0.05). The area under the receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89–0.95]. In external validation, the discrimination was good, with an AUC value of 0.833 (95% CI 0.70–0.92) for this model. Nomogram calibration plots indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability.CONCLUSION: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.]]>
Area Under Curve ; Blood Transfusion ; Calibration ; Cesarean Section ; Cohort Studies ; Discrimination (Psychology) ; Early Intervention (Education) ; Erythrocytes ; Female ; Humans ; Logistic Models ; Maternal Age ; Nomograms ; Placenta Previa ; Placenta ; Placentation ; Postpartum Hemorrhage ; Pregnancy ; ROC Curve ; Ultrasonography

Neuroinflammation is an important process underlying a wide variety of neurodegenerative diseases. Carvacrol (CAR) is a phenolic monoterpene commonly used as a food additive due to its antibacterial properties, but it has also been shown to exhibit strong antioxidative, anti-inflammatory, and neuroprotective effects. Here, we sought to investigate the effects of CAR on inflammation in the hippocampus and prefrontal cortex, as well as the molecular mechanisms underlying these effects. In our study, lipopolysaccharide was injected into the lateral ventricle of rats to induce memory impairment and neuroinflammation. Daily administration of CAR (25, 50, and 100 mg/kg) for 21 days improved recognition, discrimination, and memory impairments relative to untreated controls. CAR administration significantly attenuated expression of several inflammatory factors in the brain, including interleukin-1β, tumor necrosis factor-α, and cyclooxygenase-2. In addition, CAR significantly increased expression of brain-derived neurotrophic factor (BDNF) mRNA, and decreased expression of Toll-like receptor 4 (TLR4) mRNA. Taken together, these results show that CAR can improve memory impairment caused by neuroinflammation. This cognitive enhancement is due to the anti-inflammatory effects of CAR medicated by its regulation of BDNF and TLR4. Thus, CAR has significant potential as an inhibitor of memory degeneration in neurodegenerative diseases.
Animals ; Brain ; Brain-Derived Neurotrophic Factor ; Cyclooxygenase 2 ; Cytokines ; Discrimination (Psychology) ; Food Additives ; Hippocampus ; Inflammation ; Lateral Ventricles ; Lipopolysaccharides ; Memory ; Necrosis ; Neurodegenerative Diseases ; Neuroprotective Agents ; Phenol ; Prefrontal Cortex ; Rats ; RNA, Messenger ; Toll-Like Receptor 4

On September 12, 2018, President Jae-In Moon announced the Comprehensive Plan for Lifelong Care for People with Developmental Disabilities, with representatives from the associated government branches (Ministry of Health and Welfare, Ministry of Education, and Ministry of Employment and Labor) in attendance. The goals of this plan are to provide health, medical, rehabilitative, special education, and social welfare services according to the life-stages of the affected individuals; to reduce parental pressure; to promote social interventions; and to enhance community-level participation in order to create a ‘welfare society in harmony.’ However, in order for the plan to succeed, additional efforts must be made in the following areas. First, an epidemiological survey is needed to understand the scale, prevalence, and incidence of developmental disabilities and to establish an evidence base to support policy development. Second, accurate definitions of developmental disabilities must be established in order to avoid policy discrimination based on impairment type and age. Third, personal evaluations to assess disabled individuals' unmet needs and customized service designs to deliver those needs are required. Fourth, the plan must fulfill the goals of accessibility and fairness that the government intends to provide. Fifth, the government should consider an integrated financial support system and to propose a detailed plan for monetary distributions. Finally, an integrated system that links health, medical, employment, educational, and welfare services must be constructed.
Comprehensive Health Care ; Developmental Disabilities ; Discrimination (Psychology) ; Education ; Education, Special ; Employment ; Financial Support ; Humans ; Incidence ; Intellectual Disability ; Moon ; Parents ; Policy Making ; Prevalence ; Social Welfare

BACKGROUND AND PURPOSE: Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth. METHODS: From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score. Model performance was assessed in terms of calibration (predicted versus observed risk) and discrimination (c-statistic). RESULTS: We included 1,072 patients with a total of 1,452 aneurysms. During 4,268 aneurysm-years of follow-up, 199 (14%) aneurysms enlarged. Calibration was comparable to that of the development cohort with the overall observed risks within the range of the expected risks. The c-statistic was 0.69 (95% confidence interval [CI], 0.64 to 0.73) at 3 years, compared to 0.72 (95% CI, 0.68 to 0.76) in the development cohort. At 5 years, the c-statistic was 0.68 (95% CI, 0.64 to 0.72), compared to 0.72 (95% CI, 0.68 to 0.75) in the development cohort. CONCLUSIONS: The ELAPSS score showed accurate calibration for 3- and 5-year risks of aneurysm growth and modest discrimination in our external validation cohort. This indicates that the score is externally valid and could assist patients and physicians in predicting growth of unruptured intracranial aneurysms and plan follow-up imaging accordingly.
Aneurysm ; Calibration ; Cohort Studies ; Discrimination (Psychology) ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Risk Factors ; Subarachnoid Hemorrhage

BACKGROUND AND OBJECTIVES: Adults with congenital heart disease (CHD) are an increasing group of patients thanks to the survival of over 85% of children with CHD. 20% of these patients shall warrant a surgical procedure during their life span. However, currently there is no one risk score that assess correctly the mortality of these procedures. Thus, we analyse the risk scores used at our institution. METHODS: From May 1991 till June 2017, 608 procedures in adults with CHD were performed. The 3 risk scores (risk adjustment for congenital heart surgery [RACHS-1], Aristotle, and Euroscore I) of each procedure were analysed. We used area under the receiver operating characteristic curve (c-index) to measure model discrimination, and Hosmer-Lemeshow (H-L) statistic along with calibration plots to measure calibration. RESULTS: There was no statistical difference between the area under the curve for the 3 scores (χ²=0.58 with 2 df, p=0.750). There was no evidence of lack of fit for RACHS-1 (H-L, χ²=2.61; p=0.271) and Aristotle score (H-L, χ²=5.69; p=0.459). However, there was evidence in lack of calibration in the Euroscore I scoring system (H-L, χ²=33.69; p<0.001). The calibration slope for RACHS-1 was 0.912, for Aristotle (stratified in risk groups) was −0.14 and for Euroscore 1 (stratified in risk groups) was 0.46. CONCLUSIONS: RACHS-1 seems to be best risk scoring system for calculating mortality applied to surgery in adults with CHD.
Adult ; Calibration ; Child ; Discrimination (Psychology) ; Heart Defects, Congenital ; Humans ; Mortality ; ROC Curve ; Thoracic Surgery

We reviewed past studies on the identification of familial relationships using 22 short tandem repeat markers. As a result, we can obtain a high discrimination power and a relatively accurate cut-off value in parent-child and full sibling relationships. However, in the case of pairs of uncle-nephew or cousin, we found a limit of low discrimination power of the likelihood ratio (LR) method. Therefore, we compare the LR ranking method and data mining techniques (e.g., logistic regression, linear discriminant analysis, diagonal linear discriminant analysis, diagonal quadratic discriminant analysis, K-nearest neighbor, classification and regression trees, support vector machines, random forest [RF], and penalized multivariate analysis) that can be applied to identify familial relationships, and provide a guideline for choosing the most appropriate model under a given situation. RF, one of the data mining techniques, was found to be more accurate than other methods. The accuracy of RF is 99.99% for parent-child, 99.44% for full siblings, 90.34% for uncle-nephew, and 79.69% for first cousins.
Classification ; Data Mining ; Discrimination (Psychology) ; Forests ; Humans ; Logistic Models ; Methods ; Microsatellite Repeats ; Siblings ; Support Vector Machine ; Trees

“Yong-yi” means “quack” in English, which generally refers to a doctor who does not have good medical skills. In the Ming and Qing dynasties in China, various criticism about “Yong-yi” became popularized, and by the late Qing period, “quacks” had become a serious social issue. The theory of traditional Chinese medicine was developed during the Ming and Qing dynasties, and local medical resources also increased. Moreover, the prevalence of medical book publishing led to the openness and generalization of medical knowledge. As a result, not only the number of doctors increased, but also the number of doctors who lack medical knowledge and clinical experience increased. However, at the outset, “Yong-yi” did not only mean doctors with poor medical skills. “Yong-yi” also reflected conflicts and contradictions between doctors. Doctors consistently criticized quacks in an attempt to maintain their identity as a “good” doctor or a Confucian doctor. In this sense, “Yong-yi” was used among physicians as an expression of discrimination and exclusion. The concept of “quackery” was also determined by the relationship between patients and doctors. In general, itinerant doctors, midwives and shaman doctors were regarded as “Yong-yi”; however, they served the medical needs of various patients. Thus, to some extent, “Yong-yi” were also useful medical resources. On the contrary, in certain situations, “shiyi,” physicians who serviced a family for generations and were generally believed to be reliable and as trustworthy doctors, were also labelled as quacks, especially when the patient did not trust them or was not satisfied with the treatment. Therefore, doctors' thoughts about “Yong-yi” did not always coincide with patients' thoughts about “Yong-yi.” However, by the late Qing period, the description of quacks in media reports found a singular connotation, and the divergent social image of quacks disappeared. By this time, quacks were uniformly described as ignorant and irresponsible Chinese medicine practitioners. Specifically, in one murder case in which a “Yong-yi” was accused as the murderer, the report unilaterally reported the patient's claims. Consequently, Chinese medicine practitioners who failed in their treatment of patients became labeled as “quack” doctors. In newspaper reports, “Yong-yi” no longer simply referred to individual cases of “quacks” but had come to represent the entirety of the Chinese medicine practitioner community. On the contrary, Western medical doctors who replaced the status of traditional doctors were positively portrayed. Pictorials also had similar perspectives with newspapers, supporting the narrative of the news with ironic drawings and articles. Overall, media reports regarding “Yong-yi” did not focus on reporting facts, but they had the purpose of making quacks a serious social problem.
Asian Continental Ancestry Group ; China ; Discrimination (Psychology) ; Family Characteristics ; Generalization (Psychology) ; Homicide ; Humans ; Iron ; Medicine, Chinese Traditional ; Midwifery ; Periodicals ; Prevalence ; Social Perception ; Social Problems

Lee Kap-Soo (April 23, 1889–December 5, 1973) graduated from Gyeongseong Medical College in 1920, went to Germany to study, and returned to Korea after graduating from Berlin University in 1924. On September 14, 1933, he played a leading role in the founding of the Joseon Eugenics Society, and he contributed eugenic ideas through written publications and lectures. He was a leading eugenicist who continued his activities related to eugenics, such as re-establishing the Korean National Eugenics Society and making efforts to enact the Eugenics Act after Korea's liberation from Japanese occupation. His ideas on eugenics were then a rapid acceptance of the world's times and science, and his ideas were an expanded eugenics that emphasized the nation. He actively carried out the campaign for eugenics and maintained a consistent stance before and after liberation. His eugenic ideas and activities show that Korean society was not free from the influence of eugenics that was gaining popularity around the world. His eugenic ideas were related to enlightenment, but the basis of eugenics was the logic of discrimination and exclusion. In particular, his eugenic ideas and activities have caused pain to Hansen's patients through forced isolation and discontinuation. In addition, his doctrine of eugenics still holds sway in Korean society. The history of Lee Kap-Soo's life and eugenics-related activities shows the important points and characteristics of the history of eugenics in Korean society before and after the liberation from Japan, and furthermore provides an important clue in understanding and explaining the colonial vestige in Korean society, economic growth first ideology, enthusiasm for scientific development, and competitive social culture.
Asian Continental Ancestry Group ; Berlin ; Discrimination (Psychology) ; Economic Development ; Eugenics ; Germany ; Humans ; Japan ; Korea ; Lectures ; Leprosy ; Logic ; Occupations

The purpose of this research is to describe how Hansen's disease patients experienced the modern system of control of Hansen's disease introduced by Japan, and the inimical attitude of society against them in colonial Korea. The study also seeks to reveal the development of the system to eliminate Hansen's disease patients from their home and community to larger society and leprosarium in this era. Sorokdo Charity hospital (SCH), a hospital for Hansen's disease patients, was built in 1916, and vagrant Hansen's disease patients began to be isolated in this hospital beginning in 1917 by the Japanese Government-General of Korea (JGGK). Once the police detained and sent vagrant Hansen's disease patients to SCH, stigma and discrimination against them strengthened in Korean society. Because of strong stigma and discrimination in Korean society, Hansen's disease patients suffered from daily threats of death. First, their family members were not only afraid of the contagiousness of Hansen's disease but also the stigma and discrimination against themselves by community members. If a family had a Hansen's disease patient, the rest of community members would discriminate against the entire family. Furthermore, because Hansen's disease patients were excluded from any economic livelihood such as getting a job, the existence of the patients was a big burden for their families. Therefore, many patients left their homes and began their vagrancy. The patients who could not leave their homes committed suicide or were killed by their family members. The victims of such deaths were usually women, who were at the lower position in the family hierarchy. In the strong Confucian society in Korea, more female patients were killed by themselves than male patients. Moreover, all of patients victims in the murder were women. This shows that the stigma and discrimination against Hansen's disease patients within their families were stronger against women than men. Strong stigma and discrimination made the patients rely on superstition such as cannibalism. Patients believed that there were not any effective medicine. There were a few reports of patients who were cured, and many were treated with chaulmoogra oil in the modern Hansen's disease hospitals. Eating human flesh was known as a folk remedy for Hansen's disease. As such, patients began to kill healthy people, usually children, to eat their flesh. Increased stigma led to increased victims. Hansen's disease patients who left their homes faced many threats during their vagrancy. For survival, they established their own organizations in the late 1920's. The patients who were rejected to be hospitalized in the Western Hansen's disease hospital at Busan, Daegu, and Yeosu organized self-help organizations. The purpose of these organizations was first to secure the medicine supply of chaulmoogra oil. However, as stigma and discrimination strengthened, these organizations formed by Hansen's disease patients demanded the Japanese Government-General of Korea to send and segregate them on Sorok island. They did not know the situation of the inside of this island because news media described it as a haven for patients, and very few patients were discharged from this island to tell the truth. On this island, several hundreds of patients were killed by compulsory heavy labor, starvation, and violence. They were not treated as patients, but as something to be eliminated. Under strong suppression on this island, the patients resisted first by escaping this island. However, in 1937, some patients tried to kill a Korean staff but failed. Attempted murderers were all put in the jail, also located on this island. In 1941, a patient murdered another patient who had harassed other patients, and in 1942, Chunsang Lee, a patient, killed the director of Sorok island. These instances show that there was a system to eliminate Hansen's disease patients in colonial Korea.
Asian Continental Ancestry Group ; Busan ; Cannibalism ; Charities ; Child ; Daegu ; Discrimination (Psychology) ; Eating ; Female ; Homicide ; Humans ; Japan ; Jeollanam-do ; Korea ; Leprosy ; Male ; Medicine, Traditional ; Police ; Starvation ; Suicide ; Superstitions ; United Nations ; Violence

OBJECTIVE: To develop a diagnostic model for superficial soft tissue lesions to differentiate epidermal cyst (EC) from other lesions based on ultrasound (US) features. MATERIALS AND METHODS: This retrospective study included 205 patients who had undergone US examinations for superficial soft tissue lesions and subsequent surgical excision. The study population was divided into the derivation set (n = 112) and validation set (n = 93) according to the imaging date. The following US features were analyzed to determine those that could discriminate EC from other lesions: more-than-half-depth involvement of the dermal layer, “submarine sign” (focal projection of the hypoechoic portion to the epidermis), posterior acoustic enhancement, posterior wall enhancement, morphology, shape, echogenicity, vascularity, and perilesional fat change. Using multivariable logistic regression, a diagnostic model was constructed and visualized as a nomogram. The performance of the diagnostic model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curve and calibration plot in both the derivation and validation sets. RESULTS: More-than-half-depth involvement of the dermal layer (odds ratio [OR] = 3.35; p = 0.051), “submarine sign” (OR = 12.2; p < 0.001), and morphology (OR = 5.44; p = 0.002) were features that outweighed the others when diagnosing EC. The diagnostic model based on these features showed good discrimination ability in both the derivation set (AUC = 0.888, 95% confidence interval [95% CI] = 0.825–0.950) and validation set (AUC = 0.902, 95% CI = 0.832–0.972). CONCLUSION: More-than-half-depth of involvement of the dermal layer, “submarine sign,” and morphology are relatively better US features than the others for diagnosing EC.
Acoustics ; Calibration ; Discrimination (Psychology) ; Epidermal Cyst ; Humans ; Logistic Models ; Nomograms ; Retrospective Studies ; ROC Curve ; Ultrasonography