• Title/Summary/Keyword: Risk-Informed

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Immediate breast reconstruction following nipple-sparing mastectomy in an Asian population: Aesthetic outcomes and mitigating nipple-areolar complex necrosis

  • Pek, Wan-Sze;Tan, Bien-Keem;Ng, Yvonne Ying Ru;Tan, Veronique Kiak Mien;Rasheed, Mohamed Zulfikar;Tan, Benita Kiat Tee;Ong, Kong Wee;Ong, Yee Siang
    • Archives of Plastic Surgery
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    • v.45 no.3
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    • pp.229-238
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    • 2018
  • Background Nipple-sparing mastectomies (NSMs) are increasingly performed to obtain the best aesthetic and psychological outcomes in breast cancer treatment. However, merely preserving the nipple-areolar complex (NAC) does not guarantee a good outcome. Darkly pigmented NACs and a tendency for poor scarring outcomes are particular challenges when treating Asian patients. Herein, we review the reconstructive outcomes following NSM at Singapore General Hospital. Methods All breasts reconstructed following NSM over an 11-year period from 2005 to 2015 were reviewed. Information was collected from the patients' records on mastectomy indications, operative details, and complications. Patient satisfaction, breast sensation, and aesthetic outcomes were evaluated in 15 patients. Sensation was quantified using the Semmes-Weinstein monofilament test. Results A total of 142 NSMs were performed in 133 patients for breast cancer (n=122, 85.9%) or risk reduction (n=20, 14.1%). Of the procedures, 114 (80.2%) were autologous reconstructions, while 27 (19.0%) were reconstructions with implants. Complications occurred in 28 breasts (19.7%), with the most common complication being NAC necrosis, which occurred in 17 breasts (12.0%). Four breasts (2.8%) had total NAC necrosis. The overall mean patient satisfaction score was 3.0 (good). The sensation scores were significantly diminished in the skin envelope, areola, and nipple of breasts that had undergone NSM compared to non-operated breasts (P<0.05). Half of the subset of 15 patients in whom aesthetic outcomes were evaluated had reduced nipple projection. Conclusions Immediate reconstruction after NSM was performed with a low complication rate in this series, predominantly through autologous reconstruction. Patients should be informed of potential drawbacks, including NAC necrosis, reduced nipple projection, and diminished sensation.

Status Quo Bias in Ocean Marine Insurance and Implications for Korean Trade

  • Jung, Hongjoo;Lim, Soyoung
    • Journal of Korea Trade
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    • v.25 no.5
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    • pp.39-57
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    • 2021
  • Purpose - This research uses ocean marine insurance (OMI) statistics, international emails, focus-group interviews, and surveys to fill the gap between the theory of behavioral insurance, particularly status quo bias (SQB), and the practice of OMI in Korea. The contractual forms of OMI, the oldest and most globalized form of commercial insurance, were developed in the UK as the Institute Cargo Clauses in 1906 and revised in 1963, 1982, and 2009. SQB has been academically explored, mostly in health insurance and the financial services sector, but never in OMI. Thanks to the availability of OMI statistics in Korea, we can conduct SQB research here for the first time in this field. Design/methodology - We show the existence of SQB in the OMI of Korea through Korean statistics between 2009 and 2018, email correspondence with experts in the UK, Germany, and Japan, focus-group interviews with Korean OMI underwriters, an in-depth interview with one underwriter, and a survey of 15 OMI insureds (company representatives). Findings - We find that Korean foreign traders rely on the old-type OMI contracts developed in 1963, whereas other industrialized countries use the newest type of OMI contract developed in 2009. With a simple loss ratio analysis during 2009-2018, we show that the behavior of insurers has little to do with rational profit maximization and is instead driven by irrational bias, as they forgo the more profitable contracts provided by the new clauses by keeping the old clauses. The consistent addiction to old types of contracts in the OMI market suggests strong SQB among Korean exporters, importers, bankers, or insurers, which we confirmed in our interviews and survey. Originality/value - This research has significant originality and academic value because it reports new findings with crucial implications for the development of efficient trade practices and policy. First, this research is based on actual statistics that have not been used in previous Korean research on OMI. Second, this research shows that all-risk OMI policies provide more value to insureds, in terms of coverage given premium, than partial coverage policies, which differs from arguments previously made in Korea. Third, this research reveals strong SQB in Korea, where foreign trade plays a pivotal role in economic growth. That bias could be attributable to uninformed traders, informed but idle insurers, or conservative bankers. Fourth, to further develop foreign trade, policy initiatives are needed to review the current practices of OMI contracts and move forward with the new contract forms. All of these findings and arguments are both new and important.

Association between High Diffusion-Weighted Imaging-Derived Functional Tumor Burden of Peritoneal Carcinomatosis and Overall Survival in Patients with Advanced Ovarian Carcinoma

  • He An;Jose AU Perucho;Keith WH Chiu;Edward S Hui;Mandy MY Chu;Siew Fei Ngu;Hextan YS Ngan;Elaine YP Lee
    • Korean Journal of Radiology
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    • v.23 no.5
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    • pp.539-547
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    • 2022
  • Objective: To investigate the association between functional tumor burden of peritoneal carcinomatosis (PC) derived from diffusion-weighted imaging (DWI) and overall survival in patients with advanced ovarian carcinoma (OC). Materials and Methods: This prospective study was approved by the local research ethics committee, and informed consent was obtained. Fifty patients (mean age ± standard deviation, 57 ± 12 years) with stage III-IV OC scheduled for primary or interval debulking surgery (IDS) were recruited between June 2016 and December 2021. DWI (b values: 0, 400, and 800 s/mm2) was acquired with a 16-channel phased-array torso coil. The functional PC burden on DWI was derived based on K-means clustering to discard fat, air, and normal tissue. A score similar to the surgical peritoneal cancer index was assigned to each abdominopelvic region, with additional scores assigned to the involvement of critical sites, denoted as the functional peritoneal cancer index (fPCI). The apparent diffusion coefficient (ADC) of the largest lesion was calculated. Patients were dichotomized by immediate surgical outcome into high- and low-risk groups (with and without residual disease, respectively) with subsequent survival analysis using the Kaplan-Meier curve and log-rank test. Multivariable Cox proportional hazards regression was used to evaluate the association between DWI-derived results and overall survival. Results: Fifteen (30.0%) patients underwent primary debulking surgery, and 35 (70.0%) patients received neoadjuvant chemotherapy followed by IDS. Complete tumor debulking was achieved in 32 patients. Patients with residual disease after debulking surgery had reduced overall survival (p = 0.043). The fPCI/ADC was negatively associated with overall survival when accounted for clinicopathological information with a hazard ratio of 1.254 for high fPCI/ADC (95% confidence interval, 1.007-1.560; p = 0.043). Conclusion: A high DWI-derived functional tumor burden was associated with decreased overall survival in patients with advanced OC.

Effects of Social Support, Sleep Quality, and Oral Health Impact Profile on Depression among Pregnant Women (일부 임신부의 사회적 지지, 수면의 질 및 구강건강영향지수가 우울수준에 미치는 영향)

  • Han, Se-Young;Han, Yang-Keum
    • Journal of dental hygiene science
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    • v.17 no.2
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    • pp.134-141
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    • 2017
  • This study examined 191 pregnant women before delivery in an obstetrics and gynecology clinic in North Gyeongsang Province from May to September 2016 by using a questionnaire after obtaining informed consent for voluntary participation in the study. The study was performed to investigate the association of depression with sociodemographic characteristics, pregnancy-related characteristics, social support, sleep quality and Oral Health Impact Profile (OHIP) in pregnant women. The prevalence of depression among the pregnant women was 25.1% in the healthy group and 74.9% in the depression group. The depression level was significantly higher in women in the depression group who were unsatisfied with their marriage life, had no occupation, had lower social support, had poor sleep quality and had higher OHIP scores. The results of the logistic regression analysis indicated that, the risk ratio for more severe depression was significantly higher in the group with no experience of miscarriage and induced childbirth than in the group with childbirth experience. Conversely, the risk ratio for more severe depression was significantly lower in the group with high social support than in the group with low social support. Depression in the respondents significantly positively correlated with sleep quality and OHIP score but significantly negatively correlated with social support. The multiple regression analysis revealed that the depression level was significantly higher by 22.3% among pregnant women with lower marital satisfaction, no childbirth experience, lower social support and higher OHIP scores. In summary, depression was related to marital satisfaction, childbirth experience, social support, and OHIP score, among others, in pregnant women in this study. Therefore, further investigation is warranted to construct programs and measures that will help build positive thinking by designing and verifying a three-dimensional study model by taking into consideration various variables to reduce the incidence of depression in pregnant women.

Communication with Family Members about Positive BRCA1/2 Genetic Test Results in Korean Hereditary Breast Cancer Families (한국인 유전성 유방암 가계에서 BRCA1/2 유전자 돌연변이 사실에 대한 가족과의 의사소통 실태)

  • Kang, Eun-Young;Park, Sue-K.;Kim, Ku-Sang;Choi, Doo-Ho;Nam, Seok-Jin;Paik, Nam-Sun;Lee, Jong-Won;Lee, Min-Hyuk;Kim, Sung-Won
    • Journal of Genetic Medicine
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    • v.8 no.2
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    • pp.105-112
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    • 2011
  • Purpose: Sharing genetic information with family members is important for cancer awareness and prevention. The purpose of this study is to examine disclosure patterns of positive BRCA genetic test results to patients' relatives. Materials and Methods: A total of 106 probands who had positive BRCA genetic test results from the Korean Hereditary Breast Cancer Study participated in our study. Subjects were asked whether they had disclosed their genetic test results to first-, second-, and third-degree relatives. Univariate and multivariate analyses were used to identify factors associated with positive result sharing with close and distant relatives. Results: In total, 99 respondents (93.4%) informed at least one at-risk relative of the test result, and they all reported that they had disclosed their genetic test result to a first-degree relative. Communication of test results to other relatives occurred significantly less often, with only 31 of 99 subjects (31.3%) sharing their results with second- or third-degree relatives. In the results of univariate analyses, disclosure of genetic test results to more distant relatives was associated with marital status and months since post-test counseling. The reasons for communication were to provide information about the BRCArelated cancer risk and to recommend the genetic test. Conclusion: Most individuals with the BRCA mutation share their test results with first-degree family members; however, these results reach more distant relatives significantly less often. Therefore, it is necessary to encourage patients' communication with extended family members through systematic genetic counseling.

The prediction of the stock price movement after IPO using machine learning and text analysis based on TF-IDF (증권신고서의 TF-IDF 텍스트 분석과 기계학습을 이용한 공모주의 상장 이후 주가 등락 예측)

  • Yang, Suyeon;Lee, Chaerok;Won, Jonggwan;Hong, Taeho
    • Journal of Intelligence and Information Systems
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    • v.28 no.2
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    • pp.237-262
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    • 2022
  • There has been a growing interest in IPOs (Initial Public Offerings) due to the profitable returns that IPO stocks can offer to investors. However, IPOs can be speculative investments that may involve substantial risk as well because shares tend to be volatile, and the supply of IPO shares is often highly limited. Therefore, it is crucially important that IPO investors are well informed of the issuing firms and the market before deciding whether to invest or not. Unlike institutional investors, individual investors are at a disadvantage since there are few opportunities for individuals to obtain information on the IPOs. In this regard, the purpose of this study is to provide individual investors with the information they may consider when making an IPO investment decision. This study presents a model that uses machine learning and text analysis to predict whether an IPO stock price would move up or down after the first 5 trading days. Our sample includes 691 Korean IPOs from June 2009 to December 2020. The input variables for the prediction are three tone variables created from IPO prospectuses and quantitative variables that are either firm-specific, issue-specific, or market-specific. The three prospectus tone variables indicate the percentage of positive, neutral, and negative sentences in a prospectus, respectively. We considered only the sentences in the Risk Factors section of a prospectus for the tone analysis in this study. All sentences were classified into 'positive', 'neutral', and 'negative' via text analysis using TF-IDF (Term Frequency - Inverse Document Frequency). Measuring the tone of each sentence was conducted by machine learning instead of a lexicon-based approach due to the lack of sentiment dictionaries suitable for Korean text analysis in the context of finance. For this reason, the training set was created by randomly selecting 10% of the sentences from each prospectus, and the sentence classification task on the training set was performed after reading each sentence in person. Then, based on the training set, a Support Vector Machine model was utilized to predict the tone of sentences in the test set. Finally, the machine learning model calculated the percentages of positive, neutral, and negative sentences in each prospectus. To predict the price movement of an IPO stock, four different machine learning techniques were applied: Logistic Regression, Random Forest, Support Vector Machine, and Artificial Neural Network. According to the results, models that use quantitative variables using technical analysis and prospectus tone variables together show higher accuracy than models that use only quantitative variables. More specifically, the prediction accuracy was improved by 1.45% points in the Random Forest model, 4.34% points in the Artificial Neural Network model, and 5.07% points in the Support Vector Machine model. After testing the performance of these machine learning techniques, the Artificial Neural Network model using both quantitative variables and prospectus tone variables was the model with the highest prediction accuracy rate, which was 61.59%. The results indicate that the tone of a prospectus is a significant factor in predicting the price movement of an IPO stock. In addition, the McNemar test was used to verify the statistically significant difference between the models. The model using only quantitative variables and the model using both the quantitative variables and the prospectus tone variables were compared, and it was confirmed that the predictive performance improved significantly at a 1% significance level.

A Study on the Relationship between Adiponectin, BDNF and Leptin with Abdominal Fat Thickness in Male Workers (남성 근로자의 복부지방두께와 adiponectin, BDNF 및 leptin의 관련성)

  • Ko, Kyung-Sun;Choi, Yoon-Jung
    • Journal of radiological science and technology
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    • v.36 no.3
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    • pp.209-217
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    • 2013
  • Adiponectin (AdipoN), brain-derived nerotrophic factor (BDNF) and leptin (LeP) are mainly secreted from adipose tissue and are known to be involved in regulation of the development of obese. However, there are not many studies on the association between abdominal fat and neuropeptides such as AdipoN, BDNF and LeP. The aim of this study was undertaken to investigate the association between abdominal fat thickness, neuropeptides and cardiovascular disease (CVD) risk factors. The participants in the study were 138 male employees without CVD. This study was approved by the Institutional Review Board of Occupational Safety and Health Research Institute. Written informed consent for the participants in this study was obtained from all individuals. We obtained subcutaneous fat thickness (SFT) and visceral fat thickness (VFT) by using ultrasonography and neuropeptides levels were measured with ELISA kit according to the method suggested by kit manufacturer. The mean SFT and VFT were $1.58{\pm}0.51$ and $4.52{\pm}1.44$ cm. The mean concentrations of AdipoN, BDNF and LeP were $3.14{\pm}3.52$ ng/ml, $24.11{\pm}8.52$ pg/ml and $4.27{\pm}2.38$ ng/ml, respectively. VFT were positively correlated with total cholesterol (r=0.217, p<0.05), LDL-cholesterol (r=0.271, p<0.01), triglyceride (r=0.233, p<0.05) and insulin (r=0.338, p<0.01), but was inversely correlated with HDL-cholesterol (r=-420, p<0.01). AdipoN levels were positively correlated with HDL-cholesterol (r=0.220, p<0.05) and were inversely correlated with total cholesterol (r=-0.196, p<0.05), LDL-cholesterol (r=-0.190, p<0.05), triglyceride (r=-0.199, p<0.05), SFT (r=-0.195, p<0.05) and VFT (r=-0.412, p<0.01). However, LeP levels showed a reverse trend to AdipoN. AdipoN level was significantly higher in non-obese participants (BMI<25 kg/m), but LeP concentration was significantly higher in obese participants (BMI>25 kg/m) than in non-obese. On multiple logistic regression analysis, obese were significantly associated with AdipoN (odds ratio=0.784) and LeP (odds ratio=1.494). These results suggested that AdipoN and LeP concentrations are affected abdominal fat and that dysfunction and/or declination in the production and secretion of neuropeptides might induced ultimately obese and CVD.

Relation of Self-Efficacy and Cognition of Irradiated Food among High School Students (고등학생의 방사선조사식품에 대한 인식과 자기효능감과의 관련성)

  • Han, Eun Ok;Choi, Yoon Seok
    • Journal of Radiation Protection and Research
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    • v.38 no.2
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    • pp.106-118
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    • 2013
  • In this paper, we analyzed the Cognition of irradiated food and its relation with self-efficacy. The most important variables described behaviors based on health choices compared with the choice to choose irradiated food items. According to the survey, 33.1% of respondents said that the reason why irradiated food is considered to be a health risk is because "radiation is dangerous". 27.9% of respondents answered that "eating irradiated food is like eating a radioactive substance", 21.1% said radiated food is comparable to a "genetic variation in food" while 10.1% said "food goes bad during the irradiation process". On this basis, it is reasonable to conclude that respondents have a misunderstanding of irradiated food without reference to the general theory of irradiated knowledge. In this respect, it would be helpful to provide education showing that irradiated food is not related to eating harmful or genetically modified food to help high school students create informed opinions of irradiated food. In terms of relevance with health-specific self-efficacy, experience of acquiring information about irradiated food was marked at r=0.148 (p<0.01), experience of purchasing irradiated food was marked at r=0.077 (p<0.05), experience of eating irradiated food was marked at r=0.113 (p<0.01) while knowledge of irradiated food, attitude towards irradiated food and behavior was marked at r=0.103 (p<0.01), r=0.076 (p<0.05) and r=0.105 (p<0.01) respectively. This shows that self-efficacy is high when one has experience of acquiring information about irradiated food, purchasing or eating irradiated food resulting in a high level of knowledge, attitude and behavior. Education which serves to improve the level of self-efficacy needs to be provided along with an educational program which will increase the public's understanding of irradiated food. It is expected that if this education which increases the level of self-efficacy is provided together with correct information of irradiated food, behavior to choose and eat irradiated food will also improve.

Relationship Between Carotid Intima-Media Thickness Using Ultrasonography and Diagnostic Indices of Metabolic Syndrome (초음파를 이용한 경동맥 내-중막 두께와 대사증후군 진단지표의 연관성)

  • Ko, Kyung-Sun;Heo, Kyung-Hwa;Won, Yong-Lim;Lee, Sung-Kook;Kim, Ki-Woong
    • Journal of radiological science and technology
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    • v.32 no.3
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    • pp.285-291
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    • 2009
  • The aim of the present study was undertaken to investigate the association between diagnostic indices of metabolic syndrome(MetS) with carotid intima-media thickness using ultrasonography. The participants in the study were 315 male employees without carotid atherosclerosis and other cardiovascular disease. This study was approved by the Institutional Review Board of Occupational Safety and Health Research Institute. Written informed consent for the participants in this study was obtained from all individuals. Anthropometric parameters and biochemical characteristics were done using each specific equipments and the NCEP-ATP III criteria were used to define MetS. They were examined by B-mode ultrasound to measure the carotid intima-media thickness(carotid IMT) at the near and far walls of common carotid and bifurcation(bulb). The mean carotid IMT was $0.739{\pm}0.137\;mm$ and it's thickness significantly increased with the increase in age. Also, amounts of systolic and diastolic blood pressure, triglyceride and fasting glucose were significantly increased with the increase in age. Carotid IMT were significantly correlated with BMI(r=0.170, p=0.004), systolic(r=0.148, p=0.011) and diastolic blood pressure(r=0.123, p=0.036) and HDL-cholesterol(r=-0.164, p=0.005). On multiple logistic regression analysis for the diagnostic indices of MetS, carotid IMT were significantly associated with blood pressure(OR=4.220, p<0.01) and MetS(OR=1.301, p<0.05). The results indicate that blood pressure and MetS are important risk factors for carotid atherosclerosis.

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Environmental Interpretation on soil mass movement spot and disaster dangerous site for precautionary measures -in Peong Chang Area- (산사태발생지(山沙汰發生地)와 피해위험지(被害危險地)의 환경학적(環境學的) 해석(解析)과 예방대책(豫防對策) -평창지구(平昌地區)를 중심(中心)으로-)

  • Ma, Sang Kyu
    • Journal of Korean Society of Forest Science
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    • v.45 no.1
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    • pp.11-25
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    • 1979
  • There was much mass movement at many different mountain side of Peong Chang area in Kwangwon province by the influence of heavy rainfall through August/4 5, 1979. This study have done with the fact observed through the field survey and the information of the former researchers. The results are as follows; 1. Heavy rainfall area with more than 200mm per day and more than 60mm per hour as maximum rainfall during past 6 years, are distributed in the western side of the connecting line through Hoeng Seong, Weonju, Yeongdong, Muju, Namweon and Suncheon, and of the southern sea side of KeongsangNam-do. The heavy rain fan reason in the above area seems to be influenced by the mouktam range and moving direction of depression. 2. Peak point of heavy rainfall distribution always happen during the night time and seems to cause directly mass movement and serious damage. 3. Soil mass movement in Peongchang break out from the course sandy loam soil of granite group and the clay soil of lime stone and shale. Earth have moved along the surface of both bedrock or also the hardpan in case of the lime stone area. 4. Infiltration seems to be rapid on the both bedrock soil, the former is by the soil texture and the latter is by the crumb structure, high humus content and dense root system in surface soil. 5. Topographic pattern of mass movement spot is mostly the concave slope at the valley head or at the upper part of middle slope which run-off can easily come together from the surrounding slope. Soil profile of mass movement spot has wet soil in the lime stone area and loose or deep soil in the granite area. 6. Dominant slope degree of the soil mass movement site has steep slope, mostly, more than 25 degree and slope position that start mass movement is mostly in the range of the middle slope line to ridge line. 7. Vegetation status of soil mass movement area are mostly fire field agriculture area, it's abandoned grass land, young plantation made on the fire field poor forest of the erosion control site and non forest land composed mainly grass and shrubs. Very rare earth sliding can be found in the big tree stands but mostly from the thin soil site on the un-weatherd bed rock. 8. Dangerous condition of soil mass movement and land sliding seems to be estimated by the several environmental factors, namely, vegetation cover, slope degree, slope shape and position, bed rock and soil profile characteristics etc. 9. House break down are mostly happen on the following site, namely, colluvial cone and fan, talus, foot area of concave slope and small terrace or colluvial soil between valley and at the small river side Dangerous house from mass movement could be interpreted by the aerial photo with reference of the surrounding site condition of house and village in the mountain area 10. As a counter plan for the prevention of mass movement damage the technics of it's risk diagnosis and the field survey should be done, and the mass movement control of prevention should be started with the goverment support as soon as possible. The precautionary measures of house and village protection from mass movement damage should be made and executed and considered the protecting forest making around the house and village. 11. Dangerous or safety of house and village from mass movement and flood damage will be indentified and informed to the village people of mountain area through the forest extension work. 12. Clear cutting activity on the steep granite site, fire field making on the steep slope, house or village construction on the dangerous site and fuel collection in the eroded forest or the steep forest land should be surely prohibited When making the management plan the mass movement, soil erosion and flood problem will be concidered and also included the prevention method of disaster.

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