• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8361-8366
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• 2014

This meta-analysis was performed to assess the implementation effects of clinical pathways in patients with gastrointestinal cancer. A comprehensive search was conducted in the Cochrane Library, PubMed, EMBASE, Web of Science and Chinese Biomedical Literature Database (from inception to May 2014). Selection of studies, assessing risk of bias and extracting data were performed by two reviewers independently. Outcomes were analyzed by fixed-effects and random-effects model meta-analysis and reported as mean difference (MD), standardized mean difference (SMD) and odds ratio (OR) with 95% confidence intervals (CI). The Jadad methodological approach was used to assess the quality of included studies and the meta-analysis was conducted with RevMan 5.1 software. Nine citations (eight trials) involving 642 patients were included. The aggregate results showed that a shorter average length of stay [MD = -4.0; 95% CI (-5.1, -2.8); P < 0.00001] was observed with the clinical pathways as compared with the usual care. A reduction in inpatient expenditure [SMD = -1.5; 95% CI (-2.3, -0.7); P = 0.0001] was also associated with clinical pathways, along with higher patient satisfaction [OR = 4.9; 95% CI (2.2, 10.6); P < 0.0001]. Clinical pathways could improve the quality of care in patients with gastrointestinal cancer, as evidenced by a significant reduction in average length of stay, a decrease in inpatient expenditure and an improvement in patient satisfaction. Therefore, indicators and mechanisms within clinical pathways should be a focus in the future.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8271-8277
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• 2014

Aims: Apparent diffusion coefficient (ADC) values of nodes in diffusion-weighted imaging (DWI) are widely used in differentiating metastatic from non-metastatic lymph nodes. The purpose of this meta-analysis was to demonstrate whether DWI could contribute to the precise diagnosis of breast cancer (BC) with and without lymph node metastasis (LNM). Materials and Methods: English and Chinese electronic databases were searched for relevant studies followed by a comprehensive literature search. Two reviewers independently assessed the methodological quality of the included trials based on the quality assessment of diagnostic accuracy studies (QUADAS). Summary odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were calculated. Results: Final analysis of 624 BC subjects (patients with LNM = 254, patients without LNM = 370) were incorporated into the current meta-analysis from 9 eligible cohort studies. Combined ORs of ADCs suggested that ADC values in BC patients without LNM were higher than in patients with LNM (OR=0.56, 95%CI: 0.11-1.01, p=0.015). Subgroup analysis stratified by country indicated a low ADC value in BC patients with LNM rather than those without LNM among Chinese (OR=1.27, 95%CI: 0.89-1.66, p<0.001), Italians (OR=0.75, 95%CI: 0.13-1.38, p=0.018), and Egyptians (OR=1.27, 95%CI: 0.71-1.84, p<0.001). The findings of subgroup analysis by MRI machine type revealed that ADC values from diffusion MRI may be potential diagnostic indicators for BC using Non-Philips 1.5T (OR=1.10, 95%CI: 0.84-1.36, p<0.001). Conclusions: The main findings of our meta-analysis demonstrated that increased signal intensity on DWI and decreased signals on ADC are helpful in diagnosis of BC patients with or without LNM. DWI could therefore be an important imaging investigation in patients suspected of BC.

• The Journal of Engineering Geology
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• v.3 no.3
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• pp.241-252
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• 1993

Lead bas been found in the groundwater in Door County, Wiscorsin, with temporally and spatially irregular distribution in concentration. Correlation coeffidents were calculated among lead indicators in groundwater(frequency of lead detections, mean and maximum concentration of lead detections) and seven independent variables(stucture and geographic factors of wells, hydrogeological factors at lead-arsenate mixing sites and the level of soil contamination) which are possibly related to the lead level in groundwater. The significance of relationships was determined statistically by a t-test at the 90% confidence level, and indicated that the spatially located lead-arsenate mixing sites provided the lead in groundwater in the study area. A total of 112 groundwater samples were collected from 5 house wells with previous lead detects. Lead was detected in partides on ifiter papers with $0.45{\;}\mu\textrm{m}$ pore size, but not in filtrates. The result of chemical analysis for lead indicates that lead is associated with partides in groundwater in Door County. Subsequently, the irregular distribution of lead in the county results from the transport of particulate lead along the advective groundwater movement through the preferential pathways sucn as vertical and bedding-plane joints.

• 보존과학연구
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• s.26
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• pp.103-126
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• 2005

Coprostanol is a metabolic product of cholesterol, formed by microbial action in the mammalian gut. This chemical compound is the major sterol in human and has been routinely studied as a biomarker of sewage pollution in marine and lacustrinesediments. This has led to the search for coprostanol as a biomarker in archaeologicalsoils, in order to detect the presence of fecal material. In this study, five samples of archaeological soils excavated at Wanggung ri, Iksancity, were used to assess the possibility of using coprostanol as indicators of ancient human activity in archaeological areas. The sampled soils were analyzed MXRD,EDXRF for their physical and chemical properties. And coprostanol was analysed byGC/MSD, using SIM method to detect and quantify specific compound. The results showed the soils were composed of quartz and feldspars, inorganicelement such as $SiO_2$, $Al_2O_3$, $Fe_2O_3$ etc. Moreover, the result from the analysis wasindicated that the specific compound is coprostanol. The coprostanol was determined at $0.16~1.01\mug$/g in the range of concentrations. This finding indicate that clear promise exists for the exploitation of coprostanol as biomarker of ancient human activity inarchaeological survey. Therefore such studies can serve to increase the confidence we place on biomarker-based methodologies for assessing fecal pollution. The application of this methodology has proved a simple and effective way of searching for that pattern in successively more aged deposits either known or suspected to contain fecal material. And the more scientific analysis of the soils will be showed to utility of the area ancient dietary life style, ancient environment.

• Health Policy and Management
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• v.14 no.4
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• pp.1-20
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• 2004

This study is to examine relationships of several socioeconomic position indicators with mortality risk in a nationwide longitudinal study of South Korea. The Korea Labor & Income Panel Study, conducted on a probability sample of urban South Korean households by Korea Labor Institute, contains date of death information for the decedents which were used to estimate relative risks of mortality and their $95\%$ confidence intervals (CI) with Cox regression analysis. A total of 125 men and women among 8,415 subjects died between 1998 and 2002. Socioeconomic differentials in mortality were observed after adjustment for sex and age. Those with less than 12-year education had 1.90 times $(95\%\;CI=1.25-2.91)$ greater mortality risk than those with 12-year education or more. Greater mortality risks were also found among those with low occupational class and manual occupation. The magnitude of differentials in mortality risks between occupational class were similar in two different approaches to measuring women's occupational class: (1) approach 1 where women, married or not, retain their own occupational class, and (2) approach 2 where married women are assigned their husbands' occupational class. Relative risks of dying among those with low household Income were 1.62 $(95\%\; CI=1.08-2.42)$ compared with the counterparts. Those who reported economic hardship at the time of survey in 1998 had greater risk of mortality $(RR=1.83,\;95\%\;CI=1.21-2.78)$ than those who did not. In conclusion, increased social discourse and policy discussions about these health inequalities are needed in Korean society. Future studies should explore the causes and mechanisms of socioeconomic mortality inequalities.

• Korean Journal of Adult Nursing
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• v.22 no.3
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• pp.260-270
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• 2010

Purpose: The main question is systematic review of the published in Korea and foreign countries on warming therapy for surgical patients. Methods: The researchers searched at Medline, CINAHL, KERIS, Adult Nursing Association, Korean Society of Nursing Science, Korean Academy of fundamentals of Nursing, and National Assembly Library web site for the published on warming therapy for surgical patients from 1980 to 2008. Words for search were operation/surgery, warming, operation/surgery and warming. Studies were included randomized controlled trial, and there were no restrictions regarding operative phase and outcome measures. Results: 36 published researches that met the criteria were mostly published in foreign countries between 2000 and 2008 and focused on surgery with general anesthesia. Sample size ranged from 21 to 60 subjects, age range between 21 and 60 years of age. Thirty different warming therapies were reported, fifty-two different dependent variables. Outcome indicators included active external warming, intra-operative, and body temperature. 'Positive effects' and 'no effects' equaled. The most frequently reported 'positive effects' were body temperature, shivering, and acid-base balance. No effects were more likely to be heart rate, blood pressure, and hemodynamics. Conclusion: Many types of warming therapy, are reported in the literature with little information about the efficacy of each, many different dependant variables were studied. There were no consistent reports as to length of time used for warming procedures. Overall, the effects of warming therapy are inconsistent. And additional research must be down before any particular method of warming can be used with confidence as to its effectiveness. Attention must be made as to the research design, better measurement of the dependent variables. This review may serve as a base.

• Korean Journal of Adult Nursing
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• v.26 no.6
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• pp.630-641
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• 2014

Purpose: The purpose of current study was to explore the positive outcomes of advanced practice nurse who have experienced the roles in their clinical settings. Methods: This study adopted a qualitative research design based on conventional content analysis. Participants were 16 nurse practitioners have been worked at hospitals or community centers. Data were collected via focus group interviews and analyzed using thematic analysis method. Results: Patients' aspect outcomes were "client-centered care in providing continuity", "providing trust based on expertise", "promoting skilled intervention in patient recovering", "blocking the negative consequences", "quality improvement: nursing becoming tighter", "providing total care for cases that require intensive care", "improving patients outcomes by total management", "increasing confidence in evidence-based professional nursing", "rising the satisfaction by cost-effective services", "providing skilled professional practice", and "providing comprehensive care related to covering various aspects". Other themes elicited also included "promoting efficacy by inter-related health professions supervising", "the expansion of specialized practice areas increase business efficiency", "formation of outside customers due to increasing the satisfaction with skilled nursing care", "filling in the emptying spaces of doctors by practicing reliable role to bridge", "attracting external customers through successful management of subjects", "increasing staff's satisfaction on the role to make a bridge between inside and outside doctors", "24 hours medical expertise of professional staff ready secured", and "low cost, same results, that is, cost-effective" in reference to health care resources aspect. Conclusion: These findings suggested that advanced practice nurses perceived various positive outcomes and provided basic data for outcome indicators of advanced practice nurses' role.

• Korean Journal of Health Education and Promotion
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• v.27 no.1
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• pp.81-89
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• 2010

Objectives: To investigate the relationship between experience of hunger in childhood or adolescence and diabetes mellitus in old age. Methods: Stratified national samples of 421 men and 554 women aged 60-89 in South Korea were analyzed. Diabetes diagnosed by a doctor was used as the dependent variable. Experience of hunger in childhood was assessed with the question, "In your childhood, have you ever gone hungry with skipping a meal?" and "In your childhood, have you ever eaten porridge or some bran cake as main dish instead of rice because of lack of food?" Odds ratios (ORs) and 95% confidence interval (CI) were calculated by multiple logistic regressions. Results: ORs of diabetes by experience of hunger in childhood were 1.64(95% CI 0.95-2.83) for men and 1.58(95% CI 1.01-2.47) for women. Significant association of experience of hunger in childhood with prevalence of diabetes persisted in men after adjustment for adulthood and old age socioeconomic position indicators and other risk factors(OR 1.88(95% CI 1.04-3.41)). The effect of experience of hunger in 10-19 years was more prominent than that in less than 10 years in both gender. Conclusion: Experience of hunger in childhood or adolescence may increase the risk of diabetes in Korean elders.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.10
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• pp.5143-5148
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• 2012

Objective: The aim was to investigate indicators related to DNA damage and cancer pathogenesis in Type II diabetes cases with breast cancer. It was planned to evaluate the relationship between these markers with oral antidiabetic drugs. Research Design and Methods: Fourty patients and 10 healthy individuals were included in the study. HIF-$1{\alpha}$ and 8-OHdG are examined in blood samples taken from these individuals with an ELISA Kit. Statistical analysis of data was performed with 95% confidence using Windows package program SPSS 15.0. Results: HIF-$1{\alpha}$ parameters were found to be meaningfully higher in the patient group than the controls in both pretreatment and posttreatment periods (p<0.05). No significant differences in terms of 8-OHdG between patients and controls. However, posttreatment serum HIF-$1{\alpha}$ ve 8-OHdG levels was found lower than pretreatment levels in patients receiving metformin, but not with pioglitazone. Conversely, serum 8-OHdG levels decreased significantly in these patients. When patients were evaluated according to the treatment groups (pioglitazone vs. metfformin) no significant differences in terms of serum HIF-$1{\alpha}$ and 8-OHdG levels between treatment groups. Conclusions: HIF-$1{\alpha}$ levels decreased significantly in the patient group receiving metformin. However, there was no significant difference in terms of HIF-$1{\alpha}$ levels in the patients receiving pioglitazone.

• Clinical and Experimental Pediatrics
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• v.60 no.11
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• pp.353-358
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• 2017

Purpose: To develop and evaluate a simple screening tool to assess hearing loss in newborns. A derived score was compared with the standard clinical practice tool. Methods: This cohort study was designed to screen the hearing of newborns using transiently evoked otoacoustic emission and auditory brain stem response, and to determine the risk factors associated with hearing loss of newborns in 3 tertiary hospitals in Northern Thailand. Data were prospectively collected from November 1, 2010 to May 31, 2012. To develop the risk score, clinical-risk indicators were measured by Poisson risk regression. The regression coefficients were transformed into item scores dividing each regression-coefficient with the smallest coefficient in the model, rounding the number to its nearest integer, and adding up to a total score. Results: Five clinical risk factors (Craniofacial anomaly, Ototoxicity, Birth weight, family history [Relative] of congenital sensorineural hearing loss, and Apgar score) were included in our COBRA score. The screening tool detected, by area under the receiver operating characteristic curve, more than 80% of existing hearing loss. The positive-likelihood ratio of hearing loss in patients with scores of 4, 6, and 8 were 25.21 (95% confidence interval [CI], 14.69-43.26), 58.52 (95% CI, 36.26-94.44), and 51.56 (95% CI, 33.74-78.82), respectively. This result was similar to the standard tool (The Joint Committee on Infant Hearing) of 26.72 (95% CI, 20.59-34.66). Conclusion: A simple screening tool of five predictors provides good prediction indices for newborn hearing loss, which may motivate parents to bring children for further appropriate testing and investigations.