This study showed that DPC/PDPS was associated with reduced resource usage, but not improved healthcare quality, as with DRG/PPSs in other countries. To achieve successful healthcare reform, further discussion on additional motives will be required.

A comparison is made of the stratospheric mean-meridional circulations, Brewer-Dobson (B-D) circulations, diagnosed from the reanalyses, JRA-25, ERA-40, ERA-Interim, NCEP/NCAR and NCEP/DOE. The reanalyses coincidently exhibit seasonality of B-D circulation, although considerable discrepancy among the reanalyses is found particularly in low-latitudes. Meridional overturning circulation at 100 hPa in the northern-hemisphere is maximal in winter, while that in the southern hemisphere is maximal in fall and significantly smaller than the northern hemispheric one. Interannual variability of B-D circulation in winter is coincident among the reanalyses, because they may reasonably represent wave-mean flow interactions of planetary waves which drive meanmeridional circulation. Yearly trends are not reliably observed due to large diversity among the reanalyses. Zonal mean vertical velocity becomes very noisy owing to inconsistency between the observation and global numerical weather prediction (NWP) model used in assimilation, except for JRA-25 and ERA-Interim. Further e¤orts are desired to improve reanalyses mainly through reduction of systematic errors of NWP model and implementation of advanced data assimilation schemes.

Despite recognition of the deleterious effects of passive smoking, quantitative information on the intake of environmental tobacco smoke is still lacking. Cotinine is the major metabolite of nicotine found in the urine. We have examined the relationship between urinary cotinine excretion in 472 nonsmokers and the smokiness of their environment. The urinary cotinine levels of nonsmokers who lived with smokers were higher than those of nonsmokers who did not, increasing with the combined daily cigarette consumption of smokers in the family. The urinary cotinine values of nonsmokers who worked with smokers were also higher than those of nonsmokers who did not, increasing with the number of smokers in the workroom. The presence of smokers in both the home and the workplace also increased the cotinine levels. Urban nonsmokers had more cotinine in their urine than rural nonsmokers. We conclude that the deleterious effects of passive smoking may occur in proportion to the exposure of nonsmokers to smokers in the home, the workplace, and the community.

A major anatomical lung operation with pulmonary artery resection is feasible for selected patients with primary lung cancer. Long-term outcomes are significantly influenced by nodal status and are comparable to those of conventional lobectomy. Most operative complications are controllable with acceptable mortality and morbidity rates. The anastomosed site was not placed at risk for local recurrence. These data support pulmonary angioplasty as a valuable option in the treatment of lung cancer.

Although the Japanese government is attempting to reduce acute care hospital LOS and the number of long-term care beds in order to reduce health care costs, the results of this study suggest that a reduction in the number of long-term care beds would not necessarily reduce the LOS of acute care hospitals, and may instead exacerbate the problem.