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Comparison of Clinical Efficacy Between Percutaneous Dilatational Tracheostomy and Surgical Tracheostomy (경피적 확장 기관절개술 (Percutaneous Dilatational Tracheostomy)의 시술 용이성 및 합병증)

  • Ahn, Jong-Joon;Koh, Youn-Suck;Chin, Jae-Yong;Lee, Ki-Man;Park, Wann;Hong, Sang-Bum;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Lim, Chae-Man
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1277-1283
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    • 1998
  • Background : Surgical tracheostomy(ST) is usually performed by surgeons in operating room. For a patient with mechanical ventilation, however, transportation to operating room for ST could be dangerous for patients. In addition, ST is often delayed due to unavailability of operating room or surgeon. Percutaneous dilatational tracheostomy(PDT), although novel in Korea, is gaining popularity as a bedside procedure in the hospitals of western countries. We evaluated the technical ease and safety of PDT in comparison with ST. Method : Thirty-eight patients in medical intensive care unit (ICU) who were either under mechanical ventilation for more than 7 days or required airway protection, were randomly assigned to ST(18 patients) or PDT(20 patients). Between two groups, there was no significant clinical difference except that female to male ratio was higher in the ST group. ST was performed by second year residents of the department of otolaryngology while PDT was performed by third grade medical resident and pulmonologist under bronchoscopic guide using Ciaglia Percutaneous Tracheostomy Set(Cook Critical Care, Bloomington, USA) in medical ICU. The following factors were compared between two groups : number of delayed cases after the decision for tracheostomy, procedural time, complications related to tracheostomy. Results : Delayed cases were 11 in ST group and 3 in PDT group (P<0.05). Procedural time was significantly shorter in PDT group ($15.6{\pm}7.1min$) than in ST group ($29.1{\pm}11.6min$, P<0.0001). Complications related to tracheostomy occurred in 5 cases in ST group : accidental decannulation (1), subcutaneous emphysema (2) and minor bleeding (2), and in 4 cases in PDT group : minor bleeding (2), subcutaneous emphysema (1) and premature extubation (1) (P>0.05). Conclusion : Since percutaneous dilatational tracheostomy was easy to practice and its complications were not different from surgical tracheostomy, PDT can be a useful bedside procedure for mechanically ventilated patients.

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Study on Hospital Environmental Causes Affected the Mother′s Comfort After Her Child Birth (산욕부 안위에 영향을 미치는 병원환경 요인에 관한 연구)

  • 변수자
    • Journal of Korean Academy of Nursing
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    • v.8 no.1
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    • pp.1-15
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    • 1978
  • The Purpose of this study is to examine closely the causes influenced upon the comfort and recovery of the woman delivered of a child in the hospital at the same time to understand environmental status of hospitals in order to promote mother's health recovery, and to improve hospital environment by emphasizing the meaning of environment and health before the medical staff and hospital administrative authority. In the method of servery of the research, 165 post paestum patients have been randomly selected who were accommodated and delivered their babies at OB(obstetric ) & GY (Gynecologic) unit the 7 general hospitals for the period of 6 December 1976 through 17 December 1976. As for the survey, it has been used of Questionnaire where we have 65 items in the respect of personal environment in the hospital such as trusting nurse, ability, reliability, kindness and etiquette of nurse and tile character of nurse the relationship with patients the other respect of physical environment included 9f temperature, moisture. air-ventilation lightening noise, cleanness. facilities, and the third realm being of mother's hearth ground to have the following conclusion 1. The feature of the collected personnel they are from OB or GY sects of from OB unit of the other 5 hospitals except the two general hospitals of the college or school Otherwise the rate of the patients to nurses would be 9 : 1. As for the nurses'ground it would be appeared of 20-25 years of age as the 76%. either 3 year course or 4 year course in the education would be each 50% and less than 2 year experience case would record as of 60 %. In the respect of hospital physical environmental status, there we have two hospitals without any thermometers, on the other han4 nowhere there's hygrometer, otherwise, the lightening is normal or over than normal As for the structure of noise protection the corridors're, generally speaking worse than rooms, nerver hueless, there's no ventilating system in the hospitals. The rooms'repainted in white and yellow, light green white, or green color. The patient's clothing were in green pink blue, light green or in white co for. There're not anything special in both decoration and equipments. Most of them used tall beds except in one hospital 2. To the extent of perception of patient's hatch 9round and hospital environment it is presented that they perceived nurse's ability in highest in total human variable, though perceived kindness or etiquette in the lowest otherwise, comparatively high in total average. 3. In the respect of physical environment it is highest perceived of lightening terms, otherwise, lowest perceived of air ventilation and total average became lowest than the one of the original record 4. To ages, in the respect of hatch ground rather old aged mother than the younger one has perceived that nurse would be trusting, in good service character, able, at the same time, liable, Otherwise, in physical environment regardless of age, they perceived lightening in high and remarkably lower in ventilation As a result of the examination of the difference in hospital environment to each age it is appeared of statistical difference at 5% level of ability in the personal environment otherwise little difference as for physical environment 5. In the respect of perceiving level to educational standard it is highly perceived of personal environment for higher ranking group rather than lower group in the educational standard. In case of physical environment it is highly perceived for lower level group rather than higher level group in educational background. The variables which have statistical significance at 5% level are from trusting kindness, etiquette and total kindness, etiquette and total all significance at 5% level are from trusting, kindness, etiquette and total human environment variable in personal environment, otherwise, there's little difference in the physical environment. 6. The perceiving level due to times of admission and accommodation at the hospital would be cleared out as gradual higher perception both physical and personal environment in the hospital. At 5% significant level of the ventilation condition in physical environmental variable it is presented of meaningful difference otherwise, there we have little difference both in Personal variable and other one. 7. In accordance with living standard, the perception degree of personal environment in tee hospital would be inclined to increase to higher living standard on the other hand, in case of the physical environment, the perception level world increase to lower living standard At 5 % level, the trustuariable and total scores in the personal eicuironmectal variable there appeared a meaningful/ significant difference otherwise, there presented little difference both in physical environmental and other variable to the living standard 8. Pertaining to family unit, the mother of an independent family unit perceived highly in all respect of the personal and the physical environment in the hospital rather than the woman of succeeding family unit. At 5 % level there appeared a difference in the respect of kindness and etiquette both in personal environment variable, on the other hand, there hardly marked a difference between other variable and physical environmental one. 9. The degree of perception to comforting level has little connection with a statistical difference the age, educational level hospital admitting times, living standard or family unit. 10. The most effective variable to mother's comforting level will be nurse's ability, reliability, trusting manner, and total physical environment variable in order.

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Marine Algal Flora and Community Structure of Igidea Area in Busan, Korea (부산 이기대 지역의 해조상 및 군집구조)

  • Shin, Bong-Kyun;Kwon, Chun-Jung;Lee, Suk-Mo;Choi, Chang-Geun
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.20 no.2
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    • pp.121-129
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    • 2014
  • Marine algal flora and community structure were seasonally investigated at four sites in the vicinity of the Igidae on the southern east coast of Korea from May 2010 to February 2011. A total of 66 species including 9 of Chlorophyta, 14 of Phaeophyta, 43 of Rhodophyta were found during the survey period. Among these species, 16 species were found throughout the year. Seasonal mean biomass in wet weight was 123.6 (spring), 2,061.6 (summer), 412.0 (autumn), 678.9 (winter) $g{\cdot}m^{-2}$. Maximum biomass was recorded in summer($2,061.6g{\cdot}m^{-2}$), and minimum was recorded in spring($123.6g{\cdot}m^{-2}$). Spatial maximum and minimum species number were recorded at station 3 and 4(50 species) and at station 1(47 species). At station 1, 2 directly exposure on Yongho and Daeyeon cheon (stream) run off, and discharge from Nambu sewage treatment plants near coastal area, species diversity was relatively low and dominant species were similar throughout four seasons. The R/P, C/P and (R+C)/P value reflecting flora characteristics were 3.07, 0.64 and 3.71, respectively. The flora investigated could be classified into six functional groups such as coarsely branch form 39.39 %, sheet form 30.30 %, thick leather form 13.64 %, filamentous form 12.12 %, crustose form 3.03% and jointed calcareous form 1.52 % during survey period. The number of marine algae species in Igidea were 96 species at 1996 to 1997 and 66 species at 2010 to 2011, respectively. The change of seaweed species is due to the pollution loaded from sewage treatment plant and stream. We thus recommend that the positive maintenance control method like sewage treatment, for the protection of seaweed bed should be proceeded to near coastal area.

Establishment of the Appropriate Risk Standard through the Risk Assessment of Accident Scenario (사고시나리오별 위험도 산정을 통한 적정 위험도 기준 설정)

  • Kim, Kun-Ho;Chun, Young-Woo;Hwang, Yong-Woo;Lee, Ik-Mo;Kwak, In-ho
    • Journal of Korean Society of Environmental Engineers
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    • v.39 no.2
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    • pp.74-81
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    • 2017
  • An off-site consequence analysis is used to calculate the risks when hazardous chemicals that is being used on-site has been exposed off-site; the biggest factor that impacts the risk is the risks of accident scenarios. This study seeks to calculate risks according to accident scenarios by applying OGP/LOPA risk calculating methods for similar facilities, calculate risk reduction ratio by inspecting applicable IPL for incidents, and propose an appropriate risk standard for different risk calculating methods. Considering all applicable IPL when estimating the safety improvement of accident scenarios, the risk of OGP is 8.05E-04 and the risk of LOPA is 1.00E-04, According to the case of IPL, the risk is 1.34E-02. The optimal risk level for accident scenarios using LOPA was $10^{-2}$, but the appropriate risk criteria for accident scenarios in foreign similar studies were $10^{-3}{\sim}10^{-4}$, the risk of a scenario can be determined at an unacceptable level. When OGP is applied, it is analyzed as acceptable level, but in case of applying LOPA, all applicable IPL should be applied in order to satisfy the acceptable risk level. Compared to OGP, the risk is high when LOPA is applied. Therefore, the acceptable risk level should be set differently for each risk method.

A Study for strategic cooperaton of enterprise security and business (기업보안과 비즈니스의 전략적 협력에 관한 연구)

  • Ryu, Hyung-Chang
    • Korean Security Journal
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    • no.28
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    • pp.103-130
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    • 2011
  • This study is the research of enterprise security for raising the profitability and stability of Korean companies in global business environment and strategic cooperation of business. As the scientific technology gets complicated as day goes by and new competitors appear regardless the border in the modern business environment, the situation happens frequently which the huge company hands over their market to the new one armed with the innovative thinking overnight. To survive such new environment, the answer is the change of paradigm regarding business management method at the new point of view. With the low level of security risk management of Korean companies which stick to old habit, the security management which helps the companies secure profits is not affordable. The global village where the population of 7 billions live in 21st century is facing up to the rapid ecological adaptation. The rapid change of climatic environment creates the hundreds of thousands of sufferers in a moment, and we have been watching the millions of livestock are buried alive due to new contagious disease everyday. Such change encourages the humans in global village to change the basic way of living. The business ecosystem which is the basic root for economic life cannot be an exception. To survive the business environment of 21st century, the security risk management at management level is required and the reporting line of companies should be established newly for raising business competing power through security risk management. The companies should bear in mind that they can be disappeared into our old memories overnight if they are not sensitive to the changing environment. Out of new risks for the modern companies, the field especially Korean companies are dealing easily is the security risk. Not like past, the security risk which's size is much more massive and its propagation velocity is very fast is the one of important business risks which the management should take care. Out of security risks which influence on the modern companies significantly, the brand of companies, protection of their reputation, continuity of production and operation and keeping customer's trust are prior to the others. This study offered the suggestion regarding enterprise security and the strategic cooperation of business to deal with such security risk effectively.

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The Comparison of Protective Effects of Adenosine Included Cardioplegia According to Adenosine Dosage (심정지액 속에 포함된 아데노신의 용량에 따른 심근보호 효과 비교)

  • 유경종;강면식;이교준;임상현;박한기;김종훈;조범구
    • Journal of Chest Surgery
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    • v.31 no.9
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    • pp.837-844
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    • 1998
  • Background: Adenosine is secreted by myocardial cells during myocardial ischemia or hypoxia. It has many beneficial effects on arrhythmias, myocardial ischemia, and reperfusion ischemia. Although many investigators have demonstrated that cardioplegia that includes adenosine shows protective effects in myocardial ischemia or reperfusion injury, reports of the optimal dose of adenosine in cardioplegic solutions vary. We reported the results of beneficial effects of single dosage(0.75 mg/Kg/min) adenosine by use of self-made Langendorff system. But it is uncertain that dosage was optimal. The objective of this study is to determine the optimal dose of adenosine in cardioplegic solutions. Material and Method: We used a self-made Langendorff system to evaluate the myocardial protective effect. Isolated rat hearts were subjected to 90 minutes of deep hypothermic arrest(15$^{\circ}C$) with modified St. Thomas' Hospital cardioplegia including adenosine. Myocardial adenosine levels were augmented during ischemia by providing exogenous adenosine in the cardioplegia. Three groups of hearts were studied: (1) group 1 (n=10) : adenosine - 0.5 mg/Kg/min, (2) group 2(n=10): adenosine -0.75 mg/Kg/min, (3) group 3 (n=10) : adenosine -1 mg/Kg/min. Result: Group 3 resulted in a significantly rapid arrest time of the heart beat(p<0.05) but significantly slow recovery time of the heart beat after reperfusion(p<0.05) compared to groups 1 and 2. Group 2 showed a better percentage of recovery(p<0.05) in systolic aortic pressure, aortic overflow volume, coronary flow volume, and cardiac output compared to groups 1 and 3. Group 1 showed a a better percentage of recovery(p<0.05) in the heart rate compared to the others. In biochemical study of drained reperfusates, CPK and lactic acid levels did not show significant differences in all of the groups. Conclusion: We concluded that group 2 [adenosine(0.75 mg/Kg/min) added to cardioplegia] has better recovery effects after reperfusion in myocardial ischemia and is the most appropriate dosage compared to group 1 and 3.

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Cardioprotective Effect by Preconditioning with Calcium-free Solution (칼슘결핍용액 투여 전처치에 의한 심근보호 효과)

  • 조대윤;이종화;김호덕
    • Journal of Chest Surgery
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    • v.32 no.9
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    • pp.773-780
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    • 1999
  • Background: It has been demonstrated that brief periods of calcium depletion and repletion (calcium-free preconditioning, CP) have cardioprotective effects as seen in ischemic preconditioning(IP) which enhances the recovery of post-ischemic contractile dysfunction and reduces the incidence of reperfusion-induced arrhythmia or infarct size after a prolonged ischemia. In the present study, we tested this paradoxical phenomenon in isolated rabbit hearts. Material and Method: Hearts isolated from New Zealand white rabbits(1.5∼2.0 Kg body weight) were perfused with Tyrode solution using the Langendorff technique. After stabilizing the baseline hemodynamics, the hearts were subjected to 45 minutes of global ischemia followed by 120 minutes of reperfusion with IP(IP group, n=7) or without IP (ischemic control group, n=7). IP was induced by a single episode of 5 minutes global ischemia and 10 minutes reperfusion. In the CP group(n=7), the hearts were subjected to perfusion with Tyrode solution with calcium depletion for 5 minutes and repletion for 10 minutes, and 45 minutes of ischemia and 120 minutes of reperfusion. Left ventricular function including developed pressure, dP/dt, heart rate, left ventricular end-diastolic pressure and coronary flow was measured. Infarct size was determined by staining with 1% triphenyltetrazolium chloride and planimetry. Data were analyzed by a one-way analysis of variance and Tukey's post-hoc test. Result: In comparison with the ischemic control group, IP significantly enhanced the recovery of the left ventricular function including the left ventricular developed pressure, contractility, and coronary flow; in contrast, these functional parameters of the CP group tended to be lower than those of the ischemic control group. However, the infarct size was significantly reduced by IP or CP(p<0.05). Conclusion: These results suggest that in isolated Langendorff-perfused rabbit heart model, CP(induced by single episode of 5 minutes calcium depletion and 10 minutes repletion) could not improve the post-ischemic contractile dysfunction(after a 45-minute global ischemia) but it has an infarct size-limiting effect.

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Clinical Result of Aortic Arch Replacement using Antegrade Brain Perfusion Via Right Axillary Artery (우액와동맥을 통한 순행성 뇌관류법을 이용한 대동맥궁 치환의 임상성적)

  • Kim, Dong-Jin;Na, Yong-Jun;Jeong, Dong-Seop;Kim, Kyung-Hwan
    • Journal of Chest Surgery
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    • v.40 no.1 s.270
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    • pp.25-31
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    • 2007
  • Background: Cerebral protection is one of the most important procedures during aortic arch surgery. We can minimize neurological complications through short period of total circulatory arrest and resuming of brain perfusion. We evaluated 11 patients who underwent arch replacement using antegrade brain perfusion via right axillary artery. Material and Method: Between July 2004 and July 2006, 11 patients (male 9, female 2) underwent aortic arch replacement with antegrade brain perfusion via right axillary artery. Preoperative diagnosis was listed; 5 type A aortic dissections (5/11, 45.5%), 5 aortic aneurysms (5/11, 45,5%) and 1 type A IMH (intramural hematoma, 1/11, 9%). The mean age at the time of operation was $60.3{\pm}12.8$ years. For antegrade brain perfusion, we performed right axillary artery cannulation in all patients. Retrograde brain perfusion was used briefly during total circulatory arrest. Result: The mean total circulatory arrest time was $31.1{\pm}16.9$ minutes and the mean retrograde brain perfusion time was $21{\pm}17.8$ minutes. Mean antegrade brain perfusion time was $77.9{\pm}17.5\;(43{\sim}101)$ minutes. We had neither operative mortality nor permanent neurological complications. Conclusion: By means of antegrade brain perfusion via right axillary artery, that could lead to decrease circulatory arrest time and minimize damages to severely atheromatous arch vessels, we can expect to reduce neurological complications after aortic arch replacement. Further investigation with iarge patient populations will be required.

Personal Information Overload and User Resistance in the Big Data Age (빅데이터 시대의 개인정보 과잉이 사용자 저항에 미치는 영향)

  • Lee, Hwansoo;Lim, Dongwon;Zo, Hangjung
    • Journal of Intelligence and Information Systems
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    • v.19 no.1
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    • pp.125-139
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    • 2013
  • Big data refers to the data that cannot be processes with conventional contemporary data technologies. As smart devices and social network services produces vast amount of data, big data attracts much attention from researchers. There are strong demands form governments and industries for bib data as it can create new values by drawing business insights from data. Since various new technologies to process big data introduced, academic communities also show much interest to the big data domain. A notable advance related to the big data technology has been in various fields. Big data technology makes it possible to access, collect, and save individual's personal data. These technologies enable the analysis of huge amounts of data with lower cost and less time, which is impossible to achieve with traditional methods. It even detects personal information that people do not want to open. Therefore, people using information technology such as the Internet or online services have some level of privacy concerns, and such feelings can hinder continued use of information systems. For example, SNS offers various benefits, but users are sometimes highly exposed to privacy intrusions because they write too much personal information on it. Even though users post their personal information on the Internet by themselves, the data sometimes is not under control of the users. Once the private data is posed on the Internet, it can be transferred to anywhere by a few clicks, and can be abused to create fake identity. In this way, privacy intrusion happens. This study aims to investigate how perceived personal information overload in SNS affects user's risk perception and information privacy concerns. Also, it examines the relationship between the concerns and user resistance behavior. A survey approach and structural equation modeling method are employed for data collection and analysis. This study contributes meaningful insights for academic researchers and policy makers who are planning to develop guidelines for privacy protection. The study shows that information overload on the social network services can bring the significant increase of users' perceived level of privacy risks. In turn, the perceived privacy risks leads to the increased level of privacy concerns. IF privacy concerns increase, it can affect users to from a negative or resistant attitude toward system use. The resistance attitude may lead users to discontinue the use of social network services. Furthermore, information overload is mediated by perceived risks to affect privacy concerns rather than has direct influence on perceived risk. It implies that resistance to the system use can be diminished by reducing perceived risks of users. Given that users' resistant behavior become salient when they have high privacy concerns, the measures to alleviate users' privacy concerns should be conceived. This study makes academic contribution of integrating traditional information overload theory and user resistance theory to investigate perceived privacy concerns in current IS contexts. There is little big data research which examined the technology with empirical and behavioral approach, as the research topic has just emerged. It also makes practical contributions. Information overload connects to the increased level of perceived privacy risks, and discontinued use of the information system. To keep users from departing the system, organizations should develop a system in which private data is controlled and managed with ease. This study suggests that actions to lower the level of perceived risks and privacy concerns should be taken for information systems continuance.

A Study on the Continuous Utilization of Japan's Cultural Heritage Through the Cases of Silk Heritage, World Heritage, and the Japan Heritage Project in Gunma Prefecture (일본 문화유산의 연속적 활용에 관한 연구 - '군마 실크유산'과 세계유산, 일본유산 사업을 중심으로 -)

  • Lee, Chungsun
    • Korean Journal of Heritage: History & Science
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    • v.52 no.1
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    • pp.190-211
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    • 2019
  • In March 2015, The Agency for Cultural Affairs of Japan implemented a project called "Japan Heritage," which aims to promote the unique narratives of cultural properties of the region by branding the locality for revitalization in preparation for the 2020 Tokyo Olympics and Paralympics. This bottom-up approach of cultural policy has been called a "Cool Japan Strategy of Cultural Heritage" in the 21st century, which effectively incorporates local cultural heritage and tourism. However, although a total of 67 Japan Heritage projects have been designated as of December 2018, almost none has been introduced in the academic forum in Korea. On the basis of this background and a lack of academic awareness in Korea on Japan's recent cultural policies, this research aims to focus on the three cases of Gunma Prefecture implemented in local, global, and glocal aspects. To specify, the cases are the "Gunma Silk Heritage" project, implemented in 2011, the "Tomioka Silk Mill and Related Sites" project that was included on the UNESCO World Heritage List in 2014, and "The Best Wife in the World - Silk Story of Gunma," case certified as the first project of "Japan Heritage" launched in 2015. Based on the questionnaire method conducted with the World Heritage Registration Promotion Division in Gunma Prefectural Government, as well as a literature view, the research revealed that the consecutive implementation of a series of cultural heritage projects in Gunma is not coincidental, but rather a strategy aiming to create a synergism where each project complements the others. Moreover, this paper demonstrates that Gunma Prefecture has been utilizing the local silk industry as a tangible and intangible cultural resource in multi-layered heritage projects, resulting in a "spiral synergy effect" and a "chain of the recognition process." In conclusion, it illustrates the recent trend of utilizing cultural heritage in the context of the Cool Japan strategy, which seeks to move away from the administration of maintaining the status quo cultural heritage protection to a proactive one with greater potential growth. This research may thus provide meaningful insight into the utilization of domestic historical and cultural resources as well as related policy-making, in that it will ultimately promote the chain effect of linking the multiple heritage policies and projects at the local, global, and glocal levels.