ATNAS: Automatic Termination for Neural Architecture Search.

Neural architecture search (NAS) is a framework for automating the design process of a neural network structure. While the recent one-shot approaches have reduced the search cost, there still exists an inherent trade-off between cost and performance. It is important to appropriately stop the search and further reduce the high cost of NAS. Meanwhile, the differentiable architecture search (DARTS), a typical one-shot approach, is known to suffer from overfitting. Heuristic early-stopping strategies have been proposed to overcome such performance degradation. In this paper, we propose a more versatile and principled early-stopping criterion on the basis of the evaluation of a gap between expectation values of generalisation errors of the previous and current search steps with respect to the architecture parameters. The stopping threshold is automatically determined at each search epoch without cost. In numerical experiments, we demonstrate the effectiveness of the proposed method. We stop the one-shot NAS algorithms and evaluate the acquired architectures on the benchmark datasets: NAS-Bench-201 and NATS-Bench. Our algorithm is shown to reduce the cost of the search process while maintaining a high performance.

Epidemiology of locomotive syndrome using updated clinical decision limits: 6-year follow-ups of the ROAD study.

INTRODUCTION: Locomotive syndrome (LOCOMO) is defined by the Japanese Orthopaedic Association (JOA) as a condition requiring nursing care due to a decline in mobility resulting from musculoskeletal disorders. In 2020, the JOA announced the new definition of LOCOMO stage 3 and revision of clinical decision limits in stages of LOCOMO. However, there are few reports on the epidemiological indices of LOCOMO. This prospective cohort study aimed to investigate the prevalence, incidence, and association of poor prognosis with LOCOMO stages. MATERIALS AND METHODS: The third survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted during 2012-2013, examining a population-based cohort of 1575 participants (513 men and 1062 women, mean age 65.6 years). Three LOCOMO risk tests were performed, and patients were classified into LOCOMO stages 0, 1, 2, and 3. They were followed up for 6 years, and identical examination of LOCOMO was performed in 3- and 6-year follow-ups. Data on patients' prognoses, including disability and death, were collected. RESULTS: The prevalence of LOCOMO stages 1, 2, and 3 was 41.3, 14.9, and 11.6%, respectively. The incidence of LOCOMO stages 1, 2, and 3 were 83.7, 23.0, and 18.6 per 1000 person-years, respectively. Compared with LOCOMO stage 0, logistic regression analysis showed that LOCOMO stage 3 significantly increased the risk of disability and mortality. In addition, each value of LOCOMO risk tests for LOCOMO stage 3 increased the risk of poor prognosis. CONCLUSION: LOCOMO stage 3 is a sensitive indicator of future disability and mortality.

Principal Component Analysis for Gaussian Process Posteriors.

This letter proposes an extension of principal component analysis for gaussian process (GP) posteriors, denoted by GP-PCA. Since GP-PCA estimates a low-dimensional space of GP posteriors, it can be used for metalearning, a framework for improving the performance of target tasks by estimating a structure of a set of tasks. The issue is how to define a structure of a set of GPs with an infinite-dimensional parameter, such as coordinate system and a divergence. In this study, we reduce the infiniteness of GP to the finite-dimensional case under the information geometrical framework by considering a space of GP posteriors that have the same prior. In addition, we propose an approximation method of GP-PCA based on variational inference and demonstrate the effectiveness of GP-PCA as meta-learning through experiments.

Validity, Responsiveness, and Predictive Ability of the Japanese Version of the Cumulated Ambulation Score in Patients with Hip Fracture.

OBJECTIVES: The aim of the current study was to investigate the validity, the responsiveness, and the predictive ability for discharge to own home of the Japanese version of the Cumulated Ambulation Score (CAS-JP). This was achieved by analyzing the CAS-JP after hip fracture surgery at multiple time points until patient discharge. METHODS: Patients who underwent hip fracture surgery were evaluated using CAS-JP, the Barthel Index, and walking ability on postoperative day (POD) 1, 7, and 14 and at discharge. Floor and ceiling effects, responsiveness, and correlations between CAS-JP and other functional outcomes were assessed at each time point. The predictive ability of CAS-JP for discharge to own home was also analyzed using the area under the curve (AUC) of the receiver operating characteristic. RESULTS: A total of 121 patients were included in this study. On POD7, POD14, and at discharge, strong correlations were observed between CAS-JP and the Barthel Index (r=0.81, 0.82, and 0.87, respectively), and between CAS-JP and walking status (r=0.82, 0.81, and 0.76, respectively). CAS-JP had a large effect size (1.64-2.25) and standardized response mean (1.49-1.81). The predictive ability of CAS-JP for discharge to own home, as indicated by the AUCs, were 0.73 (95% CI: 0.62-0.83) on POD7 and 0.74 (95% CI: 0.62-0.86) on POD14. CONCLUSIONS: CAS-JP has sufficient validity and responsiveness as a mobility assessment tool in postoperative hip fracture patients. Furthermore, this study showed that early postoperative mobility status evaluation using CAS-JP can sufficiently predict discharge to own home.

Translation, Inter-rater Reliability, Agreement, and Internal Consistency of the Japanese Version of the Cumulated Ambulation Score in Patients after Hip Fracture Surgery.

OBJECTIVES: The aim of this study was to translate the Cumulated Ambulation Score (CAS) from English into Japanese in cooperation with different types of healthcare providers and to investigate its inter-rater reliability and internal consistency. METHODS: Two physical therapists at each of three general hospitals in Japan measured the mobility of 50 consecutive post-operative hip fracture patients on two occasions between 2 and 6 days after surgery using the Japanese version of the CAS (CAS-JP). We analyzed the inter-rater reliability and agreement using both the linear weighted kappa and the interclass correlation coefficient; we also analyzed the internal consistency using Cronbach's alpha coefficient. RESULTS: The mean age of patients was 81 (SD: 11.6) years and 82% were women. Approximately half of the patients had severe cognitive impairment. Kappa was ≥ 0.93 for the three mobility activities and for the total CAS-JP score, the percentage agreement was ≥ 0.98, the ICC was ≥ 0.95, and Cronbach's alpha coefficient was 0.85. CONCLUSIONS: We found that the CAS-JP possessed good inter-rater reliability, agreement, and internal consistency. The CAS-JP is a reliable and easy-to-use evaluation tool suitable for daily clinical practice across different healthcare providers to monitor mobility in older hip fracture patients in Japan. We suggest that CAS-JP be evaluated in future studies for use in younger patients and in other patient groups with mobility problems.

Reference values for the locomotive syndrome risk test quantifying mobility of 8681 adults aged 20-89 years: A cross-sectional nationwide study in Japan.

BACKGROUND: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex. METHODS: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan. RESULTS: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score. CONCLUSION: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex.

The one-leg portion of the Stand-Up Test predicts fall risk in aged individuals: A prospective cohort study.

BACKGROUND: Falls are a primary cause of physical disability in older adults, making them a major public health problem. Locomotive syndrome risk assessments have proven to be simple to administer, practical, and useful as screening tools in detecting decreased mobility in middle-aged and elderly adults. The current prospective study investigated whether these tests were associated with future falls among elderly Japanese. METHODS: This study was a two-year prospective observational study. A total of 1800 individuals (aged 65-79 years) who were without certification of long-term care or physical disability were initially invited through letters to participate in the study. Of these, 499 individuals (225 men, 274 women) agreed to participate and underwent baseline assessments. Demographic information, body function physical performance measurements, and locomotive syndrome risk tests [Stand-Up Test (SUT), Two-Step Test (TST), and the 25-question Geriatric Locomotive Function Scale (GLFS-25)] were assessed. Following baseline evaluation, we sent a follow-up questionnaire to assess fall history in the past two years. Participants were classified as either "non-fallers" or "fallers" (denoted by one or more falls). Multiple logistic regression was used to evaluate the association between falls and each factor by providing adjusted odds ratio estimates. RESULTS: The follow-up questionnaire was returned by 399 participants, 54 of whom (13.5%) fell at least once during the two-year observation period. The multiple logistic regression analysis revealed that difficulty with standing on one leg from a 40-cm-high seat (a portion of the SUT) was a significant predictor of future falls (odds ratio = 2.20, 95%CI = 1.04-4.69, p = 0.04). A history of falling was also a risk factor of falls. CONCLUSION: Our results suggest that standing on one leg from a 40-cm-high seat is predictive of falling in older adults, even after adjustment for previous falls and other confounding variables.

Sarcopenia and lower limb pain are additively related to motor function and a history of falls and fracture in community-dwelling elderly people.

OBJECTIVES: To clarify the prevalence and characteristics of pain associated with sarcopenia and to verify the usefulness of evaluation of pain for sarcopenia. METHODS: In total, 759 community-dwelling people (aged 65-79 years) with or without sarcopenia and lower limb pain were classified into 4 groups (NSp, nonsarcopenia; NSpP, nonsarcopenia with pain; Sp, sarcopenia; and SpP, sarcopenia with pain). Body composition, motor function, history of fractures since age 50 years, and number of falls in the past 1 year were compared between the groups. RESULTS: Participant proportions by group were: NSp, 53.9%; NSpP, 42.8%; Sp, 1.3%; and SpP, 2.0%. Participants with lower limb pain showed low single leg standing, walking speed, and 2-step value scores and high 25-question Geriatric Locomotive Functional Scale (GLFS-25) score after adjusting for age, sex, body mass index, and presence of sarcopenia. The SpP group showed lower functional reach test and higher GLFS-25 scores than the Sp group. Regarding the history of fractures since 50 years of age and falls in past 1 year, a high retention rate of fracture was noted in the NSpP group. They also experienced significantly more falls in the past 1 year than those in the NSp group. The SpP group noted more falls and fractures although it was insignificant. CONCLUSIONS: The results indicate that participants with lower limb pain showed declining motor function and a high risk for falls and fractures. Sarcopenia could escalate this risk. Therefore, evaluating patients for both pain and sarcopenia may be useful for risk assessment and treatment.

[Prevention of osteoporosis during pregnancy and lactation period.]

Post-pregnant osteoporosis, characterized by low back pain and vertebral fractures, is a relatively rare disease. For avoiding post-pregnant osteoporosis and decrease in bone mass during pregnancy or lactation period, it is necessary to obtain sufficient bone mass during the growth period and maintain bone mass in adulthood. From the results of the national nutrition and health survey, the total energy, protein, calcium intake of women aged 20s and 30s is the lowest in all ages. In addition, young women with exercise habits are less than 10%. In addition to the prevention of post-pregnant osteoporosis, to avoid future osteoporosis and fragility fractures of older age, it is necessary to promote young women to take measures such as adequate nutrition intake and exercise habits, considering bone health.

Identifying elderly people at risk for cognitive decline by using the 2-step test.

[Purpose] The purpose is to verify the effectiveness of the 2-step test in predicting cognitive decline in elderly individuals. [Subjects and Methods] One hundred eighty-two participants aged over 65 years underwent the 2-step test, cognitive function tests and higher level competence testing. Participants were classified as Robust, <1.3, and <1.1 using criteria regarding the locomotive syndrome risk stage for the 2-step test, variables were compared between groups. In addition, ordered logistic analysis was used to analyze cognitive functions as independent variables in the three groups, using the 2-step test results as the dependent variable, with age, gender, etc. as adjustment factors. [Results] In the crude data, the <1.3 and <1.1 groups were older and displayed lower motor and cognitive functions than did the Robust group. Furthermore, the <1.3 group exhibited significantly lower memory retention than did the Robust group. The 2-step test was related to the Stroop test (ß: 0.06, 95% confidence interval: 0.01-0.12). [Conclusion] The finding is that the risk stage of the 2-step test is related to cognitive functions, even at an initial risk stage. The 2-step test may help with earlier detection and implementation of prevention measures for locomotive syndrome and mild cognitive impairment.

Traumatic vertebral artery dissection in high school rugby players: A report of two cases.

Traumatic vertebral artery dissection (VAD) has been reported in various types of sports and recreation. However, there have been no reports of VAD in rugby players, except for those with cervical spine injuries. We experienced two cases of VAD without cervical spine injuries in high school rugby players. Attention should be paid to protect youth rugby players from VAD.

Locomotive syndrome in Japan.

The present aging rate in Japan of some 28% will continue to increase along with the advancing age of elderly persons. Therefore, the demand for care will also increase. Approximately 25% of the need for nursing-care defined by the Japanese long-term care insurance system is associated with disorders or deterioration of locomotive organs. Therefore, the prevention and treatment of diseases in the locomotor system and maintenance of motor function are important for extended healthy life span and to decrease the demand for long-term care. Based on this background, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, which is defined as reduced mobility due to impaired locomotive organs. Changes in locomotion must be noticed early to ensure the timely implementation of appropriate checks and measures of locomotion can uncover risk of acquiring LS. The acquisition of an exercise habit, appropriate nutrition, being active and evaluating and treating locomotion-related diseases are important to delay or avoid LS. The JOA recommends locomotion training consisting of four exercises to prevent and improve LS. Countermeasures against LS should become a meaningful precedent not only for Japan, but for other countries with rapidly aging populations.

[Osteoporosis Liaison Service and exercise regimens, based on Locomotive Syndrome.]

The purpose of Osteoporosis Liaison Service(OLS)is primary and secondary prevention of osteoporosis and fragility fracture by multiple medical occupations. Exercise instruction and exercise intervention are important factors in OLS. Exercise has effects of increasing bone density and preventing falls. In OLS, it is also necessary to disseminate knowledge on osteoporosis and fractures to the public. Main measures against locomotive syndrome(LS), meaning weakening of ambulatory ability, are exercise and nutrition, and the LS prevention campaign is thought to lead to prevention of falls. In addition, LS is in common with OLS because it aims to spread such preventive measures widely. Exercise for LS prevention can be used safely and effectively at hospitals and workshops, as well as regional comprehensive care system.

Romosozumab increases bone mineral density in postmenopausal Japanese women with osteoporosis: A phase 2 study.

BACKGROUND: Romosozumab is a monoclonal antibody that inhibits sclerostin and rapidly increases bone mineral density (BMD) through a dual effect on bone by increasing bone formation and decreasing bone resorption, as shown in a global phase 2 study in postmenopausal women with low bone mass. Here, we report the key results of a phase 2, double-blind, placebo-controlled, dose-ranging study to assess the efficacy and safety of romosozumab in postmenopausal Japanese women with osteoporosis. METHODS: Participants were postmenopausal Japanese women with osteoporosis aged 55-85years with a lumbar spine, total hip, or femoral neck dual-energy X-ray absorptiometry T-score≤-2.5. Women were randomized to receive placebo or romosozumab (70, 140, or 210mg) subcutaneously once monthly (QM) for 12months. The primary efficacy endpoint was the percentage change from baseline in lumbar spine BMD at month 12. Secondary efficacy endpoints included the percentage change from baseline in lumbar spine BMD at month 6, total hip and femoral neck BMD at months 6 and 12, and serum bone turnover markers procollagen type 1N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX) at multiple visits. RESULTS: This study enrolled 252 women who had a mean age of 67.7years and mean T-scores of -2.7, -1.9, and -2.3 at the lumbar spine, total hip, and femoral neck, respectively. All romosozumab doses significantly increased BMD at month 12 compared with placebo (p<0.01), with the largest mean gains from baseline observed with romosozumab 210mg QM (lumbar spine=16.9%, total hip=4.7%, and femoral neck=3.8%). All doses of romosozumab significantly increased the levels of bone-formation marker P1NP and reduced the levels of bone-resorption marker CTX by week 1 (p<0.001 vs placebo). In the 210mg QM group, P1NP levels peaked at month 1 and fell below placebo levels by month 12; CTX levels were lowest at week 1 and remained below placebo through month 12. The patient incidences of adverse events and serious adverse events were generally comparable between treatment groups. CONCLUSIONS: In postmenopausal Japanese women with osteoporosis, romosozumab treatment resulted in large and significant gains in BMD from baseline and compared with placebo. Romosozumab 210mg QM showed the largest gains in BMD and was generally well tolerated. The efficacy and safety of romosozumab 210mg QM in this phase 2 study of postmenopausal women with osteoporosis were similar to those in an international phase 2 study.

[The significance of exercises and sports in the locomotive syndrome prevention.]

In Japan, the world's fastest aging country, the locomotive syndrome that shows a decrease in the mobility due to dysfunctions of the locomotor organs is a major risk factor of long-term care need in the old age. Exercises and sports habits are well reviewed to lead to the improvement and maintenance of motor function, and exercises are also useful in the prevention of a number of musculoskeletal diseases. In addition, several trials with the exercise intervention indicated improvement in motor function, suggesting exercises could prevent the locomotive syndrome. In future, prevalence of exercise habits may lead to decrease the prevalence of locomotive syndrome, resulting in elongation of the healthy life span.

Effect of a simple and adherent home exercise program on the physical function of community dwelling adults sixty years of age and older with pre-sarcopenia or sarcopenia.

[Purpose] To evaluate the effect of a home exercise program on physical function in community dwelling elderly with pre-sarcopenia or sarcopenia. [Subjects and Methods] Fifty-two community-dwelling individuals, over 60 years and meeting the diagnostic criteria for pre-sarcopenia or sarcopenia, were randomly assigned to intervention group (n=34) and control group (n=18). The intervention group completed 6-months home exercise programs, combining walking with lower limb resistance exercises. Body mass index, skeletal mass index, body fat percentage, handgrip strength, single-leg standing, walking speed (comfortable and maximal), and knee extension strength were evaluated at baseline and post-intervention. Activity was assessed using the 25-question Geriatric Locomotive Functional Scale (GLFS-25) and quality of life using the Euro QOL questionnaire. [Results] Pre- and post-training assessments were completed by 76.5% and 77.8% of participants in the intervention and control groups, respectively. The intervention improved single-leg standing (60.5 s to 77.2 s) and knee extension strength (1.38 Nm/kg to 1.69 Nm/kg). In the control group, maximum walking speed (2.02 m/s to 1.86 m/s) and GLFS-25 score (2.9 to 5.1) worsened. Change of pre-sarcopenia/sarcopenia status was comparable for the intervention (15.4%) and control (14.3%) groups. [Conclusion] A 6-month home exercise program improved physical function in community-dwelling individuals with pre-sarcopenia or sarcopenia.

[On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Osteoporosis in relation to locomotive syndrome].

In the super-aged society of Japan, both osteoporosis and locomotive syndrome are important together from a point of view of the extension of the healthy life expectancy. Osteoporosis is an significant constituting disease of locomotive syndrome, and the measures for locomotive syndrome are important to the prevention of osteoporotic fracture, because it influences the risk of falling. Actually, a rating system and the measures for locomotive syndrome have significant relationship with evaluation and decreace of the risk of falling. To reduce the osteoporotic fracture in Japan, the spread of measures for locomotive syndrome are necessary, as well as the increase of a treatment rate of osteoporosis.

Development of a screening program to assess motor function in the adult population: a cross-sectional observational study.

BACKGROUND: Motor dysfunction is a major reason why the elderly lose their independence in their daily lives. The concept of locomotive syndrome has been proposed to describe the risk of mobility dependence caused by various locomotive organ disorders. The preservation of locomotive organs is now socially important in the middle-aged and geriatric population. Therefore, it is important to establish a screening program to evaluate motor function and related quality of life in a wide range of ages. METHODS: We propose a new set of pre-existing scales (the Two-Step test, Stand-Up test, and 25-question Geriatric Locomotive Function Scale) as screening tools to identify the population at high risk for locomotive syndrome. We performed a preliminary survey on 777 subjects who had no apparent disorders related to motor function. We also examined the reliability of the Two-Step test and Stand-Up test. RESULTS: We found that each scale did not show ceiling or floor effects in various age groups. Because the correlations between the three scales were significant but weak, we assume that each scale covers different aspects of mobility. The test-retest reliability was found to be satisfactory for the Two-Step test and the Stand-Up test. CONCLUSION: Our results suggest that our "Short Test Battery for Locomotive syndrome" is a feasible and reliable tool for screening the adult population as a preventative strategy for locomotive syndrome in a super-aged society.

Effective connectivity maps in the swine somatosensory cortex estimated from electrocorticography and validated with intracortical local field potential measurements.

Macroscopic techniques are increasingly being used to estimate functional connectivity in the brain, which provides valuable information about brain networks. In any such endeavors it is important to understand capabilities and limitations of each technique through direct validation, which is often lacking. This study evaluated a multiple dipole source analysis technique based on electrocorticography (ECOG) data in estimating effective connectivity maps and validated the technique with intracortical local field potential (LFP) recordings. The study was carried out in an animal model (swine) with a large brain to avoid complications caused by spreading of the volume current. The evaluation was carried out for the cortical projections from the trigeminal nerve and corticocortical connectivity from the first rostrum area (R1) in the primary somatosensory cortex. Stimulation of the snout and layer IV of the R1 did not activate all projection areas in each animal, although whenever an area was activated in a given animal, its location was consistent with the intracortical LFP. The two types of connectivity maps based on ECOG analysis were consistent with each other and also with those estimated from the intracortical LFP, although there were small discrepancies. The discrepancies in mean latency based on ECOG and LFP were all very small and nonsignificant: snout stimulation, -1.1-2.0 msec (contralateral hemisphere) and 3.9-8.5 msec (ipsilateral hemisphere); R1 stimulation, -1.4-2.2 msec for the ipsilateral and 0.6-1.4 msec for the contralateral hemisphere. Dipole source analysis based on ECOG appears to be quite useful for estimating effective connectivity maps in the brain.