OBJECTIVE: The progress in computer and communication technologies is making the Internet increasingly heterogeneous in terms of network, hardware and software capacities. Moreover, this has made it possible for emergency telemedicine services to provide high quality medical services. However, resource availability on the Internet varies unexpectedly. Thus, providing an efficient access to emergency telemedicine services requires that medical multimedia streams be adapted according to the environment constraints. One approach to this issue is based on the use of intermediate nodes within the network to perform such adaptations (media transformations and data transcoding). For this purpose, we have designed and implemented a proxy server for Quality of Service adaptations of medical multimedia streams. METHODS: We have organized a new emergency telemedicine system by designing a proxy server to execute transcoding. The proxy server is located between a patient system and a doctor system over heterogeneous networks. Before a patient system can deliver medical video streams to a doctor system, the proxy server measures uplink bandwidth which is one of the Quality of Service factors, from the proxy server to the doctor system. At this moment, frame rates are determined according to the measured bandwidth, and the proxy server transmits medical video streams modified for new frame rates to the doctor system. We describe the implementation of this proxy server on top of the Microsoft DirectShow(R) environment and report on a performance evaluation which demonstrates the effectiveness of the approach. RESULTS: The quality of requested medical video streams can be predicted when they are adapted to the receiver. With this prediction, adapted medical video streams which meet the frame rates constraints of the receiver can be delivered without additional measurements of bandwidth. CONCLUSION: This study represents a proxy server of a hybrid multimedia telemedicine system over heterogeneous networks. We expect that the designed proxy server can provide not only dynamic Quality of Service monitoring functions along bandwidth measurement, but also medical video adaptations to the receiver in heterogeneous network environments.
Emergencies ; Humans ; Internet ; Multimedia ; Proxy* ; Rivers* ; Telemedicine

PURPOSE: Recent studies suggest that the symptomatic improvement in benign prostatic hyperplasia significantly related with transition zone volume (TZV). The purpose of this study was to determine the clinical significance of TZV and transition zone index (TZI) in changes of prostate volume (PV) and clinical parameters following finasteride therapy. MATERIALS AND METHODS: 140 patients over 50 years of age with symptomatic benign prostatic hyperplasia were treated with finasteride (5mg/d) for 12 months and underwent transrectal ultrasound evaluation of PV and TZV prior to initiating therapy and after 12 months. Patients were grouped according to the results of PV (> OR =40ml or <40ml), TZI (> OR =0.45 or <0.45) and PSA level (> OR =2.5 or <2.5). The responders was determined as improvement in peak flow rate more than 3mL/sec. RESULTS: PV decreased by 14.11% in patients with TZI less than 0.45, while the decrease was 19.25% for men with TZI greater than 0.45 (p<0.01). In addition, PV was significantly decreased by 16.72% in patients with PV less than 40cc and TZI greater than 0.45 (p<0.01). PV decreased by 17.37% in patients with PSA less than 2.5, while the decrease was 18.92% in men with PSA greater than 2.5. In responders, only TZI was significantly different among PSA, PV and TZI (p<0.05). CONCLUSIONS: Treatment effect of finasteride on symptomatic benign prostatic hyperplasia patients was increased in proportion to enlarged PV, increased TZI, increased PSA. TZI was a useful proxy for predicting clinical outcomes in initiating finasteride therapy on benign prostatic hyperplasia.
Finasteride* ; Humans ; Male ; Prostate ; Prostatic Hyperplasia* ; Proxy ; Ultrasonography

OBJECTIVES: Deficit schizophrenia (DS) constitutes a disease separate from non-deficit schizophrenia (NDS). The aim of the current study was to compare the quantitative EEG and low resolution electromagnetic tomography (LORETA) imaging between DS and NDS. METHODS: This study was performed by 32 channels EEG for 42 schizophrenia patients who we categorized into DS and NDS using proxy instrument deficit syndrome (PDS). We performed the absolute power spectral analyses for delta, theta, alpha, low beta and high beta activities. We compared power spectrum between two groups using Independent t-test. Partial correlation test was performed with clinical parameters. Standardized LORETA (sLORETA) was used for comparison of cortical activity, and statistical nonparametric mapping (SnPM) was applied for the statistical analysis. RESULTS: DS showed significantly increased delta and theta absolute power in fontal and parietal region compared with NDS (p<0.05). Power spectrum showed significant correlation with 'anergia' and 'hostility/suspiciousness' subscale of brief psychiatric rating scale (BPRS)(p<0.05). sLORETA found out the source region (anterior cingulate cortex/limbic part) that delta activity was significantly increased in DS (p=0.042). CONCLUSIONS: DS showed different cortical activity compared with NDS. Our results may suggest QEEG and LORETA could be the marker in differentiating between DS and NDS.
Brief Psychiatric Rating Scale ; Electroencephalography ; Humans ; Magnets ; Naphthalenesulfonates ; Proxy ; Schizophrenia

Genome-wide association (GWA) studies may benefit from the inclusion of imputed SNPs into their dataset. Due to its predictive nature, the imputation process is typically not perfect. Thus, it would be desirable to develop a scheme for filtering out the imputed SNPs by maximizing the concordance with the observed genotypes. We report such a scheme, which is based on the combination of several parameters that are calculated by PLINK, a popular GWA analysis software program. We imputed the genotypes of 8,842 Korean individuals, based on approximately 2 million SNP genotypes of the CHB+JPT panel in the International HapMap Project Phase II data, complementing the 352k SNPs in the original Affymetrix 5.0 dataset. A total of 333,418 SNPs were found in both datasets, with a median concordance rate of 98.7%. The concordance rates were calculated at different ranges of parameters, such as the number of proxy SNPs (NPRX), the fraction of successfully imputed individuals (IMPUTED), and the information content (INFO). The poor concordance that was observed at the lower values of the parameters allowed us to develop an optimal combination of the cutoffs (IMPUTED> or =0.9 and INFO> or =0.9). A total of 1,026,596 SNPs passed the cutoff, of which 94,364 were found in both datasets and had 99.4% median concordance. This study illustrates a conservative scheme for filtering imputed SNPs that would be useful in GWA studies
Complement System Proteins ; Genome-Wide Association Study ; Genotype ; HapMap Project ; Humans ; Polymorphism, Single Nucleotide ; Proxy

OBJECTIVES: The objective of this study was to create a new measure for clinical information technology (IT) adoption as a proxy variable of clinical IT use. METHODS: Healthcare Information and Management Systems Society (HIMSS) data for 2004 were used. The 18 clinical IT applications were analyzed across 3,637 acute care hospitals in the United States. After factor analysis was conducted, the clinical IT adoption score was created and evaluated. RESULTS: Basic clinical IT systems, such as laboratory, order communication/results, pharmacy, radiology, and surgery information systems had different adoption patterns from advanced IT systems, such as cardiology, radio picture archiving, and communication, as well as computerized practitioner order-entry. This clinical IT score varied across hospital characteristics. CONCLUSIONS: Different IT applications have different adoption patterns. In creating a measure of IT use among various IT components in hospitals, the characteristics of each type of system should be reflected. Aggregated IT adoption should be used to explain technology acquisition and utilization in hospitals.
Adoption ; Cardiology ; Delivery of Health Care ; Humans ; Information Systems ; Medical Informatics ; Pharmacy ; Proxy ; United States

BACKGROUND: Inter-observer and intra-observer variation in histologic tumor grading are well documented. To determine whether histologic disorderliness in the arrangement of tumor cells may serve as an objective criterion for grading, we tested the hypothesis the degree of disorderliness is related to the degree of tumor differentiation on which tumor grading is primarily based. METHODS: Borrowing from the statistical thermodynamic definition of entropy, we defined a novel mathematical formula to compute the relative degree of histologic disorderliness of tumor cells. We then analyzed a total of 51 photomicrographs of normal colorectal mucosa and colorectal adenocarcinoma with varying degrees of differentiation using our formula. RESULTS: A one-way analysis of variance followed by post hoc pairwise comparisons using Bonferroni correction indicated that the mean disorderliness score was the lowest for the normal colorectal mucosa and increased with decreasing tumor differentiation. CONCLUSIONS: Disorderliness, a pathologic feature of malignant tumors that originate from highly organized structures is useful as an objective tumor grading proxy in the field of digital pathology.
Adenocarcinoma ; Colonic Neoplasms ; Entropy ; Humans ; Mucous Membrane ; Neoplasm Grading ; Observer Variation ; Pathology ; Proxy ; Thermodynamics

Hospitals and medical research institutions have vast holdings of tissues stored in tissue banks. Tissue can end up in a tissue bank for many different reasons. Tissue samples are taken as part of normal diagnostic procedures, and the remaining samples after analysis may be stored for secondary analysis to confirm the diagnosis, for quality control or for research purposes. If the tissues have been stored properly, in principle, it is possible to perform almost all the genetic tests. This opens up possibilities for an expanded use of such tissues in medical research, and therefore tissue banks have become scientifically and economically valuable resources. New genetic testing technologies with their scientific and economic potential are raising ethical concerns about the use of older, stored tissue samples, in particular those that were obtained for one purpose and can now be used for other purposes. Much of these tissues was obtained without consent or with a consent that does not cover genetic testing. There are no general ethical guidelines that can decide whether a specific research project is justifiable. In some cases, proxy consent or an analysis of ownership may be useful. However, use of tissue samples, in most cases, will depend on whether the project is worthwhile and ethically acceptable according to today's standards.
Diagnosis ; Genetic Testing ; Humans* ; Informed Consent ; Ownership ; Proxy ; Quality Control ; Tissue Banks

OBJECTIVES: This study presents the indicators and proxy variables for the quantitative assessment of green chemistry technologies and evaluates the relative importance of each assessment element by consulting experts from the fields of ecology, chemistry, safety, and public health. METHODS: The results collected were subjected to an analytic hierarchy process to obtain the weights of the indicators and the proxy variables. RESULTS: These weights may prove useful in avoiding having to resort to qualitative means in absence of weights between indicators when integrating the results of quantitative assessment by indicator. CONCLUSIONS: This study points to the limitations of current quantitative assessment techniques for green chemistry technologies and seeks to present the future direction for quantitative assessment of green chemistry technologies.
Chemistry ; Ecology ; Green Chemistry Technology* ; Health Resorts ; Humans ; Proxy ; Public Health ; Weights and Measures

OBJECTIVES: This study presents the indicators and proxy variables for the quantitative assessment of green chemistry technologies and evaluates the relative importance of each assessment element by consulting experts from the fields of ecology, chemistry, safety, and public health. METHODS: The results collected were subjected to an analytic hierarchy process to obtain the weights of the indicators and the proxy variables. RESULTS: These weights may prove useful in avoiding having to resort to qualitative means in absence of weights between indicators when integrating the results of quantitative assessment by indicator. CONCLUSIONS: This study points to the limitations of current quantitative assessment techniques for green chemistry technologies and seeks to present the future direction for quantitative assessment of green chemistry technologies.
Chemistry ; Ecology ; Green Chemistry Technology* ; Health Resorts ; Humans ; Proxy ; Public Health ; Weights and Measures

OBJECTIVES: The aim of this study was to assess the socioeconomic inequality in malnutrition in under-5 children in Iran in order to help policymakers reduce such inequality. METHODS: Data on 8443 under-5 children were extracted from the Iran Multiple Indicator Demographic and Health Survey. The wealth index was used as proxy for socioeconomic status. Socioeconomic inequality in stunting, underweight, and wasting was calculated using the concentration index. The concentration index was calculated for the whole sample, as well as for subcategories defined in terms of categories such as area of residence (urban and rural) and the sex of children. RESULTS: Stunting was observed to be more prevalent than underweight or wasting. The results of the concentration index at the national level, as well as in rural and urban areas and in terms of children's sex, showed that inequality in stunting and underweight was statistically significant and that children in the lower quintiles were more malnourished. The wasting index was not sensitive to socioeconomic status, and its concentration index value was not statistically significant. CONCLUSIONS: This study showed that it can be misleading to assess the mean levels of malnutrition at the national level without knowledge of the distribution of malnutrition among socioeconomic groups. Significant socioeconomic inequalities in stunting and underweight were observed at the national level and in both urban and rural areas. Regarding the influence of nutrition on the health and economic well-being of preschool-aged children, it is necessary for the government to focus on taking targeted measures to reduce malnutrition and to focus on poorer groups within society who bear a greater burden of malnutrition.
Child* ; Growth Disorders ; Health Surveys* ; Humans ; Iran* ; Malnutrition* ; Proxy ; Social Class ; Socioeconomic Factors* ; Thinness