Ring-Sp1 decoy oligonucleotide effectively suppresses extracellular matrix gene expression and fibrosis of rat kidney induced by unilateral ureteral obstruction.

Tubulointerstitial fibrosis is the consequence of an injury characterized by the accumulation of excess collagen and other extracellular matrix components, resulting in the destruction of the normal kidney architecture and subsequent loss of function. A transcription factor Sp1, originally described as a ubiquitous transcription factor, is involved in the basal expression of extracellular matrix genes and may, therefore, be important in fibrotic processes. Here, we report on the design of a ring-Sp1 decoy oligonucleotide, containing the consensus Sp1 binding sequence in a single decoy molecule without an open end, to create a novel therapeutic strategy for fibrosis. The ring-Sp1 decoy oligonucleotide is highly resistant to degradation by nucleases or serum compared to the conventional phosphorothioated double-stranded Sp1 decoy oligonucleotide, and effectively suppressed the expression of transforming growth factor-beta1 and fibronectin, the binding of Sp1 to the promoter region of these genes, and proliferation in response to serum in normal rat kidney fibroblasts. Moreover, treatment with the ring-Sp1 decoy in vivo significantly attenuates extracellular matrix gene expression in the rat kidney in which a unilateral ureteral obstruction had been induced. These results suggest that the ring-Sp1 decoy oligonucleotide represents promising therapeutic alternative to the conventional treatment of fibrotic disorders.

Development of an intelligent laboratory information system for community health promotion center.

This study aimed to develop an Intelligent Laboratory Information System (ILIS) for the community health promotion center in Kwachun city to help process an increasing number of laboratory test data in an efficient manner, and to support the clinical decision-making of public health doctors. A sample of 170 cases was used for validation of the system. Overall, the system correctly predicted 92.5% of the cases. This paper also analyzed the economic feasibility of the ILIS based on the Information Economics approach. The results showed that the ILIS not only helps screen more people by increasing the capacity of a health promotion center, but also brings in more revenue to the center.

Experimental and theoretical studies on the thermal decomposition of heterocyclic nitrosimines.

A series of substituted 2-nitrosiminobenzothiazolines (2) were synthesized by the nitrosation of the corresponding 2-iminobenzothiazolines (6). Thermal decomposition of 2a--f and of the seleno analogue 7 in methanol and of 3-methyl-2-nitrosobenzothiazoline (2a) in acetonitrile, 1,4-dioxane, and cyclohexane followed first-order kinetics. The activation parameters for thermal deazetization of 2a were measured in cyclohexane (Delta H(++) = 25.3 +/- 0.5 kcal/mol, Delta S(++) = 1.3 +/- 1.5 eu) and in methanol (Delta H(++) = 22.5 +/- 0.7 kcal/mol, Delta S(++) = -12.9 +/- 2.1 eu). These results indicate a unimolecular decomposition and are consistent with a proposed stepwise mechanism involving cyclization of the nitrosimine followed by loss of N(2). The ground-state conformations of the parent nitrosiminothiazoline (9a) and transition states for rotation around the exocyclic C==N bond, electrocyclic ring closure, and loss of N(2) were calculated using ab initio molecular orbital theory at the MP2/6-31G* level. The calculated gas-phase barrier height for the loss of N(2) from 9a (25.2 kcal/mol, MP4(SDQ, FC)/6-31G*//MP2/6-31G* + ZPE) compares favorably with the experimental barrier for 2a of 25.3 kcal/mol in cyclohexane. The potential energy surface is unusual; the rotational transition state 9a-rot-ts connects directly to the orthogonal transition state for ring-closure 9aTS. The decoupling of rotational and pseudopericyclic bond-forming transition states is contrasted with the single pericyclic transition state (15TS) for the electrocyclic ring-opening of oxetene (15) to acrolein (16). For comparison, the calculated homolytic strength of the N--NO bond is 40.0 kcal/mol (MP4(SDQ, FC)/6-31G*//MP2/6-31G* + ZPE).

Data mining approach to policy analysis in a health insurance domain.

This study examined the characteristics of the knowledge discovery and data mining algorithms to demonstrate how they can be used to predict health outcomes and provide policy information for hypertension management using the Korea Medical Insurance Corporation database. Specifically, this study validated the predictive power of data mining algorithms by comparing the performance of logistic regression and two decision tree algorithms, CHIAD (Chi-squared Automatic Interaction Detection) and C5.0 (a variant of C4.5) using the test set of 4588 beneficiaries and the training set of 13,689 beneficiaries. Contrary to the previous study, the CHIAD algorithm performed better than the logistic regression in predicting hypertension, and C5.0 had the lowest predictive power. In addition, the CHIAD algorithm and the association rule also provided the segment-specific information for the risk factors and target group that may be used in a policy analysis for hypertension management.

Patient satisfaction with telemedicine in home health services for the elderly.

In a pilot study of telemedicine in home health services (HHS) for elderly patients, we implemented and evaluated a telemedicine system with a 33-kbs narrow-band approach to determine its effectiveness in providing quality services. Fifty patients were selected for the study. We found that telemedicine was effective in terms of reducing the number of clinic visits and achieving patient satisfaction. The average number of clinic visits per month was significantly decreased from 0.64 to 0.42 (p < 0.05) after the use of telemedicine. 72% of patients were satisfied with telemedicine, but only patient location showed a significant difference for patient satisfaction (p < 0.05). Patients in their homes (82%) were more satisfied than patients in nursing homes (50%). Of four types of services provided, medical consultation (100%) was the most highly satisfactory service with telemedicine, followed by physical therapy (83.3%). Although the satisfaction scores did not indicate a significant difference in the system characteristics, the quality of verbal communication appeared to be a more important factor in influencing patient satisfaction than set-up time or quality of image. A computer-based patient record was also developed to view a patient summary and to document encounters at the patient's home. Since the system is a low-cost approach that is easy to interface with a notebook computer, it can support various other HHSs.

The reliability and acceptability of telemedicine for patients with schizophrenia in Korea.

We conducted a pilot study to evaluate telemedicine for patients with schizophrenia. The telemedicine system was connected over the ordinary telephone network at 33 kbit/s. A computer-based patient record was used to view patient summaries and to allow nursing notes to be entered at the patient's home. Fifteen patients with schizophrenia were assessed over the telemedicine system and 15 patients were assessed face to face, using the Brief Psychiatric Rating Scale (BPRS). Our low-bandwidth telemedicine system appeared to be as reliable as higher-bandwidth ISDN systems. In addition, the patients' acceptance of the telemedicine interview, in terms of comfort, ease of self-expression, quality of interpersonal relationship and usefulness, was good in most cases. The only factors significantly affecting the patients' level of acceptance of their particular type of interview were the assessment type (i.e. whether the patient had had a telemedicine assessment or not) and their BPRS score. Since the system was of low cost and was easy to interface with a notebook computer, it could be used support other home-health nursing services.

Development of medical decision support system for leukemia management.

A leukemia management system was developed in this study which is comprised of four modules: registry, diagnosis, prognosis of treatment, and CAI. The emphasis was on patient management as a whole. Three knowledge models were developed to predict accurate diagnosis and prognosis of treatment: case-based reasoning, neural network, and discriminant analysis, Of these, discriminant analysis model produced the most accurate diagnosis, whereas neural network produced the most accurate prognosis of treatment.

Correlation between the postmortem stature and the dried limb-bone lengths of Korean adult males.

The postmortem stature was measured in 57 Korean adult males (age range: 20-86 years old, mean: 52.3 years old) in supine position. After dissection of the corpses, we measured the maximum length of the remaining limb-bones (humerus, radius, ulna, femur, tibia and fibula). The correlation coefficients between the stature and each limb-bone length were calculated. Simple regression equations for estimating stature from each limb-bone length and multiple regression equations from the combination of limb-bone lengths were also obtained.

Effects of the situational context and interactional process on the quality of family caregiving.

A staged theoretical model designed to explain the quality of elder caring by family members was tested. The model posits how the situational context, interactional process, and caregiving burden perceived by the caregiver affect the quality of elder caring. The purpose was to determine the amount of variance explained by the interactional process beyond that explained by the situational context and caregiving burden. Data were collected from 209 elder-caregiver dyads using interviews, observations, and caregiver self-reports. The strongest predictors of caregiving burden were the caregiver's stressful negative life events (situational context) and discrepancy between past and present image of elder (interactional process). The strongest predictors of quality of elder caring were the caregiver's perception of subjective burden and a monitoring role definition on the part of the caregiver (interactional process).

Structural modeling of differential diagnosis, treatment, and results for allergic rhinitis.

This paper analyzed the relationship among the differential diagnosis, treatment, and results for allergic rhinitis using the covariance structural model. The data were collected from 274 patients with suspected allergic rhinitis who visited the Otorlaryngology Department of the Paik Hospital during 1991-1993. After each patient's characteristics was categorized and combined into several common factors, covariance structure analysis was performed to analyze the structural relationships among the differential diagnosis, treatment, and results of treatment using the significant factors obtained from discriminant analysis. The significant characteristics influenced the diagnosis were the results of skin test from mite/animal, and from mugworts, the results from laboratory tests, rhinorrhea and sneezing, and nasal polyps. The significant characteristics that influenced the method of treatment were: nasal polyps, headache/general symptom, family history/medication, and septal deviation. Headache/general symptom was the only significantly influencing factor for the treatment results.

Measuring the success of implementation of information system for health center.

The purpose of this study is to analyze the effects of the Health Management Information System (HMIS) on the productivity and adoption process of health center staff as well as the satisfaction with the services provided by the Kwonsun health center located in Suwon city as a study subject. Three surveys were conducted to measure the changes in productivity and adoption process (knowledge, persuasion, decision, implementation, and confirmation) of health center staffs over time. In addition, the effects of HMIS on the level of satisfaction with the services perceived by the visitors were also measured by comparing the satisfaction level between the study health center and a similar health center as a control group. The results suggest that HMIS increased productivity and satisfaction of staffs but did not increase persuasion and decision level, and that it succeeded in increasing the satisfaction with the services for the visitors.

Implementing health management information systems: measuring success in Korea's health centers.

This article analyses the effects that the introduction and adoption of a health management information system (HMIS) can have on both the productivity of health center staff as well as on user-satisfaction. The focus is upon the service provided by the Kwonsun Health Center located in Suwon City, Korea. Two surveys were conducted to measure the changes in productivity and adoption (knowledge, persuasion, decision, implementation and confirmation) of health center staff over time. In addition, a third survey was conducted to measure the effects of HMIS on the level of satisfaction perceived by the visitors, by comparing the satisfaction level between the study health center and a similar health center identified as a control. The results suggest that HMIS increased the productivity and satisfaction of the staff but did not increase their persuasion and decision levels; and, that is also succeeded in increasing the levels of visitors' satisfaction with the services provided.

Morphogenic development of the pancreas in the staged human embryo.

The Carnegie stage is widely applied in the field of human embryology, and it is more logical to analyze the embryos by this stage than CR length or menstrual age. In this study, the early development of the pancreas is studied by tissue observation and reconstruction using serial sections of 33 human embryo ranging from Carnegie stages 11 to 23. The dorsal pancreas develops from the dorsal wall of the duodenum in stage 12, and the ventral pancreas from the proximal part of the cystic primordium in stage 13 or 14 as a single epithelial thickening, but in one case, as a bilateral thickening which contains some isolated spaces. The rotation of the ventral pancreas starts in stage 15, and completes in stage 17. Surrounding connective tissue differentiates in stage 18.

The development of a decision support system for diagnosing nasal allergy.

This paper deals with the problem of improving the capability of the medical decision support system (MDSS) for diagnosing nasal allergy by integrating the previously developed expert system with the neural network approach. Three knowledge acquisition methods were used to develop the expert system: statistical, rule-based, and the combined approach. Among the three, a combined approach showed the best prediction rate based on discriminant analysis. Using the results of a combined approach as input values, the neural network was developed using back-propagation method. Unlike the expert system, the neural network system provides the resulting allergy status in probabilistic terms. Managerial as well as legal issues were also discussed in this paper.

The QUALCARE Scale: developing an instrument to measure quality of home care.

In previous research, the theoretical and methodological problems associated with operationalizing elder abuse have been multiple. The QUALCARE Scale was developed in response to the documented problems. The scale is an observational rating scale designed to quantify the quality of family caregiving to home-dwelling elders in six areas: physical, medical management, psychosocial, environmental, human rights and financial. The scale is a 53 item scale in a Likert type format. The QUALCARE Scale is completed by professional nurses after a nursing assessment of the degree to which the caregiver meets the needs of the elder in the six dimensions. The nursing assessment involves both observations and verbal data gathering. In this paper, the development of the scale and the methodological issues associated with scale development are discussed.

The QUALCARE Scale: testing of a measurement instrument for clinical practice.

This article continues the discussion of the theoretical and methodological issues associated with the use of measurement instruments in nursing such as the QUALCARE Scale. The QUALCARE Scale is an observational rating scale designed to quantify the quality of family caregiving to home-dwelling elders in six areas: physical, medical management, psychosocial, environmental, human rights and financial. This manuscript continues the discussion by reporting the psychometric properties of the scale. The QUALCARE Scale was tested in a descriptive correlational study with 249 caregiver-elder dyads. The results supported evidence of interrater reliability, internal consistency, and criterion and construct validity. Three issues in the use of measurement instruments in clinical practice are discussed: (i) quantification versus qualification, (ii) clinical relevance and (iii) the establishment of rating standards.