• Title/Summary/Keyword: Rare events

Search Result 157, Processing Time 0.024 seconds

Prognostic significance of non-chest pain symptoms in patients with non-ST-segment elevation myocardial infarction

  • Kim, Inna;Kim, Min Chul;Park, Keun Ho;Sim, Doo Sun;Hong, Young Joon;Kim, Ju Han;Jeong, Myung Ho;Cho, Jeong Gwan;Park, Jong Chun;Cho, Myeong Chan;Kim, Jong Jin;Kim, Young Jo;Ahn, Youngkeun
    • The Korean journal of internal medicine
    • /
    • v.33 no.6
    • /
    • pp.1111-1118
    • /
    • 2018
  • Background/Aims: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy. Methods: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128). Results: In this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time ($2,618{\pm}381minutes$ vs. $1,739{\pm}241minutes$, p = 0.050), the symptoms-to-balloon time ($3,426{\pm}389minutes$ vs. $2,366{\pm}255minutes$, p = 0.024), and the door-to-balloon time ($2,339{\pm}380minutes$ vs. $1,544{\pm}244minutes$, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487). Conclusions: Acute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.

Risk Factors of Allogenous Bone Graft Collapse in Two-Level Anterior Cervical Discectomy and Fusion

  • Woo, Joon-Bum;Son, Dong-Wuk;Lee, Su-Hun;Lee, Jun-Seok;Lee, Sang Weon;Song, Geun Sung
    • Journal of Korean Neurosurgical Society
    • /
    • v.62 no.4
    • /
    • pp.450-457
    • /
    • 2019
  • Objective : Anterior cervical discectomy and fusion (ACDF) is commonly used surgical procedure for cervical degenerative disease. Among the various intervertebral spacers, the use of allografts is increasing due to its advantages such as no harvest site complications and low rate of subsidence. Although subsidence is a rare complication, graft collapse is often observed in the follow-up period. Graft collapse is defined as a significant graft height loss without subsidence, which can lead to clinical deterioration due to foraminal re-stenosis or segmental kyphosis. However, studies about the collapse of allografts are very limited. In this study, we evaluated risk factors associated with graft collapse. Methods : We retrospectively reviewed 33 patients who underwent two level ACDF with anterior plating using allogenous bone graft from January 2013 to June 2017. Various factors related to cervical sagittal alignment were measured preoperatively (PRE), postoperatively (POST), and last follow-up. The collapse was defined as the ratio of decrement from POST disc height to follow-up disc height. We also defined significant collapses as disc heights that were decreased by 30% or more after surgery. The intraoperative distraction was defined as the ratio of increment from PRE disc height to POST disc height. Results : The subsidence rate was 4.5% and graft collapse rate was 28.8%. The pseudarthrosis rate was 16.7% and there was no association between pseudarthrosis and graft collapse. Among the collapse-related risk factors, pre-operative segmental angle (p=0.047) and intra-operative distraction (p=0.003) were significantly related to allograft collapse. The cut-off value of intraoperative distraction ${\geq}37.3%$ was significantly associated with collapse (p=0.009; odds ratio, 4.622; 95% confidence interval, 1.470-14.531). The average time of events were as follows: collapse, $5.8{\pm}5.7months$; subsidence, $0.99{\pm}0.50months$; and instrument failure, $9.13{\pm}0.50months$. Conclusion : We experienced a higher frequency rate of collapse than subsidence in ACDF using an allograft. Of the various preoperative factors, intra-operative distraction was the most predictable factor of the allograft collapse. This was especially true when the intraoperative distraction was more than 37%, in which case the occurrence of graft collapse increased 4.6 times. We also found that instrument failure occurs only after the allograft collapse.

Effects of Vegetation Recovery for Surface Runoff and Soil Erosion in Burned Mountains, Yangyang (양양 산불지역 지표유출 및 토양침식에 대한 식생회복의 영향)

  • Shin, Seung Sook;Park, Sang Deog;Cho, Jae Woong;Lee, Kyu Song
    • KSCE Journal of Civil and Environmental Engineering Research
    • /
    • v.28 no.4B
    • /
    • pp.393-403
    • /
    • 2008
  • While characteristics of topography, soil, and vegetation coverage were surveyed, also surface runoff and soil erosion for each rainfall event were measured to analyze effect of change of land cover conditions in mountain areas, Yangyang, directly after wildfire. Fifteen rainfall events were taken in total during the survey period. The result of this survey appeared that the amount of surface runoff and soil erosion are a great difference between plots with rapidly recovered vegetation and bare plots after wildfire. The burned plots where vegetation recovered rapidly generated two times or more of surface runoff and soil erosion than control plots, as burned plots with bare soil showed about ten times of surface runoff and sediment than control plots. The result of correlation analysis between main parameters of the surface runoff and soil erosion presented that rainfall factors and vegetation factors had significant effects on runoff and soil erosion. The sensitivity of runoff and soil erosion showed specially high correlation with vegetation indices. If the land surface disturbed by wildfire are recovered by natural vegetation as time passes, runoff and soil erosion may be decreased gradually. Because runoff and soil erosion in the areas with rare vegetation or bare soil are generated continuously, the discriminated mediation strategies would be established as condition of each region.

Correlation of Nonpoint Pollutant and Particulate Matters at a Small Suburban Area (비시가화지역에서 비점오염물질과 입자성물질의 유출 상관성)

  • Park, Ji-Young;Bae, Sang-Ho;Yoon, Young-H.;Lim, Hyun-Man;Park, Jae-Roh;Oh, Hyun-Je;Kim, Weon-Jae
    • Journal of Korean Society of Environmental Engineers
    • /
    • v.34 no.11
    • /
    • pp.720-728
    • /
    • 2012
  • In general, nonpoint pollutant of a watershed is drained out in the form of storm water runoff during rainfall events. As the bulk of the nonpoint pollutant is in adsorbed form on particulate matters, in order to understand the behavior of nonpoint pollutant it is essential to grasp the characteristics of particulate matters in rainfall runoff. Though, previous studies for the relationship between the runoff characteristics of pollutants and the size distribution of particulate matters are very rare. In this study, a small non-urbanized area (basin area of 52.8 ha) with various landuse types including paddy, dry fields and forest was selected and investigated in detail for the runoff properties of each pollutant during several rainfall events. The correlation and effects between particulate matters and nonpoint pollutant were analyzed quantitatively. As a result, the significant first flush was observed on each event and it became clear that fine particulate matters ($80{\mu}m$ or less) has contributed in the runoff process of nutrients and heavy metals. Organic matters ($BOD_5$, TOC), nutrients (TN, TP) and several heavy metals (Al, Cr, Cu, Fe, Hg and Zn) represented high correlations with SS (total), VSS, SS (d < $20{\mu}m$) and SS ($20{\mu}m$ $$\leq_-$$ d < $80{\mu}m$). On the other hand, $COD_{cr}$, Cd, Mn and Pb did not show clear correlations with the behavior of particulate matters. Therefore, we have to examine the introduction of nonpoint pollution mitigation facilities considering the facts that nonpoint pollutant runoff process has high correlation with the behavior of particulate matters and is changeable based on the target pollutants.

A Study on the Traditional Costumes and Tattoo of the Maori (마오리族 傳統 服飾과 文身 考察)

  • 황춘섭;정현주
    • The Research Journal of the Costume Culture
    • /
    • v.3 no.2
    • /
    • pp.241-260
    • /
    • 1995
  • The Maori's traditional clothing materials, basic forms of dress, and the pattern and technique of tatoo were examined in the present study in order to deepen the appreciation of the cultural heritage of the Maori. The research method employed was the analysis of written materials. And a fild-trip was also made for the study. The study was limitted to the traditional culture of body adornment of the Maori including the clothing which is preserved and practicing by them at the present day, and the origin and the process of the historical development of those are not included in the scope of the present study. Followings are the results of the study: (1) By far the most widely used fiber for Maori clothing is abtained from what is commonly called New Zealand Flax. The fiber of kiekie(Freycinetia baueriana) and cabbage trees(Cordyline spp.) may also be used. The strong, long-lasting fiber of toi(cordyline indivisa) is used for a prestige warrior's cloak. Flat strips of ti kauka(Cordyline australi) are also used as thatch on rain cloaks. (2) Regardless of technique used, Maori weaving is always worked horizontally from left to right. Traditionally the work was suspended between two upright turuturu or weaving sticks. As the work progressed a second pair of uprights was used to keep the work off the ground. These uprights were moved forward as required. Because the weaver sat on the ground, the working edge was kept at a height that was comfortable to reach. No weaving tools are used, the wefts(aho) being manipulated by the fingers. The two main Maori weaving techniques are whatu aho patahi(single-pair twining) and whatu aho rua(double-pair twining). (3) The Maori wore two basic garments - a waist met and a cloak. The cloth of commoners were of plain manufacture, while those of people of rank were superior, sometimes being decorated with feather or dyed tags and decorated borders. Children ran more-or-less naked until puberty, being dressed only for special events. Some working dress consisted of nothing more than belts with leaves thrust under them. Chiefs and commoners usually went barefoot, using rough sandals on journeys over rough country (4) The adornment of men and women of rank was an important matter of tribal concern as it was in chiefly persons that prestige of the group was centred, The durable items of Maori persons adornment were either worn or carried. Ornaments of various kinds were draped about the neck or suspended from pierced earlobes. Combs decorated the head. Personal decorations not only enhanced the appearance of men and women, but many had protective magical function. The most evident personal ornament was the hei-tiki made of jade or other material. Maori weapons were treasured by their owners. They served on bottle and were also personal regalia. A man of rank was not fully dressed without a weapon in hand. Also weapons were essential to effective oratory. (5) No man or woman of rank went without some tattoo adornment except in extremely rare instances when a person was too sacred to have any blood shed. The untattooed were marked as beeing commoners of no social standing. This indelible mark of rank was begun, with appropriate rite and ritual, at puberty. And tattoo marked the person as being of a marriageable age. Maori tattoo was unlike most traditional tattoo in that its main line were 'engraved' on the face with deep cuts made by miniature bone chisels. The fill-in areas were not tattooed with cuts but with the multiple pricks of small bone 'combs' that only lightly penetrated the skin surface. The instrument of tattoo consisted of small pots of pumice or wood into which was placed a wetted black pigment made from burnt kauri gum, burnt vegetable caterpillars or other sooty materials. A bird bone chisel or comb set at right angles on a short wooden handle was dipped into the gigment, that a rod or stick was used to tap head of this miniature adze, causing penetration of the skin surface. Black pigment lodged under the skin took on a bluish tinge. A full made facial tattoo consisted of major spirals with smaller spirals on each side of the nose and sweeping curved lines radiating out from between the brows over the forehead and from the nose to the chin. The major patterns were cut deep, while the secondary koru patterns were lightly pricked into the skin.

  • PDF

A Stochastic Study for the Emergency Treatment of Carbon Monoxide Poisoning in Korea (일산화탄소중독(一酸化炭素中毒)의 진료대책(診療對策) 수립(樹立)을 위한 추계학적(推計學的) 연구(硏究))

  • Kim, Yong-Ik;Yun, Dork-Ro;Shin, Young-Soo
    • Journal of Preventive Medicine and Public Health
    • /
    • v.16 no.1
    • /
    • pp.135-152
    • /
    • 1983
  • Emergency medical service is an important part of the health care delivery system, and the optimal allocation of resources and their efficient utilization are essentially demanded. Since these conditions are the prerequisite to prompt treatment which, in turn, will be crucial for life saving and in reducing the undesirable sequelae of the event. This study, taking the hyperbaric chamber for carbon monoxide poisoning as an example, is to develop a stochastic approach for solving the problems of optimal allocation of such emergency medical facility in Korea. The hyperbaric chamber, in Korea, is used almost exclusively for the treatment of acute carbon monoxide poisoning, most of which occur at home, since the coal briquette is used as domestic fuel by 69.6 per cent of the Korean population. The annual incidence rate of the comatous and fatal carbon monoxide poisoning is estimated at 45.5 per 10,000 of coal briquette-using population. It offers a serious public health problem and occupies a large portion of the emergency outpatients, especially in the winter season. The requirement of hyperbaric chambers can be calculated by setting the level of the annual queueing rate, which is here defined as the proportion of the annual number of the queued patients among the annual number of the total patients. The rate is determined by the size of the coal briquette-using population which generate a certain number of carbon monoxide poisoning patients in terms of the annual incidence rate, and the number of hyperbaric chambers per hospital to which the patients are sent, assuming that there is no referral of the patients among hospitals. The queueing occurs due to the conflicting events of the 'arrival' of the patients and the 'service' of the hyperbaric chambers. Here, we can assume that the length of the service time of hyperbaric chambers is fixed at sixty minutes, and the service discipline is based on 'first come, first served'. The arrival pattern of the carbon monoxide poisoning is relatively unique, because it usually occurs while the people are in bed. Diurnal variation of the carbon monoxide poisoning can hardly be formulated mathematically, so empirical cumulative distribution of the probability of the hourly arrival of the patients was used for Monte Carlo simulation to calculate the probability of queueing by the number of the patients per day, for the cases of one, two or three hyperbaric chambers assumed to be available per hospital. Incidence of the carbon monoxide poisoning also has strong seasonal variation, because of the four distinctive seasons in Korea. So the number of the patients per day could not be assumed to be distributed according to the Poisson distribution. Testing the fitness of various distributions of rare event, it turned out to be that the daily distribution of the carbon monoxide poisoning fits well to the Polya-Eggenberger distribution. With this model, we could forecast the number of the poisonings per day by the size of the coal-briquette using population. By combining the probability of queueing by the number of patients per day, and the probability of the number of patients per day in a year, we can estimate the number of the queued patients and the number of the patients in a year by the number of hyperbaric chamber per hospital and by the size of coal briquette-using population. Setting 5 per cent as the annual queueing rate, the required number of hyperbaric chambers was calculated for each province and for the whole country, in the cases of 25, 50, 75 and 100 per cent of the treatment rate which stand for the rate of the patients treated by hyperbaric chamber among the patients who are to be treated. Findings of the study were as follows. 1. Probability of the number of patients per day follows Polya-Eggenberger distribution. $$P(X=\gamma)=\frac{\Pi\limits_{k=1}^\gamma[m+(K-1)\times10.86]}{\gamma!}\times11.86^{-{(\frac{m}{10.86}+\gamma)}}$$ when$${\gamma}=1,2,...,n$$$$P(X=0)=11.86^{-(m/10.86)}$$ when $${\gamma}=0$$ Hourly arrival pattern of the patients turned out to be bimodal, the large peak was observed in $7 : 00{\sim}8 : 00$ a.m., and the small peak in $11 : 00{\sim}12 : 00$ p.m. 2. In the cases of only one or two hyperbaric chambers installed per hospital, the annual queueing rate will be at the level of more than 5 per cent. Only in case of three chambers, however, the rate will reach 5 per cent when the average number of the patients per day is 0.481. 3. According to the results above, a hospital equipped with three hyperbaric chambers will be able to serve 166,485, 83,242, 55,495 and 41,620 of population, when the treatmet rate are 25, 50, 75 and 100 per cent. 4. The required number of hyperbaric chambers are estimated at 483, 963, 1,441 and 1,923 when the treatment rate are taken as 25, 50, 75 and 100 per cent. Therefore, the shortage are respectively turned out to be 312, 791. 1,270 and 1,752. The author believes that the methodology developed in this study will also be applicable to the problems of resource allocation for the other kinds of the emergency medical facilities.

  • PDF

Consideration on National Rituals and Folk Beliefs Found in 『Hajaeilgi』 (『하재일기』에 나타난 국가의례와 민간신앙 일고찰)

  • Song, Jae Yong
    • (The)Study of the Eastern Classic
    • /
    • no.69
    • /
    • pp.349-371
    • /
    • 2017
  • "Hajaeilgi(荷齋日記)" was written by Ji Gyu-sik, a gongin of Saongwon(司饔院)'s branch, almost everyday for 20 years and 7 months from January 1st, 1891 until the leap month of June 29th, 1911. It deals with many different areas including domestic and foreign circumstances, custom, rituals, all the affairs related to the branch, and also everyday life events he did see or hear about. Particularly, Ji Gyu-sik did not belong to the yangban class, and we can hardly find diaries written by such class' people. Here, what this author pays attention to among the things written in "Hajaeilgi" is the contents about folklore. Ji Gyu-sik wrote in his "Hajaeilgi" about things related to folklore, for example, seasonal customs, folk plays, rituals, or folk beliefs that were actually practiced then as a person not belonging to the yangban class. Such diaries are rare, and its value is highly appreciated as a material, and it is meaningful in the aspects of folklore as well. Therefore, as part of the work to look into folklore found in "Hajaeilgi", this author focuses on national rituals and folk beliefs in it. The things that have been discussed earlier can be summed up as follows: About national rituals, it is sorry that it only deals with the emperor's enthronement and emperor and crown prince's birthday in garye(嘉禮); however, it is meaningful to know that the people faithfully carried out national ceremonies and celebrations then. Particularly, it is noteworthy that during the national ceremonies or celebrations, students were asked to sing the national anthem. About hyungrye(凶禮), only it deals with the court funeral rite. Aside from Minbi's funeral rite, the court funeral rite was performed properly at the right time according to the procedure like before, and also, it seems that the people fulfilled it faithfully by order of the government. Also, it can be learned from it that Japanese killed Minbi, burned the body with oil, and left the ashes behind. About folk beliefs, the branch held a memorial service at the shrine of the town regularly. The town, too, performed Gocheongsinsa each year. The money needed for the memorial service was collected from the town people differently according to their financial situations, and they prepared for jesu for the ancestral rite altogether. The memorial service was carried out in Sansindang or Bugeundang, too, and it was common that they summoned a shaman to perform a gut. The diary is valuable as material. After being a Christian, Ji Gyu-sik once tried to abolish sinsa jesa held in hoesa and get rid of saesin(賽神), that is, a gut or pudakgeori, but he had no choice but to follow the precedent. Meanwhile, it is also noteworthy that when the town suffered from floor and infectious disease, Ji Gyu-sik installed an altar in front of his house for the town's wellbeing and health, prepared for jesu including offerings and drinks, and held a memorial service to Hwangcheonhuto(皇天后土; the gods of heaven and earth) accompanied with the town people. Also, when he had any hardships in his family, Ji Gyu-sik summoned a shaman for a gut or offered a devout prayer to the mountainous god. Such shamanism or the things like worshiping Gwanseongjegun(關聖帝君) mostly in the beginning of January and telling fortunes about the year were all folk beliefs. This was very popular among the people, and it seems that it was deeply rooted in his life as well. Also, Ji Gyu-sik supported Fengshui beliefs, and it seems that it is not different from the people's general tendencies, either. As described above, "Hajaeilgi" dealing with national rituals and folk beliefs in it is valuable as material and is meaningful for research on forklore, and moreover, it is also significant in the aspects of forklore as well.