• Journal of Korean Academy of Nursing
• /
• v.45 no.4
• /
• pp.554-564
• /
• 2015

Purpose: The purpose of this study was to develop and evaluate a self-management program based on INR monitoring for patients with cardiac valve replacement. Methods: This program was comprised of five weekly sessions based on Sousa's Enhance-Behavior Performance Model. The first session included individual teaching, and the other four sessions included Prothrombin Time International Normalized Ratios (PT INR) self-monitoring, telephone counseling and self-management checklist recording. Participants were patients who had cardiac valve replacement. They were randomly assigned to the experimental or control group. Sixteen in the experimental group participated in the self-management program and seventeen in the control group participated in general care. Self-management knowledge, self-efficacy, self-management behavior and PT INR were measured as dependent variables. Data were analyzed using Mann Whitney U-test, t-test and ANCOVA. Results: The experimental group showed significantly higher post-test scores in self-management knowledge (t=5.86, p<.001), self-efficacy (F=18.32, p<.001), and self-management behavior (t=3.44, p=.002) compared to the control group. Also, the experimental group showed significantly higher frequency in maintaining the treatment range of PT INR compared to the control group (${\chi}^2=4.80$, p=.028). Conclusion: The results of the research on the self-management program based on PT INR monitoring showed that it is effective in improving self-management knowledge, self-efficacy, and self-management behavior as well as maintaining treatment range of PT INR of patients with cardiac valve replacement.

• Journal of Information Science Theory and Practice
• /
• v.4 no.1
• /
• pp.21-29
• /
• 2016

Given the difference in research performance in various scientific fields, this study aims to weight and valuate current indicators used for evaluation of scientific productions (publications), in order to adjust these indicators in comparison to each other and make possible a more precise evaluation of scientific productions. This is a scientometrics study using documentary, evaluative, and survey techniques. The statistical population consisted of 106 top Iranian researchers, scientists, and scientific and research managers. Then their research résumé information was gathered and analyzed based on research questions. In order to compare values, the data gathered from research production performance of the population was weighted using Shannon entropy method. Also, the weights of each scientific production importance according to expert opinions (extracted from other works) was analyzed and after adjustment the final weight of each scientific production was determined. A pairwise matrix was used in order to determine the ratios. According to the results, in the area of engineering sciences, patents (0.142) in the area of science, international articles (0.074) in the area of humanities and social sciences, books (0.174), and in the area of medical sciences, international articles (0.111) had the highest weight compared to other information formats. By dividing the weights for each type of publication, the value of each scientific production compared to other scientific productions in the same field and productions of other fields was calculated. Validation of the results in the studied population resulted in very high credibility for all investigated indicators in all four fields. By using these values and normalized ratios of publication indicators it is possible to achieve precise and adjusted results, making it possible to feasibly use these results in realistic policy making.

• Journal of Chest Surgery
• /
• v.42 no.2
• /
• pp.193-200
• /
• 2009

Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs $(2.16{\pm}0.23)$ of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those $(2.03{\pm}0.27)$ measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). Conclusion: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients’ compliance should be done for achieving more effective anticoagulation therapy.

• Atmosphere
• /
• v.17 no.2
• /
• pp.159-169
• /
• 2007

A comparison of the three land cover data sets (United States Geological Survey: USGS, International Geosphere Biosphere Programme: IGBP, and University of Maryland: UMd), derived from 1992-1993 Advanced Very High Resolution Radiometer(AVHRR) data sets, was performed over the Asian continent. Preprocesses such as the unification of map projection and land cover definition, were applied for the comparison of the three different land cover data sets. Overall, the agreement among the three land cover data sets was relatively high for the land covers which have a distinct phenology, such as urban, open shrubland, mixed forest, and bare ground (>45%). The ratios of triple agreement (TA), couple agreement (CA) and total disagreement (TD) among the three land cover data sets are 30.99%, 57.89% and 8.91%, respectively. The agreement ratio between USGS and IGBP is much greater (about 80%) than that (about 32%) between USGS and UMd (or IGBP and UMd). The main reasons for the relatively low agreement among the three land cover data sets are differences in 1) the number of land cover categories, 2) the basic input data sets used for the classification, 3) classification (or clustering) methodologies, and 4) level of preprocessing. The number of categories for the USGS, IGBP and UMd are 24, 17 and 14, respectively. USGS and IGBP used only the 12 monthly normalized difference vegetation index (NDVI), whereas UMd used the 12 monthly NDVI and other 29 auxiliary data derived from AVHRR 5 channels. USGS and IGBP used unsupervised clustering method, whereas UMd used the supervised technique, decision tree using the ground truth data derived from the high resolution Landsat data. The insufficient preprocessing in USGS and IGBP compared to the UMd resulted in the spatial discontinuity and misclassification.

• Journal of Environmental Science International
• /
• v.13 no.5
• /
• pp.479-488
• /
• 2004

Five sediment cores from the tidal flat of artificial Lake Shihwa are analyzed in terms of sedimentology and geochemistry to evaluate the heavy metal contamination and redox condition of surficial sediment following the Shihwa seawall construction. The variability of concentrations of various elements depends on the depositional environment, and reflects the various redox conditions and sediment provenances. The amounts of Ti and Al and their ratio of Ti/ Al with respect to Li clearly indicate that there is an anthropogenic contribution to the surficial sediment. The high concentrations of heavy metals suggest an anthropogenic contribution at ST. 34 and ST. 22. Concentrations of most elements (Cr, Cu, Zn and Pb) are higher near the Shihwa-Banwol industrial complex than in the central part of Lake Shihwa. Concentrations of heavy metal in surficial sediment near the Shihwa-Banwol industrial complex are two to eight times higher than in the center of Lake Shihwa. Enrichment factors (EF), which are normalized by the unpolluted shale, suggests a significant metallic contamination near the Shihwa-Banwol industrial complex (SBIC). The redox condition is divided into two anoxic and mixed oxi $c_oxic zones based on the carbon:sulfur (C/S) ratios of organic matter and elemental relationships. Correlations among geochemical elements Mn, U and Mo are significantly different from site to site, and may therefore be an indicator of the spatial redox condition. Controlling factors for switching anoxic/oxic conditions are thought to be water depth and the differences in industrial effluent supply. The variations of the Cu/Mn ratio in the sediments confirms above mentioned spatial differences of a redox condition in part, and therefore shows a location-dependence redox condition in sediments at four other sites. The redox condition of the surficial sediment characteristics of the Shihwa Lake are controlled by its geographic location and water depth.th.

• Nuclear Engineering and Technology
• /
• v.55 no.2
• /
• pp.717-724
• /
• 2023

An essential step in evaluating and comparing the performance of two passive radiation dosimeter types, thermosluminescent (TLD) and optically stimulated luminescence (OSL), used by workers in environments with ionizing radiation for individual radiological monitoring and control of external exposure at various times (cumulative dose for 1 month), is to compare the measured dose accuracy, energy response, and coefficient of variation. In fact this performance study consists in determining the accuracy of both R(10) and R(0.07) which are considered as the ratios of the measured dose (Hp(10) or Hp(0.07)) to the delivered dose (Hp(10) or Hp(0.07)) for each photon energy. The validity of the results of this test is based on the acceptance limits of the ICRP and the international standard IEC-62387. The relative energy response used is normalized to the ¹³⁷Cs 662 keV energy to find which energy response is closest to the ideal case, and the coefficient of variation that allows to determine the statistical fluctuation of the Hp(10) and Hp(0.07) doses. The results of the accuracy test for the OSL and TLD dosimeters are acceptable because they fall within the ICRP limits. For the energy response, the OSL performs better than the TLD for Hp(10) and Hp(0.07), and for the coefficient of variation, the OSL satisfies the requirements of ISO 62387 for both Hp(10) and Hp(0.07), while the TLD satisfies these requirements only for the measurement of Hp (0.07).

• Journal of Chest Surgery
• /
• v.31 no.12
• /
• pp.1172-1182
• /
• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.