The purpose of this study was to determine the effects of well-rounded exercise program (WREP) on cardiorespiratory fitness, muscular strength, flexibility, body composition, and serum lipid concentration in a group of older outpatients. WREP was composed of programmed aerobic/ anaerobic accommodating circuit exercise (PACE) and flexibility exercises. Twenty-two volunteers (69.6±3.2 yr) were used as subjects. All participants engaged in a supervised exercise program (50 min/day and 3 days/week) for 12 weeks. After 12 weeks of training, there was a significant increase in VO₂ corresponding to lactate threshold (13.4%) but peak V0₂ did not change. There were significant increases for knee extension (17.1%) and flexion (12.3%), chest pull (10.9%), low back flexion (26.6%), and shoulder press (14.6%) after training. Side stepping agility (13%), trunk flexion (129%) and trunk extension (19%) were also significantly improved. There were significant decreases in percent of body fat (-8.3%), total cholesterol (-7.1%) and low-density lipoprotein cholesterol (-9.7%) . Blood pressure also decreased in SBP (-lOmmHg) and DBP (- 5 mmHg) . The decline in SBP was significant in thirteen hypertensive patients (-14 mmHg) compared to non-hypertensive patients (- 5 mmHg) . These results indicate that WREP elicits significant improvement of overall fitness in older outpatients.

The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

Objective: Monitoring the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants is important due to concerns regarding infectivity, transmissibility, immune evasion and disease severity. We evaluated the temporal and regional replacement of previous SARS-CoV-2 variants by the emergent strains, Alpha and Delta. Methods: We obtained the results of polymerase chain reaction screening tests for variants conducted in multiple commercial laboratories. Assuming that all previous strains would be replaced by one variant, the new variant detection rate was estimated by fitting a logistic growth model. We estimated the transmission advantage of each new variant over the pre-existing virus strains. Results: The variant with the N501Y mutation was first identified in the Kinki region in early February 2021, and by early May, it had replaced more than 90% of the previous strains. The variant with the L452R mutation was first detected in the Kanto-Koshin region in mid-May, and by early August, it comprised more than 90% of the circulating strains. Compared with pre-existing strains, the variant with the N501Y mutation showed transmission advantages of 48.2% and 40.3% in the Kanto-Koshin and Kinki regions, respectively, while the variant with the L452R mutation showed transmission advantages of 60.1% and 71.9%, respectively. Discussion In Japan, Alpha and Delta variants displayed regional differences in the replacement timing and their relative transmission advantages. Our method is efficient in monitoring and estimating changes in the proportion of variant strains in a timely manner in each region.