PURPOSE: This study aimed to investigate trends in home-visit nursing care by agencies' characteristics under the national long-term care insurance system. METHODS: Cochran-Mantel-Haenzel tests were conducted, using data drawn from the nationwide long-term care insurance claim database of the Korean National Health Insurance Corporation from 2009 to 2011. RESULTS: The number of home-visit nursing care agencies has decreased continuously since 2009. There were also similar trends in the total amount of service provided by home-visit nursing care agencies, the number of recipients, the number of employees, and payments. This study showed that there were statistically significant differences in the trends in home-visit nursing care by agencies' characteristics. Despite the overall downward trend, there were some increases in the percentage of home-visit nursing care provided by agencies which were established by individuals, located in large cities, and which combined home-visit care with home-visit bathing. CONCLUSION: Home-visit nursing care agencies are responsible for providing community-based healthcare services. For past three years, however, they have not been utilized to their full potential. Understanding the trends in home-visit nursing care by agencies' characteristics is important to develop utilization strategies for home-visit nursing care.
Delivery of Health Care ; Home Nursing ; Insurance, Long-Term Care ; Long-Term Care ; National Health Programs ; Nursing Care

The purpose of this study has been performed to investigate the possibility of external audit program using thermoluminescence dosimetry for electron beam in korea. The TLD system consists of LiF powder, type TLD-700 read with a PCL 3 reader. In order to determine a calibration coefficient of the TLD system, the reference dosimeters are irradiated to 2 Gy in a (60)Co beam at the KFDA The irradiation is performed under reference conditions is water phantom using the IAEA standard holder for TLD of electron beam. The energy correction factor is determined for LiF powder irradiated of dose to water 2 Gy in electron beams of 6, 9, 12, 16 and 20 MeV (Varian CL 2100C). The dose is determined according to the IAEA TRS-398 and by measurement with a PTW Roos type plane-parallel chamber. The TLD for each electron energy are positioned in water at reference depth. In this study, to verify of the accuracy of dose determination by the TLD system are performed through a 'blind' TLD irradiation. The results of blind test are 2.98%, 3.39% and 0.01% (1sigma) at 9, 16, 20 MeV, respectively. The value generally agrees within the acceptance level of 5% for electron beam. The results of this study prove the possibility of the TLD quality assurance program for electron beams. It has contributed to the improvement of clinical electron dosimetry in radiotherapy centers.
Calibration ; Fibrinogen ; Korea ; Radiotherapy ; Water

The purpose of study is to investigate whether glass rod detector (GRD) would be suitable for dosimeter of radiotherapy units. A GRD is used for the measurement of the output factors and x-axis beam profiles from Gamma Knife. The output factors measured with GRD from the 14, 8 and 4 mm collimators relative to the 18 mm collimator are 0.980+/-0.013, 0.949+/-0.013 and 0.872+/-0.012, respectively. The output factors obtained with a GRD are within 1.0% in good agreement with the values recommended by the manufacture. The full width at half maximum (FWHM) of x-axis beam profiles measured with GRD are 5.9 mm at a 4 mm collimator.
Glass* ; Radiotherapy

PURPOSE: This study was to design and fabricate a phantom for prostate cancer brachytherapy to validate a developed program applying a 3-film technique, and to compare it with the conventional 2-film technique for determining the location of an implanted seed. MATERIALS AND METHODS: The images were obtained from overlapped seeds by randomly placing a maximum of 63 seeds in the anterior-posterior (AP) position and at -30degrees to 30degrees at 15degrees intervals. Images obtained by use of the phantom were applied to the image processing procedure, and were then processed into the development program for seed localization. In this study, cases were set where one seed overlapped, where two seeds overlapped and where none of the three views resolved all seeds. The distance between the centers of each seed to the reference seed was calculated in a prescribed region. This distance determined the location of each seed in a given band. The location of the overlapped seeds was compared with that of the 2-film technique. RESULTS: With this program, the detection rate was 92.2% (at +/-15degrees), 94.1% (at +/-30degrees) and 70.6% (compared to the use of the 2-film technique). The overlaps were caused by one or more than two seeds that overlapped; the developed program can identify the location of each seed perfectly. However, for the third case the program was not able to resolve the overlap of the seeds. CONCLUSION: This program can be used to improve treatment outcome for the brachytherapy of prostate cancer by reducing the number of errors in the process of reconstructing the locations of perfectly overlapped seeds.
Brachytherapy* ; Image Processing, Computer-Assisted* ; Prostate* ; Prostatic Neoplasms ; Treatment Outcome

In proton therapy, the analysis of secondary particles is important due to delivered dose outside the target volume and thus increased potential risk for the development of secondary cancer. The purpose of this study is to analyze the influence of secondary particles from proton beams on fluence and energy deposition in the presence of inhomogeneous material by using Geant4 simulation toolkit. The inhomogeneity was modeled with the condition that the adipose tissue, bone and lung equivalent slab with thickness of 2 cm were inserted at 30% (Plateau region) and 80% (Bragg peak region) dose points of maximum dose in Bragg curve. The energy of proton was varied with 100, 130, 160 and 190 MeV for energy dependency. The results for secondary particles were presented for the fluence and deposited energy of secondary particles at inhomogeneous condition. Our study demonstrates that the fluence of secondary particles is neither influenced insertion of inhomogeneties nor the energy of initial proton, while there is a little effect by material density. The deposited energy of secondary particles has a difference in the position placed inhomogeneous materials. In the Plateau region, deposited energy of secondary particles mostly depends on the density of inserted materials. Deposited energy in the Bragg region, in otherwise, is influenced by both density of inserted material and initial energy of proton beams. Our results suggest a possibility of prediction about the distribution of secondary particles within complex heterogeneity.
Adipose Tissue ; Dependency (Psychology) ; Lung ; Population Characteristics ; Proton Therapy ; Protons

Geant4 (GEometry ANd Tracking) provides various packages specialized in modeling electromagnetic interactions. The validation of Geant4 physics models is a significant issue for the applications of Geant4 based simulation in medical physics. The purpose of this study is to evaluate accuracy of Geant4 electromagnetic physics for proton therapy. The validation was performed both the Continuous slowing down approximation (CSDA) range and the stopping power. In each test, the reliability of the electromagnetic models in a selected group of materials was evaluated such as water, bone, adipose tissue and various atomic elements. Results of Geant4 simulation were compared with the National Institute of Standards and Technology (NIST) reference data. As results of comparison about water, bone and adipose tissue, average percent difference of CSDA range were presented 1.0%, 1.4% and 1.4%, respectively. Average percent difference of stopping power were presented 0.7%, 1.0% and 1.3%, respectively. The data were analyzed through the kolmogorov-smirnov Goodness-of-Fit statistical analysis test. All the results from electromagnetic models showed a good agreement with the reference data, where all the corresponding p-values are higher than the confidence level alpha=0.05 set.
Adipose Tissue ; Magnets ; Proton Therapy ; Protons ; Water

Epidermal cysts slowly growing, intradermal or subcutaneous tumors that usually cease growing after having reached 1 to 5 cm in diameter. We report a case of giant epidermal cyst on the scapular region with the appearance of well delineated huge mass measured 19×17×14cm in size. Its clinical and surgical management are illustrated.
Epidermal Cyst

PURPOSE: To analyze the long-term stability of Farmer-type cylindrical ionization chambers by calibration factor provided from the KFDA (Korea Food Drug Administration) MATERIALS AND METHODS: The cylindrical ionization chambers used in this study were the PTW 30001 (30006), 30013, 30002, 30004, 23333, the Capintec PR06C, the NE 2571, the Exradin A12 and the Wellhofer FC65G (IC70). We were analyzed that the N(k) and N(D,W) calibration factor for the cylindrical chambers and compared between the measured N(D,W) and calculated N(D,W) calibration factor. RESULTS: We have observed that the long-term stability of the PTW 30013 (30006), the Wellhofer FC65G (IC70) and the NE 2571 has varied within 0.2%. The measured N(D,W) calibration factor was about 1.0% higher than the calculated N(D,W) that determined by the N(k) calibration factor. CONCLUSION: The study has evaluated that the long-term stability of the cylindrical chambers through analysis for the Nk and N(D,W) calibration factor. It has contributed to the improvement of clinical electron dosimetry in radiotherapy centers.
Calibration ; Radiotherapy

OBJECTIVE: The aim of this study was to examine whether polymorphic variation in GSTs confers susceptibility to Endometriosis in Korean populations. METHODS: The GSTM1, GSTT1, and GSTP1 genotypes were determined in 124 patients with Endometriosis (stage 3, 4) and 155 healthy control subjects at Ewha woman's university Mok-dong hospital from 1996 to 2003. RESULTS: The homozygous wild allele in GSTP1 gene was most common genotypes both Endometriosis and healthy control groups (69.4% vs. 64.5%). Neither the heterozygous nor homozygous mutant allele in GSTP1 gene differed in frequency between the two groups (30.6% vs 35.5%). When null mutations in GSTM1, GSTT1 were combined with GSTP1 polymorphism, there was no evidence of increase in the risk of endometriosis, as the number of high risk alleles of the GST family increased. CONCLUSION: Our findings suggest that GSTP1 genetic polymorphism may not be associated with development of Endometriosis in Korean populations. There is no evidence of a trend in increasing risk with the number of putative high risk alleles of the GST family carried.
Alleles ; Endometriosis* ; Female ; Genotype ; Humans ; Polymorphism, Genetic*

Understanding brain function-related neural circuit connectivity is essential for investigating how cognitive functions are decoded in neural circuits. Trans-synaptic viral vectors are useful for identifying neural synaptic connectivity because of their ability to be transferred from transduced cells to synaptically connected cells. However, concurrent labeling of multisynaptic inputs to postsynaptic neurons is impossible with currently available trans-synaptic viral vectors. Here, we report a neural circuit tracing system that can simultaneously label postsynaptic neurons with two different markers, the expression of which is defined by presynaptic input connectivity. This system, called “cFork (see fork)”, includes delivering serotype 1-packaged AAV vectors (AAV1s) containing Cre or flippase recombinase (FlpO) into two different presynaptic brain areas, and AAV5 with a dual gene expression cassette in postsynaptic neurons. Our in vitro and in vivo tests showed that selective expression of two different fluorescence proteins, EGFP and mScarlet, in postsynaptic neurons could be achieved by AAV1-mediated anterograde trans-synaptic transfer of Cre or FlpO constructs. When this tracing system was applied to the somatosensory barrel field cortex (S1BF) or striatum innervated by multiple presynaptic inputs, postsynaptic neurons defined by presynaptic inputs were simultaneously labeled with EGFP or mScarlet. Our new anterograde tracing tool may be useful for elucidating the complex multisynaptic connectivity of postsynaptic neurons regulating diverse brain functions.