• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1077-1082
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• 2016

Background: The three standard biomarkers used in breast cancer are the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). The Ki-67 index, a proliferative marker, has been shown to be associated with a poorer outcome, and despite absence of standardization of pathological assessment, is widely used for therapy decision making. We aim to study the role of the Ki-67 index in a group of Asian women with breast cancer. Materials and Methods: A total of 450 women newly diagnosed with Stage 1 to 3 invasive breast cancer in a single centre from July 2013 to Dec 2014 were included in this study. Univariable and multivariable logistic regression was used to determine the association between Ki-67 (positive defined as 14% and above) and age, ethnicity, grade, mitotic index, ER, PR, HER2, lymph node status and size. All analyses were performed using SPSS Version 22. Results: In univariable analysis, Ki -67 index was associated with younger age, higher grade, ER and PR negativity, HER2 positivity, high mitotic index and positive lymph nodes. However on multivariable analysis only tumour size, grade, PR and HER2 remained significant. Out of 102 stage 1 patients who had ER positive/PR positive/HER2 negative tumours and non-grade 3, only 5 (4.9%) had a positive Ki-67 index and may have been offered chemotherapy. However, it is interesting to note that none of these patients received chemotherapy. Conclusions: Information on Ki67 would have potentially changed management in an insignificant proportion of patients with stage 1 breast cancer.

• 한국환경복원기술학회지
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• 제21권2호
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• pp.27-38
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• 2018

Environmental planning includes resource allocation and spatial planning process for the conservation and management of environment. Because the spatialization of the environmental planning is not specifically addressed in the relevant statutes, it actually depends on the qualitative methodology such as expert judgement. The results of the qualitative methodology have the advantage that the accumulated knowledge and intuition of the experts can be utilized. However, it is difficult to objectively judge whether it is enough to solve the original problem or whether it is the best of the possible scenarios. Therefore, this study proposed a methodology to quantitatively and objectively spatialize various environmental planning. At first, we suggested a quantitative spatial planning model based on an optimization algorithm. Secondly, we applied this model to two kinds of environmental planning and discussed about the model performance to present the applicability. Since the models were developed based on conceptual study site, there was a limitation in showing possibility of practical use. However, we expected that this study can contribute to the fields related to environmental planning by suggesting flexible and novel methodology.

• 한국비블리아학회지
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• 제23권4호
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• pp.261-282
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• 2012

본 연구는 대구광역시 소재 공공도서관 사서들을 대상으로 직무만족도를 측정하고 이를 운영방식과 고용형태에 따라 분석하는 데 목적이 있다. 이론적 배경으로 공공도서관의 운영방식과 직무만족의 개념 및 변인을 논하고, 이를 바탕으로 직무만족도 측정을 위한 직무자체, 동료, 상사, 업무, 임금, 복지, 고용 등 7가지 직무만족 변인을 선정하여 설문을 실시하였다. 응답자 전체 평균으로 나타난 만족도를 보았을 때, 직무자체, 동료, 상사, 업무 등 4가지 변인에서 긍정적인 만족감을 표한 반면, 임금, 복지, 고용의 3가지 변인에서는 낮은 만족감을 나타냈다. 운영방식에 따른 직무만족 분석에서 주목할 것은 지자체 위탁도서관과 타 직영도서관 간의 차이였다. 지자체 위탁도서관은 고용불안감에 대한 체감 정도에서 정규직과 비정규직이 거의 동일한 수치를 보였다. 정규직과 비정규직이라는 고용형태에 따른 분석에서 가장 먼저 눈에 띄는 것은 업무결정 참여도와 업무 재량권 측면이었고, 이들 간 차이는 임금, 복지, 고용 측면에서 더욱 확연히 드러났다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권24호
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• pp.10565-10571
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• 2015

Gastric cancer incidence rates vary dramatically by world region with East Asia having the highest rate. The Asian population of the United States (US) is growing rapidly and over 17 million Americans are of Asian descent. A majority of Chinese, Korean and Vietnamese Americans are immigrants. Americans of East and Southeast Asian descent experience marked gastric cancer disparities and the incidence rate among Korean men in the US is over five times higher than the incidence rate among non-Hispanic white men. Randomized controlled trials have provided evidence for the effectiveness of helicobacter pylori identification and eradication in preventing gastric cancer. Additionally, Japan and South Korea have both experienced improvements in gastric cancer mortality following the implementation of programs to detect early stage gastric cancers. There are currently no clear US guidelines regarding the primary and secondary prevention of gastric cancer in high-risk immigrant populations. However, it is likely that a proportion of US physicians are already recommending gastric cancer screening for Asian patients and some Asian immigrants to the US may be completing screening for gastric cancer in their native countries. Surveys of US primary care physicians and Asian American communities should be conducted to assess current provider practices and patient uptake with respect to gastric cancer prevention and control. In the absence of clinical guidelines, US health care providers who serve high-risk Asian groups could consider a shared decision-making approach to helicobacter pylori identification and eradication, as well as gastric endoscopy.

• 대한간호학회지
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• 제43권2호
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• pp.145-153
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• 2013

Purpose: The purpose of this manuscript is to discuss the need for use of evidence based practice (EBP) in LTC, the current use of evidence in long term care facilities and what we know about adoption of the use of EBP in LTC. Methods: Literature review and reporting of findings from the M-TRAIN study that was a quasi-experimental design to test the effectiveness of an intervention to increase the use of EBPs for urinary incontinence and pain in 48 LTC facilities. Results: Barriers to adopting EBPs include lack of available time, lack of access to current research literature, limited critical appraisal skills, excessive literature to review, non-receptive organizational culture, limited resources, and limited decision-making authority of staff to implement change. Strategies to promote adoption of EBP include the commitment of management; the culture of the home; leadership; staff knowledge, time, and reward; and facility size, complexity, the extent that members are involved outside the facility, NH chain membership, and high level of private pay residents. Findings from the M-TRAIN add, stability of nurse leader and congruency between the leaders perception of their leadership and the staff's perception of the leadership. Conclusion: There is clear evidence of the need and the benefits to residents of LTC and to the health care system yet adoption of EBP continues to be slow and sporadic. There is also evidence for the process of establishing best evidence and many resources to find the available EBPs. The urgent need now is finding ways to best get the EBPs implemented in LTC. There is growing evidence about best methods to do this but continued research is needed. Clearly, residents in LTC deserve the best care possible and EBPs represent an important vehicle by which to do this.

• 의료법학
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• 제8권2호
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• pp.119-164
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• 2007

Improving the formal objection system regarding reviewing medical expenses requires authority and confidence in the aspect of well-functioning the health insurance review and assessment system, legally and appropriately. The purposes of improvement of the formal objection system should aim for protecting the people's right of health. On handling the formal objections, the disputes of the rights should be settled economically and promptly by fairness, specialty, and objectivity in the health insurance review and assessment administration. Therefore, in order to promote the administrative specialty of health insurance, the formal objection committee needs to be organized independently and guaranteed expertly. Under the current formal objection system, however, the organization of committee lacks right-relief function, recognition and public relation as a health insurance appeal system, and related professional man powers. It is also analyzed that there are several controversial points, such as mass deliberation to the formal objection committee and its conference procedure. As a measure of improvement, it is analyzed that the committee needs to be organized independently with a proper number of professional man powers. The strict deliberation procedures and the prohibition of the decision-making by non-conference are also required to be empowered. The formal objection procedure provides the beneficiaries and the claims legitimately, so that it secures the legal relations on the health insurance system. Therefore, on the conference process of formal objection, the expert and guaranteed protection should be provided promptly, and its procedures to the appellants should also be assisted kindly.

• 한국물환경학회지
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• 제29권5호
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• pp.681-690
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• 2013

Watershed models have been increasingly used to support an integrated management of land and water, non-point source pollutants, and implement total daily maximum load policy. However, these models demand a great amount of input data, process parameters, a proper calibration, and sometimes result in significant uncertainty in the simulation results. For this reason, uncertainty analysis is necessary to minimize the risk in the use of the models for an important decision making. The objectives of this study were to evaluate three different uncertainty analysis algorithms (SUFI-2: Sequential Uncertainty Fitting-Ver.2, GLUE: Generalized Likelihood Uncertainty Estimation, ParaSol: Parameter Solution) that used to analyze the sensitivity of the SWAT(Soil and Water Assessment Tool) parameters and auto-calibration in a watershed, evaluate the uncertainties on the simulations of runoff and sediment load, and suggest alternatives to reduce the uncertainty. The results confirmed that the parameters which are most sensitive to runoff and sediment simulations were consistent in three algorithms although the order of importance is slightly different. In addition, there was no significant difference in the performance of auto-calibration results for runoff simulations. On the other hand, sediment calibration results showed less modeling efficiency compared to runoff simulations, which is probably due to the lack of measurement data. It is obvious that the parameter uncertainty in the sediment simulation is much grater than that in the runoff simulation. To decrease the uncertainty of SWAT simulations, it is recommended to estimate feasible ranges of model parameters, and obtain sufficient and reliable measurement data for the study site.

• Smart Structures and Systems
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• 제26권4호
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• pp.495-506
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• 2020

Monitoring of complex processes faces several challenges mainly due to the lack of relevant sensory information or insufficient elaborated decision-making strategies. These challenges motivate researchers to adopt complex data processing and analysis in order to improve the process representation. This paper presents the development and implementation of quality monitoring framework based on a model-driven approach using embedded artificial intelligence strategies. In this work, the strategies are applied to the supervision of a microfabrication process aiming at showing the great performance of the framework in a very complex system in the manufacturing sector. The procedure involves two methods for modelling a representative quality variable, such as surface roughness. Firstly, the hybrid incremental modelling strategy is applied. Secondly, a generalized fuzzy clustering c-means method is developed. Finally, a comparative study of the behavior of the two models for predicting a quality indicator, represented by surface roughness of manufactured components, is presented for specific manufacturing process. The manufactured part used in this study is a critical structural aerospace component. In addition, the validation and testing are performed at laboratory and industrial levels, demonstrating proper real-time operation for non-linear processes with relatively fast dynamics. The results of this study are very promising in terms of computational efficiency and transfer of knowledge to manufacturing industry.

• 가정간호학회지
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• 제18권2호
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• pp.81-87
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• 2011

Purpose: The aim of this study was to estimate optimization model of stay time in EMC. Methods: Data were collected at an EMC in a hospital using medical records from June to August in 2007. The sample size was 8,378. The data were structured by stay time for doctor visit, decision making, and discharge from EMC. Descriptive statistics were used to find out general characteristics of patients. Average mean and quantile regression models were adopted to estimate optimized stay time in EMC. Results: The stay times in EMC were highly skewed and non-normal distributions. Therefore, average mean as an indicator of optimal stay time was not appropriate. The total stay time using conditional quantile regression model was estimated about 110 min, that was about 166 min shorter than estimated time using average mean. Conclusion: According to these results, we recommend to use a conditional quantile regression model to estimate optimal stay time in EMC. We suggest that this results will be used to develop a guideline to manage stay time more effectively in EMC.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.106-115
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• 2018

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (${\leq}14F$) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.