• Title/Summary/Keyword: Internal Remodeling

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Strategic Planning for the Contract-Managed Hospital Foodservice Through QFD Methodology (QFD 기법을 이용한 병원 위탁급식 운영전략 수립)

  • 양일선;박수연;김현아;박문경;신서영;이해영
    • Korean Journal of Community Nutrition
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    • v.8 no.5
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    • pp.744-754
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    • 2003
  • At present, health care industries throughout the world are struggling with the challenges to set up financial structures as cost-effective ways and means of satisfying customer needs for health care services. Many hospitals consign foodservice management to foodservice companies for the purpose of efficiency. The companies taking charge of hospital foodservice are also striving to gain an advantage over keen competitions. This study applied Quality Function Deployment(QFD) to one hospital (which will be shown as $\ulcorner$A hospital$\lrcorner$ below) managed by a contract foodservice company for the purpose of strategy planning to provide sustainable competitive advantage. First of all, this study scanned internal and external environment of $\ulcorner$A hospital$\lrcorner$ by means of a Quality Measurement Tool and a fieldwork study. With the result of environment scanning, this study elicited 20 strategies through SWOT analysis, which were categorized by 4 perspectives such as financial, customer, internal process, learning and growth perspectives. Finally, the priorities of 20 strategies were extracted from QFD methodology. According to the results obtained by applying QFD to $\ulcorner$A hospital$\lrcorner$'s foodservice, the strategies which $\ulcorner$A hospital$\lrcorner$ foodservice was obliged to introduce and implement were : the specialization of Children's hospital foodservice, scientific foodservice management through the standardization of foodservice operations, the maintenance of sanitary quality through sanitary system, the remodeling of facilities, the introduction of new equipment, the prompt and accurate response to customer needs, the development of appropriate patient menus, the provision of competitively priced meals for patient selection, the development of a demand forecast model by considering the characteristics of a children's hospital, improvement of productivity and the reduction of labor costs through the employment of experienced employees based on their seniority.

Clinical Application of a Newly Developed Basket Device for Interventional Heartworm Extraction in Three Dogs

  • Lee, Yooyoung;Kim, Hyesung;Yoon, Kwangyong;Park, Jihyeon;Oh, Younna;Oh, Miju;Ban, Jiyoung;Lee, Minju;Kim, Hakhyun;Kang, Byeong-Teck;Chang, Dongwoo
    • Journal of Veterinary Clinics
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    • v.39 no.4
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    • pp.177-184
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    • 2022
  • Caval syndrome is a severe complication of canine heartworm disease in which affected dogs present with various clinical signs that are often life-threatening. In cases of severe infection, adulticidal treatment has numerous complications as a result of a marked immune response against dead worms. Therefore, several surgical and non-surgical methods, including interventional extraction, have been applied in veterinary medicine. Despite the usefulness and efficiency of conventional retrieval devices, a few associated limitations must be addressed to reduce their risks and increase their applicability. Herein, we introduced a case of treating three dogs with caval syndrome by applying a newly developed heartworm basket device. The dogs were diagnosed with heartworm disease by heartworm antigen testing and direct smear. Imaging findings revealed remarkable remodeling of the right heart and pulmonary vessels and the presence of heartworms in the right heart. Additionally, heartworms were confirmed in the distal part of the abdominal aorta and femoral arteries in one dog, indicating aberrant systemic migration of the worms. Under general anesthesia, the heartworm basket device was introduced into the right heart via femoral venotomy and arteriotomy in one dog and jugular venotomy in the other two dogs. Although the number of cases in this study was small, the basket device was successful in gradual and cautious extraction of the heartworms in all three dogs. They exhibited good prognosis of clinical symptoms as indicated by imaging analyses.

High-Resolusion Magnetic Resonance Imaging of Carotid Atherosclerotic Plaque (경동맥 죽상경화반의 고해상도 자기공명영상)

  • Byun, Woo-Mok;Cho, Jae-Ho
    • Journal of Yeungnam Medical Science
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    • v.21 no.2
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    • pp.143-150
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    • 2004
  • A thromboembolic stroke is believed to be precipitated by a rupture of vulnerable atheromatous plaques. Until recently the assessment of a further risk of stroke in high-risk patients in whom atherosclerosis has presented with a transient ischaemic attack (TIA), has been confined to a quantitative assessment of the luminal patency of the internal carotid artery. These traditional stratification parameters are no longer believed to be the most accurate predictors of a thrombo-embolism. This is because the process of vessel wall remodeling can maintain a luminal patency, and consequently, quite large friable plaques may remain unidentified. Accordingly, there is a need for an improved risk assessment. The fibrous cap of a vulnerable plaque is thinner, and an intraplaque hemorrhage and inflammation can occur during the development of atherosclerotic plaque. Several imaging methods for identifying vulnerable plaques have been developed. Recently, high resolution magnetic resonance (MR) imaging has emerged as an accurate non-invasive tool that can characterize the carotid plaque components in vivo. A High resolution carotid magnetic resonance is capable of distinguishing an intact, thick fibrous cap from a thin and ruptured cap in carotid plaque. In addition, a plaque MR can identify the active inflammation and detect a hemorrhage. High resolution carotid MR imaging is a valuable noninvasive method for quantifying the plaque components and identifying vulnerable plaque.

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A Study on Periodic Buffer Allocation for Program Master Schedule (프로그램 공정계획을 위한 주기적 버퍼 설치에 관한 고찰)

  • Koo Kyo-Jin
    • Proceedings of the Korean Institute Of Construction Engineering and Management
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    • autumn
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    • pp.81-87
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    • 2001
  • In a dynamically changing environment, the manager of a maintenance and remodeling (M/R) program is confronted with an increasing complexity of coordinating and cooperating multi-resource constrained multiple projects. The root causes of the complexity, uncertainty and interdependence, cause an internal disruption of an activity and chain reactions of disturbance propagation that deteriorate the stability and manageability of the program. This paper evaluates previous endeavors to apply production control and management techniques to the construction industry, and investigates the possibility of applying other management concepts and theories to organizational program management. In particular, this paper proposes a buffer allocation model by which periodic buffers are allocated in the flows of program constraint resources to stabilize a program master schedule instead of protecting individual activities. Comparative experiments by Monte Carlo simulations illustrate improved performance of the proposed model in terms of program's goals: productivity, flexibility, and long-term stability.

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A Study on the Application of Barrier Free in Library Architecture - Focused on the Case of the Gwangju, Metropolitan City University Library - (도서관 건축에 있어서 베리어프리 적용 현황에 관한 연구 - 광주광역시 대학 도서관 사례를 중심으로 -)

  • Kim, Chae Yi;Kim, Hong Bae
    • Journal of the Korean Institute of Rural Architecture
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    • v.26 no.2
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    • pp.17-25
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    • 2024
  • This study is to use B.F. certification standards to identify the application and differences of B.F. facilities according to various approaches, and to use the analysis results as basic data for the expansion and renovation of new facilities, the National University (Jeonnam University Library), which underwent remodeling before the implementation of the certification system, and the two newly established private universities (Joseon University Library) that were subject to legal application before the implementation of the certification system. First, Chosun University met more B.F. certification standards than Chonnam National University, and mainly intermediary facilities belonged to the best to the best. Second, Chosun University and Chonnam National University's internal facilities met many B.F. certification standards, and Chonnam National University had many areas to improve and found areas to remodel. Third, information facilities at Chonnam National University and Chosun University only had facilities for the hearing impaired, and there were no information facilities for the visually impaired. Facilities for the visually impaired had to be installed, and compared to Chosun University, Chonnam National University fell short of the B.F. certification standard, so there were many areas that needed to be remodeled.

What Is Normal for an Aging Heart?: A Prospective CMR Cohort Study

  • Johannes Kersten;Carsten Hackenbroch;Muriel Bouly;Benoit Tyl;Peter Bernhardt
    • Journal of Cardiovascular Imaging
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    • v.30 no.3
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    • pp.202-211
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    • 2022
  • BACKGROUND: This study aims to investigate normal changes throughout aging of the heart in cardiac magnetic resonance (CMR) imaging in healthy volunteers. While type 2 diabetes mellitus is a frequent finding in the elderly population, also the influence of this circumstance in otherwise healthy persons is part of our study. METHODS: In this prospective single-center trial, 75 healthy subjects in distinct age groups and 10 otherwise healthy diabetics were enrolled. All subjects underwent functional, flow sensitive, native T2- and T1-mapping in a 1.5T CMR scanner. RESULTS: No differences in right and left ventricular ejection fractions were observed between aging healthy groups. Bi-ventricular volumes lowered significantly (p<0.001) between the age groups. There was also a significant decrease in myocardial T1 values, aortic distensibility, and left ventricular peak diastolic strain rates. There were no differences in T2 mapping and the other deformation parameters. Patients with type 2 diabetes mellitus had lower end-diastolic volume indexes; all the other measurements were comparable. CONCLUSIONS: Aging processes in the healthy heart involve a decrease in ventricular volumes, with ejection fractions remaining normal. Stiffening of the myocardium and aorta and a decrease in T1 values are potential indications of age-related remodeling. Type 2 diabetes mellitus seems to have no major influence on aging processes of the heart.

The Expression of MMPs and TIMPs in IPF and NSIP (IPF와 NSIP에서 MMPs와 TIMPs의 발현)

  • Kim, Yu Jin;Kim, Jung Ho;Jeon, Hyo Keun;Kim, Mi Kyeong;Jo, Young Chan;Kyung, Sun Yong;An, Chang Hyeok;Lee, Sang Pyo;Park, Jung Woong;Ha, Seung Yeon;Jeong, Sung Hwan
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.5
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    • pp.447-455
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    • 2006
  • Background: MMPs and TIMPs are important factors for abnormal remodeling the pulmonary parenchyme in idiopathic interstitial pneumonia(IIP) This study evaluated the expression of MMPs and TIMPs in the tissue of IPF, NSIP and normal control subjects. Method: The MMP-2 and -9 activity in the lung tissue was studied by gelatin zymography, and the expression of MMP-1, -2, -9, TIMP-1 and -2 in the lung tissue was measured by immunohistochemistry. Thirty five patients, who were diagnosed with IIP (UIP ; 22, NSIP ; 13), were enrolled in the immunohistochemical study. Thirteen patients with IIP (UIP ; 9, NSIP ; 4) and five patients with lung cancer were enrolled in the zymographic assay. Results: (1) The immunohistochemistry for MMP-1,-2,-9, TIMP-1 and-2 ; MMP-1,-9 and TIMP-2 were stained stronger in the UIP subjects than NSIP and the normal control. TIMP-2 was strongly stained in the UIP tissue. particularly the fibroblasts in the fibroblastic foci. (2) Zymography for MMP-2 and MMP-9 revealed MMP-2 to have prominent expression in the UIP tissue than in the NSIP tissue. Conclusions: These results suggest that the overexpression of the TIMPs and gelatinases in UIP might be important factors in the irreversible fibrosis of the lung parenchyme.

Inhibitory Effect of Biotransformed-Fucoidan on the Differentiation of Osteoclasts Induced by Receptor for Activation of Nuclear Factor-κB Ligand

  • Park, Bobae;Yu, Sun Nyoung;Kim, Sang-Hun;Lee, Junwon;Choi, Sung Jong;Chang, Jeong Hyun;Yang, Eun Ju;Kim, Kwang-Youn;Ahn, Soon-Cheol
    • Journal of Microbiology and Biotechnology
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    • v.32 no.8
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    • pp.1017-1025
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    • 2022
  • Bone homeostasis is regulated by constant remodeling through osteogenesis by osteoblasts and osteolysis by osteoclasts and osteoporosis can be provoked when this balance is broken. Present pharmaceutical treatments for osteoporosis have harmful side effects and thus, our goal was to develop therapeutics from intrisincally safe natural products. Fucoidan is a polysaccharide extracted from many species of brown seaweed, with valuable pharmaceutical activities. To intensify the effect of fucoidan on bone homeostasis, we hydrolyzed fucoidan using AMG, Pectinex and Viscozyme. Of these, fucoidan biotransformed by Pectinex (Fu/Pec) powerfully inhibited the induction of tartrate-resistant acid phosphatase (TRAP) activity in osteoclasts differentiated from bone marrow macrophages (BMMs) by the receptor for activation of nuclear factor-κB ligand (RANKL). To investigate potential of lower molecular weight fucoidan it was separated into >300 kDa, 50-300 kDa, and <50 kDa Fu/Pec fractions by ultrafiltration system. The effects of these fractions on TRAP and alkaline phosphatase (ALP) activities were then examined in differentiated osteoclasts and MC3T3-E1 osteoblasts, respectively. Interestingly, 50-300 kDa Fu/Pec suppressed RANKL-induced osteoclasts differentiation from BMMs but did not synergistically enhance osteoblasts differentiation induced by osteogenic agents. In addition, this fraction inhibited the expressions of NFATc1, TRAP, OSCAR, and RANK, which are all key transcriptional factors involved in osteoclast differentiation, and those of Src, c-Fos and Mitf, as determined by RT-PCR. In conclusion, enzymatically low-molecularized 50-300 kDa Fu/Pec suppressed TRAP by downregulating RANKL-related signaling, contributing to the inhibition of osteoclasts differentiation, and represented a potential means of inducing bone remodeling in the background of osteoporosis.

Long-Term Outcomes of Stenting on Non-Acute Phase Extracranial Supra-Aortic Dissections

  • Jiang, Yeqing;Di, Ruoyu;Lu, Gang;Huang, Lei;Wan, Hailin;Ge, Liang;Zhang, Xiaolong
    • Journal of Korean Neurosurgical Society
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    • v.65 no.3
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    • pp.422-429
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    • 2022
  • Objective : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs. Methods : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed. Results : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5-77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91). Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.

Alteration of Coagulation and Fibrinolysis System According to Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease (만성폐쇄성폐질환에서 우심실 기능 부전에 따른 혈액응고 및 섬유소용해계 변화)

  • Kim, Young;Jang, Yoon Soo;Kim, Hyung Jung;Kim, Se Kyu;Chang, Joon;Ahn, Chul Min;Kim, Sung Kyu;Kwak, Jin Young;Choi, Jin Hwa
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.6
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    • pp.625-630
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    • 2006
  • Background: Pulmonary hypertension in COPD patients is the result of a direct effect of tobacco smoke on the intrapulmonary vessels with the abnormal production of the mediators that control vasoconstriction, vasodilatation, and vascular cell proliferation, which ultimately lead to aberrant vascular remodeling and physiology. COPD patients are prone to the developmint of an acute and chronic thromboembolism with an elevation of the plasma procoagulant and fibrinolytic markers However, the roles of the coagulation and fibrinolysis system on the right ventricular dysfunction in COPD patients are not well defined. We examined the alteration of the coagulation and fibrinolysis system in COPD patients according to the right ventricular function measured using cardiac multidetector computed tomography (MDCT). Methods: The right ventricular ejection fraction (RVEF) was measured using cardiac MDCT in 26 patients who were diagnosed with COPD according to the definition of the GOLD guideline. The plasma level of thrombin antithrombin (TAT) and plasminogen activator inhibitor (PAI)-1 were measured using an enzyme linked immunoassay. Results: The plasma TAT was markedly elevated in COPD patients ($10.5{\pm}19.8{\mu}g/L$) compared with those of the control ($3.4{\pm}2.5{\mu}g/L$) (p<0.01). However, the plasma PAI-1 in COPD patients ($29.6{\pm}20.7ng/mL$) was similar to that in the controls. The plasma TAT showed a significant inverse relationship with the RVEF measured by the cardiac MDCT in COPD patients (r=-0.645, p<0.01). However, the plasma PAI-1 did not show a relationship with the RVEF (r=0.022, p=0.92). Conclusion: These results suggest that the coagulation system in COPD patients is markedly activated, and that the plasma level of TAT might be a marker of a right ventricular dysfunction in COPD patients.