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Reverse brain drain in South Korea: state-led model.

Korea's reverse brain drain (RBD) has been an organized government effort, rather than a spontaneous social phenomenon, in that various policies and the political support of President Park, Chung-Hee were instrumental in laying the groundwork for its success. Particular features of Korea's RBD policies are the creation of a conducive domestic environment (i.e., government-sponsored strategic R & D institution-building, legal, and administrative reforms), and importantly, the empowerment of returnees (via, i.e., exceptionally good maternal benefits, guarantees of research autonomy). President Park played the cardinal role in empowering repatriates at the expense of his own civil bureaucracy, and his capacity for such patronage derived from Korea's bureaucratic-authoritarian political system. Returning scientists and engineers directly benefitted from this political system as well as Park's personal guardianship. For Park, empowerment of returning "brains" was necessary to accomplish his national industrialization plan, thereby enhancing his political legitimacy in domestic politics. An alliance with the R & D cadre was functionally necessary to successfully consolidate strong presidential power, and politically nonthreatening due to the particular form of "pact of domination" in Korea's power structure. RBD in Korea will continue in the near future given Korea's drive for high technology, and the remarkable expansion of local industrial and educational sectors. Korea's future RBD, however, needs to pay closer attention to the following 4 problems: research autonomy; equality issues; skill-based repatriation of technicians and engineers rather than Ph.Ds; and subsidies to small and medium industry for RBD.

Asia↗

Mutations and modifications support a 'pitted-flexiball' model for alpha-crystallin.

alpha-Crystallin is renown for resisting crystallization and electron microscopic image analysis. The spatial conformation thus remaining elusive, the authors explored the structure and chaperone functioning by analyzing the effects of site-directed mutagenesis, the properties of naturally occurring aberrant forms of alpha-crystallin and the influence of chemical modifications. The authors observed that the globular multimeric structure, as well as the chaperoning capacity are remarkably tolerant towards changes and modifications in the primary structure. The essential features of the quaternary structure--globular shape, flexibility, highly polar exterior and accessible hydrophobic surface pockets--support a 'pitted-flexiball' model, which combines tetrameric subunit building blocks in an open micelle-like arrangement.

Amino Acid Sequence↗

[Psychosomatic medicine--the future of an illusion].

This paper presents the phenomenology and the development of theories about alexithymia, a "behavioral neurosis" in psychosomatic patients, with background of the american (F. Alexander, R. Grinker and P. Knapp) and french (P. Marty) psychosomatic schools. Luminet's understanding comprises the combination of an object-relations-theory perspective of alexithyma with the clinical theory of "depréssion essentielle" of Marty. Primary and secondary shortcomings and dysregulations in the early mother-child-relation lead to essential insecurity in building up stable self and object representations with a specifically reduced libidinal tonus of the self and dependency of objects. These conditions lead to the formation of alexithymic disturbances in thought, interaction and object relations, as well as to impaired capacity for self reflection in perception and evaluation of affects, which do not become available as signals for the ego-functions. Moreover, as the capacity for self regulation, as a function of maternal care, could not be internalized, there is an increased proneness for somatisation. In literature, these characteristics were commonly taken for the main limitations for the success of psychoanalytic or psychodynamic treatments. Luminet's psychotherapeutic access in the treatment of alexithymic patients is based on activation and differentiation of the self and object representations through verbal and nonverbal techniques, aiming on actualisation and development of maternal functions; this implies the acknowledgement of the physical body within the therapeutic relationship and awareness of specific counter-transference reactions.

Affective Symptoms↗

New library buildings: the Houston Academy of Medicine--Texas Medical Center Library.

A historical account is given of the Houston Academy of Medicine--Texas Medical Center Library within its Texas Medical Center setting in Houston, Texas. Outlined are planning, financing, and construction of the new library, which consists in part of new building and in part of renovated interiors of an old building originally completed in 1954. A concise picture is given of the new library's interiors, showing its functional success for users and employees alike. An architectural summary is appended showing gross and net footages, source of funds, costs and capacities.

Facility Design and Construction↗

Chronic respiratory disease and respiratory function in a group of fire fighters.

A sample of 193 subjects drawn from the New South Wales Fire Brigade was studied to examine the prevalence of chronic respiratory disease and impairment of respiratory function. The prevalence of respiratory disease was less than that reported in other groups of firemen and reflects the lower level of occupational exposure, and possibly a survivor effect, within the New South Wales Fire Brigade. Among recent recruits, the effects of cigarette smoking far outweighed any contribution from occupational exposure. Among firemen with 20 years or more service a twofold increase in the prevalence of chronic bronchitis is considered to result from the additive effects of cigarette smoking and the high occupational smoke exposures consequent to the availability of respiratory protection and earlier attitudes to its use. The increasingly toxic nature of combustion products at fires was not accompanied by a discernible increase in the prevalence of chronic respiratory disease or impairment of respiratory function. The major combustion products responsible for respiratory damage were self-administered, arising from burning tobacco rather than from burning buildings.

Adult↗

St. Francis Hospital and Medical Center, Topeka, KS. A fast-track project: keeping going while growing.

St. Francis Hospital and Medical Center, Topeka, used careful planning, good communication, and the fast-track design and construction method in a $20-million project to nearly double the facility's size. Although keeping the hospital going while building this addition involved inconvenient trade-offs, the facility's administration "would do it again."

Community-Institutional Relations↗

Award-winning design for special care.

A five-year planning and design effort resulted in an award-winning health sciences building for Chicago's Northwestern Memorial Hospital and Northwestern University.

Academic Medical Centers↗

Developing a health service system for the elderly in Japan.

The present public medical care system in Japan was originally designed in 1961 and covers the entire population. However, several converging medical and demographic factors are forcing the Japanese to redesign their system, particularly as it relates to their increasing elderly population. An estimated 17% of the population will be over 65 years of age by 2000, and nearly one million of them will be bedridden. The Japanese legislature is currently considering new legislation that by the end of this century would provide 10 times as many nursing facility beds, 14 times as many temporary-stay beds, and build or renovate 500 times as many care houses (handicapped accessible) as currently exist.

Aged↗

Building on abilities.

This article reviews generalizations about effective continuing education that pertain to cognitive aging and memory and to a broader range of influences related to adult learning and development and to the context of professional practice. Features of excellent continuing education include attention to diversity, objectives, motivation, active learning, feedback, and application. The learning abilities and capacities of most professionals are sufficient for them to continue to enhance their proficiencies throughout their careers. Cognitive aging is one influence among various psychological characteristics. Effective continuing professional education should address career span learning and performance, including emphasis on abilities and not just disabilities.

Adult↗

Getting data out of the electronic patient record: critical steps in building a data warehouse for decision support.

Health care has taken advantage of computers to streamline many clinical and administrative processes. However, the potential of health care information technology as a source of data for clinical and administrative decision support has not been fully explored. This paper describes the process of developing on-line analytical processing (OLAP) capacity from data generated in an on-line transaction processing (OLTP) system (the electronic patient record). We discuss the steps used to evaluate the EPR system, retrieve the data, and create an analytical data warehouse accessible for analysis. We also summarize studies based on the data (lab re-engineering, practice variation in diagnostic decision-making and evaluation of a clinical alert). Besides producing a useful data warehouse, the process also increased understanding of organizational and cost considerations in purchasing OLAP tools. We discuss the limitations of our approach and ways in which these limitations can be addressed.

Database Management Systems↗

Creating a school without walls and building a learning organization: a case study.

Abstract: This article describes the genesis of a "school without walls" philosophy and the implementation of learning organization principles at Boston University School of Dental Medicine (BUSDM). In Peter Senge's five-discipline approach to organizational learning, a learning organization is defined as "an organization that is continually expanding its capacity to create its future." It is an organization that changes and innovates based on continuous learning, which in BUSDM's case constituted learning from industry trends, patients, students, staff, faculty, and other key stakeholders. Most important, such organizations successfully translate that learning into effective action. It is this capacity to innovate and create change that is critical to competitive advantage and success in a changing environment. This case study of organizational change provides a discussion of the conceptual framework guiding the design and implementation of the learning organization and the chronology of transformation that occurred in three phases over a period of twenty years. We also describe the lessons we learned and the lessons that are still emerging.

Boston↗

A microcosm study on bioremediation of p-nitrophenol-contaminated soil using Arthrobacter protophormiae RKJ100.

p-Nitrophenol (PNP), a toxic nitroaromatic compound, can build up in soils due to extensive usage of nitrophenolic pesticides and hence needs to be removed. Arthrobacter protophormiae RKJ100, a PNP-degrading organism, was used in this work to study factors affecting its growth, and then evaluated for its capacity to degrade PNP in soil microcosms. Molasses (10%) treated with 0.1% potassium hexacyanoferrate was found to be a suitable and cheap carbon source for inoculum preparation. Induction studies showed that PNP depletion was quicker when cells were induced by pre-exposure to PNP. The efficiency of PNP degradation in soil by strain RKJ100 was seen to be dependent on pH, temperature, initial PNP concentration and inoculum size. Microcosm studies performed with varying concentrations (1.4-210 ppm) of PNP-spiked soils showed that strain RKJ100 could effectively degrade PNP over the range 1.4-140 ppm. A cell density of 2x10(8) colony forming units/g soil was found to be suitable for PNP degradation over a temperature range of 20-40 degrees C and at a slightly alkaline pH (7.5). Our results indicate that strain RKJ100 has potential for use in in situ bioremediation of PNP-contaminated sites. This is a model study that could be used for decontamination of sites contaminated also with other compounds.

Arthrobacter↗

Designing the critical care unit: a multidisciplinary approach.

Planning for the physical facility of an ICU has not kept pace with the dramatic technologic improvements in the care of critically ill patients. Specific guidelines for planning of critical care units must be generated by combined input from physicians, nurses, and architects in order to avoid inconsistency of planning. Because most critical care is delivered in the community facility, planning must be directed toward this type of institution, and adapted as necessary for the university or research center. The 4-yr planning and building of a 40-bed critical care center is described for a community hospital.

Critical Care↗

Building the road map for a performance-driven organization.

The strategic importance of performance improvement (PI) in healthcare is being recognized across the country. Organizations that recognize PI's importance and support PI will be better prepared for a healthcare future that mandates measurable value. Building the foundation for success is neither a simple task nor a cheap one. It requires a total systems perspective on improving processes and systems, a commitment to continual learning, and recognition of what other industries have already learned--to succeed, you must constantly innovate and improve. This article discusses one organization's approach to building the foundation for a performance-driven 21st-century healthcare system.

Benchmarking↗

Synthesis and characterization of a novel hyaluronic acid hydrogel.

Hyaluronic acid (hyaluronan, HA) has many medical applications as a biomaterial. To enhance its biostability, a novel hydrogel of cross-linked hyaluronic acid was prepared using a double cross-linking process, which involves building cross-linkages between hydroxyl group pairs and carboxyl group pairs. The present study explored a number of cross-linking processes in order to obtain different degrees of cross-linking, which were evaluated by the measurement of water absorption capacity as an index of the gel network density. To gain a better understanding of the stability of the gel, the chemical structure and particularly the rheological behaviour of the cross-linked HA, which included the influences of factors, such as degree of cross-linking, HA concentration and gel particle size, were investigated. The in vitro biostability against hyaluronidase and free radical degradation was tested to show that the cross-linked hydrogel had improved resistance to in vitro hyaluronidase and free radical degradation.

Biocompatible Materials↗

Freud's three theories of love in the light of later developments.

Evidence is presented that Freud developed three very different theories on love. These theories were not integrated into a coherent theory. In subsequent developments each theory had its own history. The paper discusses the history of the controversy on the genital character, the relation between love and gender identity, between love and narcissism, the hierarchical structure of the capacity to love, and the relation between love and object loss. The impact of some concepts such as symbiosis and the rapprochmente subphase on the understanding of conflicts in loving is raised. While at present differences in emphasis make it difficult to build a coherent psychoanalytic theory of love, it is productive to bring divergent views in touch with each other. A unified theory of love based on psychoanalytic observations is suggested.

Freudian Theory↗

The use of volcanic soil as mineral landfill liner--III. Heavy metals retention capacity.

The volcanic soil of Southern Chile was tested for its heavy metal retention capacity. The maximum uptakes for CrO4(2-) (CrVI), Cu(2+), Zn(2+) and Pb(2+) were determined to be 2.74, 5.32, 5.86 and 7.44 mg g(-1), respectively. At a slightly alkaline pH value (7.5), it seems that a precipitation-adsorption process was responsible for the Cu(2+) and Zn(2+) uptake onto volcanic soil. All the determined values are of the same order of magnitude as natural zeolites heavy metals adsorption capacities. In addition, the heavy metals diffusion model through a 1 m volcanic soil mineral liner shows breakthrough times of 21.6, 10.2 and 8.9 years, for Pb(2+), Zn(2+) and Cu(2+), respectively, confirming the trend obtained in the adsorption isotherms. The natural volcanic soil of Southern Chile is an interesting material for possible use as landfill mineral basal sealing. It has an appropriate sealing potential (average Kf value of 5.85 x 10(-9) m s(-1)) and a heavy metals retention capacity comparable with natural zeolites. About two-thirds of the agricultural land in Chile (approximately 0.4 million km2) is derived from volcanic ash, suggesting an important soil volume for future landfill projects, that could be obtained in sufficient quantities from urban building activities.

Adsorption↗

Building a foundation for systems change: increasing access to physical activity programs for older adults.

Although 25% of U.S. adults are physically inactive, this percentage increases dramatically for older adults. Organizational change theory guided a state health department in identifying system gaps and developing strategies to expand programming for seniors. A survey of provider agencies in New Jersey assessed (a) capacity for physical activity programs for older adults, (b) accessibility of programs, and (c) barriers to providing programs. One hundred sixty agencies provided physical activity programs to almost 184,000 individuals annually. Fewer than one half of the agencies provided exercise programs for people with disabilities, and only 44% provided in-home programs. Eighty-two percent of program providers wanted to expand programming but cited lack of trained instructors and peer leaders, inadequate facility space, insufficient funding, and limited transportation resources as barriers. Sustaining older adult behavior change requires infrastructure that will ensure access to diverse physical activities. This article provides strategies to expand access to physical activity programs for older adults.

Aged↗