Search

For years, neoadjuvant chemotherapy for locally advanced pancreatic cancer is being investigated and radical surgical resection with laparoscopic approach is getting up to speed. Pathological complete remission is known as a predictive marker for a good prognosis for various carcinomas. Although there are a few case reports about pathological complete remission, there has been no case report of pathological complete remission resulted from successful extensive resection by laparoscopic surgery after a neoadjuvant modified FOLFIRINOX chemotherapy. A 68-year-old male patient was admitted due to a palpable abdominal mass which turned out to be 16-cm-sized huge locally advanced left-sided pancreatic cancer with possible stomach, left adrenal gland, left kidney, and colon invasion. After administration of 10th modified FOLFIRINOX chemotherapy, the tumor had decreased and he underwent laparoscopic radical distal pancreatectomy with splenectomy, left adrenalectomy, wedge resection of stomach, and segmental resection of transverse colon. Although patient had a postoperative micro-abscess around the colon anastomosis site, he was successfully managed with conservative treatment and discharged on 12 days postoperatively. The final pathology reported complete tumor regression. We hereby emphasize the oncologic significance of neoadjuvant chemotherapy in huge left-sided pancreatic cancer and the potential role of laparoscopic conversion surgery.

Objective: To investigate trends and associated factors of utilization of hospital palliative care among patients with systemic lupus erythematosus (SLE) and analyze its impact on length of hospital stay, hospital charges, and in-hospital mortality. Methods: Using the 2005-2014 National Inpatient Sample in the United States, the compound annual growth rate was used to investigate the temporal trend of utilization of hospital palliative care. Multivariate multilevel logistic regression analyses were performed to analyze the association with patient-related factors, hospital factors, length of stay, in-hospital mortality, and hospital charges. Results: The overall proportion of utilization of hospital palliative care for the patient with SLE was 0.6% over 10 years. It increased approximately 12-fold from 0.1% (2005) to 1.17% (2014). Hospital palliative care services were offered more frequently to older patients, patients with high severity illnesses, and in urban teaching hospitals or large size hospitals. Patients younger than 40 years, the lowest household income group, or Medicare beneficiaries less likely received palliative care during hospitalization. Hospital palliative care services were associated with increased length of stay (β = 1.407, P < .0001) and in-hospital mortality (odds ratio, 48.18; 95% confidence interval, 41.59-55.82), and reduced hospital charge (β = −0.075, P = .009). Conclusion: Hospital palliative care service for patients with SLE gradually increased during the past decade in US hospitals. However, this showed disparities in access and was associated with longer hospital length of stay and higher in-hospital mortality. Nevertheless, hospital palliative care services yielded a cost-saving effect.

IntroductionMedullary thyroid carcinoma (MTC) is a rare cancer that accounts for 5% of thyroid cancers. Serum calcitonin is a good biomarker for MTC, which is used for diagnosis, prognosis, and monitoring of recurrence. Calcitonin-negative MTC (CNMTC) is rare but confounds diagnostic and prognostic directions. This study introduces 19 cases of CNMTC in a single center.MethodFrom 2002 March to 2020 July, more than 76,500 patients had undergone thyroid surgery due to thyroid cancer at the Severance Hospital, and a total of 320 patients were diagnosed with MTC (0.4%). Serum calcitonin levels were obtained from every patient who was suspected with MTC. These patients had undergone either bilateral total thyroidectomy or unilateral thyroidectomy with central compartment lymph node dissection, and additional modified radical lymph node dissection if lateral lymph node metastasis was positive. Postoperative monitoring and out-patient clinic follow-up were performed with obtaining the serum calcitonin levels.ResultNineteen patients tested negative for calcitonin preoperatively (6%). The mean preoperative calcitonin level was 5.1pg/mL if undetectable level is regarded as 0pg/mL. Only two patients were males, and the female bias was significant (p = 0.017). No one except two patients with modified radical neck dissection showed central compartment lymph node metastasis. Every patient’s postoperative calcitonin level remained low. The median follow-up period was 71 months. There was no recurrence and only one fatality, and the overall survival rate was 95%.ConclusionSince incidence of CNMTC is not negligible, MTC should not be ruled out in the diagnostic phase even if serum calcitonin is negative in preoperative examination. We presented 19 cases of CNMTC whose prognosis in general were favorable. Markers of serum and immunohistochemical samples other than calcitonin should be actively examined.

ObjectiveWe have investigated the molecular function of SCAMP5, a candidate risk gene for SLE exclusively expressed in plasmacytoid dendritic cells (pDCs) among peripheral leucocytes.MethodsWe tested the independence of the association in SCAMP5 with SLE by performing conditional analyses. We profiled the expression pattern of SCAMP5 among circulating leucocytes at the transcript and protein levels. Using lentiviral vectors, we localised the subcellular distribution of SCAMP5 alongside the interferon secretory pathway. We analysed pDCs for the expression of SCAMP5 and interferon production capacity by SCAMP5 genotype. Finally, we examined pDC-specific SCAMP5 isoforms by total RNAseq analysis and examined for genotype-associated quantitative differences therein.ResultsA conditional analysis revealed evidence of an independent genetic association of SCAMP5 with SLE. Among circulating leucocytes, SCAMP5 is uniquely expressed in pDCs at the transcript and protein levels, with main presence in the Golgi apparatus and minor presence at the cell periphery. In live cells, SCAMP5 displayed dynamic Golgi-cell surface trafficking and localised with the interferon secretory pathway. SCAMP5 did not differ in expression levels in pDCs between genotyped donors; however, a transient interferon secretory defect was noted in pDCs from donors carrying the risk genotype.ConclusionsSCAMP5 constitutes a novel SLE risk gene on the basis of genomic data and expression in a cell type widely implicated in SLE pathogenesis. While we could not find evidence of quantitative expression differences in SCAMP5 between genotyped donors, SCAMP5 remains an attractive gene to explore given its highly restricted expression pattern and colocalisation with interferon secretion.

Background In Korea, the universal health system offers coverage to all members of society. Despite this, it is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. We evaluated the impact of low income on HCC mortality. Methods The Korean National Health Insurance sampling cohort was used to identify new HCC cases (n = 7325) diagnosed between 2004 and 2008, and the Korean Community Health Survey data were used to investigate community-level effects. The main outcome was 5-year all-cause mortality risk, and Cox proportional hazard models were applied to investigate the individual- and community-level factors associated with the survival probability of HCC patients. Results From 2004 to 2008, there were 4658 new HCC cases among males and 2667 new cases among females. The 5-year survival proportion of males was 68%, and the incidence per person-year was 0.768; the female survival proportion was 78%, and the incidence per person-year was 0.819. Lower income was associated with higher hazard ratio (HR), and HCC patients with hepatitis B (HBV), alcoholic liver cirrhosis, and other types of liver cirrhosis had higher HRs than those without these conditions. Subgroup analyses showed that middle-aged men were most vulnerable to the effects of low income on 5-year mortality, and community-level characteristics were associated with survival of HCC patients. Conclusion Having a low income significantly affected the overall 5-year mortality of Korean adults who were newly diagnosed with HCC from 2004 to 2008. Middle-aged men were the most vulnerable. We believe our findings will be useful to healthcare policymakers in Korea as well as to healthcare leaders in countries with NHI programs who need to make important decisions about allocation of limited healthcare resources according to a consensually accepted and rational framework.

Background To comprehensively understand the molecular mechanism of tamoxifen resistance (TamR) acquisition by epigenetically regulated genes, it is essential to identify pivotal genes by genome-wide methylation analysis and verify their function in xenograft animal model and cancer patients. Methods The MCF-7/TamR breast cancer cell line was developed and a genome-wide methylation array was performed. The methylation and expression of ELOVL2 was validated in cultured cells, xenografted tumor tissue, and breast cancer patients by methylation-specific PCR, qRT-PCR, Western blot analysis, and immunohistochemistry. Deregulation of ELOVL2 and THEM4 was achieved using siRNA or generating stable transfectants. Tam sensitivity, cell growth, and apoptosis were monitored by colorimetric and colony formation assay and flow cytometric analysis. Pathway analysis was performed to generate networks for the differentially methylated genes in the MCF-7/TamR cells and for the differentially expressed genes in the ELOVL2-overexpressing cells. Results Genome-wide methylation analysis in the MCF-7/TamR cells identified elongation of very-long chain fatty acid protein 2 (ELOVL2) to be significantly hypermethylated and downregulated, which was further verified in the tumor tissues from TamR breast cancer patients (n = 28) compared with those from Tam-sensitive (TamS) patients (n = 33) (P THEM4, which plays crucial roles in drug resistance. Conclusions ELOVL2 was hypermethylated and downregulated in TamR breast cancer patients compared with TamS patients. ELOVL2 is responsible for the recovery of Tam sensitivity. AKT- and ERα-hubbed networks are pivotal in ELOVL2 signaling, where THEM4 contributes to the relaying ELOVL2 signaling. This study implies that deregulation of a gene in fatty acid metabolism can lead to drug resistance, giving insight into the development of a new therapeutic strategy for drug-resistant breast cancer.

Background: Palliative care services and life-sustaining treatments are provided to dying patients with lung cancer in the United States. However, data on the utilization trends of palliative care services and life-sustaining treatments of dying patients with lung cancer are not available. Methods: This study was a retrospective analysis of the National Inpatient Sample data (2005-2014) and included patients with lung cancer, aged ≥ 18 years, who died in the hospitals. Claims data of palliative care services and life-sustaining treatments that contained systemic procedures, local procedures, or surgeries were extracted. Compound annual growth rates (CAGRs) using Rao-Scott correction for χ2 tests were used to determine the statistical significance of temporal utilization trends of palliative care services and life-sustaining treatments and their hospital costs. Multilevel multivariate regressions were performed to identify factors associated with hospital costs. Results: A total of 120 144 weighted patients with lung cancer died in the hospitals and 41.9% of them received palliative care services. The CAGRs of systemic procedures, local procedures, surgeries, palliative care services, and hospital cost were 3.42%, 3.48%, 6.08%, 18.5%, and 5.0% (all P < .001), respectively. Increased hospital cost was attributed to systemic procedures (50.6%), local procedures (74.4%), and surgeries (68.5%; all P < .001), respectively. Palliative care services were related to decreasing hospital costs by 28.6% ( P < .001). Conclusion: The temporal trends of palliative care services indicate that their utilization has increased gradually. Palliative care services were associated with reduced hospital costs. However, life-sustaining treatments were associated with increased hospital costs.

Background In 2000, the South Korean government introduced a program in emergency medical institutions throughout the country to establish effective management system for emergency patients. The aim of this study was is to investigate the effectiveness of this program for emergency patients and establish evidence for more effective strategy by comparing the relationship between types of emergency medical center and 30 day mortality after hospitalization in inpatients with cerebrovascular and cardiovascular diseases. Methods We used National Health Insurance claim data (n = 111,741) from 115 hospitals during 2010–2013 to analyze readmissions within 30 days after hospitalization due to cerebrovascular and cardiovascular diseases. We performed χ2 tests, analysis of variance and logistic regression analysis using generalized estimating equation (GEE) modeling to investigate associations with 30 day mortality after hospitalization. Results Deaths within 30 days of hospitalization due to cerebrovascular and cardiovascular diseases were 6.5%. Regional emergency medical center and localized emergency medical center had lower risk in 30 days mortality after hospitalization than localized emergency medical agency (regional emergency medical center = OR: 0.71, 95 CI: 0.60–0.84; localized emergency medical center = OR: 0.81, 95% CI: 0.72–0.90; ref. = localized emergency medical agency). In addition, reduction in 30 days mortality by types of emergency medical institutes was more highly associated in cerebrovascular diseases than cardiovascular diseases. Conclusions Government designated higher level emergency medical institutes had better outcomes in emergency medical care than localized emergency medical agencies. Thus, health policy makers have to consider optimal reimbursement in the field of emergency medicine.

Background/Aim We aimed to evaluate the efficacy of sending educational video clips via smartphone mobile messenger (SMM) on enhancing bowel preparation before colonoscopy. Methods This was a prospective, endoscopist-blinded, randomized controlled study. Patients in the SMM group received two video clips sent via SMM that explained the diet and regimen for bowel preparation, whereas those in the control group did not receive any video clips. We compared the quality of bowel preparation between the two groups, which was assessed by an endoscopist using the Ottawa scale. Results Between August and November 2014, 140 patients in the SMM group and 141 patients in the control group underwent colonoscopic examination. T he total Ottawa score of the SMM group was significantly lower than that of the control group (5.47±1.74 vs. 5.97±1.78, p=0.018). These results were particularly prominent in the younger age group; the total Ottawa score of patents in the SMM group aged

Multiple sclerosis (MS) is a chronic neuro-inflammatory disease of the central nervous system, associated with accumulation of irreversible neurological disabilities through both inflammatory relapses and progressive neurodegeneration. Patients with debilitating MS could benefit from palliative care perspectives both during relapses that lead to transient disability as well as later in the disease course when significant physical and cognitive disability have accrued. However, no data about palliative care utilization trends of MS patients are available. We examined 10-year temporal trends of palliative care and assessed independent associations of palliative care with hospital utilization and cost using the 2005-2014 national inpatient sample. The national trends of palliative care utilization in MS patients increased by 120 times from 0.2% to 6.1% during 2005-2014, particularly with the dramatic single-year increase between 2010 (1.5%) and 2011 (4.5%). Moreover, the proportion of receiving palliative care in in-hospital death gradually increased from 7.7% in 2005 to 58.8% in 2014. Palliative care in MS inpatients may affect hospital utilization and charges in different ways. Hospital palliative care was associated with increased length of stay (LOS) (β = 0.444 days, p 0.001) and in-hospital death (OR = 15.35, 95% CI [13.76, 17.12]), but associated with decreased hospital charges (β = -$2261, p 0.001). In conclusion, the temporal trends of palliative care use in MS inpatients gradually increased with an exponential increase between 2010 and 2011 during 2005-2014, which is mostly attributed to patients with higher risk of in-hospital death. Moreover, palliative care was associated with reduced hospital charge with increased LOS and in-hospital death.

Aims In 1995, nutrition labeling became mandatory in South Korea. These regulations help consumers make reasonable choices when purchasing food based on nutritional value by providing the nutritional properties of processed foods. We investigated the association between perceptions about nutrition labeling and insulin resistance (IR) in people with no diagnosis of diabetes mellitus (DM). Methods This study used data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-3 in 2015, n = 2931). We used multiple regression analysis to investigate the relationship between perceptions about nutrition labeling and the homeostatic model assessment for insulin resistance (HOMA-IR). Results 75.2% of participants were aware of nutrition labeling and 24.8% of participants checked nutrition labeling and actively used the information. “Actively checked and used the nutrition labeling” was inversely associated with HOMA-IR scores (check nutrition facts and make labeling-dependent purchase decisions: β = −0.108, p = 0.0164). These associations were more significant in people who were obese or paid more attention to their health. Conclusion High levels of perceptions about nutrition labeling and active use of such information could have positive effects on reducing IR and preventing DM. Therefore, it is necessary to improve public perception for effective implementation of healthcare programs.

Supplemental Digital Content is available in the text, This study aimed to analyze the trends of opioid use disorders, cannabis use disorders, and palliative care among hospitalized patients with gastrointestinal cancer and to identify their associated factors. We analyzed the National Inpatient Sample data from 2005 to 2014 and included hospitalized patients with gastrointestinal cancers. The trends of hospital palliative care and opioid or cannabis use disorders were analyzed using the compound annual growth rates (CAGR) with Rao-Scott correction for χ2 tests. Multivariate logistic regression analyses were performed to identify the associated factors. From 2005 to 2014, among 4,364,416 hospitalizations of patients with gastrointestinal cancer, the average annual rates of opioid and cannabis use disorders were 0.4% (n = 19,520), and 0.3% (n = 13,009), respectively. The utilization rate of hospital palliative care was 6.2% (n = 268,742). They all sharply increased for 10 years (CAGR = 9.61%, 22.2%, and 21.51%, respectively). The patients with a cannabis use disorder were over 4 times more likely to have an opioid use disorder (Odds ratios, OR = 4.029; P

Supplemental Digital Content is available in the text To identify the trend of opioid-use disorder among hospitalized patients with spine conditions and treatment, we analyzed the NIS data sample from 2005 to 2014 using ICD-9 CM. Opioid-use disorder among these populations increased and was associated with several demographic and economic factors, including cannabis-use disorder from 2005 to 2014., Study Design. Serial cross-sectional study utilizing the National Inpatient Sample (NIS) 2005 to 2014. Objective. The aim of this study was to examine the trends of opioid-use disorders among hospitalized patients with spinal conditions and treatment and to identify its contributing factors. Summary of Background Data. The opioid is widely used in chronic spinal conditions, and misuse of prescriptions is the main culprit of the opioid crisis. Cannabis, the most commonly utilized illicit drug, has recently been substituted for opioid despite increasing cannabis-use emergency room visits. There is limited information on opioid-use disorders, the association with cannabis, and other contributing factors. Methods. We analyzed the 2005 to 2014 NIS data that identified opioid-use disorders among hospitalized patients with cervical and lumbar spinal conditions and treatment using the International Classification of Disease, Ninth Revision-Clinical Modification codes for opioid abuse, dependence, poisoning, and cervical and lumbar spinal diseases and procedures. The compound annual growth rate (CAGR) was used to quantify trends of opioid-use disorders among hospitalized patients. Multilevel and multivariable regression analyses were performed to determine their contributing factors. Results. The number of hospitalizations with spinal conditions and treatment increased from 2005 to 2011, then decreased between 2011 and 2014 with an overall decrease in length of stay, resulting in the CAGR of −1.60% (P

Paclitaxel (Tx) is a widely used therapeutic chemical for breast cancer treatment, however, cancer recurrence remains an obstacle for improved prognosis of cancer patients. In this study, cold atmospheric plasma (CAP) was tested for its potential to overcome the drug resistance. After developing Tx-resistant MCF-7 (MCF-7/TxR) breast cancer cells, CAP was applied to the cells, and its effect on the recovery of drug sensitivity was assessed in both cellular and molecular aspects. Sensitivity to Tx in the MCF-7/TxR cells was restored up to 73% by CAP. A comparison of genome-wide expression profiles between the TxR cells and the CAP-treated cells identified 49 genes that commonly appeared with significant changes. Notably, 20 genes, such as KIF13B, GOLM1, and TLE4, showed opposite expression profiles. The protein expression levels of selected genes, DAGLA and CEACAM1, were recovered to those of their parental cells by CAP. Taken together, CAP inhibited the growth of MCF-7/TxR cancer cells and recovered Tx sensitivity by resetting the expression of multiple drug resistance&ndash, related genes. These findings may contribute to extending the application of CAP to the treatment of TxR cancer.

The current study evaluated risk factors of early hospital readmission in geriatric patients with acute heart failure (HF) and analyzed 2,279 consecutively hospitalized older adults with decompensated HF from November 2013 to October 2014 across 15 U.S. hospitals. The eTracker-HF was designed to make risk factors known to treating clinicians in electronic health records. Multilevel multivariate logistic regression was applied to examine the association between risk factors and all-cause and HF 30-day readmission rates. All-cause and HF 30-day readmission rates were 22.3% and 9.8%, respectively. Old age, non-White ethnicity, delirium, physical impairment, ejection fraction [Res Gerontol Nurs. 2018; 11(4):190–197.]

Background The South Korean government introduced a policy in 2 phases, in September 2005 and in January 2010, for reducing copayments for patients with critical diseases, including stroke, to prevent excessive medical expenditures and to ease economic barriers. Previous studies of the effect of this policy were focused primarily on cancer. Therefore, we investigated the relationship between this policy and 1-year mortality after surgery among patients with stroke. Methods We used data from the Korean National Health Insurance sampling cohort (n = 2173 in 2003-2012) and performed an interrupted time series analysis. Results Approximately 26% of the patients died within 1 year after surgery. The time trends after reducing copayments from 10% to 5% (phase 2) were inversely associated with risk of 1-year mortality (relative risk = .855, 95% confidence interval: .749-.975; P = .0196). In addition, this inverse association was greater in patients with low incomes, of older ages, and with higher Charlson comorbidity indices. Conclusions The introduction of a policy for reducing copayments to ease excessive cost burdens for patients with stroke was positively associated with a reduced risk of 1-year mortality after surgical treatment due to stroke. On the basis of our results, health policy makers should make an effort to identify vulnerable populations and to overcome economic barriers for providing effective alternatives to ensure patients receive optimal health care.

Aim: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in US hospitals. We examined temporal trends and the impact of palliative care on the use of life-sustaining procedures in this population. Materials and Methods: A retrospective nationwide cohort analysis was performed using weighted National Inpatient Sample (NIS) data obtained from 2010 to 2014. Decedents ≥18 years of age at the time of death and with a principal diagnosis of COPD were included. We examined the receipt of life-sustaining procedures, defined as1 ventilation (intubation, mechanical ventilation, and noninvasive ventilation),2 vasopressor use (infusion and intravascular monitoring),3 nutrition (enteral and parenteral infusion of concentrated nutrition),4 dialysis, and5 cardiopulmonary resuscitation as well as palliative care consultation and do not resuscitate (DNR). We used compound annual growth rates (CAGRs) and the Rao-Scott correction of the χ2 statistic to determine the statistical significance of temporal trends of life-sustaining procedures, palliative care utilization, and DNR status. Results: Among 37 312 324 hospitalizations, 38 425 patients were examined. The CAGRs of life-sustaining procedures were 6.61% and −9.73% among patients who underwent multiple procedures and patients who did not undergo any procedure, respectively (both P < .001). The CAGRs of palliative consultation and DNR were 5.25% and 36.62%, respectively (both P < .001). Conclusions: Among adults with COPD dying in US hospitals between 2010 and 2014, the utilization of life-sustaining procedures, palliative care, and DNR status increased.

Malone antegrade continent enema (ACE) is a procedure in which an appendicostomy is performed to effectively control intractable fecal incontinence. In this procedure, spontaneous knotting of the enema catheter inside the cecum may occur, albeit rarely. In such a situation, the knot of the ACE catheter in the cecum could not be removed easily. Here, we aimed to report two cases of spontaneous knotting of the ACE catheter during routine ACE. Moreover, we aimed to discuss the mechanism of spontaneous knotting of the catheter during ACE, preventive methods, and methods to remove the knotted catheters.

Previous studies on hospital specialization in spinal joint disease have been limited to patients requiring surgical treatment. The lack of similar research on the nonsurgical spinal joint disease in specialized hospitals provides limited information to hospital executives. To analyze the relationship between hospital specialization and health outcomes (length of stay and medical expenses) with a focus on nonsurgical spinal joint diseases. The data of 56,516 patients, which were obtained from the 2018 National Inpatient Sample, provided by the Health Insurance Review and Assessment Service, were utilized. The study focused on inpatients with nonsurgical spinal joint disease and used a generalized linear mixed model with specialization status as the independent variable. Hospital specialization was measured using the Inner Herfindahl–Hirschman Index (IHI). The IHI (value ≤1) was calculated as the proportion of hospital discharges accounted for by each service category out of the hospital's total discharges. Patient and hospital characteristics were the control variables, and the mean length of hospital stay and medical expenses were the dependent variables. The majority of the patients with the nonsurgical spinal joint disease were female. More than half of all patients were middle-aged (40–64 years old). The majority did not undergo surgery and had mild disease, with Charlson Comorbidity Index score ≤1. The mean inpatient expense was 1265.22 USD per patient, and the mean length of stay was 9.2 days. The specialization status of a hospital had a negative correlation with the length of stay, as well as with medical expenses. An increase in specialization status, that is, IHI, was associated with a decrease in medical expenses and the length of stay, after adjusting for patient and hospital characteristics. Hospital specialization had a positive effect on hospital efficiency. The results of this study could inform decision-making by hospital executives and specialty hospital-related medical policymakers.

We proposed a novel approach based on dual ammonium and nitrate nitrogen isotope ratios (δ15NNH4 and δ15NNO3, respectively) axes to identify nitrogen sources in intensive livestock farming watersheds, especially those with swine excreta treatment facilities. The δ15NNH4 and δ15NNO3 values in water samples were measured monthly in 2016–2017. Soil and mineral fertilizers, sewage, sewage effluent, manure, and swine effluents were the five sources considered to identify nitrogen sources. The results showed that nitrogen pollution from agricultural activities was well reflected by the seasonal δ15NNH4 and δ15NNO3 patterns in the river, and microbial nitrification was suggested as the dominant nitrogen transformation process in the river. This study revealed that δ15NNH4 and δ15NNO3 axes provided better results than the traditionally used nitrate oxygen (δ18ONO3) and δ15NNO3 axes for identifying nitrogen sources in agricultural watersheds with swine excreta treatment facilities. The mixing model results showed that stream water was severely contaminated with swine effluents (e.g., a mean minimum contribution of 31%), thus affecting the quality of the mainstream (p = 0.068

In this letter, we have investigated the properties of In0.53Ga0.47As quantum-well (QW) metal–oxide–semiconductor field-effect-transistors (MOSFETs) on a 300-mm(100) Si wafer. We have explored the impact of scaling down In0.53Ga0.47As channel thickness ( $\text{t}_{\mathrm {ch}})$ from 15 to 5 nm. The fabricated devices show excellent electrostatic integrity, such as subthreshold-swing (SS) $\mu _{\textit {n$\_{}$eff}})$ of the fabricated devices to investigate the carrier transport properties of the InGaAs MOSFETs with different values of $\text{t}_{\mathrm {ch}}$ . The device with $\text{t}_{\mathrm {ch}} = 15$ nm displayed a value of $\mu _{\textit {n$\_{}$eff}} = 2,190$ cm2/V-s at room temperature. This valuewas found to decrease as $\text{t}_{\mathrm {ch}}$ was scaled down.

Objective Although competition is known to affect quality of care, less is known about the effects of competition on outpatient health service utilization under the diagnosis-related group payment system. This study aimed to evaluate these effects and assess differences before and after hospitalization in South Korea. Design Population-based retrospective observational study. Setting We used two data set including outpatient data and hospitalization data from National Health Claim data from 2011 to 2014. Participants Participants who were admitted to the hospital for hemorrhoidectomy were included. A total of 804 884 hospitalizations were included in our analysis. Main outcome measure(s) The outcome variables included the costs associated with outpatient examinations and the number of outpatient visits within 30 days before and after hospitalization. Results High-competition areas were associated with lower pre-surgery examination costs (rate ratio [RR]: 0.88, 95% confidence interval [CI]: 0.88-0.89) and fewer outpatient visits before hospitalization (RR: 0.98, 95% CI: 0.98-0.99) as well as after hospitalization compared with moderate-competition areas. Conclusion Our study reveals that outpatient health service utilization is affected by the degree of market competition. Future evaluations of hospital performance should consider external factors such as market structure and hospital location.

Objective In Korea, the Value Incentive Program (VIP) was first applied to selected clinical conditions in 2007 to evaluate the performance of medical institutes. We examined whether the condition-specific performance of the VIP resulted in measurable improvement in quality of care and in reduced medical costs. Design Population-based retrospective observational study. Setting We used two data set including the results of quality assessment and hospitalization data from National Health Claim data from 2011 to 2014. Participants Participants who were admitted to the hospital for obstetrics and gynecology were included. A total of 535 289 hospitalizations were included in our analysis. Methods We used a generalized estimating equation (GEE) model to identify associations between the quality assessment and length of stay (LOS). A GEE model based on a gamma distribution was used to evaluate medical cost. The Poisson regression analysis was used to evaluate readmission. Main outcome measures The outcome variables included LOS, medical costs and readmission within 30 days. Results Higher condition-specific performance by VIP participants was associated with shorter LOSs, decreases in medical cost, and lower within 30-day readmission rates for target and non-target surgeries. LOS and readmission within 30 days were different by change in quality assessment at each medical institute. Conclusions Our findings contribute to the body of evidence used by policy-makers for expansion and development of the VIP. The study revealed the positive effects of quality assessment on quality of care. To reduce the between-institute quality gap, alternative strategies are needed for medical institutes that had low performance.

Summary Purpose Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity in many countries, and it has high rate of hospital readmissions due to recurrent exacerbations of the disease. Many previous studies have suggested further examination of the factors that contribute to hospital readmissions of COPD patients. However, evidence on the effects of nurse staffing by registered nurses (RNs) on the readmission of COPD patients is lacking in Korea. The aim of our study was to evaluate the effects of nurse staffing on hospital readmissions of COPD patients. Methods We used National Health Insurance claim data from 2002 to 2012. A total of 1,070 hospitals and 339,379 hospitalization cases were included in the analysis. We divided the number of RNs per 100 beds and the proportion of RNs on staff to one of three groups (Q1: low; Q2: moderate; Q3: high). A generalized estimating equation model was used to evaluate the associations between readmission and nurse staffing. Results A higher number of RNs was associated with lower readmission rates of 8.9% (Q2) and 7.9% (Q3) respectively. A similar effect was observed as the proportion of RNs among the total nursing staff gradually increased, resulting in lower readmission rates of 7.7% (Q2) and 8.3% (Q3). Conclusions Our results suggest notable positive effects of nurse staffing by RNs on patient outcomes. In addition, the magnitude of impact differed between different sizes of hospitals. Thus, human resource planning to solve staffing shortages should carefully consider the qualitative aspects of the nursing staff composition.

// Tae Woo Kim 1, 2, * , Seon-Jin Lee 1, 2, * , Jong-Tae Kim 1 , Sun Jung Kim 3 , Jeong-Ki Min 4 , Kwang-Hee Bae 5 , Haiyoung Jung 1 , Bo-Yeon Kim 6 , Jong-Seok Lim 7 , Young Yang 7 , Do-Young Yoon 8 , Yong-Kyung Choe 1 , Hee Gu Lee 1, 2 1 Immunotherapy Convergence Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea 2 Department of Biomolecular Science, University of Science and Technology (UST), Daejeon, Korea 3 Department of Life Science, Dongguk University-Seoul, Seoul, Republic of Korea 4 Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea 5 Research Center for Metabolic Regulation, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea 6 World Class Institute, Korea Research Institute of Bioscience and Biotechnology, Ochang, Cheongwon, Republic of Korea 7 Department of Biological Sciences, Sookmyung Women’s University, Seoul, Republic of Korea 8 Department of Bioscience and Biotechnology, Konkuk University, Seoul, Republic of Korea * These authors have contributed equally to this work Correspondence to: Hee Gu Lee, email: hglee@kribb.re.kr Yong-Kyung Choe, email: ykccoruk@kribb.re.kr Keywords: kallikrein-related peptidase 6, autophagy, auranofin, cell death, chemoresistance Received: April 14, 2016 Accepted: October 14, 2016 Published: November 15, 2016 ABSTRACT Kallikrein-related peptidase 6 (KLK6) is a biomarker of gastric cancer associated with poor prognosis. Mechanisms by which KLK6 could be exploited for chemotherapeutic use are unclear. We evaluated auranofin (AF), a compound with cytotoxic effects, in KLK6-deficient cells, and we investigated whether KLK6 expression induces autophagy and acquisition of drug resistance in gastric cancer. Using cultured human cells and a mouse xenograft model, we investigated how KLK6 affects antitumor-reagent-induced cell death and autophagy. Expression levels of KLK6, p53, and autophagy marker LC3B were determined in gastric cancer tissues. We analyzed the effects of knockdown/overexpression of KLK6, LC3B, and p53 on AF-induced cell death in cancer cells. Increased KLK6 expression in human gastric cancer tissues and cells inhibited AF-induced cell motility due to increased autophagy and p53 levels. p53 dependent induction of KLK6 expression increased autophagy and drug resistance, whereas KLK6 silencing decreased the autophagy level and increased drug sensitivity. During AF-induced cell death, KLK6 and LC3B colocalized to autophagosomes, associated with p53, and were then trafficked to the cytosol. In the xenograft model of gastric cancer, KLK6 expression decreased AF-induced cell death and KLK6-induced autophagy increased AF resistance. Taken together, the data suggest that the induction of autophagic processes through KLK6 expression may increase acquisition of resistance to AF. Our findings may contribute to a new paradigm for tumor therapeutics.

Aim: Pancreas cancer continues to carry a poor prognosis. Hospitalized patients with advanced chronic pancreatic illnesses increasingly receive palliative care due to its perceived clinical benefits. Meanwhile, a growing proportion of elderly patients are reportedly receiving life-sustaining procedures. Temporal trends in the utilization of life-sustaining procedures and palliative care consultation among dying patients with advanced chronic pancreatic illnesses in US hospitals were examined. Methods and Materials: A serial, cross-sectional analysis was carried out using the National Inpatient Sample Database. Decedents 18 years and older with a principal diagnosis of pancreas cancer or other advanced chronic pancreatic illnesses from 2005 through 2014. The compound annual growth rates (CAGRs) and Cochrane-Armitage correction of χ2 statistic were used. The receipt of life-sustaining systemic procedures, intra-abdominal local procedures and surgeries, and palliative care consultation were examined. Multilevel multivariate logistic regressions were performed to examine the association of various procedures with the utilization of palliative care consultation. Results: Among 77 394 183 hospitalizations, 29 515 patients were examined. The CAGRs of systemic procedures, intra-abdominal procedures, surgeries, and palliative care were −4.19% ( P = .008), 2.17%, −1.40%, and 14.03% ( P < .001), respectively. The receipt of systemic procedures (odds ratio [OR] = 2.40, 95% confidence interval [CI], 2.08-2.74), local intra-abdominal procedures (OR = 1.46, 95% CI, 1.27-1.70), and surgeries (OR = 2.51, 95% CI, 2.07-3.05) was associated with palliative care consultation ( Ps < .001). Conclusions: Among adults with pancreatic cancer or other advanced chronic pancreatic illnesses in the US hospitals from 2005 to 2014, the utilization of life-sustaining systemic procedures decreased while the prevalence of palliative care consultation increased.

Identification of function and potential pathogenic mechanisms of SLE risk genes in dendritic cells. Functional studies of individual SLE risk factors in dendritic cells were performed, and functional alterations of some risk genes in dendritic cells were observed. Recent studies confirmed the pathogenic function of known risk genes. These findings postulate novel pathogenic mechanisms made by dendritic cells. SLE is a complex disease and its etiology is not clearly understood. Dendritic cells are innate immune cells and critical for determining immune activation and immune tolerance. Genetic studies identified several new candidate genes which predispose to development of autoimmune diseases, but the mechanism of those genes has not been identified. This report updates functional implications or pathways in dendritic cells which are putatively important for the development or propagation of SLE based on genetic and functional studies performed in both human and animal models.

Purpose Biological age (BA) has recently emerged as a substitute for chronological age (CA), and many subjects seek to optimally control their BA. However, in South Korea, no study has adequately explored factors that affect BA, although individual health management is essential to preventing chronic diseases. In the present study, we focus on the use of health information, in particular nutrition facts, to control BA. Methods We used data from the Korea National Health and Nutrition Examination Surveys (2010&ndash, 2015, 26,914 eligible participants) using BA and age differences as outcome variables. We used multiple linear regression to explore the relationship between the use of nutrition data and differences in BA after adjusting for covariates. In addition, we used multiple linear regression to examine subgroup differences in such relationships. Results 12.8% of males and 27.5% of females used nutrition facts when deciding which foods to purchase. The more attention paid to such facts, the lower the BA and BA differences in both males and females (males: &beta, = &minus, 2.646, females: &beta, 2.787, p &lt, 0.05, for BA, males: &beta, 1.181, females, &beta, 2.161, p &lt, 0.05, for BA differences). However, BA differences were more significant in subjects with chronic disease, obesity, and/or a family history of chronic disease. Conclusion High-level awareness of and active use of nutrition facts permitted effective self-management in preventing chronic disease and improving BA, particularly in subjects at higher risk for chronic disease. Thus, considering nutrition facts when deciding what to purchase is important.

Arthritis is not only a chronic disease but also causes physical inactivity. We investigated the association between arthritis and quality of life and psychological problems, as measured by suicidal ideation. We used data from the 2013 Community Health Survey, and 162,598 persons aged 40 years and older were included as study subjects. Our main focus was to investigate association of arthritis with suicidal ideation and quality of life. Multivariate survey logistic regression analysis was used to estimate the odds ratio for suicidal ideation, and multivariate survey linear regression analysis used to identify associations between variables and scores on the EuroQol Visual Analogue Scale(EQ-VAS). 8.30% of male and 13.90% of female experienced suicidal ideation, and 16.17% of and 21.23% of female suffered from arthritis. Individuals with arthritis were more likely to report suicidal ideation and have lower health-related quality of life (HRQOL) scores. Furthermore, higher rates of suicidal ideation and lower HRQOLs were also associated with older age, low income and less education. Arthritis was associated with higher rates of suicidal ideation and lower HRQOL scores. These results should contribute to the development and implementation of polices and management strategies to alleviate suicidal ideation and increase HRQOL scores among arthritis patients.

Background The Korean government implemented an outpatient co-payment scheme in July 2007 to control Medical-Aid beneficiaries⿿ overutilization of healthcare services. Objectives To assess changes in the utilization of medical services resulting from the outpatient co-payment scheme. Methods 410,142 subjects were selected and health insurance reimbursement data from July 2006 to June 2011 was examined. We assessed the changes in the total medical cost, total adjusted patient days, inpatient days, inpatient total medical cost, the number of outpatient visits, and outpatient total medical cost using segmented regression analysis. Results Following the introduction of the policy, the number of outpatient visits per person fell by 0.16 days in July 2008, and by 0.06 days in July 2010, compared to June 2007. The outpatient total medical cost per person rose by $4.11 in July 2010 compared to June 2007. The inpatient utilization increased constantly during the period of the study. So the total medical cost as well as the total adjusted number of patient days also increased constantly. Conclusion The outpatient co-payment policy was effective for reducing the number of outpatient visits. It could not control the cost per outpatient visit and inpatient utilization. So the total medical cost was increased.

Cesarean sections (CSs) are the most expensive method of delivery, which may affect the physician's choice of treatment when providing health services to patients. We investigated the effects of the diagnosis-related group (DRG)-based payment system on CSs in Korea. We used National Health Insurance claim data from 2011 to 2014, which included 1,289,989 delivery cases at 674 hospitals. We used a generalized estimating equation model to evaluate the association between the likelihood of cesarean delivery and the length of the DRG adoption period. A total of 477,309 (37.0%) delivery cases were performed by CSs. We found that a longer DRG adoption period was associated with a lower odds ratio of CSs (odds ratio [OR]: 0.997, 95% CI: 0.996-0.998). In addition, a longer DRG adoption period was associated with a lower odds ratio for CSs in hospitals that had voluntarily adopted the DRG system. Similar results were also observed for urban hospitals, primiparas, and those under 28 years old and over 33 years old. Our results suggest that the change in the reimbursement system was associated with a low likelihood of CSs. The impact of DRG adoption on cesarean delivery can also be expected to increase with time, as our finding provides evidence that the reimbursement system is associated with the health provider's decision to provide health services for patients.

Since 2004, the South Korean government has introduced a policy that decreases copayment for cancer patients by strengthening public coverage in the National Health Insurance (NHI) system (first phase=copayment for outpatient care from 30% to 20%; second phase=copayment for total medical expenditures from 20% to 10%; third phase=copayment for total medical expenditures from 10% to 5%). We aimed to investigate the relationship between the policy introduction and patient visits to hospitals in the capital area. We used data from the NHI Cohort 2003-2013, which included all medical claims (7193 cases) filed for 2124 patients who visited the hospital due to stomach cancer, and performed a segmented Poisson regression analysis. Of all hospital visits, 40.6% of patients were from the capital area. After the introduction of the second phase of the policy, there was an increase in patient concentration in the capital area, although there were no significant effects on patient concentration during the first and third phases of the policy. In conclusion, our findings suggest that the introduction of a policy that reduces copayment for cancer patients had a substantial impact on patient concentration in the capital area. Therefore, health policymakers should consider effective alternatives including efficient allocation of medical resources or support for the more vulnerable population as flexible benefit plans to aid healthcare utilization by cancer patients.

(1) Background: South Korea ranked worst in sleep duration compared to other countries, but there are no clear healthcare programs to guarantee sufficient sleep. Studies are needed to suggest evidence and arouse public awareness of the negative effects of abnormal sleep duration. In this study, we investigated the relationship between biological age (BA) and sleep duration. (2) Methods: We used data from the Korea National Health and Nutrition Examination Surveys (KNHANES V-VI, 2010&ndash, 2015, which is an annually cross-sectional study including 29,309 participants). We performed multiple linear regression to investigate the associations between sleep duration and differences in BA and chronological age (CA). (3) Results: A total of 14.22% of respondents had short sleep duration (less than 6 h per day) and 7.10% of respondents had long sleep duration (more than 8 h per day). People with long sleep duration had a positive correlation with difference between BA and CA (&gt, 8 h per day, &beta, = 1.308, p-value = 0.0001, ref = 6~8 h per day, normal). Short sleep duration had an inverse trend with the difference, although the result was not statically significant. Associations were greater in vulnerable populations, such as low income, obese, or people with chronic diseases. (4) Conclusions: Excess sleep duration that is greater than the normal range was associated with increased BA. In particular, such relationships that are related to worsening BA were greater in patients with low income, obesity, and chronic diseases. Based on our findings, healthcare professionals should also consider the negative effects of excess sleep, not only insufficient sleep. Alternatives for controlling optimal sleep duration should be reviewed, especially with vulnerable populations.

Heart failure (HF) remains the most common diagnosis of hospital admission among U.S. adults. Although diagnosis and treatment have improved, mortality rates have not changed, and mortality risk remains high after hospitalization. The current researchers examined how limited health literacy is associated with mortality risk in adults with recent hospitalization due to decompensated HF. Researchers conducted a systematic literature search, selecting three cohort and three intervention studies. The fixed-effect model was used. From the three cohort studies, 2,858 study participants were analyzed. Among participants, limited health literacy was associated with higher all-cause mortality (pooled odds ratio = 2.95; 95% confidence interval [2.34, 3.72]; p < 0.01; I 2 = 47.38%). However, none of the intervention studies showed an association between limited health literacy and cardiac (or all-cause) mortality. Future research should focus on the efficiency and safety of telehealth-based medicine in patients with HF, particularly those with limited health literacy. [Res Gerontol Nurs. 2019; 12(2):91–108.]

Single fulcrum laparoscopic cholecystectomy (SFLC) is a modified version of single incision laparoscopic cholecystectomy (SILC). In this article we report on the first experience of SFLC in a patient with situs inversus totalis (SIT). A 36-year-old female patient with SIT whose gallbladder was located on the left side was admitted to hospital due to a symptomatic gallbladder stone; 2 ㎝ of transumbilical skin and subcutaneous fat layer were dissected and the fascia layer was left undissected to make two openings at the upper and lower part each, dividing where trocars were placed. Compared to conventional SFLC or SILC, the right hand, which is dominant for most people, performed the main operating movements, such as cutting and clipping, while the other hand was retracting the fundus of the gallbladder to show the Calot triangle. SFLC is a facilitating operation in that it does not require a specialized trocar or instruments, and is also convenient for a patient with SIT.

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.

Received February 11, 2015, Revised May 20, 2015, Accepted May 27, 2015 Correspondence to: Tae Hyun Kim Department of Hospital Administration, Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: +82-2-2228-1521, Fax: +82-2-392-8133, E-mail: THKIM@yuhs.ac This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective Cancer is one of the leading causes of morbidity and mortality worldwide. Recently, survival rates of cancer patients have been improving. Many patients are diagnosed with cancer at an age when their career is an important component of their lives, and job status can have a significant impact on health-related quality of life (HRQOL). The purpose of this study was to determine the association of job status and HRQOL with respect to particular situations, such as long-term cancer survival and the presence of comorbid conditions, as compared with the general population. Methods Data on a total of 27,089 eligible participants from the 2007–2012 Korea National Health and Nutrition Examination Survey were used in the study. To identify factors associated with the HRQOL of long-term cancer survivors, multiple linear regression analysis was performed. HRQOL was measured by the EuroQol five-dimension instrument (EQ-5D). Results People who once had a job and lost it because of health issues have been shown to have a lower EQ-5D (β =−8.997, p

Objective: The purpose of the study is to develop quantitative usability evaluation criteria for senior-friendly autonomous transportation robot. Background: The Republic of Korea has become the most rapidly aging society, and is anticipated to enter the post-aged society in 2026. To raise the quality of life of a senior with limited mobility and to reduce the burden of caregivers, many hightech assistive products with information technologies are developed nowadays. The senior-friendly autonomous transportation robot is one person robot vehicle to move a senior to the destination for hospitals, nursing homes or silver town complex. With built-in navigation system and environmental monitoring censors, it automatically seeks the path to the destination and avoids collision to obstacles and pedestrians on the way. Due to the early stage of the product, few usability studies in this field have been done, mostly on general service robots to assist seniors, power wheelchairs and delivery robots. ISO and KS standards for the service robots are focused on safety. Method: Based on the reference usability index, the early draft of the usability evaluation questionnaires was developed. After small group tests and interviews, the experts modified the initial draft to the Usability Evaluation Criteria for Senior-Friendly Autonomous Transportation Robot (UEC-SFATR). Result: UEC-SFATR consisted of 4 subscales - Safety, Controllability, Efficiency and Satisfaction. All of the 4 subscales of UEC-SFATR were passed the reliability criteria by 4 groups of seniors, divided by gender and familiarity of smart-devices. Conclusion: UEC-SFATR covers wider area of user experiences of the SFATR and is a good measurement tool to help both the users and developers of the robot. Application: This study provides guide to the future product development and product competitiveness evaluation by quantifying user experiences for the SFATR.

This study aimed to develop methods for assessing and identifying nitrogen sources in the Cheongmi River, Korea, that has intensive livestock farming areas (ILFA) in its watershed. The assessment focused on the feasibility of the simultaneous use of stable isotopic compositions of ammonium (δ15NNH4) and nitrate (δ15NNO3) for identifying the main nitrogen pollution sources in the Cheongmi River watershed. Our results suggested that the organic nitrogen (Org-N) to total nitrogen (T-N) ratio could be used as an indicator for assessing the effect of livestock excreta on waterways in ILFA. We observed that the T-N concentration was much more strongly affected by livestock excreta than the T-P concentration in the mainstream of the Cheongmi River. The positive correlation was more significant between δ15NNH4 and NH4-N than that between δ15NNO3 and NO3-N for river water samples. Furthermore, the use of δ15NNH4 was more effective than that of δ15NNO3 in evaluating nitrogen variations between May and August in the Cheongmi River because the differences in δ15NNH4 between May and August were more remarkable compared to those in δ15NNO3. Finally, the simultaneous use of δ15NNH4 and δ15NNO3 showed that the dominant nitrogen source at sites M3, M4, M5, and M6, specifically in May, was livestock excreta in the Cheongmi River. The results of this study could be used for sustainable water quality management in the Cheongmi River watershed.

Objective To explore the impact of mandatory adoption of diagnosis-related groups (DRGs) on the use of outpatient care in Korea. Data Sources National Health Claim data from 2,022 hospitals and 1,029,101 admission cases during 2011–2014: tonsillectomy/adenoidectomy, inguinal/femoral hernia operation, and hemorrhoidectomy. Study Design Outcome variables included probability of outpatient visit, number of outpatient visits, and outpatient medical expenditures within 30 days. Presurgery examination before hospitalization for surgery, including basic and other examination, was conducted to evaluate a possible shift in health care service. A difference-in-difference research design was used to evaluate the impact of the DRG system on the use of outpatient care. Principal Findings Before the introduction of the DRG system, 384,609 (91.1 percent) participants used an outpatient clinic either before or after hospitalization. In our study, the number of outpatient visits and outpatient medical expenditures within 30 days increased after mandatory adoption of the DRG system. After adoption of the DRG system, volume and costs for presurgery examinations increased before hospitalization. Conclusion We observed a spillover effect after mandatory adoption of the DRG system. A future payment system should be designed for spillover effects, and the introduction of a new payment system that expands the DRG-based reimbursement system should be considered.

Background To aim of this study was to examine the association between perceived possibility of purchasing cigarettes and e-cigarette experience among adolescents who currently smoke cigarettes. METHODS Data were derived from the Korea Youth Risk Behavior Web-Based Survey; a total of 29,169 current smokers participated. The dependent variable was e-cigarette experience in the previous month. Analyses included χ2 test and survey logistic regression. RESULTS A perceived easy possibility of purchasing cigarettes increased the odds of e-cigarette experience (odds ratio, 1.19; 95% confidence interval, 1.07-1.33) compared to when it was perceived as impossible. An easy possibility of purchasing cigarettes increased the odds of e-cigarettes experience among males aged 12-15 or 17 years compared to when it was impossible to purchase cigarettes. CONCLUSION A perceived easy possibility of purchasing cigarettes was more likely to increase e-cigarette experience among adolescents. Laws restricting adolescents' access to e-cigarettes must be strengthened.

Objectives To assess the overall quality of life of long-stay nursing home residents with preserved cognition, to examine whether the Centers for Medicare and Medicaid Service's Nursing Home Compare 5-star quality rating system reflects the overall quality of life of such residents, and to examine whether residents' demographics and clinical characteristics affect their quality of life. Design/measurements Quality of life was measured using the Participant Outcomes and Status Measures—Nursing Facility survey, which has 10 sections and 63 items. Total scores range from 20 (lowest possible quality of life) to 100 (highest). Setting/participants Long-stay nursing home residents with preserved cognition (n = 316) were interviewed. Results The average quality- of-life score was 71.4 (SD: 7.6; range: 45.1–93.0). Multilevel regression models revealed that quality of life was associated with physical impairment (parameter estimate = −0.728; P = .04) and depression (parameter estimate = −3.015; P = .01) but not Nursing Home Compare's overall star rating (parameter estimate = 0.683; P = .12) and not pain (parameter estimate = −0.705; P = .47). Conclusion The 5-star quality rating system did not reflect the quality of life of long-stay nursing home residents with preserved cognition. Notably, pain was not associated with quality of life, but physical impairment and depression were.

Background Since 2011, specialty hospitals in South Korea have been known for providing high- quality care in specific clinical areas. Much research related to specialty hospitals and their performance in many such areas has been performed, but investigations about their performance in obstetrics and gynecology are lacking. Thus, we aimed to compare specialty vs. non-specialty hospitals with respect to mode of obstetric delivery, especially the costs and length of stay related to Cesarean section (CS) procedures, and to provide evidence to policy-makers for evaluating the success of hospitals that specialize in obstetric and gynecological (OBGYN) care. Methods We obtained National Health Insurance claim data from 2012 to 2014, which included information from 418,141 OBGYN cases at 214 hospitals. We used a generalized estimating equation model to identify a potential association between the likelihood of CS at specialty hospitals compared with other hospitals. We also evaluated medical costs and length of stay in specialty hospitals according to type of delivery. Results We found that 150,256 (35.9%) total deliveries were performed by CS. The odds ratio of CS was significantly lower in specialty hospitals (OR: 0.95, 95% CI: 0.93–0.96compared to other hospitals Medical costs (0.74%) and length of stay (1%) in CS cases increased in specialty hospitals, although length of stay following vaginal delivery was lower (0.57%) in specialty hospitals compared with other hospitals. Conclusions We determined that specialty hospitals are significantly associated with a lower likelihood of CS delivery and shorter length of stay after vaginal delivery. Although they are also associated with higher costs for delivery, the increased cost could be due to the high level of intensive care provided, which leads to improve quality of care. Policy-makers should consider incentive programs to maintain performance of specialty hospitals and promote efficiency that could reduce medical costs accrued by patients.

A 2,3,4,6-tetrafluoro-7,7,8,8,-tetracyanoquinodimethane (F4-TCNQ) doping interlayer was developed to improve charge imbalance and the efficiency in indium phosphide (InP)-based quantum dot light-emitting diodes (QLEDs). The doping layer was coated between a hole injecting layer (HIL) and a hole transport layer (HTL) and successfully diffused with thermal annealing. This doping reduces the hole injection barrier and improves the charge balance of InP-based QLEDs, resulting in enhancement of an external quantum efficiency (EQE) of 3.78% (up from 1.6%) and a power efficiency of 6.41 lm/W (up from 2.77 lm/W). This work shows that F4-TCNQ interlayer doping into both HIL and HTL facilitates hole injection and can provide an efficient solution of improving charge balance in QLED for the device efficiency.