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Garbarino JT, O'Connor S, Pepin RL, Aitken MS, Flaherty E. Age-friendly health care and the 4Ms in RN-led annual wellness visits. J Am Geriatr Soc 2024; 72 Suppl 2:S13-S20. [PMID: 38038359 DOI: 10.1111/jgs.18671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Medicare annual wellness visits (AWVs) are prevention-focused healthcare visits free to Medicare recipients. These visits focus on health maintenance, health risk assessment, prevention of illness, and maintaining independence, all of which are within the scope of registered nurse (RN) practice as well as aligned with what matters, medication, mentation, and mobility - the 4Ms - of age-friendly health care. The objective of this pilot study was to evaluate the implementation of the 4Ms in the context of RN-led Medicare AWVs in a primary care practice. METHODS In a primary care practice with approximately 2500 patients, including approximately 571 of whom were enrolled in Medicare, RN-led Medicare AWVs were implemented, incorporating the 4Ms framework. During this time, data were collected on the effect of the AWV on access to care-conceptualized here as the number of visits available as well as the type of clinician open to staff these visits. Data collection also included patient responses to the 4Ms question "what matters most?" RESULTS Overall, the RN-led visits were successful and beneficial to the practice. Each RN-led visit allowed for 2 additional acute or monitoring visits per provider (nurse practitioner, MD) per day, increasing patient access to their primary care providers. Inclusion of the 4Ms questions facilitated discussion around overall mental and emotional well-being, life stressors, quality of life, and goals of care. CONCLUSION RN-led Medicare AWVs incorporating the 4Ms framework enhances the role of RNs in primary care by focusing on a health promotion role, utilizing RNs to their full scope of practice. RN-led AWVs increase provider availability for acute and chronic care appointments, as well as foster conversations around quality of life, as well as mental and emotional well-being.
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Affiliation(s)
- Jason T Garbarino
- Department of Nursing, University of Vermont, Burlington, Vermont, USA
- InSpring, Boston, Massachusetts, USA
| | - Sharon O'Connor
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Renée L Pepin
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Margaret S Aitken
- Department of Nursing, University of Vermont, Burlington, Vermont, USA
| | - Ellen Flaherty
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Health, Lebanon, New Hampshire, USA
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Abayomi SN, Sritharan P, Yan E, Saripella A, Alhamdah Y, Englesakis M, Tartaglia MC, He D, Chung F. The diagnostic accuracy of the Mini-Cog screening tool for the detection of cognitive impairment-A systematic review and meta-analysis. PLoS One 2024; 19:e0298686. [PMID: 38483857 PMCID: PMC10939258 DOI: 10.1371/journal.pone.0298686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/30/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The Mini-Cog is a rapid screening tool that can be administered to older adults to detect cognitive impairment (CI); however, the accuracy of the Mini-Cog to detect CI for older patients in various healthcare settings is unclear. OBJECTIVES To evaluate the diagnostic accuracy of the Mini-Cog to screen for cognitive impairment in older patients across different healthcare settings. METHODS/DESIGN We searched nine electronic databases (including MEDLINE, Embase) from inception to January 2023. We included studies with patients ≥60 years old undergoing screening for cognitive impairment using the Mini-Cog across all healthcare settings. A cut-off of ≤ 2/5 was used to classify dementia, mild cognitive impairment (MCI), and cognitive impairment (defined as either MCI or dementia) across various settings. The diagnostic accuracy of the Mini-Cog was assessed against gold standard references such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). A bivariate random-effects model was used to estimate accuracy and diagnostic ability. The risk of bias was assessed using QUADAS-2 criteria. RESULTS The systematic search resulted in 4,265 articles and 14 studies were included for analysis. To detect dementia (six studies, n = 4772), the Mini-Cog showed 76% sensitivity and 83% specificity. To detect MCI (two studies, n = 270), it showed 84% sensitivity and 79% specificity. To detect CI (eight studies, n = 2152), it had 67% sensitivity and 83% specificity. In the primary care setting, to detect either MCI, dementia, or CI (eight studies, n = 5620), the Mini-Cog demonstrated 73% sensitivity and 84% specificity. Within the secondary care setting (seven studies, n = 1499), the Mini-Cog to detect MCI, dementia or CI demonstrated 73% sensitivity and 76% specificity. A high or unclear risk of bias persisted in the patient selection and timing domain. CONCLUSIONS The Mini-Cog is a quick and freely available screening tool and has high sensitivity and specificity to screen for CI in older adults across various healthcare settings. It is a practical screening tool for use in time-sensitive and resource-limited healthcare settings.
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Affiliation(s)
| | - Praveen Sritharan
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ellene Yan
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Yasmin Alhamdah
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - David He
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Frances Chung
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Hsu JH, Liu CC, Chen IW, Wu JY, Huang PY, Liu TH, Hung KC. Efficacy of the visual cognitive assessment test for mild cognitive impairment/mild dementia diagnosis: a meta-analysis. Front Public Health 2023; 11:1293710. [PMID: 38026272 PMCID: PMC10644725 DOI: 10.3389/fpubh.2023.1293710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Mild cognitive impairment (MCI) is an intermediate stage between normal ageing and dementia. The early identification of MCI is important for timely intervention. The visual cognitive assessment test (VCAT) is a brief language-neutral screening tool for detecting MCI/mild dementia. This meta-analysis evaluated the diagnostic efficacy of the VCAT for MCI/mild dementia. Methods Medline, Embase, Google Scholar, and Cochrane Library were searched from their inception until August 2023 to identify studies using VCAT to diagnose MCI/mild dementia. The primary outcome was to assess the diagnostic accuracy of the VCAT for detecting MCI/mild dementia through area under the receiver operating characteristic curve (AU-ROC) analysis. The secondary outcome was to explore the correlation between VCAT scores and MCI/mild dementia presence by comparing scores among patients with and without MCI/mild dementia. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated. Results Five studies with 1,446 older adults (mean age 64-68.3 years) were included. The percentage of participants with MCI/mild dementia versus controls ranged from 16.5% to 87% across studies. All studies were conducted in Asian populations, mostly Chinese, in Singapore and Malaysia. The pooled sensitivity was 80% [95% confidence interval (CI) 68%-88%] and the specificity was 75% (95% CI 68%-80%). The AU-ROCC was 0.77 (95% CI 0.73-0.81). Patients with MCI/mild dementia had lower VCAT scores than the controls (mean difference -6.85 points, p < 0.00001). Conclusion VCAT demonstrated acceptable diagnostic accuracy in distinguishing MCI/mild dementia in cognitively normal older adults. As a language-neutral and culturally unbiased tool, the VCAT shows promise in detecting MCI/mild dementia. Further studies in non-Asian populations are required. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42023453453.
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Affiliation(s)
- Jui-Hung Hsu
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chien-Cheng Liu
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Nursing, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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Politis A, Vorvolakos T, Kontogianni E, Alexaki M, Georgiou EZE, Aggeletaki E, Gkampra M, Delatola M, Delatolas A, Efkarpidis A, Thanopoulou E, Kostoulas K, Naziri V, Petrou A, Savvopoulou K, Siarkos K, Soldatos RF, Stamos V, Nguyen KH, Leroi I, Kiosses D, Tsimpanis K, Alexopoulos P. Old-age mental telehealth services at primary healthcare centers in low- resource areas in Greece: design, iterative development and single-site pilot study findings. BMC Health Serv Res 2023; 23:626. [PMID: 37312113 DOI: 10.1186/s12913-023-09583-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Even though communities in low-resource areas across the globe are aging, older adult mental and cognitive health services remain mainly embedded in tertiary- or secondary hospital settings, and thus not easily accessible by older adults living in such communities. Here, the iterative development of INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) services addressing the mental and cognitive healthcare needs of older adults residing in low-resource areas of Greece is depicted. METHODS INTRINSIC was developed and piloted in three iterative phases: (i) INTRINSIC initial version conceptualization; (ii) A 5-year field testing in Andros island; and (iii) Extending the services. The INTRINSIC initial version relied on a digital platform enabling videoconferencing, a flexible battery of diagnostic tools, pharmacological treatment and psychosocial support and the active involvement of local communities in service shaping. RESULTS Ιn 61% of the 119 participants of the pilot study, new diagnoses of mental and/or neurocognitive disorders were established. INTRINSIC resulted in a significant reduction in the distance travelled and time spent to visit mental and cognitive healthcare services. Participation was prematurely terminated due to dissatisfaction, lack of interest or insight in 13 cases (11%). Based on feedback and gained experiences, a new digital platform, facilitating e-training of healthcare professionals and public awareness raising, and a risk factor surveillance system were created, while INTRINSIC services were extended to incorporate a standardized sensory assessment and the modified problem adaptation therapy. CONCLUSION The INTRINSIC model may be a pragmatic strategy to improve access of older adults with mental and cognitive disorders living in low-resource areas to healthcare services.
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Affiliation(s)
- Antonios Politis
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sophias 72, Athens, 11528, Greece
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry, Johns Hopkins Medical School, 600 N. Wolfe Street Meyer Building, Baltimore, MD, 21287, USA
| | - Theofanis Vorvolakos
- Department of Psychiatry, School of Health Sciences, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis, 68100, Greece
| | - Evaggelia Kontogianni
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sophias 72, Athens, 11528, Greece
| | - Maria Alexaki
- Primary Healthcare Center of Andros, Chora, Andros, 84500, Greece
| | - Eleni-Zacharoula Eliza Georgiou
- Mental Health Services, University General Hospital of Patras, Department of Medicine, School of Health Sciences, University of Patras, Rion, Patras, 26504, Greece
| | - Eleutheria Aggeletaki
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Geor. Papandreou 2, Ermoupolis, 84100, Greece
| | - Maria Gkampra
- Primary Healthcare Center of Xanthi, Andrea Dimitriou 1, Xanthi, 67133, Greece
| | - Maria Delatola
- Primary Healthcare Center of Tinos, Mark. Krikeli 18, Tinos, 84200, Greece
| | - Antonis Delatolas
- Primary Healthcare Center of Tinos, Mark. Krikeli 18, Tinos, 84200, Greece
| | - Apostolos Efkarpidis
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Geor. Papandreou 2, Ermoupolis, 84100, Greece
| | | | | | - Vassiliki Naziri
- Primary Healthcare Center of Soufli, Soufli Evros, 68400, Greece
| | - Anna Petrou
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Geor. Papandreou 2, Ermoupolis, 84100, Greece
| | | | - Kostas Siarkos
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sophias 72, Athens, 11528, Greece
| | - Rigas Filippos Soldatos
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sophias 72, Athens, 11528, Greece
| | - Vasileios Stamos
- Primary Healthcare Center of Erymanthia, Erymanthia Achaea, 25015, Greece
| | - Kim-Huong Nguyen
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, The University of Dublin, Lloyd Building Trinity College Dublin, Dublin 2, Dublin, Republic of Ireland
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital campus, Woolloongabba, QLD, 4102, Australia
| | - Iracema Leroi
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, The University of Dublin, Lloyd Building Trinity College Dublin, Dublin 2, Dublin, Republic of Ireland
| | - Dimitrios Kiosses
- Cognition, and Psychotherapy Lab, Department of Psychiatry, Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, 315 East 62nd Street, 5th Floor, New York, NY, 10065, USA
| | - Konstantinos Tsimpanis
- Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Panepistimiopolis, Athens, Ilissia, 15784, Greece
| | - Panagiotis Alexopoulos
- Mental Health Services, University General Hospital of Patras, Department of Medicine, School of Health Sciences, University of Patras, Rion, Patras, 26504, Greece.
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, The University of Dublin, Lloyd Building Trinity College Dublin, Dublin 2, Dublin, Republic of Ireland.
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Anghelescu A. Telerehabilitation: A Practical Remote Alternative for Coaching and Monitoring Physical Kinetic Therapy in Patients with Mild and Moderate Disabling Parkinson's Disease during the COVID-19 Pandemic. PARKINSON'S DISEASE 2022; 2022:4370712. [PMID: 35979169 PMCID: PMC9377913 DOI: 10.1155/2022/4370712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/27/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Background The COVID-19 pandemic imposed social/physical distancing, lockdown measures, and forced reorientation of the rehabilitation programs for people with Parkinson's disease (PD). Epidemiologic safety measures boosted remote exercise-based treatment. Objectives Remote delivery of rehabilitation care services is not typically used in our department. Therefore, this study aimed to assess and implement a telehealth physical rehabilitation program tailored for outpatients with idiopathic PD and slight or medium functional limitations. Methods A prospective study was performed on a group of outpatients with idiopathic PD, selected from the database of the neurorehabilitation clinic of the Emergency Teaching Hospital "Bagdasar-Arseni." We studied 17 patients (5 women and 12 men), aged between 54-70 years (average 65.9 ± 4.87), with a disease history of 7.3 ± 3.6 (years), with mild or moderate disabling clinical forms, quantified by an average Hoehn and Yahr score of 2.3 ± 0.35 (limits 1.5-3). All patients underwent pharmacologic treatment with unchanged doses throughout the study. No patients had disabling osteoarticular problems (all could walk independently) and had no significant psycho-cognitive dysfunction. Patients were supervised and coached online in tandem by the therapist and physician. In addition, a family member assisted and supervised the patient's performance and coordinated the technical electronic procedures. Walking biodynamics was assessed by timing "6-meters walking" and "Get up and walk 3 meters" (TUG) tests. Each person attended ten sessions of motor telerehabilitation procedures (2 per week) lasting 50 minutes each during social distancing (October-December 2021). Results None of the patients was at increased risk of falling. They all improved their locomotor performance, reflected in a significant decrease in TUG duration (the initial average time improved from 13.50 seconds to 10.57). The telerehabilitation program also significantly improved the average walking speed (initially, 44.5 cm/sec and finally, it raised to 56.8 cm/sec). Discussion. The TUG and "6-meters walking" tests are helpful tools for a global biodynamic remote assessment of PD patients. Limitations of the study: a small group of selected patients, restrictive working conditions (due to epidemiological social/physical restrictions and no direct physiotherapist-patient contact), and need for supervision by an attendant to assist the subject and perform the audio-video transmission. Further studies are necessary to identify the optimal web-based model of care and boost the implementation of this modern neurorehabilitation concept. Conclusions Telemedicine turned the virtual space into a new reality and may compensate for the restrictions imposed on face-to-face meetings in pandemic conditions. Moreover, with modern telecommunication techniques, a regular and individualized physical kinetic rehabilitation program can be performed even in pandemic conditions. Remote delivery of kinetic motor programs was appropriate for selected groups of PD patients.
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Affiliation(s)
- Aurelian Anghelescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Neurorehabilitation Clinic, Teaching Emergency Hospital “Bagdasar-Arseni”, Berceni Av., No. 12, Postal Code: 041915, 4th Sector, Bucharest, Romania
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Saito Y, Nakamura S, Tanaka A, Watanabe R, Narimatsu H, Chung UI. Checking the validity and reliability of the Japanese version of the Mini-Cog using a smartphone application. BMC Res Notes 2022; 15:222. [PMID: 35752807 PMCID: PMC9233764 DOI: 10.1186/s13104-022-06101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Cognitive decline is an important and well-documented health problem. The Mini-Cog, a simple cognitive function test, is recommended as a potential early cognitive screening tool. Kanagawa Prefecture, one of the largest prefectures in Japan, developed this self-testing application on a smartphone to enable a large number of residents to assess their cognitive function. This study aimed to verify the validity and reliability of the Mini-Cog. Results Twenty men and 20 women aged 65–85 years were enrolled. Criterion-related validity of the method tested by professional staff was found to have an acceptable positive association. The test–retest reliability was lower than the clinically expected intraclass correlation coefficient value because of the inclusion of learning and order effects. If the Mini-Cog score of this application is low, the system is equipped with a function that advises the users on preventing cognitive decline, directing them to the appropriate services, and recommending visits to a medical institution. Therefore, the system can be used continuously as a tool for health behaviors and promotions. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06101-4.
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Affiliation(s)
- Yoshinobu Saito
- Faculty of Sport Management, Nippon Sport Science University, 1221-1 Kamoshida-cho, Aoba-ku, Yokohama, Kanagawa, 227-0033, Japan. .,Center for Innovation Policy, Kanagawa University of Human Services, Research Gate Building TONOMACHI 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan.
| | - Sho Nakamura
- Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan.,Graduate School of Health Innovation, Kanagawa University of Human Services, Research Gate Building TONOMACHI 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan
| | - Ayumi Tanaka
- Division of Health Promotion, Fujisawa City Health and Medical Foundation, 5527-1 Oba, Fujisawa, Kanagawa, 251-0861, Japan
| | - Ryo Watanabe
- Center for Innovation Policy, Kanagawa University of Human Services, Research Gate Building TONOMACHI 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan.,Graduate School of Health Innovation, Kanagawa University of Human Services, Research Gate Building TONOMACHI 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan
| | - Hiroto Narimatsu
- Center for Innovation Policy, Kanagawa University of Human Services, Research Gate Building TONOMACHI 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan.,Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan.,Graduate School of Health Innovation, Kanagawa University of Human Services, Research Gate Building TONOMACHI 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan
| | - Ung-Il Chung
- Graduate School of Health Innovation, Kanagawa University of Human Services, Research Gate Building TONOMACHI 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0821, Japan.,Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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