• The Korean journal of internal medicine
• /
• 제33권6호
• /
• 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.

• Journal of Korean Neurosurgical Society
• /
• 제62권4호
• /
• 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.

• 대한토목학회논문집
• /
• 제28권4B호
• /
• pp.393-403
• /
• 2008

양양 산불 피해 지역 당해년도의 극심한 지표 변화에 따른 지표유출 및 토양침식을 분석하기 위해 산불 산지사면에 10개의 소규모 조사구를 설치하여, 지형, 토양, 식생, 강우사상별 유출 및 토양침식량을 측정하였다. 조사는 총 15개 단일강우사상을 기준하여 이루어졌다. 산불이후 식생회복이 빠른 지역과 그렇지 않은 사면의 유출 및 토양침식량은 매우 큰 차이를 보였다. 식생회복이 빠른 조사구들은 대조구보다 약 2배 많은 평균 유출량 및 토양침식량을 나타냈으나, 나지상태 조사구들에서는 대조구의 약 10배 이내의 유출 및 토양침식이 발생되었다. 지표유출 및 토양침식에 대한 주요 인자들과의 상관분석에 의하면 강우인자 및 식생인자는 유출과 토양침식에 상당한 영향을 미쳤다. 유출 및 토양침식 민감도는 식생지수들과 높은 상관성을 보였다. 산불에 의해 교란된 지표식생이 시간이 경과함에 따라 회복되고, 산불초기에 다량의 토사유출이 발생된 이후 사면 토양의 안정화에 따라 전반적으로 유출 및 토양침식량이 감소하였다. 그러나 식생회복이 안되거나, 식생회복이 더딘 지역은 지속적으로 유출 및 토양침식이 발생하기 때문에 산불 지역별로 차별화된 대응전략 수립이 필요하다.

• 대한환경공학회지
• /
• 제34권11호
• /
• pp.720-728
• /
• 2012

강우시 상당 부분의 비점오염물질은 입자성물질에 흡착된 형태로 유출되기 때문에 비점오염물질의 유출 거동을 보다 정확하게 이해하기 위해서는 입자성물질과의 상관성을 정량적으로 파악하는 것이 중요하다. 그러나 강우시 오염물질별 유출특성과 입도분포와의 상관성에 대한 연구사례는 매우 부족한 실정으로, 특히 도시화가 진전되지 않은 비시가화지역을 대상으로 한 국내 연구는 보고된 예가 거의 없다. 본 연구에서는 논, 밭 및 임야 등으로 구성된 소규모 비시가화지역(유역면적 52.8 ha)을 선정하여 다양한 규모의 강우사상별 유출특성을 조사하고, 오염물질의 유출특성과 입자성물질의 거동 사이의 상관관계를 분석하였다. 또한, 비점오염물질의 유출에 미치는 입자성물질의 영향에 대하여 정량적인 분석을 실시하였다. 연구결과, 중소규모 강우에서도 초기유출현상이 관찰되었으며, 입자성물질이 영양염류 및 중금속의 유출과정에 큰 기여를 하고 있는 것으로 나타났다. 특히, $BOD_5$와 TOC의 유기물항목, TN과 TP의 영양염류, Al, Cr, Cu, Fe, Hg 및 Zn의 중금속항목 등이 SS (total), VSS, SS (d < $20{\mu}m$) 및 SS ($20{\mu}m$ $$\leq_-$$ d < $80{\mu}m$)와 높은 상관성을 보여 입자성물질과 유사한 유출거동을 갖는 것으로 나타났다. 한편, $COD_{cr}$, Cd, Mn 및 Pb는 입자성물질의 유출거동과 뚜렷한 상관성을 보이지 않았다. 비시가화지역에서 비점오염물질의 유출과정은 입자성물질의 거동과 상관성이 높을 뿐만 아니라 처리대상물질에 따라서도 상이한 특성을 갖는다는 점을 고려한 비점오염 저감시설의 도입이 이루어져야 할 것으로 판단된다.

• 복식문화연구
• /
• 제3권2호
• /
• 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.

• Journal of Preventive Medicine and Public Health
• /
• 제16권1호
• /
• 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.

• 동양고전연구
• /
• 제69호
• /
• pp.349-371
• /
• 2017

사옹원(司饔院) 분원(分院)의 공인(貢人)이었던 지규식이 1891년 1월 1일부터 1911년 윤6월 29일까지 20년 7개월에 걸쳐 거의 매일 쓴 "하재일기"에는 보고 들은 국내외 정세와 풍속, 의례, 분원 관련 각종 제반사항, 일상생활사 등을 다방면에 걸쳐 다양하게 기록으로 남기고 있다. 필자가 여기서 주목한 것은 "하재일기"에 기록된 민속 관련 내용이다. 지규식은 양반이 아닌 신분으로 당시 실제로 행했던 세시풍속 민속놀이 의례 민간신앙 등 민속 관련 내용을 "하재일기"에 기록으로 남겼다. 이러한 일기는 드물 뿐만 아니라 자료적으로도 그 가치가 매우 높이 평가되며, 민속학적으로도 의미가 있다. 그러므로 필자는 "하재일기"에 나타난 민속을 연구하기 위한 작업의 일환으로 국가의례와 민간신앙에 초점을 맞추었다. 앞에서 논의된 사항들을 요약 정리하면 다음과 같다. 국가의례의 경우, 가례(嘉禮)는 황제의 즉위기념일과 황제 황태자 탄신기념일 관련 기록만 전하고 있어 아쉬움이 남지만, 국가적인 기념식과 경축식행사를 백성들이 충실하게 실행하였는데 의미가 있다고 하겠다. 특히 이러한 국가적인 기념식과 경축식행사 때 학생들에게 애국가를 제창케 했다는 사실이 눈길을 끈다. 흉례(凶禮)는 궁중상례 관련 내용만 전하고 있는데, 민비의 상례를 제외하고는 궁중 상례를 종전처럼 절차에 의해 제때 제대로 치루고 있었을 뿐만 아니라 백성들도 정부의 명에 따라 이를 잘 실행하였던 것으로 보인다. 그리고 일본인들이 민비를 살해하고 석유를 뿌려 시신을 불태워 재로 된 것을 버려둔 채 간 사실을 확인할 수 있었다. 민간신앙의 경우, 분원에서 정기적으로 동리의 신사를 지냈고, 동리에서도 매년 고청신사를 지냈는데, 제사비용은 마을 사람들의 경제적 사정에 따라 차등적으로 배분해 추렴하고, 마을 사람들 모두 힘을 합쳐 제수를 준비하고 제사를 지냈다. 제사는 산신당과 부군당에도 지냈으며, 무당을 불러 굿을 하는 것이 통례였다. 이는 자료적으로 가치가 있다. 그런데 지규식은 기독교인이 된 후, 회사에서 지내는 신사 제사를 폐지하려 한 적이 있을 뿐 아니라 새신(賽神), 즉 굿이나 푸닥거리하는 것도 없애려 했지만, 전례대로 어쩔 수 없이 따랐다. 한편, 지규식은 마을에 홍수가 나고 전염병이 퍼지자 마을의 안녕과 건강을 위해 자기 집 앞에 제단을 설치하고 희생과 술 등 제수를 갖추어 마을사람들과 함께 황천후토(皇天后土)에 제사를 지냈다는 내용이 있는바 주목할 필요가 있다. 그리고 지규식은 집안에 우환이 있을 경우, 무당을 불러 굿을 하거나 산신에게 치성을 드리는 등 이러한 무속이나, 주로 정초에 관성제군(關聖帝君)을 참배하고 한 해의 운수를 점쳤던 것들은 모두 민간신앙으로서 당시 민간에 널리 퍼져 있었을 뿐 아니라, 그의 생활 속에도 깊숙이 자리 잡고 있었던 것으로 보인다. 또한 지규식의 풍수신앙 선호도 당대인들의 일반적인 인식태도와 다르지 않다고 여겨진다. 이상에서 보듯, "하재일기"에 나타난 국가의례와 민간신앙 관련 내용은 자료적으로 가치가 있을 뿐 아니라, 민속 연구의 일환으로도 의미가 있으며, 민속학적으로도 나름대로 의의가 있다고 하겠다.