• Journal of the Korean Society for Marine Environment & Energy
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• v.9 no.1
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• pp.1-13
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• 2006

A field survey on the spatio-temporal distribution characteristics and origins of organic matter in surface sediments was carried out monthly at six stations in Gamak Bay, South Korea from April 2000 to March 2002. The range of ignition loss(IL) was $4.6{\sim}11.6%(7.1{\pm}1.6%)$, while chemical oxygen demand(CODs) ranged from $12.25{\sim}99.26mgO_2/g-dry(30.98{\pm}19.09mgO_2/g-dry)$, acid volatile sulfide(AVS) went from no detection(ND)${\sim}10.29mgS/g-dry(1.02{\pm}0.58mgS/g-dry)$, and phaeopigment was $6.84{\sim}116.18{\mu}g/g-dry(23.72{\pm}21.16{\mu}g/g-dry)$. The ranges of particulate organic carbon(POC) and particulate organic nitrogen(PON) were $5.45{\sim}23.24 mgC/g-dty(10.34{\pm}4.40C\;mgC/g-dry)$ and $0.71{\sim}2.99mgN/g-dry(1.37{\pm}0.58mgN/g-dry)$, respectively. Water content was in the range of $43.1{\sim}77.6%(55.8{\pm}5.6%)$, and mud content(silt+clay) was higher than 95% at all stations. The spatial distribution of organic matter in surface sediments was greatly divided between the northwestern, central and eastern areas, southern entrance area from the distribution characteristic of their organic matters. The concentrations of almost all items were greater at the northwestern and southern entrance area than at the other areas in Gamak Bay. In particular, sedimentary pollution was very serious at the northwestern area, because the area had an excessive supply of organic matter due to aquaculture activity and the inflow of sewage from the land. These materials stayed longer because of the topographical characteristics of such as basin and the anoxic conditions in the bottom seawater environment caused by thermocline in the summer. The tendency of temporal change was most prominently in the period of high-water temperatures than low-water ones at the northwestern and southern entrance areas. On the other hand, the central and eastern areas did not show a regular trend for changing the concentrations of each item but mainly showed a higher tendency during the low-water temperatures. This was observed for all but AVS concentrations which were higher during the period of high-water temperature at all stations. Especially, the central and eastern areas showed a large temporal increase of AVS concentration during those periods of high-water temperature where the concentration of CODs was in excess of $20mgO_2/g-dry$. The results show that the organic matters in surface sediments in Gamak Bay actually originated from autochthonous organic matters with eight or less in average C/N ratio including the organic matters generated by the use of ocean, rather than terrigenous organic matters. However, the formation of autochthonous organic matter was mainly derived from detritus than living phytoplankton, indicated the results of the POC/phaeopigment ratio. In addition, the CODs/IL ratio results demonstrate that the detritus was the product of artificial activities such as dregs feeding and fecal pellets of farm organisms caused by aquaculture activities rather than the dynamic of natural ocean activities.

• Journal of Life Science
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• v.19 no.11
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• pp.1538-1546
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• 2009

This study was conducted to estimate the in vitro fermentation characteristics and in situ degradabilities of total mixed rations fermented by the synbiotic co-cultures composed of various anaerobic microorganisms in the rumen of cow. Seventy two TMR bags (4 treatments $\times$ 6 fermentation days $\times$ 3 replications) were manufactured for in vitro and in situ experiments. The experiment was composed of four treatments including the control, the mould and bacteria synbiotics (T1), the mould and yeast synbiotics (T2) and the bacteria and yeast synbiotics (T3). Each treatment had six fermentation days (1, 3, 5, 7, 14, 21 day) with three replications. Two rumen cannulated Holstein cows (550 ㎏ of mean body wt) were used for in situ trial, and a total of 96 nylon bags were retrieved from the rumen according to eight fermentation times (1, 3, 6, 9, 18, 24, 48 and 72 hr). The mean fermentation temperatures of TMRs by supplementation of anaerobic micoorganism co-cultures ranged from $22.97^{\circ}C$ to $26.07^{\circ}C$, and tended to increase steadily during the entire period. pH values of the F-TMRs ranged from 4.39 to 4.98 and tended to decrease with the extension of the fermentation period, and decreased by supplementation of synbiotics (p<0.05). The ammonia concentrations of F-TMRs were not affected by addition of synbiotic co-cultures during the early fermentation period (within 7 days), but was lowest (p<0.05) in T3 during the late fermentation periods (after 14 days). Lactic acid concentration of F-TMR was lowest in T3 at 1 day of fermentation, but was not different from treatments in the other fermentation days. Microbial growth rates of F-TMR reached a peak at 7 days of fermentation, and afterward tended to decrease. In in situ experiment, the DM disappearance rates were higher in T1 than the control during early fermentation times (within 3 hours), but was vice versa at 48 hours of fermentation (p<0.05). There was no significant difference in effective DM degradability among treatments. NDF and ADF disappearance rates in situ were similar to those of DM. From the above results, the supplementation of synbiotics, particularly the mould and bacteria synbiotics, resulted in improving the pH and concentration of lactic acid of F-TMR as parameters of fermentation compare to the control, and also had higher in situ disappearance rates of DM, NDF and ADF than the control at early fermentation time. However, effective DM degradability was not affected by supplementation of synbiotics.

• Journal of Korean Society of Environmental Engineers
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• v.31 no.2
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• pp.79-89
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• 2009

Naphthalene is a volatile, hydrophobic, and possibly carcinogenic compound that is known to have a severe detrimental effect to aquatic ecosystem. Our research examined the effects of various operating conditions (temperature, pH, initial concentration, and frequency and type of ultrasound) on the sonochemical degradation of naphthalene and OH radical production. The MDL (Method detection limit) determined by LC/FLD (1200 series, Agilient) using C-18 reversed column is measured up to 0.01 ppm. Naphthalene vapor produced from ultrasound irradiation was detected under 0.05 ppm. Comparison of naphthalene sonodegradion efficiency tested under open and closed reactor cover fell within less than 1% of difference. Increasing the reaction temperature from $15^{\circ}C$ to $40^{\circ}C$ resulted in reduction of naphthalene degradation efficiency ($15^{\circ}C$: 95% ${\rightarrow}$ $40^{\circ}C$: 85%), and altering pH from 12 to 3 increased the effect (pH 12: 84% ${\rightarrow}$pH 3: 95.6%). Pseudo first-order constants ($k_1$) of sonodegradation of naphthalene decreased as initial concentration of naphthalene increased (2.5 ppm: $27.3{\times}10^{-3}\;min^{-3}\;{\rightarrow}$ 10 ppm : $19.3{\times}10^{-3}\;min^{-3}$). Degradation efficiency of 2.5 ppm of naphthalene subjected to 28 kHz of ultrasonic irradiation was found to be 1.46 times as much as when exposed under 132 kHz (132 kHz: 56%, 28 kHz: 82.7%). Additionally, its $k_1$ constant was increased by 2.3 times (132 kHz: $2.4{\times}10^{-3}\;min^{-1}$, 28 kHz: $5.0{\times}10^{-3}\;min^{-1}$). $H_2O_2$ concentration measured 10 minutes after the exposure to 132 kHz of ultrasound, when compared with the measurement under frequency of 28 kHz, was 7.2 times as much. The concentration measured after 90 minutes, however, showed the difference of only 10%. (concentration of $H_2O_2$ under 28 kHz being 1.1 times greater than that under 132 kHz.) The $H_2O_2$ concentration resulting from 2.5 ppm naphthalene after 90 minutes of sonication at 24 kHz and 132 kHz were lower by 0.05 and 0.1 ppm, respectively, than the concentration measured from the irradiated M.Q. water (no naphthalene added.) Degradation efficiency of horn type (24 kHz) and bath type (28 kHz) ultrasound was found to be 87% and 82.7%, respectively, and $k_1$ was calculated into $22.8{\times}10^{-3}\;min^{-1}$ and $18.7{\times}10^{-3}\;min^{-1}$ respectively. Using the multi- frequency and mixed type of ultrasound system (28 kHz bath type + 24 kHz horn type) simultaneously resulted in combined efficiency of 88.1%, while $H_2O_2$ concentration increased 3.5 times (28 kHz + 24 kHz: 2.37 ppm, 24 kHz: 0.7 ppm.) Therefore, the multi-frequency and mixed type of ultrasound system procedure might be most effectively used for removing the substances that are easily oxidized by the OH radical.

• Journal of Oral Medicine and Pain
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• v.30 no.2
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• pp.163-199
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• 2005

Dentistry had been considered to be a relatively safe zone from the risk of medical accidents for there are less number of emergency cases. However, in these days, the number of medical dispute is increasing that the dentists would not be able to overlook it as if it is none of their matters. Hence, researches on various medical accidents and analyses on related matters to seek proper management have been carried out recently, but the datas are not enough yet. This study analysed the actual conditions of medical accidents as well as disputes and the general awareness of dental practitioners in local clinics with the purpose of understanding the general situation and to suggest counterplan. The study was conducted by analysing 1,882 questionnaires collected from total of 3,684 dentists belonging to Seoul Dental Association and where Doctors and Hospitals Medical Malpractice Insurance for dentists is administered. The results were as follows: 1. 98.47% of the respondents doubted the risk of medical accident and dispute. 2. 27.42% of the respondents experienced medical dispute, and there was no significant difference between the rate of medical disputes and the resident training. 3. Among the cases of medical accidents, those related to the periodontal/operative treatment showed the highest rate of 20.50%, and that related to implant treatment was 6.17%. 4. 43.02% of the respondents explained about the treatment procedure before the treatment while 25.90% started the treatment without consent of the patients. 5. Medical dispute resulted from not having any explanation or consent of the patients were of 16.55%. 10.26% had difficulties in solving the problem for missing the medical records. 6. 49.73% responded to be capable of administering first aid treatment. Among them, 23.60% were equipped with accurate knowledge regarding the emergency care. 7. During medical dispute, 88.09% sought counsel from other dentists, and Local district dental association was found to be the most frequently asked group. 8. In cases of medical dispute, 5.26% of the respondents were asked to submit relevant data from customer protection organization, and among them, 75.61% acceded the demand sincerely. 9. After the settlement of the dispute, 83.63% recovered relatively stable state of mind. 10. 99.46% of the respondents felt the necessity of medical dispute management organization, and 78.58% responded that it was urgent. 11. 66.70% of the respondents joined Doctors and Hospitals Medical Malpractice Insurance, although they had not experienced medical dispute. However, 73.36% of the respondent were not aware of it, and 93.36% of the members were not aware of the procedure of the dispute settlement. 12. 79.0% of the respondents who joined the Doctors and Hospitals Medical Malpractice Insurance still felt confused when medical dispute occured, but relatively safer than before. 13. When medical dispute was settled through Doctors and Hospitals Medical Malpractice Insurance, 71.92% of the dentists were contented more than moderately, however, 35.16% of the patients were contented. 14. For complement of Doctors and Hospitals Medical Malpractice Insurance, 53.22% of the respondents felt that insurance company, dentist, and patient should all participate in bringing mutual agreement for quick settlement of the dispute. In addition, 29.08% of the respondents wanted insurance company to prevent patients from disturbing their practices. From the above results, improvement of the general awareness on increasing rate of medical disputes, and education as well as complementary measures for settlement of the disputes are required.

• Journal of Intelligence and Information Systems
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• v.22 no.4
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• pp.109-122
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• 2016

Recently, big data analysis has developed into a field of interest to individuals and non-experts as well as companies and professionals. Accordingly, it is utilized for marketing and social problem solving by analyzing the data currently opened or collected directly. In Korea, various companies and individuals are challenging big data analysis, but it is difficult from the initial stage of analysis due to limitation of big data disclosure and collection difficulties. Nowadays, the system improvement for big data activation and big data disclosure services are variously carried out in Korea and abroad, and services for opening public data such as domestic government 3.0 (data.go.kr) are mainly implemented. In addition to the efforts made by the government, services that share data held by corporations or individuals are running, but it is difficult to find useful data because of the lack of shared data. In addition, big data traffic problems can occur because it is necessary to download and examine the entire data in order to grasp the attributes and simple information about the shared data. Therefore, We need for a new system for big data processing and utilization. First, big data pre-analysis technology is needed as a way to solve big data sharing problem. Pre-analysis is a concept proposed in this paper in order to solve the problem of sharing big data, and it means to provide users with the results generated by pre-analyzing the data in advance. Through preliminary analysis, it is possible to improve the usability of big data by providing information that can grasp the properties and characteristics of big data when the data user searches for big data. In addition, by sharing the summary data or sample data generated through the pre-analysis, it is possible to solve the security problem that may occur when the original data is disclosed, thereby enabling the big data sharing between the data provider and the data user. Second, it is necessary to quickly generate appropriate preprocessing results according to the level of disclosure or network status of raw data and to provide the results to users through big data distribution processing using spark. Third, in order to solve the problem of big traffic, the system monitors the traffic of the network in real time. When preprocessing the data requested by the user, preprocessing to a size available in the current network and transmitting it to the user is required so that no big traffic occurs. In this paper, we present various data sizes according to the level of disclosure through pre - analysis. This method is expected to show a low traffic volume when compared with the conventional method of sharing only raw data in a large number of systems. In this paper, we describe how to solve problems that occur when big data is released and used, and to help facilitate sharing and analysis. The client-server model uses SPARK for fast analysis and processing of user requests. Server Agent and a Client Agent, each of which is deployed on the Server and Client side. The Server Agent is a necessary agent for the data provider and performs preliminary analysis of big data to generate Data Descriptor with information of Sample Data, Summary Data, and Raw Data. In addition, it performs fast and efficient big data preprocessing through big data distribution processing and continuously monitors network traffic. The Client Agent is an agent placed on the data user side. It can search the big data through the Data Descriptor which is the result of the pre-analysis and can quickly search the data. The desired data can be requested from the server to download the big data according to the level of disclosure. It separates the Server Agent and the client agent when the data provider publishes the data for data to be used by the user. In particular, we focus on the Big Data Sharing, Distributed Big Data Processing, Big Traffic problem, and construct the detailed module of the client - server model and present the design method of each module. The system designed on the basis of the proposed model, the user who acquires the data analyzes the data in the desired direction or preprocesses the new data. By analyzing the newly processed data through the server agent, the data user changes its role as the data provider. The data provider can also obtain useful statistical information from the Data Descriptor of the data it discloses and become a data user to perform new analysis using the sample data. In this way, raw data is processed and processed big data is utilized by the user, thereby forming a natural shared environment. The role of data provider and data user is not distinguished, and provides an ideal shared service that enables everyone to be a provider and a user. The client-server model solves the problem of sharing big data and provides a free sharing environment to securely big data disclosure and provides an ideal shared service to easily find big data.

• Journal of Forest and Environmental Science
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• v.21 no.1
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• pp.34-58
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• 2005

This study was executed to find out how to improve the planting and use of landscaping plants in Weonju and Hoengseong. 1. The number of street trees were 22,068 and the species number were 10 species in Weonju in 2004. The major species of street trees were Ginkgo biloba(58%), Prunus sargentii(15%), Zelkova serrata(9%), Prunus armeniaca var. ansu(8%), and Acer palmatum(6%). The ratio of native species versus exotic were 50:50. In Hoengseong, the number of street trees was 13,500 and the species number were 15 species. The major species of street trees were Prunus sargentii(42%), Ginkgo biloba(23%), Acer triflorum(12%), Prunus armeniaca var. ansu(6%), and Prunus mume(4%). The ratio of native species versus exotic were 67:33. The species of which planting frequency within two areas was very high were Ginkgo biloba and Prunus sargentii. 2. It is necessary to select tree species suitable for the characteristics of the locality and to raise distinctive street trees that contribute to the tourist industry. For the purpose, the appropriate street trees in two areas are Cornus controversa, Quercus aliena, Zelkova serrata, Prunus padus, Sorbus alnifolia, Sorbus comixta, Albizzia julibrissin, Acer triflorum, Styrax japonica, Chionanthus retusus, Celtis sinensis, Prunus yedoensis, Malus sieboldii, Crataegus Pinnatifida, Prunus armeniaca var. ansu and Pyrus pyrifolia etc.. 3. Appropriate pruning adds to the aesthetic and prolongs the useful life, it also requires less managing of insects and diseases to maintain good healthy of street trees. Street trees were not properly pruned due to electric lines and shortage of pruning information. The pruning was controlled by Korea Electric Power Co, which has no pruning information. Pruning must be maintained by a professional landscape company to maintain good shape such as with Bonsai. The shrubs planting zone between street trees and other trees, and preservation plates were established for healthy of street trees. They have to be repaired and maintained well to keep better environmental conditions. The proper fertilization, the control of pests and diseases, the installation of drainpipe and the use of soil brought from another place were needed to improve the planting, use and maintenance of landscape plants. 4. The species number of school trees and flowers of 102 schools in Weonju and Hoengseong were 17species, 16species respectively. The major species of school trees in Weonju were Juniperus chinensis(24%), Ginkgo biloba(17%), Pinus densiflora(14%), Zelkova serrata(14%), and Pinus koraiensis(9%), and those of school trees in Hoengseong were Pinus koraiensis(44%), Abies holophylla(25%), Juniperus chinensis(8%), and Ginkgo biloba(8%). The major species of school flowers in Weonju were Rosa centifolia(47%), Forsythia koreana(24%), Magnolia kobus(12%), and Rhododendron schlippenbachii(6%), and those of school flowers in Hoengseong were Forsythia koreana(36%), Rhododendron schlippenbachii(33%), Magnolia kobus(6%) and Dicentra spectabilis(6%). 5. The species number of the protection trees designated by Woenju and Hoengseong were 15 species. The major species of protection trees were Zelkova serrata(100 trees), Ginkgo biloba(18) Pinus densiflora(7), Quercus spp. (5), Juniperus chinensis(4) and Alnus japonica(4). 6. The landscape plants planted around 2004 in weonju were Prunus yedoensis(2,563 trees), Betula platyphylla var. japonica(2,000), Abies holophylla(1,785), Diospyros kaki(1,100), Prunus sargentii(880) and Prunus armeniaca var. ansu(708) etc.. The shrubs planted were Rhododendron obutusum(21,559 plants), Rosa centifolia (7,150), Rhododendron yedoense var. poukhanense(5,950), Forsythia koreana(3,000) and Ligustrum obtusi[olium(2,500) etc.. The landscape plants planted in Hoengseong Acer triflorum(928trees), Prunus yedoensis(455), Zelkova serrata(327), Thuja orientalis(261), Prunus sargentii(257), Pinus koraiensis(200), Prunus persica for. rubro-plena(200) and Pyrus pyrifolia (200) etc.. The shrubs planted were Rhododendron yedoense var. poukhanense(15,936), Syringa dilatata(10,090), Forsythia koreana(9,660), Cercis chinensis(3,200), Buxus microphylla var. koreana(2,600) and Rosa centifolia(1,868) etc.. 7. The species numbers of the herbaceous plants planted in 2004 in Weonju were 24 species and the ratio of native species versus exotic were 7:17. The major species of perennial plants were Aster koraiensis(30,656 plants), Coreopsis drummondii(7,656), Rudbeckia bicolor(6,000), Chrysanthemum morifolium(4,850) and Chrysanthemum zawadskii var. latilobum(4,312). The major species of annuals and biennials were Cosmos bipinnatus(672,000 plants), Zinnia elegans(35,600), Petunia hybrida(26,920), Viola tricolor(23,000), Helianthus annuus(17,000), and Geranium cinereum var. pubcaulescens(5,200). In Hoengseong, the numbers of herbaceous plants were 906,310 plants and the species numbers were 15 species. The major species of perennials plants were Aster koraiensis(70,480 plants), Hemerocallis fulva(20,070), and Phlox drummondii(18,000). The major species of annuals and biennials were Phlox hybrida(174,000 plants), Cosmos bipinnatus(125,000), Zinnia elegans(109,000), Tagetes patula(96,700), Vinca rosea(89,000) and Calendula officinalis(70,000). 8. Through these result, it was thought that the diversification of planting species, the selection of plants suitable to each space and the generalization of use of native species were needed.

• Journal of agricultural medicine and community health
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• v.28 no.1
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• pp.93-106
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• 2003

Objectives: This study was conducted to investigate the treatment status and its related factors of the rural hypertensives. Methods: A questionnaire survey was performed to 618 rural hypertensives during September, 2002. Results: The proportion of those who were compliant to the antihypertensive medication was 68.9%. The compliance rate to the antihypertensive medication was significantly related with sex and economic status(p<0.05). That is, if they were female, higher economic level, the regular antihypertensive medication rate was higher. The regular antihypertensive medication rate was higher when they had higher knowledge for hypertension, higher severity for hypertension of him or her(p<0.01). And the compliance rate to the antihypertensive medication was significantly related with hypertensives' own explanatory model for hypertension(p<0.01). The rate of drug use except antihypertensives was 12.5%. The rate of drug use except antihypertensives was higher when they experienced side effects of antihypertensive drug and when they had irregular medication for antihypertensive drug(p<0.01). The rate of medical equipment use was 18.9%. The utilization rate of medical equipment such as jade mat, germanium material was significantly related with age, experience of side effects of antihypertensive drug, medication status for antihypertensive drug(p<0.05). The rate of folk therapy use was 16.2%. The rate of folk therapy use was higher when they had no family, when they had knowledge about hypertension on the average, when they had hypertension over 10 years(p<0.05), and when they experienced side effects of antihypertensive drug and when they had irregular medication for antihypertensive drug(p<0.01). The rates of drug use except antihypertensives, medical equipment use, and folk therapy were significantly related with hypertensives' own explanatory model for hypertension(p<0.05). Conclusions: On consideration of above findings, it would be essential to provide knowledge about hypertension and its treatment, and severity of hypertension complications through health education.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.871-877
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• 1995

Background: The index which could predict the prognosis of critically ill patients is needed to find out high risk patients and to individualize their treatment. The APACHE III scoring system was established in 1991, but there has been only a few studies concerning its prognostic value. We wanted to know whether the APACHE III scores have prognostic value in discriminating survivors from nonsurvivors in sepsis. Methods: In 48 patients meeting the Bones criteria for sepsis, we retrospectively surveyed the day 1(D1), day 2(D2) and day 3(D3) scores of patients who were admitted to intensive care unit. The scores of the sepsis survivors and nonsurvivors were compared in respect to the D1 score, and also in respect to the changes of the updated D2 and D3 scores. Results: 1) Of the 48 sepsis patients, 21(43.5%) survived and 27(56.5%) died. The nonsurvivors were older($62.7{\pm}12.6$ vs $51.1{\pm}18.1$ yrs), presented with lower mean arterial pressure($56.9{\pm}26.2$ vs $67.7{\pm}14.2\;mmHg$) and showed greater number of multisystem organ failure($1.2{\pm}0.8$ vs $0.2{\pm}0.4$) than the survivors(p<0.05, respectively). There were no significant differences in sex and initial body temperature between the two groups. 2) The D1 score was lower in the survivors (n=21) than in the nonsurvivors ($44.1{\pm}14.6$, $78.5{\pm}18.6$, p=0.0001). The D2 and D3 scores significantly decreased in the survivors (D1 vs D2, $44.1{\pm}14.6$ : $37.9{\pm}15.0$, p=0.035; D2 vs D3, $37.9{\pm}15.0$ : $30.1{\pm}9.3$, p=0.0001) but showed a tendency to increase in the nonsurvivors (D1 vs D2 (n=21), $78.5{\pm}18.6$ : $81.3{\pm}23.0$, p=0.1337; D2 vs D3 (n=11), $68.2{\pm}19.3$ : $75.3{\pm}18.8$, p=0.0078). 3) The D1 scores of 12 survivors and 6 nonsurvivors were in the same range of 42~67 (mean D1 score, $53.8{\pm}10.0$ in the survivors, $55.3{\pm}10.3$ in the nonsurvivors). The age, sex, initial body temperature, and mean arterial pressure were not different between the two groups. In this group, however, D2 and D3 was significantly decreased in the survivors(D1 vs D2, $53.3{\pm}10.0$ : $43.6{\pm}16.4$, p=0.0278; D2 vs D3, $43.6{\pm}16.4$ : $31.2{\pm}10.3$, p=0.0005), but showed a tendency to increase in the nonsurvivors(D1 vs D2 (n=6), $55.3{\pm}10.3:66.7{\pm}13.9$, p=0.1562; D2 vs D3 (n=4), $64.0{\pm}16.4:74.3{\pm}18.6$, p=0.1250). Among the individual items of the first day APACHE III score, only the score of respiratory rate was capable of discriminating the nonsurvivors from the survivors ($5.5{\pm}2.9$ vs $1.9{\pm}3.7$, p=0.046) in this group. Conclusion: In sepsis, nonsurvivors had higher first day APACHE III score and their updated scores on the following days failed to decline but showed a tendency to increase. Survivors, on the other hand, had lower first day score and showed decline in the updated APACHE scores. These results suggest that the first day and daily updated APACHE III scores are useful in predicting the outcome and assessing the response to management in patients with sepsis.

• Tuberculosis and Respiratory Diseases
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• v.43 no.2
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• pp.201-209
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• 1996

Background : Auto-PEEP which develops when expiratory lung emptying is not finished until the beginning of next inspiration is frequently found in patients on mechanical ventilation. Its presence imposes increased risk of barotrauma and hypotension, as well as increased work of breathing (WOB) by adding inspiratory threshold load and/or adversely affecting to inspiratory trigger sensitivity. The aim of this study is to evaluate the relationship of auto-PEEP with WOB and to evaluate the effect of PEEP applied by ventilator (external PEEP) on WOB in patients with auto-PEEP. Method : 15 patients, who required mechanical ventilation for management of acute respiratory failure, were studied. First, the differences in WOB and other indices of respiratory mechanics were examined between 7 patients with auto-PEEP and 8 patients without auto-PEEP. Then, we applied the 3 cm $H_2O$ of external PEEP to patients with auto-PEEP and evaluated its effects on lung mechanics as well as WOB. Indices of respiratory mechanics including tidal volume ($V_T$), repiratory rate, minute ventilation ($V_E$), peak inspiratory flow rate (PIFR), peak expiratory flow rate (PEFR), peak inspiratory pressure (PIP), $T_I/T_{TOT}$, auto-PEEP, dynamic compliance of lung (Cdyn), expiratory airway resistance (RAWe), mean airway resistance (RAWm), $p_{0.1}$, work of breathing performed by patient (WOB), and pressure-time product (PTP) were obtained by CP-100 Pulmonary Monitor (Bicore, USA). The values were expressed as mean $\pm$ SEM (standard error of mean). Results : 1) Comparison of WOB and other indices of respiratory mechanics in patients with and without auto-PEEP : There was significant increase in WOB ($l.71{\pm}0.24$ vs $0.50{\pm}0.19\;J/L$, p=0.007), PTP ($317{\pm}70$ vs $98{\pm}36\;cm$ $H_2O{\cdot}sec/min$, p=0.023), RAWe ($35.6{\pm}5.7$ vs $18.2{\pm}2.3\;cm$ H2O/L/sec, p=0.023), RAWm ($28.8{\pm}2.5$ vs $11.9{\pm}2.0cm$ H2O/L/sec, p=0.001) and $P_{0.1}$ ($6.2{\pm}1.0$ vs 2.9+0.6 cm H2O, p=0.021) in patients with auto-PEEP compared to patients without auto-PEEP. The differences of other indices including $V_T$, PEFR, $V_E$ and $T_I/T_{TOT}$ showed no significance. 2) Effect of 3 cm $H_2O$ external PEEP on respiratory mechanics in patients with auto-PEEP : When 3 cm $H_2O$ of external PEEP was applied, there were significant decrease in WOB ($1.71{\pm}0.24$ vs $1.20{\pm}0.21\;J/L$, p=0.021) and PTP ($317{\pm}70$ vs $231{\pm}55\;cm$ $H_2O{\cdot}sec/min$, p=0.038). RAWm showed a tendency to decrease ($28.8{\pm}2.5$ vs $23.9{\pm}2.1\;cm$ $H_2O$, p=0.051). But PIP was increased with application of 3 cm $H_2O$ of external PEEP ($16{\pm}2$ vs $22{\pm}3\;cm$ $H_2O$, p=0.008). $V_T$, $V_E$, PEFR, $T_I/T_{TOT}$ and Cdyn did not change significantly. Conclusion : The presence of auto-PEEP in mechanically ventilated patients was accompanied with increased WOB performed by patient, and this WOB was decreased by 3 cm $H_2O$ of externally applied PEEP. But, with 3 cm $H_2O$ of external PEEP, increased PIP was noted, implying the importance of close monitoring of the airway pressure during application of external PEEP.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1318-1325
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• 1997

Background : Since the late 1960s, mechanical ventilation has been accomplished primarily using volume controlled ventilation(VCV). While VCV allows a set tidal volume to be guaranteed, VCV could bring about excessive airway pressures that may be lead to barotrauma in the patients with acute lung injury. With the increment of knowledge related to ventilator-induced lung injury, pressure controlled ventilation(PCV) has been frequently applied to these patients. But, PCV has a disadvantage of variable tidal volume delivery as pulmonary impedance changes. Since the concept of combining the positive attributes of VCV and PCV(dual control ventilation, DCV) was described firstly in 1992, a few DCV modes were introduced. Pressure-regulated volume control(PRVC) mode, a kind of DCV, is pressure-limited, time-cycled ventilation that uses tidal volume as a feedback control for continuously adjusting the pressure limit However, no clinical studies were published on the efficacy of PRVC until now. 'This investigation studied the efficacy of PRVC in the patients with unstable respiratory mechanics. Methods : The subjects were 8 mechanically ventilated patients(M : F=6 : 2, $56{\pm}26$ years) who showed unstable respiratory mechanics, which was defined by the coefficients of variation of peak inspiratory pressure for 15 minutes greater than 10% under VCV, or the coefficients of variation of tidal volume greater than 10% under PCV. The study was consisited of 3 modes application with VCV, PCV and PRVC for 15 minutes by random order. To obtain same tidal volume, inspiratory pressure setting was adjusted in PCV. Respiratory parameters were measured by pulmonary monitor(CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). Results : 1) Mean tidal volumes($V_T$) in each mode were not different(VCV, $431{\pm}102ml$ ; PCV, $417{\pm}99ml$ ; PRVC, $414{\pm}97ml$) 2) The coefficient of variation(CV) of $V_T$ were $5.2{\pm}3.9%$ in VCV, $15.2{\pm}7.5%$ in PCV and $19.3{\pm}10.0%$ in PRVC. The CV of $V_T$ in PCV and PRVC were significantly greater than that in VCV(p<0.01). 3) Mean peak inspiratory pressure(PIP) in VCV($31.0{\pm}6.9cm$ $H_2O$) was higher than PIP in PCV($26.0{\pm}6.5cm$ $H_2O$) or PRVC($27.0{\pm}6.4cm$ $H_2O$)(p<0.05). 4) The CV of PIP were $13.9{\pm}3.7%$ in VCV, $4.9{\pm}2.6%$ in PVC and $12.2{\pm}7.0%$ in PRVC. The CV of PIP in VCV and PRVC were greater than that in PCV(p<0.01). Conclusions : Because of wide fluctuations of VT and PIP, PRVC mode did not seem to have advantages compared to VCV or PCV in the patients with unstable respiratory mechanics.