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

A Nationwide health care utilization survey was conducted from March 11 to September 19, 1985 to assess the level of illness and the magnitude of medical care utilization. A probability sample of 15,427 persons was taken from 180 Enumerated Districts designated by the Economic Planning Board. Of those 4,500 housewives were proxy respondents. A interview was conducted with pre-tested questionnaire schedule which was recorded by well trained interviewers. Age and sex compositions of the study population were similar to those of general population structure in 1985. The major findings of this survey are as follows: 1) A total of 64.5% of the study population lived in city area and 35.5% lived in county area. 2) While no difference was observed in interview rate between city and county area, it showed statistically significant difference in the medical security program coverage rate between the two areas(44.7% and 37.1%, respectively). 3) Morbidity rate was 79 per 1,000 persons during the two week periods. There was difference in age and sex adjusted morbidity rates between city and county area. Furthermore morbidity rates by the status of the program were significantly difference between the two areas. 4) Average ambulatory care utilization rate was 7.2 visits per person per year and average admission rate was 1.8 per 100 persons per year. There was significant difference in average ambulatory care utilization rate by the program. but no significant difference in medical utilization rate between city and county area. 5) The major symptoms of the perceived illness was the respiratory system(44.1%). 6) A total of 50.4% of the perceived illness among the covered group by the program were treated at the hospital and clinics, but those who are not covered used primarily drug stores(61.3%).
Ambulatory Care ; Appointments and Schedules ; Surveys and Questionnaires ; Delivery of Health Care* ; Humans ; Korea* ; Proxy ; Surveys and Questionnaires ; Sampling Studies

BACKGROUND AND PURPOSE: Vocabulary knowledge is used as a representative index of general intelligence, and is regarded as a marker for cognitive reserve in elderly people. However, vocabulary knowledge mainly depends on formal education, hence, it may not fully represent cognitive functioning in elderly people with poor educational backgrounds. Herein, we investigated whether vocabulary knowledge is a measure of general cognitive ability among normal elderly people with few years of formal education. METHODS: The association between vocabulary knowledge and general cognitive functioning was compared between 35 elderly females with very low educational attainment and 68 elderly females with higher education. RESULTS: The vocabulary knowledge was a significant predictor of general cognitive functioning in elderly individuals with more than primary education, even after controlling the effects of age and years of education. However, it was not a significant predictor of general cognitive functioning in elderly individuals with very low educational attainment. CONCLUSIONS: Vocabulary assessment was effective in estimating general cognitive functioning in elderly individuals who received ≥6 years of education. Our findings suggested that vocabulary knowledge may not be an effective proxy of premorbid intelligence or cognitive reserve in people who have not completed elementary schooling.
Aged* ; Cognitive Aging ; Cognitive Reserve ; Education ; Female ; Humans ; Intelligence ; Proxy ; Vocabulary*

PURPOSE: The purpose of this study was to evaluate Korean advance directives (K-AD) by examining the degree of adults' acceptance and reliability of the directive itself. METHODS: Survey was performed with 181 adults aged 20 or older who were recruited from three regions. A questionnaire used to examine the participants' acceptance of their K-AD in terms of visual analogue scale score of complexity, difficulty, necessity, satisfaction, recommendation. Then, a retest was carried out by asking participants to write up a K-AD again to confirm the reliability of the directives. RESULTS: On a scale of 100, the average acceptance score was 70 or above, which represents rather high level of acceptance in all five categories. The test-retest reliability kappa values ranged from 0.592 to 0.950, and the conformity degree was moderate or high. Regarding K-AD components such as values, treatment preference, proxy appointment, differences among age groups were observed in each component. CONCLUSION: The results of this study suggest that K-AD is a feasible instrument to analyze its acceptability and reliability for adult population. K-AD could be utilized to help people make their own decision on their end-of-life care. Further studies are needed to confirm this study results and promote widespread use of K-AD.
Adult ; Advance Directives* ; Feasibility Studies ; Humans ; Proxy ; Reproducibility of Results ; Terminal Care

PURPOSE: Prostate volume has been known to be poorly correlated with various parameters used to assess the severity of benign prostatic hyperplasia (BPH). However, recently there were reports that the ratio between transition zone(TZ) volume and prostate volume, which termed the TZ index might served as a useful proxy for evaluating worsening obstruction. The purpose of this study was to determine if transrectal ultrasound(TRUS) measurement of RI(resistive index), PCAR (presumed circle area ratio) correlate with the parameters of prostate volume(total prostate volume, TZ volume, TZ index), Qmax, international prostate symptom score(IPSS) or age. This study was conducted to reveal the relative effects of ultrasonic appearance of BPH on urinary symptoms. MATERIALS AND METHODS: A total of 81 men aged 50 to 89 years with moderate symptom of BPH(IPSS> or =8) underwent measurement of RI, PCAR, total prostate and TZ volume at transrectal ultrasonography. All men were requested to undergo uroflowmetry and complete the IPSS. The IPSS was compared to age, Qmax, prostatic volume, RI and PCAR using simple and multiple regression analysis. RESULTS: Simple regression analysis demonstrated that IPSS correlated with age(r=0.050, p<0.05), Qmax(r=0.253, p<0.05), TV(r=0.096, p<0.05) and PCAR(r=0.266, p<0.05). However, multiple regression analysis showed that age, Qmax and PCAR were significant independent determinants of the IPSS. CONCLUSIONS: As a parameter representing the degree of BPH in terms of the severity of lower urinary symptoms, simple and multiple regression analysis confirmed that the IPSS was influenced considerably by age, peak flow rate and PCAR.
Humans ; Lower Urinary Tract Symptoms* ; Male ; Prostate* ; Prostatic Hyperplasia* ; Proxy ; Ultrasonics ; Ultrasonography

All along the medical procedures, the patient's right of self determination may conflict with the medical doctor's professional decisions. The discharge against medical advice (DAMA) is a kind of conflict which becomes a hot issue recently. We tried to summarize various epidemiologic studies to know how many DAMAs have been. And we consider the limits on DAMA. Patient's right to self-DAMA is to be esteemed within a limit of other interests, especially a life self-DAMA is to be esteemed within a limit of other interests, especially a life of fetus in pregnancy woman as the proxy-DAMA is to a life of patient. Through the balance of these interests, the legitimation of DAMA can be established. When patient or proxy violates the principles in DAMA, the method of punishment on doctor in question. Lastly, we inquire into the types of punishment on doctor, intentional type of crime, negligence type of crime, or not guilty. We concludes with the preference on the negligence type of crime.
Crime ; Epidemiologic Studies ; Female ; Fetus ; Humans ; Korea* ; Malpractice ; Patient Rights ; Personal Autonomy ; Pregnancy ; Proxy ; Punishment

Munchausen syndrome by proxy(MBP) is the act of one person fabricating or inducing an illness in another to meet his or her own emotional needs through the treatment process. MBP is thought to be rare. We report the case of 11-year-old girl who presented with general weakness, dizziness, headache, and nausea and she was suspected of Munchausen syndrome by proxy.
Child ; Dizziness ; Headache ; Humans ; Mothers ; Munchausen Syndrome ; Munchausen Syndrome by Proxy ; Nausea

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