based and MAX-DOAS measurements bridged by kilometer-scale regional air quality modeling

To advance our understanding of surface and aloft nitrogen dioxide (NO2) pollution, this study extensively evaluated NO2 concentrations simulated by the regional air quality modeling system with a 1.3 km horizontal grid resolution using the Atmospheric Environmental Regional Observation System ground-based observation network and aloft measurements by multi-axis differential optical absorption spectroscopy (MAX-DOAS) over the greater Tokyo area. Observations are usually limited to the surface level, and gaps remain in our understanding of the behavior of air pollutants above the near-surface layer, particularly within the planetary boundary layer (PBL). Therefore, MAX-DOAS measurement was used, which observes scattered sunlight in the ultraviolet/visible range at several elevation angles between the horizon and zenith to determine the aloft NO2 pollution averaged over 0–1 km. In total, four MAX-DOAS measurement systems at Chiba University (35.63°N, 140.10°E) systematically covered the north, east, west, and south directions to capture the aloft NO2 pollution over the greater Tokyo area. The target period was Chiba-Campaign 2015 conducted during 9–23 November 2015. The evaluations showed that the air quality modeling system can generally capture the observed behavior of both surface and aloft NO2 pollution in terms of spatial and temporal coverage. The diurnal variation, which typically showed an increase from evening to early morning without daylight and a decrease during the daytime, was also captured by the model. During Chiba-Campaign 2015, two cases of episodic higher NO2 concentration were identified: one during the nighttime and another during the daytime as different diurnal patterns. These were related to a stagnant wind field, with the latter also connected to a lower PBL height in cloudy conditions. Comparison of the modeled daily-averaged surface and aloft NO2 concentrations showed that aloft NO2 concentration exhibited a strong linear correlation with surface NO2 concentration, with the aloft (0–1 km) value scaled to 0.4–0.5-fold the surface value, irrespective of whether the day was clean or polluted. This scaling value was lower during the nighttime and higher during the daytime. Based on this synergetic analysis of surface and aloft observation bridged by a kilometer-scale fine-resolution modeling simulation, this study contributes to fostering understanding of aloft NO2 pollution.

How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study

BackgroundPatient incident reporting systems have been widely used for ensuring safety and improving quality in care settings in many countries. However, little is known about the way in which incident data are used by frontline clinical staff. Furthermore, while the use of a systems perspective has been reported as an effective way of learning from incident data in a multidisciplinary team, the level of adaptability of this perspective to a different cultural context has not been widely explored. The primary aim of the study, therefore, was to investigate how healthcare practitioners in Japan perceive the reporting systems and utilize a systems perspective in learning from incident data in acute care and mental health settings.MethodsA non-experimental, descriptive and exploratory research design was adopted with the following two data-collection methods: 1) Sixty-one semi-structured interviews with frontline staff in two hospitals; and 2) Non-participatory observations of thirty-seven regular incident review meetings. The two hospitals in the Greater Tokyo area which were invited to take part were: 1) a not-for-profit, privately-run, acute care hospital with approximately 500 beds; and 2) a publicly-run mental health hospital with 200 beds.ResultsWhile the majority of staff acknowledge the positive impacts of the reporting systems on safety, the observation data found that little consideration was given to systems aspects during formal meetings. The meetings were primarily a place for the exchange of practical information, as opposed to in-depth discussions regarding causes of incidents and corrective measures. Learning from incident data was influenced by four factors: professional boundaries; dealing with a psychological burden; leadership and educational approach; and compatibility of patient safety with patient-centered care.ConclusionsHealthcare organizations are highly complex, comprising of many professional boundaries and risk perceptions, and various communication styles. In order to establish an optimum method of individual and organizational learning and effective safety management, a fine balance has to be struck between respect for professional expertise in a local team and centralized safety oversight with a strong focus on systems. Further research needs to examine culturally-sensitive organizational and professional dynamics, including leader–follower relationships and the impact of resource constraints.