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  • Articles  (35)
  • Oxford University Press  (35)
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  • Articles  (35)
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  • 1
    Publication Date: 2016-02-03
    Description: Background : The diagnosis-related group-based prospective payment programme was introduced in Korea in 1997 as a pilot programme to control health spending. In July 2013, the programme was implemented throughout the nation. The aim of our study is to evaluate the relationship between quality of care and market competition following the introduction of the new payment system in Korea. Methods : We conduct an observational analysis using National Health Insurance claim data from 2011 to 2014. We analyse data on readmission within 30 days, length of stay, and number of outpatient visits for 1742 hospitals and 821 912 cases. We use a generalized estimating equation model to evaluate readmission within 30 days and number of outpatient visits and a multi-level regression model to assess length of stay. Results : Total readmission within 30 days is 10 727 (1.3%). High competition areas present a lower risk of readmission [odds ratio (OR): 0.95, P : 0.0277], a longer length of stay (1%, P 〈 0.0001), and an increased number of outpatient visits (Relative Risk: 1.11, P : 0.0011) as compared with moderate competition areas. Risk of readmission is higher in low competition areas as compared with moderate competition areas (OR: 1.21, P 〈 0.0001). Conclusion: The effects of the introduction of the new payment system differed by degree of market competition. Thus, evaluation about the effect of new payment system on hospital performance should be measured in combination with the degree of hospital market structure.
    Print ISSN: 1101-1262
    Electronic ISSN: 1464-360X
    Topics: Medicine
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  • 2
    Publication Date: 2013-08-17
    Description: Electron microscopy is used to determine the form and size of samples from images. Consequently, distortion or error in the images produces incorrect data. This study developed an algorithm to enhance the scanner signal in order to improve the orthogonality of the image. The results of images with poor orthogonality, when observed from the central axis standard, are analogous to those of rotationally transformed images. Therefore, we believe that transmitting enhanced signals with rotationally transformed images will improve the quality of the data.
    Print ISSN: 0022-0744
    Electronic ISSN: 1477-9986
    Topics: Electrical Engineering, Measurement and Control Technology , Natural Sciences in General , Physics
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  • 3
    Publication Date: 2015-02-28
    Description: Background Epstein–Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is defined only in adults older than 50 years. However, EBV-positive DLBCL can affect younger patients. We investigated the prevalence, clinical characteristics and survival outcomes of EBV-positive DLBCL in young adults. Patients and methods We analyzed patients with de novo DLBCL who were registered in the Samsung Medical Center (SMC) retrospective lymphoma cohort and prospective SMC Lymphoma Cohort Study I (ClinicalTrials.gov: NCT00822731). Results A total of 571 cases were included in the analysis. The prevalence of EBV positivity was 6.7% (13/195) and 9.3% (35/376) in the young group (≤50 years) and in the elderly group (〉50 years), respectively. EBV status was closely associated with unique unfavorable clinical characteristics [older age, more advanced stage, two or more sites of extranodal involvement, higher International Prognostic Index (IPI), and age-adjusted IPI risk] only in the elderly group. Poor prognostic impact of EBV positivity on overall survival was observed only in the elderly group [hazard ratio (HR) 2.86; 95% confidence interval (CI) 1.83–4.47; P 〈 0.001], but not in the young group (HR 1.17; 95% CI 0.35–3.89; P = 0.801). Conclusion A substantial proportion of EBV-positive DLBCL of the elderly can occur in young adults. EBV positivity of DLBCL in young adults was not associated with unfavorable clinical characteristics or worse outcomes. We suggest that EBV-positive DLBCL should not be confined only in the elderly and ‘EBV-positive DLBCL in young adults’ needs to be considered as a clinically distinct disease entity. ClinicalTrials.gov NCT02060435.
    Print ISSN: 0923-7534
    Electronic ISSN: 1569-8041
    Topics: Medicine
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  • 4
    Publication Date: 2015-10-08
    Description: We present mid-infrared (MIR) luminosity functions (LFs) of local ( z  〈 0.3) star-forming (SF) galaxies in the AKARI 's North Ecliptic Pole (NEP)-Wide survey field. In order to derive more accurate LF, we used spectroscopic sample only. Based on the NEP-Wide point source catalogue containing a large number of infrared (IR) sources distributed over the wide (5.4 deg 2 ) field, we incorporated the spectroscopic redshift ( z ) data for ~1790 selected targets obtained by optical follow-up surveys with MMT/Hectospec and WIYN/Hydra. The AKARI 's continuous 2–24 μm wavelength coverage as well as photometric data from optical u * band to near-infrared H band with the spectroscopic redshifts for our sample galaxies enable us to derive accurate spectral energy distributions (SEDs) in the MIR. We carried out SED fit analysis and employed 1/ V max method to derive the MIR (e.g. 8, 12, and 15 μm rest-frame) LFs. We fit our 8 μm LFs to the double power-law with the power index of α = 1.53 and β = 2.85 at the break luminosity 4.95  x  10 9 L . We made extensive comparisons with various MIR LFs from several literatures. Our results for local galaxies from the NEP region are generally consistent with other works for different fields over wide luminosity ranges. The comparisons with the results from the NEP-Deep data as well as other LFs imply the luminosity evolution from higher redshifts towards the present epoch.
    Print ISSN: 0035-8711
    Electronic ISSN: 1365-2966
    Topics: Physics
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  • 5
    Publication Date: 2014-09-12
    Description: We present herein galaxy number counts of the nine bands in the 2–24 μm range on the basis of the AKARI North Ecliptic Pole (NEP) surveys. The number counts are derived from NEP-deep and NEP-wide surveys, which cover areas of 0.5 and 5.8 deg 2 , respectively. To produce reliable number counts, the sources were extracted from recently updated images. Completeness and difference between observed and intrinsic magnitudes were corrected by Monte Carlo simulation. Stellar counts were subtracted by using the stellar fraction estimated from optical data. The resultant source counts are given down to the 80 per cent completeness limit; 0.18, 0.16, 0.10, 0.05, 0.06, 0.10, 0.15, 0.16 and 0.44 mJy in the 2.4, 3.2, 4.1, 7, 9, 11, 15, 18 and 24 μm bands, respectively. On the bright side of all bands, the count distribution is flat, consistent with the Euclidean universe, while on the faint side, the counts deviate, suggesting that the galaxy population of the distant universe is evolving. These results are generally consistent with previous galaxy counts in similar wavebands. We also compare our counts with evolutionary models and find them in good agreement. By integrating the models down to the 80 per cent completeness limits, we calculate that the AKARI NEP survey revolves 20–50 per cent of the cosmic infrared background, depending on the wavebands.
    Print ISSN: 0035-8711
    Electronic ISSN: 1365-2966
    Topics: Physics
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  • 6
    Publication Date: 2015-12-13
    Description: The scanning electron microscope is used in various fields to go beyond diffraction limits of the optical microscope. However, the electron pathway should be conducted in a vacuum so as not to scatter electrons. The pretreatment of the sample is needed for use in the vacuum. To directly observe large and fully hydrophilic samples without pretreatment, the atmospheric scanning electron microscope (ASEM) is needed. We developed an electron filter unit and an electron detector unit for implementation of the ASEM. The key of the electron filter unit is that electrons are transmitted while air molecules remain untransmitted through the unit. The electron detector unit collected the backscattered electrons. We conducted experiments using the selected materials with Havar foil, carbon film and SiN film.
    Print ISSN: 0022-0744
    Electronic ISSN: 1477-9986
    Topics: Electrical Engineering, Measurement and Control Technology , Natural Sciences in General , Physics
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  • 7
    Publication Date: 2015-11-17
    Description: Aims To investigate the impact of lesion angle on the incidence and distribution of acute vessel wall injuries and incomplete stent apposition (ISA) following second-generation drug-eluting stent (DES) implantation using optical coherence tomography (OCT). Several ex vivo studies demonstrated that angled arterial walls are exposed to imbalanced mechanical stress from deployed stents. Methods and results We included 243 lesions treated with a single DES (148 everolimus-eluting stent and 95 zotarolimus-eluting stent). Angled lesions were defined as lesions with angle ≥45° on an angiogram ( n = 58). The vessel wall injuries and ISA were evaluated by OCT. The results were compared with non-angled lesions (〈45°, n = 185). The incidence of instent dissection, thrombus, and ISA was significantly higher in the angled group than in the non-angled group (84.5 vs. 63.2%, P 〈 0.01; 55.2 vs. 35.1%, P 〈 0.01; 75.9 vs. 44.9%, P 〈 0.001, respectively). In the angled group, the normalized tissue protrusion volume around the centre of angle (6.59 ± 6.81, mm 3 x 10 2 ) was higher than in the distal sub-segment (2.21 ± 2.87, mm 3 x 10 2 , P 〈 0.001), in the proximal sub-segment (4.14 ± 5.34, mm 3 x 10 2 , P = 0.02), and in the non-angled group (3.30 ± 2.81, mm 3 x 10 2 , P 〈 0.001). The incidence of major adverse cardiac events within 12 months was similar between the groups. Conclusions Angled coronary lesions had a higher incidence rate of OCT-detected vessel wall injuries and ISA compared with non-angled lesions following second-generation DES implantation. Further studies are needed to understand the long-term clinical significance of these findings.
    Print ISSN: 1525-2167
    Electronic ISSN: 1532-2114
    Topics: Medicine
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  • 8
    Publication Date: 2016-03-01
    Description: Background Romidepsin, a histone deacetylase (HDAC) inhibitor, has been approved for the treatment of relapsed and refractory peripheral T-cell lymphoma. However, the efficacy and safety of romidepsin has never been studied in patients with relapsed or refractory extranodal natural killer (NK)/T-cell lymphoma (ENKTL). Patients and methods We conducted an open-label, prospective pilot study to evaluate the efficacy and feasibility of romidepsin in the treatment of patients with ENKTL. The treatment was intravenous infusion of romidepsin (14 mg/m 2 ) for 4 h on days 1, 8, and 15 of a 28-day cycle, and was repeated until disease progression or the occurrence of unacceptable toxicity. Results A total of five patients enrolled on to this pilot study. However, three patients developed fever and elevated liver enzyme and bilirubin levels immediately after their first administration of romidepsin. We suspected that these events were associated with Epstein–Barr virus (EBV) reactivation because of the rapidly elevated EBV DNA titers in blood from these patients. An in vitro study with the ENKTL cell line SNK-6 cells also showed that HDAC inhibitors including romidepsin increased the copy number of EBV DNA in a dose-dependent manner. These findings suggested that romidepsin-induced histone acetylation reversed the repressed state of the genes required for EBV reactivation and that romidepsin treatment may have caused EBV reactivation in EBV-infected tumor cells in ENKTL patients. Therefore, we discontinued the enrollment of patients into this pilot study. Conclusions Our study suggests that the use of romidepsin may cause severe EBV reactivation in patients with ENKTL.
    Print ISSN: 0923-7534
    Electronic ISSN: 1569-8041
    Topics: Medicine
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  • 9
    Publication Date: 2016-05-26
    Description: Background The use of imatinib combined with chemotherapy has demonstrated improved outcome in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL). However, a substantial proportion of patients continue to die as a result of disease progression. Patients and methods We assessed the minimal residual disease (MRD)-based effect and long-term outcome of first-line incorporation of dasatinib (100 mg once daily) into chemotherapy alternatively for adults with Ph-positive ALL. The primary end point was the major molecular response (MMR) rate by the end of the second dasatinib cycle. Patients with a donor proceeded to allogeneic stem cell transplantation (SCT) as early as possible. MRD monitoring was centrally evaluated by real-time quantitative polymerase chain reaction (4.5-log sensitivity) using bone marrow samples. Results Fifty-one patients (median age, 46 years) were enrolled and treated with this strategy. After the first dasatinib cycle, 50 patients (98.0%) achieved complete remission (CR). By the end of the second dasatinib cycle, 46 (93.9%) of 49 assessable patients had persistent CR, and 38 (77.6%) had MMR (32.7%) or undetectable MRD (44.9%). On the basis of the MRD kinetics by this time point, the numbers of early-stable, late, and poor molecular responders were 23 (46.9%), 15 (30.7%), and 11 (22.4%), respectively. Thirty-nine patients (76.5%) underwent allogeneic SCT in CR1. After a median follow-up of 54 months, the 4-year cumulative incidence of relapse and disease-free survival (DFS) rate for all patients were 30.0% and 52.0%, respectively, and the corresponding outcomes among those receiving allogeneic SCT in CR1 were 20.5% and 64.1%, respectively. Poor molecular responders had a higher risk of relapse and DFS than those of early-stable molecular responders. Conclusion This dasatinib-based protocol was effective for achieving a good quality molecular response and durable DFS in adults with Ph-positive ALL. Trial registration clinicaltrials.gov, NCT01004497.
    Print ISSN: 0923-7534
    Electronic ISSN: 1569-8041
    Topics: Medicine
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  • 10
    Publication Date: 2015-07-18
    Description: We present infrared (IR) galaxy luminosity functions (LFs) in the AKARI North Ecliptic Pole (NEP) deep field using recently-obtained, wider Canada–France–Hawaii Telescope (CFHT) optical/near-IR images. AKARI has obtained deep images in the mid-infrared (IR), covering 0.6 deg 2 of the NEP deep field. However, our previous work was limited to the central area of 0.25 deg 2 due to the lack of optical coverage of the full AKARI NEP survey. To rectify the situation, we recently obtained CFHT optical and near-IR images over the entire AKARI NEP deep field. These new CFHT images are used to derive accurate photometric redshifts, allowing us to fully exploit the whole AKARI NEP deep field. AKARI 's deep, continuous filter coverage in the mid-IR wavelengths (2.4, 3.2, 4.1, 7, 9, 11, 15, 18, and 24 μm) exists nowhere else, due to filter gaps of other space telescopes. It allows us to estimate rest-frame 8 and 12 μm luminosities without using a large extrapolation based on spectral energy distribution fitting, which was the largest uncertainty in previous studies. Total infrared (TIR) luminosity is also obtained more reliably due to the superior filter coverage. The resulting rest-frame 8 and 12 μm, and TIR LFs at 0.15 〈  z  〈 2.2 are consistent with previous works, but with reduced uncertainties, especially at the high-luminosity end, thanks to the wide-field coverage. In terms of cosmic infrared luminosity density ( IR ), we found that the IR evolves as (1 +  z ) 4.2 ± 0.4 .
    Print ISSN: 0035-8711
    Electronic ISSN: 1365-2966
    Topics: Physics
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