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BackgroundIn Japan, the shortage of physicians has been recognized as a major medical issue. In our previous study, we reported that the absolute shortage will be resolved in the long term, but maldistribution among specialties will persist. To address regional shortage, several Japanese medical schools increased existing quota and established “regional quotas.” This study aims to assist policy makers in designing effective policies; we built a model for forecasting physician numbers by region to evaluate future physician supply–demand balances.MethodsFor our case study, we selected Hokkaido Prefecture in Japan, a region displaying disparities in healthcare services availability between urban and rural areas. We combined a system dynamics (SD) model with geographic information system (GIS) technology to analyze the dynamic change in spatial distribution of indicators. For Hokkaido overall and for each secondary medical service area (SMSA) within the prefecture, we analyzed the total number of practicing physicians. For evaluating absolute shortage and maldistribution, we calculated sufficiency levels and Gini coefficient. Our study covered the period 2010–2030 in 5-year increments.ResultsAccording to our forecast, physician shortage in Hokkaido Prefecture will largely be resolved by 2020. Based on current policies, we forecast that four SMSAs in Hokkaido will continue to experience physician shortages past that date, but only one SMSA would still be understaffed in 2030.ConclusionThe results show the possibility that diminishing imbalances between SMSAs would not necessarily mean that regional maldistribution would be eliminated, as seen from the sufficiency levels of the various SMSAs. Urgent steps should be taken to place doctors in areas where our forecasting model predicts that physician shortages could occur in the future.

Vernalization promotes flowering in winter wheat cultivars, whereas spring wheat cultivars are able to transition from vegetative to reproductive phase without vernalization. The wheat vernalization requirement is mainly controlled by the major locus Vrn-1, an APETALA1/FRUITFULL MADS-box gene homolog. To study natural variation of the vernalization requirement in a wild progenitor of common wheat, we sequenced the Vrn-D(t)1 locus in four accessions of Aegilops tauschii Coss. Some structural mutations were found in the promoter and first intron regions of Vrn-D(t)1, and haplotype analysis was conducted to examine the distribution of each identified mutation within 211 accessions of Ae. tauschii germplasm. Out of the total, nine accessions, which were originally collected in Afghanistan and Pakistan, contained deletions of a 5.4-kb sequence in the critical region of the Vrn-D(t)1 first intron. The 5.4-kb deletion mutation appeared independently of the dominant allele of the common wheat Vrn-D1 locus. The large deletion was absolutely associated with a lack of vernalization requirement for flowering under long-day conditions, but had no influence on heading date under field growth conditions. The levels of Vrn-1 and WFT transcript increased in the Ae. tauschii accessions having the large deletion. Identification of natural mutant accessions with a loss of vernalization requirement indicates the agricultural significance of Ae. tauschii as a genetic resource for wheat breeding.