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Cost and Effectiveness Comparison of Immediate Colposcopy Versus Human Papillomavirus DNA Testing in Management of Atypical Squamous Cells of Undetermined Significance in Turkish Women

  • Kececioglu, Mehmet;Seckin, Berna;Baser, Eralp;Togrul, Cihan;Kececioglu, Tugban Seckin;Cicek, Mahmut Nedim;Gungor, Tayfun
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.1
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    • pp.511-514
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    • 2013
  • Background: A small but significant proportion of cases with atypical squamous cells of undetermined significance (ASCUS) may harbour CIN 2-3, or even invasive carcinoma. Although immediate colposcopy, HPV-DNA testing or expectant management are three recommended options in ASCUS triage, a consensus does not currently exist on which one of these approaches is the most efficient. In this study, we aimed to compare the performance and cost of immediate colposcopy and colposcopy based on the human papillomavirus (HPV) testing for detecting histologically confirmed high-grade cervical intraepithelial neoplasia (CIN) in women with ASCUS. Materials and Methods: Records of 594 women with an index Papanicolaou smear showing ASCUS were retrospectively analyzed. Women in the immediate colposcopy arm were referred directly to colposcopy (immediate colposcopy group, n=255) and those in the HPV triage arm were proceeded to colposcopy if the high-risk HPV (hrHPV) test was positive (HPV triage group, n=339). High grade CIN (CIN2+) detection rate and treatment costs were compared between the groups. Results: The detected rate of CIN2+ was higher in the HPV triage group compared to immediate colposcopy group (8% vs. 1.6%, p=0.011). In the HPV triage group, the total cost, cost per patient, and the cost for detecting one case of high grade CIN were higher than the immediate colposcopy group (p<0.001). Conclusions: In women with ASCUS cytology, HPV DNA testing followed by colposcopy is more costly than immediate colposcopy, but this approach is associated with a higher rate of CIN2+ detection. This findings suggest that HPV DNA testing combined with cervical cytology could reduce the referral rate to colposcopy.

Clinical Observation on 39 Patients of Spondylolisthesis with Lumbar Herniated Intervertebral Disc Treated by Conservative Oriental Medical Treatment (요추 추간판 탈출을 동반한 척추 전방 전위증 환자 39례에 대한 임상고찰)

  • Nam, Ji-Hwan;Lee, Joon-Seok;Lee, Seul-Ji;Kim, Kie-Won;Lee, Min-Jung;Jun, Jae-Yun;Lim, Su-Jin;Song, Ju-Hyun;Moon, Ja-Young;Yeom, Seung-Chul;Lee, Sung-Chul;Hong, Nam-Jung
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.7 no.2
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    • pp.63-74
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    • 2012
  • Objectives : The purpose of this study was to evaluate the effect of Oriental medical treatment in patients with Spondylolisthesis and lumbar Herniated Intervertebral Disc(HIVD). Methods : This clinical study was carried out on 39 patients with Spondylolisthesis and lumbar Herniated Intervertebral Disc(HIVD), who had been admitted from Jan. 2012 to Nov. 2012. All of 39 patients were treated with acupuncture, Chuna treatment and herbal medicine during the whole admission period. Verbal numerical rating scale(VNRS) and Oswestry disability index(ODI) were used to evaluated the effectiveness of the Oriental medical treatment. Results : 1. Significant improvement of the symptoms of low back pain and leg pain on 39 patients with Spondylolisthesis and lumbar Herniated Intervertebral Disc(HIVD) was seen when evaluated with VNRS and ODI. 2. There was no significant difference of improvement by herniated type when evaluated with VNRS and ODI.. 3. There was no significant difference of improvement by spondylolisthesis type(degenerative and spondylolytic) when evaluated with VNRS and ODI. Conclusions : These results suggest that in the case of low back pain and lower limb numbness caused by Spondylolisthesis and HIVD, conservative treatments can be considered as one of the options of treating the symptoms beside surgical way.

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A Study of Predictability of VKOSPI on the KOSPI200 Intraday Jumps using different Jump Size and Trading Time (점프발생 강도 및 거래시간에 따른 변동성지수의 KOSPI200 일중 점프 예측력에 관한 연구)

  • Jung, Dae-Sung
    • Management & Information Systems Review
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    • v.35 no.1
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    • pp.273-286
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    • 2016
  • This study investigated the information contents of KOSPI200 Options for intraday big market movement by using minute by minute data. The major findings are summarized as follows; First, big market movement occurred more frequently during 9:00~10:00 and 14:00~14:50. These phenomena reflect market unstability just after opening and near closing. Second, VKSOPI is most closely associated with extreme changes such as KOSPI200 jumps. Third, VKOSPI is showed more predictive power with negative KOSPI200 jumps than KOSPI200 jumps. Fourth, VKOSPI showed predictive power for the positive and negative jumps up to 30 minutes before the jumps occurs. The purpose of this study is to explore the most recent topics in the field of finance, research on market microstructure. This study is an important contribution to investigate intraday information comprehensively in terms of market microstructure effects using the 15-year long-term and the high-frequency data(minute by minute). The results of this study are expected to contribute to detect intraday true jumps, proactive development of market risk indicators, risk management, derivatives investment strategy.

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The Clinical Accuracy of Endoscopic Ultrasonography and White Light Imaging in Gastric Endoscopic Submucosal Dissection

  • Park, Soon-Hong;Sung, Sang-Hun;Lee, Seung-Jun;Jung, Min-Kyu;Kim, Sung-Kook;Jeon, Seong-Woo
    • Journal of Gastric Cancer
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    • v.12 no.2
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    • pp.99-107
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    • 2012
  • Purpose: Gastric mucosal neoplastic lesions should have characteristic endoscopic features for successful endoscopic submucosal dissection. Materials and Methods: Out of the 1,010 endoscopic submucosal dissection, we enrolled 62 patients that had the procedure cancelled. Retrospectively, whether the reasons for cancelling the endoscopic submucosal dissection were consistent with the indications for an endoscopic submucosal dissection were assessed by analyzing the clinical outcomes of the patients that had the surgery. Results: The cases were divided into two groups; the under-diagnosed group (30 cases; unable to perform an endoscopic submucosal dissection) and the over-diagnosed group (32 cases; unnecessary to perform an endoscopic submucosal dissection), according to the second endoscopic findings, compared with the index conventional white light image. There were six cases in the under-diagnosed group with advanced gastric cancer on the second conventional white light image endoscopy, 17 cases with submucosal invasion on endoscopic ultrasonography findings, 5 cases with a size greater than 3 cm and ulcer, 1 case with diffuse infiltrative endoscopic features, and 1 case with lymph node involvement on computed tomography. A total of 25 patients underwent a gastrectomy to remove a gastric adenocarcinoma. The overall accuracy of the decision to cancel the endoscopic submucosal dissection was 40% (10/25) in the subgroup that had the surgery. Conclusions: The accuracy of the decision to cancel the endoscopic submucosal dissection, after conventional white light image and endoscopic ultrasonography, was low in this study. Other diagnostic options are needed to arrive at an accurate decision on whether to perform a gastric endoscopic submucosal dissection.

Spatial Assessment of Climate Suitability for Summer Cultivation of Potato in North Korea (기후적합도 모형을 활용한 북한지역 내 감자의 여름재배 적지 탐색)

  • Kang, Minju;Hyun, Shinwoo;Kim, Kwang Soo
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.24 no.1
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    • pp.35-47
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    • 2022
  • Expansion of potato production areas can improve the food security in North Korea because the given crop has less requirements for agricultural materials and facilities. The Global Agro-Ecological Zones (GAEZ) model, which was developed to evaluate climate suitability under different cultivation conditions, was used to identify potential areas for the potato production. The spatial estimates of crop suitability under low and high input management conditions were downloaded from the GAEZ data portal. The values of suitability were obtained at the potato occurrence sites retrieved from the Global Biodiversity Information Facility (GBIF) database. The suitable areas for the potato production were identified using a threshold value derived from the suitability estimates at the occurrence sites. It was found that 90% of the occurrence sites had the suitability index value >3,333, which was set to be the threshold value. The suitable areas in North Korea were summarized by province and county. Rice cultivation areas were excluded from the analysis. The reported relative acreage of potato production was better represented by the suitable areas under the low input management options than the high input conditions. The suitable areas also had a similar distribution to the reported acreage of potato production by county. These results indicated that the GAEZ model would be useful to identify the candidate production areas, which would facilitate the increases in potato production especially under future climate conditions. Furthermore, monthly maps of crop suitability can be used to design cropping systems that would improve crop production under the limited use of agricultural materials and facilities.

Pharmacoacupuncture for the Treatment of Frozen Shoulder: protocol for a systematic review and meta-analysis

  • Ji-Ho Lee;Hyeon-Sun Park;Sang-Hyeon Park;Dong-Ho Keum;Seo-Hyun Park
    • Journal of Pharmacopuncture
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    • v.27 no.1
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    • pp.14-20
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    • 2024
  • Objectives: Frozen shoulder (FS) is one of the most challenging shoulder disorders for patients and clinicians. Its symptoms mainly include any combination of stiffness, nocturnal pain, and limitation of active and passive glenohumeral joint movement. Conventional treatment options for FS are physical therapy, nonsteroidal anti-inflammatory drugs, injection therapy, and arthroscopic capsular release, but adverse and limited effects continue to present problems. As a result, pharmacoacupuncture (PA) is getting attention as an alternative therapy for patients with FS. PA is a new form of acupuncture treatment in traditional Korean medicine (TKM) that is mainly used for musculoskeletal diseases. It has similarity and specificity compared to corticosteroid injection and hydrodilatation, making it a potential alternative injection therapy for FS. However, no systematic reviews investigating the utilization of PA for FS have been published. Therefore, this review aims to standardize the clinical use of PA for FS and validate its therapeutic effect. Methods: The protocol was registered in Prospero (CRD42023445708) on 18 July 2023. Until Aug. 31, 2023, seven electronic databases will be searched for randomized controlled trials of PA for FS. Authors will be contacted, and manual searches will also be performed. Two reviewers will independently screen and collect data from retrieved articles according to predefined criteria. The primary outcome will be pain intensity, and secondary outcomes will be effective rate, Constant-Murley Score, Shoulder Pain and Disability Index, range of motion, quality of life, and adverse events. Bias and quality of the included trials will be assessed using the Cochrane handbook's risk-of-bias tool for randomized trials. Meta analyses will be conducted using Review Manager V.5.3 software. GRADE will be used to evaluate the level of evidence for each outcome. Results: This systematic review and meta-analysis will be conducted following PRISMA statement. The results will be published in a peer-reviewed journal. Conclusion: This review will provide scientific evidence to support health insurance policy as well as the standardization of PA in clinical practice.

Development of Predictive Models for Rights Issues Using Financial Analysis Indices and Decision Tree Technique (경영분석지표와 의사결정나무기법을 이용한 유상증자 예측모형 개발)

  • Kim, Myeong-Kyun;Cho, Yoonho
    • Journal of Intelligence and Information Systems
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    • v.18 no.4
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    • pp.59-77
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    • 2012
  • This study focuses on predicting which firms will increase capital by issuing new stocks in the near future. Many stakeholders, including banks, credit rating agencies and investors, performs a variety of analyses for firms' growth, profitability, stability, activity, productivity, etc., and regularly report the firms' financial analysis indices. In the paper, we develop predictive models for rights issues using these financial analysis indices and data mining techniques. This study approaches to building the predictive models from the perspective of two different analyses. The first is the analysis period. We divide the analysis period into before and after the IMF financial crisis, and examine whether there is the difference between the two periods. The second is the prediction time. In order to predict when firms increase capital by issuing new stocks, the prediction time is categorized as one year, two years and three years later. Therefore Total six prediction models are developed and analyzed. In this paper, we employ the decision tree technique to build the prediction models for rights issues. The decision tree is the most widely used prediction method which builds decision trees to label or categorize cases into a set of known classes. In contrast to neural networks, logistic regression and SVM, decision tree techniques are well suited for high-dimensional applications and have strong explanation capabilities. There are well-known decision tree induction algorithms such as CHAID, CART, QUEST, C5.0, etc. Among them, we use C5.0 algorithm which is the most recently developed algorithm and yields performance better than other algorithms. We obtained data for the rights issue and financial analysis from TS2000 of Korea Listed Companies Association. A record of financial analysis data is consisted of 89 variables which include 9 growth indices, 30 profitability indices, 23 stability indices, 6 activity indices and 8 productivity indices. For the model building and test, we used 10,925 financial analysis data of total 658 listed firms. PASW Modeler 13 was used to build C5.0 decision trees for the six prediction models. Total 84 variables among financial analysis data are selected as the input variables of each model, and the rights issue status (issued or not issued) is defined as the output variable. To develop prediction models using C5.0 node (Node Options: Output type = Rule set, Use boosting = false, Cross-validate = false, Mode = Simple, Favor = Generality), we used 60% of data for model building and 40% of data for model test. The results of experimental analysis show that the prediction accuracies of data after the IMF financial crisis (59.04% to 60.43%) are about 10 percent higher than ones before IMF financial crisis (68.78% to 71.41%). These results indicate that since the IMF financial crisis, the reliability of financial analysis indices has increased and the firm intention of rights issue has been more obvious. The experiment results also show that the stability-related indices have a major impact on conducting rights issue in the case of short-term prediction. On the other hand, the long-term prediction of conducting rights issue is affected by financial analysis indices on profitability, stability, activity and productivity. All the prediction models include the industry code as one of significant variables. This means that companies in different types of industries show their different types of patterns for rights issue. We conclude that it is desirable for stakeholders to take into account stability-related indices and more various financial analysis indices for short-term prediction and long-term prediction, respectively. The current study has several limitations. First, we need to compare the differences in accuracy by using different data mining techniques such as neural networks, logistic regression and SVM. Second, we are required to develop and to evaluate new prediction models including variables which research in the theory of capital structure has mentioned about the relevance to rights issue.

The lesson From Korean War (한국전쟁의 교훈과 대비 -병력수(兵力數) 및 부대수(部隊數)를 중심으로-)

  • Yoon, Il-Young
    • Journal of National Security and Military Science
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    • s.8
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    • pp.49-168
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    • 2010
  • Just before the Korean War, the total number of the North Korean troops was 198,380, while that of the ROK(Republic of Korea) army troops 105,752. That is, the total number of the ROK army troops at that time was 53.3% of the total number of the North Korean army. As of December 2008, the total number of the North Korean troops is estimated to be 1,190,000, while that of the ROK troops is 655,000, so the ROK army maintains 55.04% of the total number of the North Korean troops. If the ROK army continues to reduce its troops according to [Military Reform Plan 2020], the total number of its troops will be 517,000 m 2020. If North Korea maintains the current status(l,190,000 troops), the number of the ROK troops will be 43.4% of the North Korean army. In terms of units, just before the Korean War, the number of the ROK army divisions and regiments was 80% and 44.8% of North Korean army. As of December 2008, North Korea maintains 86 divisions and 69 regiments. Compared to the North Korean army, the ROK army maintains 46 Divisions (53.4% of North Korean army) and 15 regiments (21.3% of North Korean army). If the ROK army continue to reduce the military units according to [Military Reform Plan 2020], the number of ROK army divisions will be 28(13 Active Division, 4 Mobilization Divisions and 11 Local Reserve Divisions), while that of the North Korean army will be 86 in 2020. In that case, the number of divisions of the ROK army will be 32.5% of North Korean army. During the Korean war, North Korea suddenly invaded the Republic of Korea and occupied its capital 3 days after the war began. At that time, the ROK army maintained 80% of army divisions, compared to the North Korean army. The lesson to be learned from this is that, if the ROK army is forced to disperse its divisions because of the simultaneous invasion of North Korea and attack of guerrillas in home front areas, the Republic of Korea can be in a serious military danger, even though it maintains 80% of military divisions of North Korea. If the ROK army promotes the plans in [Military Reform Plan 2020], the number of military units of the ROK army will be 32.5% of that of the North Korean army. This ratio is 2.4 times lower than that of the time when the Korean war began, and in this case, 90% of total military power should be placed in the DMZ area. If 90% of military power is placed in the DMZ area, few troops will be left for the defense of home front. In addition, if the ROK army continues to reduce the troops, it can allow North Korea to have asymmetrical superiority in military force and it will eventually exert negative influence on the stability and peace of the Korean peninsular. On the other hand, it should be reminded that, during the Korean War, the Republic of Korea was attacked by North Korea, though it kept 53.3% of troops, compared to North Korea. It should also be reminded that, as of 2008, the ROK army is defending its territory with the troops 55.04% of North Korea. Moreover, the national defense is assisted by 25,120 troops of the US Forces in Korea. In case the total number of the ROK troops falls below 43.4% of the North Korean army, it may cause social unrest about the national security and may lead North Korea's misjudgement. Besides, according to Lanchester strategy, the party with weaker military power (60% compared to the party with stronger military power) has the 4.1% of winning possibility. Therefore, if we consider the fact that the total number of the ROK army troops is 55.04% of that of the North Korean army, the winning possibility of the ROK army is not higher than 4.1%. If the total number of ROK troops is reduced to 43.4% of that of North Korea, the winning possibility will be lower and the military operations will be in critically difficult situation. [Military Reform Plan 2020] rums at the reduction of troops and units of the ground forces under the policy of 'select few'. However, the problem is that the financial support to achieve this goal is not secured. Therefore, the promotion of [Military Reform Plan 2020] may cause the weakening of military defence power in 2020. Some advanced countries such as Japan, UK, Germany, and France have promoted the policy of 'select few'. However, what is to be noted is that the national security situation of those countries is much different from that of Korea. With the collapse of the Soviet Unions and European communist countries, the military threat of those European advanced countries has almost disappeared. In addition, the threats those advanced countries are facing are not wars in national level, but terrorism in international level. To cope with the threats like terrorism, large scaled army trops would not be necessary. So those advanced European countries can promote the policy of 'select few'. In line with this, those European countries put their focuses on the development of military sections that deal with non-military operations and protection from unspecified enemies. That is, those countries are promoting the policy of 'select few', because they found that the policy is suitable for their national security environment. Moreover, since they are pursuing common interest under the European Union(EU) and they can form an allied force under NATO, it is natural that they are pursing the 'select few' policy. At present, NATO maintains the larger number of troops(2,446,000) than Russia(l,027,000) to prepare for the potential threat of Russia. The situation of japan is also much different from that of Korea. As a country composed of islands, its prime military focus is put on the maritime defense. Accordingly, the development of ground force is given secondary focus. The japanese government promotes the policy to develop technology-concentrated small size navy and air-forces, instead of maintaining large-scaled ground force. In addition, because of the 'Peace Constitution' that was enacted just after the end of World War II, japan cannot maintain troops more than 240,000. With the limited number of troops (240,000), japan has no choice but to promote the policy of 'select few'. However, the situation of Korea is much different from the situations of those countries. The Republic of Korea is facing the threat of the North Korean Army that aims at keeping a large-scale military force. In addition, the countries surrounding Korea are also super powers containing strong military forces. Therefore, to cope with the actual threat of present and unspecified threat of future, the importance of maintaining a carefully calculated large-scale military force cannot be denied. Furthermore, when considering the fact that Korea is in a peninsular, the Republic of Korea must take it into consideration the tradition of continental countries' to maintain large-scale military powers. Since the Korean War, the ROK army has developed the technology-force combined military system, maintaining proper number of troops and units and pursuing 'select few' policy at the same time. This has been promoted with the consideration of military situation in the Koran peninsular and the cooperation of ROK-US combined forces. This kind of unique military system that cannot be found in other countries can be said to be an insightful one for the preparation for the actual threat of North Korea and the conflicts between continental countries and maritime countries. In addition, this kind of technology-force combined military system has enabled us to keep peace in Korea. Therefore, it would be desirable to maintain this technology-force combined military system until the reunification of the Korean peninsular. Furthermore, it is to be pointed out that blindly following the 'select few' policy of advanced countries is not a good option, because it is ignoring the military strategic situation of the Korean peninsular. If the Republic of Korea pursues the reduction of troops and units radically without consideration of the threat of North Korea and surrounding countries, it could be a significant strategic mistake. In addition, the ROK army should keep an eye on the fact the European advanced countries and Japan that are not facing direct military threats are spending more defense expenditures than Korea. If the ROK army reduces military power without proper alternatives, it would exert a negative effect on the stable economic development of Korea and peaceful reunification of the Korean peninsular. Therefore, the desirable option would be to focus on the development of quality of forces, maintaining proper size and number of troops and units under the technology-force combined military system. The tableau above shows that the advanced countries like the UK, Germany, Italy, and Austria spend more defense expenditure per person than the Republic of Korea, although they do not face actual military threats, and that they keep achieving better economic progress than the countries that spend less defense expenditure. Therefore, it would be necessary to adopt the merits of the defense systems of those advanced countries. As we have examined, it would be desirable to maintain the current size and number of troops and units, to promote 'select few' policy with increased defense expenditure, and to strengthen the technology-force combined military system. On the basis of firm national security, the Republic of Korea can develop efficient policies for reunification and prosperity, and jump into the status of advanced countries. Therefore, the plans to reduce troops and units in [Military Reform Plan 2020] should be reexamined. If it is difficult for the ROK army to maintain its size of 655,000 troops because of low birth rate, the plans to establish the prompt mobilization force or to adopt drafting system should be considered for the maintenance of proper number of troops and units. From now on, the Republic of Korean government should develop plans to keep peace as well as to prepare unexpected changes in the Korean peninsular. For the achievement of these missions, some options can be considered. The first one is to maintain the same size of military troops and units as North Korea. The second one is to maintain the same level of military power as North Korea in terms of military force index. The third one is to maintain the same level of military power as North Korea, with the combination of the prompt mobilization force and the troops in active service under the system of technology-force combined military system. At present, it would be not possible for the ROK army to maintain such a large-size military force as North Korea (1,190,000 troops and 86 units). So it would be rational to maintain almost the same level of military force as North Korea with the combination of the troops on the active list and the prompt mobilization forces. In other words, with the combination of the troops in active service (60%) and the prompt mobilization force (40%), the ROK army should develop the strategies to harmonize technology and forces. The Korean government should also be prepared for the strategic flexibility of USFK, the possibility of American policy change about the location of foreign army, radical unexpected changes in North Korea, the emergence of potential threat, surrounding countries' demand for Korean force for the maintenance of regional stability, and demand for international cooperation against terrorism. For this, it is necessary to develop new approaches toward the proper number and size of troops and units. For instance, to prepare for radical unexpected political or military changes in North Korea, the Republic of Korea should have plans to protect a large number of refugees, to control arms and people, to maintain social security, and to keep orders in North Korea. From the experiences of other countries, it is estimated that 115,000 to 230,000 troops, plus ten thousands of police are required to stabilize the North Korean society, in the case radical unexpected military or political change happens in North Korea. In addition, if the Republic of Korea should perform the release of hostages, control of mass destruction weapons, and suppress the internal wars in North Korea, it should send 460,000 troops to North Korea. Moreover, if the Republic of Korea wants to stop the attack of North Korea and flow of refugees in DMZ area, at least 600,000 troops would be required. In sum, even if the ROK army maintains 600,000 troops, it may need additional 460,000 troops to prepare for unexpected radical changes in North Korea. For this, it is necessary to establish the prompt mobilization force whose size and number are almost the same as the troops in active service. In case the ROK army keeps 650,000 troops, the proper number of the prompt mobilization force would be 460,000 to 500,000.

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