• Journal of Preventive Medicine and Public Health
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• 제38권3호
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• pp.276-282
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• 2005

Objectives : To evaluate the predictive validity of three scoring systems; the acute physiology and chronic health evaluation(APACHE) III, simplified acute physiology score(SAPS) II, and mortality probability model(MPM) II systems in critically ill patients. Methods : A concurrent and retrospective study conducted by collecting data on consecutive patients admitted to the intensive care unit(ICU) including surgical, medical and coronary care unit between January 1, 2004, and March 31, 2004. Data were collected on 348 patients consecutively admitted to the ICU(aged 16 years or older, no transfer, ICU stay at least 8 hours). Three models were analyzed using logistic regression. Discrimination was assessed using receiver operating characteristic(ROC) curves, sensitivity, specificity, and correct classification rate. Calibration was assessed using the Lemeshow-Hosmer goodness of fit H-statistic. Results : For the APACHE III, SAPS II and MPM II systems, the area under the receiver operating characterist ic(ROC) curves were 0.981, 0.978, and 0.941 respectively. With a predicted risk of 0.5, the sensitivities for the APACHE III, SAPS II, and MPM II systems were 81.1, 79.2 and 71.7%, the specificities 98.3, 98.6, and 98.3%, and the correct classification rates 95.7, 95.7, and 94.3%, respectively. The SAPS II and APACHE III systems showed good calibrations(chi-squared H=2.5838 p=0.9577 for SAPS II, and chi-squared H=4.3761 p=0.8217 for APACHE III). Conclusions : The APACHE III and SAPS II systems have excellent powers of mortality prediction, and calibration, and can be useful tools for the quality assessment of intensive care units(ICUs).

• Journal of Preventive Medicine and Public Health
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• 제34권3호
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• pp.244-252
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• 2001

Objective : Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. Methods : The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHE III and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. Results : The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and $R^2$ than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. Conclusion : These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used.

• Tuberculosis and Respiratory Diseases
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• 제58권3호
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• pp.213-229
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• 2005

The first and the longest criminal indictment case of Korean medico-legal battle, so called BORAMAE Hospital Incident, was finally on its end by Korean Supreme Court's decision on June 24, 2004, after 7 years long legal dispute via Seoul District Court and Seoul Superior Appeal Court's decision. Boramae Hospital case was the first Korean legal case of Withdrawing Life-sustaining treatment of mechanical respirator on 58 years old Extradural Hematoma victim who was on Respirator under Coma after multi-organ failure postoperatively(APACHE II score: 34-39). Two physicians who have involved patient's care and had helped to make discharge the Near-death patient to home after repeated demand of patient's wife, due to economic reason, were sentenced as homicidal crime. This review article will discuss the following items with the review of US cases, Quinlan(1976), Nancy Cruzan(1990), Barber (1983), Helen Wanglie(1990), Baby K (1994) and Baby L cases, along with Official Statement of ATS and other Academic dignitaries of US and World.: [1] Details of Boramae Hospital incident, medical facts description and legal language of homicidal crime sentence. [2] The medical dispute about the legal misinterpretation of patient's clinical status, regarding the severity of the victim with multi-organs failure on Respirator under coma with least chance of recovery, less than 10% probability. [3] Case study of US, of similar situation. [4] Introduction of ATS official Statement on Withdrawing/ Withholding Life sustaining treatment. [5] Patient Autonomy as basic principle. [6] The procedural formality in Medical practise for keeping the legitimacy. [7] The definition of Medical Futility and its dispute. [8] Dying in Dignity and PAS(Physician Assisted Suicide)/and/or Euthanasia [9] The Korean version of "Dying in Dignity", based on the Supreme Court's decision of Boramae Hospital incident (2004.6.24.) [10] Summary and Author's Note for future prospects.

• 한국전문물리치료학회지
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• 제19권3호
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• pp.124-131
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• 2012

Most conventional instruments measuring disability rely on total score by simply adding individual item responses, which is dependent on the items chosen to represent the underlying construct (test-dependent) and a test statistic, such as coefficient alpha for the estimate of reliability, varying from sample to sample (sample-dependent). By contrast, item response theory (IRT) method focuses on the psychometric properties of the test items instead of the instrument as a whole. By estimating probability that a respondent will select a particular rating for an item, item difficulty and person ability (or disability) can be placed on same linear continuum. These estimates are invariant regardless of the item used (test-free measurement) and the ability of sample applied (sample-free measurement). These advantages of IRT allow the creation of invariantly calibrated large item banks that precisely discriminate the disability levels of individuals. Computer adaptive testing (CAT) method often requiring a testing algorithm promise a means for administering items in a way that is both efficient and precise. This method permits selectively administering items that are closely matched to the ability level of individuals (measurement precision) and measuring the ability without the loss of precision provided by the full item bank (measurement efficiency). These measurement properties can reasonably be achieved using IRT and CAT method. This article aims to investigate comprehensive overview of the existing disability instrument for back pain and to inform physical therapists of an alternative innovative way overcoming the shortcomings of conventional disability instruments. An understanding of IRT and CAT method will equip physical therapist with skills in interpreting the measurement properties of disability instruments developed using the methods.

• 한국수자원학회:학술대회논문집
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• 한국수자원학회 2009년도 학술발표회 초록집
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• pp.1590-1596
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• 2009

최근 기후변화의 영향으로 인한 기상이변으로 인해 세계적으로 많은 피해가 발생하고 있으며, 규모도 점점 커지고 있다. 특히 가뭄에 대한 피해는 더욱 더 심화되는 현상으로 보이고 있다. 본 연구에서는 국내에 적합한 월단위와 주단위 가뭄전망을 제시하였다. 월단위 전망에서는 앙상블 기법을 기반으로 기상청에서 제공하는 월간산업기상정보의 적용에 따른 가뭄전망 정확성을 비교하였다. 주단위 전망에서는 기상청에서 제공하는 GDAPS를 이용하여 확정론적 가뭄전망을 하였다. 가뭄지수로서는 강수, 유량, 지하수위를 인자로 하는 MSWSI(Modified Surface Water Supply Index)를 가뭄지수로 사용하였으며, MSWSI는 5개 구간으로 나누었다. 월단위 가뭄전망에서는 물수지모형인 abcd모형에 과거 강수와 잠재증발산량 시나리오를 입력변수로 하여 최종적으로 유량과 지하수위 시나리오를 생산하여, 확률 가뭄전망을 위해 각 구간의 발생확률을 산정하고 실측자료로부터 산정한 MSWSI와 비교하였다. 정확성 평가를 위해서 RPS(Ranked Probability Score)를 이용하였다. 금강유역에 적용한 결과, 이수기(10월-이듬해 6월)에는 4개 달이 초보전망보다 높았으나 전체 RPS는 1.87로서 초보전망의 1.84보다 높아 현재 월단위 가뭄전망기법에는 많은 불확실성이 존재하였다. 또한 월간산업기상정보를 이용한 월단위 가뭄전망에서도 초보전망보다 정확성이 낮아, 현재 중장기 기상정보를 이용하기에는 어려운 것으로 나타났다. 주단위 가뭄전망에서는 abcd모형에 GDAPS를 입력변수로 하여 확정론적 MSWSI를 산정하여 실측자료로부터 산정한 MSWSI와 비교하였으며, Hit ratio를 이용하여 그 정확성을 평가하였다. 주단위 가뭄전망 결과, 주단위 가뭄전망의 Hit ratio가 0.480으로서 초보전망보다 높아 주단위 가뭄전망은 효용성이 있음을 입증하였다. 본 연구에서 적용기간이 짧아 가뭄전망의 정확성을 판단하기는 이르나, 월단위 가뭄전망에서는 기상정보의 정확성이 향상에 따라 가뭄전망의 정확성도 향상될 것으로 판단된다. 장기적으로 본 연구 결과를 토대로 단기와 중장기 가뭄전망을 수행하고 평가한다면, 가뭄전망에 대한 신뢰도가 더 높아질 것으로 사료된다.

• 한국정보과학회논문지:소프트웨어및응용
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• 제37권10호
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• pp.736-744
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• 2010

모바일 기기에서 얻을 수 있는 로그 데이터는 다수의 유의미한 정보를 담고 있다. 그러나 모바일 기기의 연산능력 제약과 정보 분석 자체의 어려움 등으로 상황정보를 활용한 모바일 에이전트의 구현이 쉽지 않다. 본 논문에서는 제한적인 모바일 플랫폼에서 효율적인 상황인지를 위한 베이지안 네트워크 용용 기법을 제안한다. 베이지안 네트워크는 다수의 세부 모듈로 구성되며, 모듈간 인과성은 가상증거를 통해 보존된다. 각 모듈은 이전 증거값과 추론결과를 저장하고, 현재 증거값과 비교하여 전체 네트워크에 변화를 주는 경우에만 선택적으로 추론을 수행한다. 다양한 수집 주기의 모바일 데이터를 이용한 추론결과의 신뢰성을 높이기 위해 기억감소함수를 이용하여 결과를 보정하는 방법을 살펴본다. 마지막으로 실제 모바일 환경에서의 실험을 통해 제안하는 방법의 유용성을 확인한다.

• 대기
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• 제19권3호
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• pp.269-287
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• 2009

CAT (clear-air turbulence) forecasting algorithm, the Graphical Turbulence Guidance (GTG) system developed at NCAR (national center for atmospheric research), is evaluated with available observations (e.g., pilot reports; PIREPs) reported in South Korea during the recent 5 years (2003-2008, excluding 2005). The GTG system includes several steps. First, 44 CAT indices are calculated in the domain of the Regional Data Assimilation and Prediction System (RDAPS) analysis data with 30 km horizontal grid spacing provided by KMA (Korean Meteorological Administration). Second, 10 indices that performed ten best forecasting scores are selected. Finally, 10 indices are combined by measuring the score based on the probability of detection, which is calculated using PIREPs exclusively of moderate-or-greater intensity. In order to investigate the best performance of the GTG system in Korea, various statistical examinations and sensitivity tests of the GTG system are performed by yearly and seasonally classified PIREPs. Performances of the GTG system based on yearly distributed PIREPs have annual variations because the compositions of indices are different from each year. Seasonal forecasting is generally better than yearly forecasting, because selected CAT indices in each season represent meteorological condition much more properly than applying the selected CAT indices to all seasons. Wintertime forecasting is the best among the four seasonal forecastings. This is likely due to that the GTG system consists of many CAT indices related to the jet stream, and turbulence associated with the jet stream can be activated mostly in wintertime under strong jet magnitude. On the other hand, summertime forecasting skill is much less than other seasons. Compared with current operational CAT prediction system (KITFA; Korean Integrated Turbulence Forecasting System), overall performance of the GTG system is better when CAT indices are selected seasonally.

• 대한예방한의학회지
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• 제20권2호
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• pp.17-26
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• 2016

Objectives : We presented the results of reliability study in advance, and analyzed agreement between Korean medicine doctors(KMDs)' diagnosis and cold-heat pattern identification questionnaire(CHPI)'s diagnosis. Methods : This survey was conducted from May 16 to 17, 2015. The subjects were 93 adults living in rural society. Diagnosis of CHPI was performed by 2 KMDs who have clinical experience more than 5 years. The KMDs' diagnosis was set as a reference index, and then we compare 23 items(cold pattern 11 items and heat pattern 12 items) of CHPI questionnaire and 15 items(cold pattern 8 items and heat pattern 7 items) that were brief form of it. We had cut-off value by standard of KMDs' diagnosis using receiver operating characteristic-curve(ROC-curve), with which we calculated agreement including kappa value. Correlation analysis between CHPI evaluation score by KMDs and by the questionnaire was fulfilled as well. Results : Agreement about 11 and 8 cold pattern items showed 87.1% together, and the value of kappa each recorded 0.742 and 0.741. Agreement about 12 and 7 heat pattern items suggested 81.7% and 78.5%, and the value of kappa showed 0.634 and 0.570. Correlation coefficients were 0.803 of 11 items and 0.761 of 8 items about cold pattern. In addition, correlation coefficients were 0.789 of 12 items and 0.767 of 7 items about heat pattern. The significant probability (p-value) was under 0.001. Conclusions : We have developed CHPI questionnaire involving reliability and agreement based on usual symptoms, and hope additional complements so that Korean medicine diagnostics and Korean preventive medicine would be improved.

• 대한지역사회영양학회지
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• 제17권3호
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• pp.329-340
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• 2012

Hypertension is a well-known risk factor for cardiovascular disease. Previous studies have shown that changes in diet and lifestyle factors can prevent the development of hypertension, but the combined effects of these modifiable factors on hypertension are not well established. The objective of this study is to investigate associations of diet and lifestyle factors, evaluated both individually and in combination, with prevalent hypertension among Korean adults. We analyzed data obtained from the 2007-2008 Korean National Health and Nutritional Examination Survey, a nationwide cross-sectional study using a stratified, multistage probability sampling design. The associations of 12 nutrient intakes and lifestyle factors with risk of hypertension were explored using restricted cubic spline regression and logistic regression models among 6,351 adults. Total energy and several nutrients and minerals, including, calcium, vitamin A, vitamin C, and sodium, showed non-linear relationships with the risk of prevalent hypertension. In multivariate logistic regression models, dietary score, obesity and alcohol intake were independently associated with the risk of prevalent hypertension, but smoking and physical activity were not. Overall, participants whose dietary habits and lifestyle factors were all in the low-risk group had 68% lower prevalence of hypertension (OR: 0.32, 95 CI: 0.14-0.74) compared to those who were at least one in the high-risk group of any dietary or lifestyle factors. The result suggests that combined optimal lifestyle habits are strongly associated with lower prevalence of hypertension among Korean adults.

• KSII Transactions on Internet and Information Systems (TIIS)
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• 제10권1호
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• pp.288-307
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• 2016

Image distortions are typically characterized by degradations of structures. Dictionaries learned from natural images can capture the underlying structures in images, which are important for image quality assessment (IQA). This paper presents a general-purpose no-reference image quality metric using a GRadient-Induced Dictionary (GRID). A dictionary is first constructed based on gradients of natural images using K-means clustering. Then image features are extracted using the dictionary based on Euclidean-norm coding and max-pooling. A distortion classification model and several distortion-specific quality regression models are trained using the support vector machine (SVM) by combining image features with distortion types and subjective scores, respectively. To evaluate the quality of a test image, the distortion classification model is used to determine the probabilities that the image belongs to different kinds of distortions, while the regression models are used to predict the corresponding distortion-specific quality scores. Finally, an overall quality score is computed as the probability-weighted distortion-specific quality scores. The proposed metric can evaluate image quality accurately and efficiently using a small dictionary. The performance of the proposed method is verified on public image quality databases. Experimental results demonstrate that the proposed metric can generate quality scores highly consistent with human perception, and it outperforms the state-of-the-arts.