• Title/Summary/Keyword: SIMPLE method

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The Clinical Value of Intima-media Thickness in Patients with Stable Coronary Artery Disease and C-reactive Protein within Normal Limits (경동맥 내중막 두께가 정상 C-반응성 단백질 농도를 가진 안정형 협심증 환자에서 가지는 임상적 의의)

  • Kwon, Jong-Bum;Park, Kuhn;Choi, Si-Young;Park, Chan-Beom;Kim, Yong-Hwan;Her, Sung-Ho;Park, Mahn-Won;Lee, Jong-Ho
    • Journal of Chest Surgery
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    • v.43 no.5
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    • pp.482-489
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    • 2010
  • Background: The purpose of this study was to determine whether hand-measured carotid intima-media thickness (IMT) was a reliable and simple tool that could be used to evaluate the severity of stable coronary artery disease (CAD) with normal high-sensitivity C-reactive protein (CRP). Material and Method: We examined left carotid IMTs in 688 patients with stable CAD and excluded 121 patients with abnormally elevated hs-CRP ($\geq$0.5 mg/dL). We sought to determine the association between risk factors and the severity of stable CAD and carotid IMT in 567 patients who were divided into lower and higher groups based on the median value. Patients underwent a coronary artery angiogram and had at least significant stenosis (>50% of the original luminal diameter involving one or more major coronary artery). Result: Of the 567 patients, 300 (52.9%) were in the lower IMT group and 267 (47.1%) were in the higher IMT group; the median value was 0.76 mm. By multivariable logistic regression analysis, the following groups were different: older age (~49 vs. 70~ years, respectively; OR=6.552), high FBS (~99 vs. 120~ mg/dL; OR=1.713) and severity of CAD (1 vessel vs. 2 vessel disease; OR=1.711, 1 vessel vs. 3 vessel disease; OR=1.714). Conclusion: We conclude that there are correlations between increased carotid IMT and severity of CAD in stable angina patients with normal CRP levels.

Optimal Time to Localize Bleeding Focus and the Usefulness of Flexible Bronchoscopy in Hemoptysis (객혈에서 굴곡성 기관지경의 출혈부위 결정을 위한 적절한 시행시기 및 그 유용성)

  • Lee, Jae-Ho;Koh, Won-Joong;Lee, Chan-Ju;Chung, Hee-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.3
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    • pp.353-364
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    • 2000
  • Background : Bronchoscopy is a useful diagnostic tool, for accurate localization of the bleeding site and the management of hemoptysis. However, there is some controversy about the optimal timing of bronchoscopy. Method : To determine the optimal timing of bronchoscopy in hemoptysis, we reviewed the medical records of 118 patients and analyzed the following relationships amongst simple chest PA findings, namely, the duration and amount of hemoptysis, and the timing of bronchoscopy retrospectively. Results : The major causes of hemoptysis were active tuberculosis(28.8%), inactive tuberculosis(10.2%), bronchiectasis(17.0%), lung cancer(7.6%), and aspergilloma(7.6%). Localization of the bleeding focus by bronchoscopy was possible in 87.5% (21/24 cases) during active bleeding, and it was possible in 40.4% after bleeding had stopped(p<0.05). The localization rate of bleeding focus was 59.8% when the chest PA showed certain abnormalities, but it decreased to 27.8% when the chest PA finding was normal(p<0.05). When chest PA showed diffuse abnormalities or its finding was normal, the localization rate of bleeding focus significantly increased if bronchoscopy was performed during bleeding or within 48 hours of the cessation of active bleeding. The localization rate was higher as the amount of hemoptysis became larger(p<0.05). The localization rate of early bronchoscopy(during bleeding or within 48 hours of the cessation of active bleeding) was significantly higher when the duration of hemoptysis was less than 1 week, but there was no advantage if the duration was 1 week or longer. Early bronchoscopy was also necessary to localize the bleeding focus for surgical resection in 4 patients, and the bronchoscopy itself was therapeutic in 1 patient whose bleeding was successfully managed with thrombin-application via bronchoscope. Conclusion : It is concluded that flexible bronchoscopy is useful at not only localizing the bleeding focus but also in preparing a therapeutic plan, and early bronchoscopy is more favorable in hemoptysis.

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The Influence of Private Health Insurance on Admission among Some Patients with Cervical or Lumbar Sprain (민영의료보험 가입이 일부 경·요추부 염좌 환자의 입원에 미치는 영향)

  • Jang, Dong-Ryul;Kang, Myung-Geun
    • Journal of agricultural medicine and community health
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    • v.37 no.2
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    • pp.84-95
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    • 2012
  • Background: In Korea, private health insurance has neglected to induce externality on national health insurance by moral hazard. Therefore, we conducted this study in order to explore the influence of private health insurance on unnecessary medical utilization among patients with cervical or lumbar sprain. Method: The study examined a population of 449 patients (admission, 384; out-patient; 85) diagnosed with simple cervical or lumbar sprain without neurological symptoms at 20 small hospitals or clinics in Gwangju and Jeollanam provinces from Jul. 1 to Aug. 31 2008. The data were collected using structured, self-administrated questionnaire which collected information such as whether or not the patient was admitted (as a dependent variable), whether or not they had private health insurance (as a independent variable), and covariates such as socio-demographic characteristics, the factors related to the sprain, and characteristics of the insurance provider. Results: From hierarchical multiple logistic regression analysis, it was found that the admission rate of patient with private health insurance was higher than that those without it (Odds ratio=3.31, 95% Confidence interval; 1.14-9.58), meaning that private health insurance was an independent factor influencing the admission of patients with these conditions. Other determinants of admission were patient age and physician referral. Conclusions: This study is the first empirical study to explore the influence of private health insurance on inducing moral hazard in admission services, specifically among patients with cervical or lumbar sprain. Regulation of benefits provided by private health insurance may be necessary, as the effect of this moral hazard may mean existence of externality.

Development of teaching-learning lesson plan untilizing TAI model based on module, used in survey subject of construction department - By applying standard-based assessment system for technical subject (건설계열 측량교과에서 활용할 모듈 기반의 TAI 모형 적용 교수-학습 과정안 개발 - 전문교과 성취평가제를 적용하여)

  • Lee, Ju-Min;Jang, Young-Il;Park, Wan-Shin
    • 대한공업교육학회지
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    • v.38 no.2
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    • pp.89-113
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    • 2013
  • The study started from the point that learners should be basically equipped to quickly respond to changes in demand for future human resources efficiently and effectively, and an attitude to take part in learning voluntarily should thus be cultivated. To this end, the author applied the TAI model based on a module as a class strategy to solve problems related to several classes occurred in specialized high schools. This application of the TAI model was also motivated by the necessity for designing an appropriate teaching-learning method that encourages improvement of self-learning capacity, consistent learning motivation, and willingness rather than external factors. Through this work, the author aims to heighten the interest of learners and improve endurance in learning. The study results are as follows. First, the learning unit was structuralized as a module and then learning stages were proceeded with so that capacity to adapt to learning would improve. The achievement standard (learning goal) was structuralized in a module type by analyzing and reorganizing the textbook considering the link between the actual practice field and a curriculum based on subject characteristics. Through the process of module type learning stages, the student's capacity to ascertain characteristics of units and to adapt to learning both improved. Second, through application of a TAI model based on a module, Self-Directed Learning capacity and capacity to adapt to a new field improved. By applying the module, Self-Directed Learning could be accomplished more effectively than in the existing passive learning environment. By grafting cooperative learning of the TAI model, students had greater interest and achievement in classes, self-confidence and community consciousness, and an opportunity to broaden their thinking. In particular, improvement of self-confidence is effective in cultivating the capacity required in industrial society to transcend the learning of simple functions and knowledge, as well as the capacity to adapt to new environments. Third, by solving tasks focused on fields related to industrial sites, not only actual survey capacity but also additional capacity to identify and solve tasks through various experiences improved. Furthermore, it was helpful for students to have interest and motivation about their own life and learning to cultivate the qualities and capacity to adapt to the working world where new knowledge and technology rapidly change. Fourth, by applying a standard-based assessment system for technical subjects introduced in 2012 to model design for learning plans, clearer and more objective assessment criteria were arranged, and individual learning through instruction at each achievement level could be accomplished. This improved achievement level of individual learners was helpful in reaching achievement goals at specific levels by overcoming the disadvantages of cooperative learning in each group.

Low Volume Peritoneal Dialysis in Newborns and Infants (신생아와 영아의 급성신부전증 치료를 위한 저용량 복막투석)

  • Park, Young-Hoon;Ahn, Soo-Ho;Shin, Son-Moon;Hah, Jeong-Ok
    • Journal of Yeungnam Medical Science
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    • v.8 no.2
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    • pp.128-137
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    • 1991
  • Peritoneal dialysis has been widely considered to be the dialytic treatment of choice for acute renal failure in infants and young children, because the technique is simple, safe and easily adapted for these patients. Also peritoneal dialysis in infants might have more effective ultrafiltration and clearance than in adults. In certain circumstances associated with hemodynamic instability, ordinary volume peritoneal dialysis(30-50 ml/kg body weight per exchange) or hemodialysis may not be suitable unfortunately. But frequent cycled, low volume, high concentration peritoneal dialysis may be more available to manage the hemodynamically untable acute renal failure of newborns and infants. Seven infants underwent peritoneal dialysis for hemodynamically unstable acute renal failure with low exchange volume($14.2{\pm}4.2ml/kg$), short exchange time(30 to 45 minutes) and hypertonic glucose solution(4.25% dextrose). Age was $1.9{\pm}1.3$ months and body weight was $4.6{\pm}1.6kg $. Etiology of acute renal failure was secondary to sepsis with or without shock(5 cases) and postcardiac operation(2 cases). Catheter was inserted percutaneously with pigtail catheter or Tenkhoff catheter by Seldinger method. Dialysate was commercially obtained Peritosol which contained sodium, chloride, potassium, magnesium, lactate and calcium. Net ultrafiltration(ml/min) showed no difference between low volume dialysis and control($0.27{\pm}0.09$ versus $0.29{\pm}0.09$) Blood BUN decreased from $95.7{\pm}37.5$ to $75.7{\pm}25.9mg/dl$ and blood pH increased from $7.122{\pm}0.048$ to $7.326{\pm}0.063$ after 24 hours of peritoneal dialysis. We experienced hyperglycemia which were controlled by insulin(2 episodes), leakage at the exit site(2), mild hyponatremia(1) and Escherichia coli peritonitis(1). Two children of low volume dialysis died despite the treatment. In our experience, low volume and high concentration peritoneal dialysis with frequent exchange may have sufficient ultrafiltration and clearance without significant complications in the certain risked acute renal failure of infants.

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Spur-like Lesion on the Lateral Tibial Condyle - A Sign of Chronic ACL tear - (경골 외과의 골극 유사 병변 - 만성 전방 십자 인대 파열의 징후 -)

  • Cho Sung-Do;Ko Sang-Hun;Hwang Su-Yeon;Yang Jung-Hun
    • Journal of the Korean Arthroscopy Society
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    • v.7 no.2
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    • pp.201-205
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    • 2003
  • Purpose : Authors experienced cases of chronic ACL tear with spur-like lesion on the tibial condyle which is different from the lateral capsular sign and degenerative change and evaluated the significance of 'spur-like lesion' in relations with chronic ACL injury. Material and Method : We have 5 patients with spur-like lesion on the lateral tibial condyle in simple radiogram. The location, shape and size of the lesion were studied using radiogram and MRI. Cause of injury, associated injury and chronicity of the ACL tear were analyzed. All 5 patients were male, and mean age was 33.8 $(17\~46)$ years. Result : The spur-like lesion was located from 3.8 mm(avg.) below the articular surface of the lateral tibial condyle to the apex of the fibular head and protruded laterally or inferolaterally from just posterior to the Gerdy's tubercle with a round or sharp-end triangular shape. Average length was 6 mm and average width ortho base was 9.2 mm. The cause of injury were sports jnjury 4 cases and traffic accident in one. The chronicity of the ACL tear was average 10.7(8 months$\~$23 years) years and medial meniscus tear was shown in all cases and lateral meniscus tear in three. Conclusion : We suggest that a patient who has a history of trauma with spur-like lesion on the lateral tibial condyle of the knee is expected to have chronic ACL tear.

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Colon Perforation during Air Enema Reduction of Intussusception (소아 장중첩증에서 공기 주입 정복술 시행 도중 발생한 장천공)

  • Kim, Yong Kuk;Im, Hae Ra;Lee, Gwang Hoon;Han, Soo Jin;Sun, Yong Han;Ryoo, Eell;Cho, Kang Ho;Tchah, Hann;Lee, Hak Soo
    • Clinical and Experimental Pediatrics
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    • v.46 no.1
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    • pp.37-41
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    • 2003
  • Purpose : Although air enema reduction has been known as a good method of diagnosis and treatment of intussusception, it could develop colon perforation. However, there have been few studies about this complication. So we analyzed the risk factors of colon perforation during air enema reduction in patients with intussusception. Methods : We reviewed the charts of 12 colon perforation patients during air enema reduction of intussusception, who were admitted to Gil Medical Center from Jan. 1990 to Dec. 2001. Their age, sex, major symptoms, length of time till hospital visit, types of intussusception, operative findings and pathologic reports were reviewed. Results : Among 657 cases, 596 patients(90.7%) were successfully treated, but 12 patients(1.83%) failed in air enema reduction and had colon perforation. In patients with colon perforation the male to female ratio was 11 : 1, and average age was 5.3 months. The most common symptom at the time of hospital visit was vomiting(91.7%). Cyclic irritability(75.0%), bloody stool(75.0%) and abdominal mass(41.7%) were also noted. The average length of time between symptom onset and hospital visit was 44.7 hours. Types of intussusception were predominantly ileocolic, ileocecal, and ileoileocolic. The site of perforation was most commonly found at the proximal part of intussusception including ascending colon(50%) and transverse colon(50%). Most cases were uncomplicated, and had a single perforation. Pathologic reports showed hemorrhagic necrosis and mesenteric laceration at the site of colon perforation. Complications of colon perforation were tension pneumoperitonium(58.3%), requiring immediate decompression. Conclusion : The chance of colon perforation during air enema reduction increases in cases with small bowel obstruction on simple abdominal x-ray of a patient younger than 6 months, delay in time till hospital visit and higher air pressure during reduction. Therefore more careful investigation is needed in these cases.

An analysis of horizontal deformation of a pile in soil using a beam-on-spring model for the prediction of the eigenfrequency of the offshore wind turbine (해상풍력터빈의 고유진동수 예측을 위한 지반에 인입된 파일의 탄성지지보 모델 기반 수평 거동 해석)

  • Ryue, Jungsoo;Baik, Kyungmin;Kim, Tae-Ryong
    • The Journal of the Acoustical Society of Korea
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    • v.35 no.4
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    • pp.261-271
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    • 2016
  • In the prediction of response of a pile in soil, numerical approaches such as a finite element method are generally applied due to complicate nonlinear behaviors of soils. However, the numerical methods based on the finite elements require heavy efforts in pile and soil modelling and also take long computing time. So their usage is limited especially in the early design stage in which principal dimensions and properties are not specified and tend to vary. On the contrary, theoretical approaches adopting linear approximations for soils are relatively simple and easy to model and take short computing time. Therefore, if they are validated to be reliable, they would be applicable in predicting responses of a pile in soil, particularly in early design stage. In case of wind turbines regarded in this study, it is required to assess their natural frequencies in early stages, and in this simulation the supporting pile inserted in soil could be replaced with a simplified elastic boundary condition at the bottom end of the wind turbine tower. To do this, analysis for a pile in soil is performed in this study to extract the spring constants at the top end of the pile. The pile in soil can be modelled as a beam on elastic spring by assuming that the soils deform within an elastic range. In this study, it is attempted to predict pile deformations and influence factors for lateral loads by means of the beam-on-spring model. As two example supporting structures for wind turbines, mono pile and suction pile models with different diameters are examined by evaluating their influence factors and validated by comparing them with those reported in literature. In addition, the deflection profiles along the depth and spring constants at the top end of the piles are compared to assess their supporting features.

Developing Measurement Tool of Entrepreneurship for Young Entrepreneurs (청년 창업자를 위한 창업역량 측정도구 개발)

  • Lee, Ji An;Ahn, Young Sik
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.13 no.4
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    • pp.197-209
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    • 2018
  • Recently, many start-up failures occur as the number of attempts to start a business increases in a social atmosphere that encourages start-up. In particular, young entrepreneurs have a lower survival rate than general entrepreneurs because young entrepreneurs are challenging just with a simple idea to overcome the difficulties of employment while lacking prior knowledge and experience of business. Therefore, the reason for the failure of start-up is lack of preparation for start-up and lack of entrepreneurship. The purpose of this study is to develop a measurement tool to build a basic framework for entrepreneurship development and start - up preparation activities for young people. To develop an entrepreneurship measurement tool, researchers developed a preliminary question through qualitative research methods such as literature research, focus group interview, and expert verification. After that, researchers surveyed 102 entrepreneurs using quantitative research method and to verify the construct validity of the measurement tool, the final entrepreneurship measurement tool was completed through exploratory factor analysis and confirmatory factor analysis. The entrepreneurship measurement tool developed through this research process consists of 7 components and 15 measurement items. First, in the step of 'confirming entrepreneurial intention', two items of 'self-analytic competence', three items of 'ability of establishing start-up philosophy'are contained. Second, in the step of 'drawing up a start-up model', two items are contained in each category such as, 'ability of eliciting entrepreneurial idea,' 'ability of analyzing idea validity,' 'competence of planning a venture start-up model'. Third, in the step of 'planning the venture start-up,' two items are contained in each category such as, 'business-plan presentation competency,' 'ability of implementing organizational system.'. The measurement tool of entrepreneurship is meaningful as it could help young entrepreneur find out their lacking competence in preparing their start-ups and strengthen necessary competences by measuring their own entrepreneurship. Rather in the entrepreneurship education, basic data that can diagnose the entrepreneurship of young entrepreneurs is provided.

Potential of River Bottom and Bank Erosion for River Restoration after Dam Slit in the Mountain Stream

  • Kang, Ji-Hyun;So, Kazama
    • Proceedings of the Korea Water Resources Association Conference
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    • 2011.05a
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    • pp.46-46
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    • 2011
  • Severe sediment erosion during floods occur disaster and economic losses, but general sediment erosion is basic mechanism to move sediment from upstream to downstream river. In addition, it is important process to change river form. Check dam, which is constructed in mountain stream, play a vital role such as control of sudden debris flow, but it has negative aspects to river ecosystem. Now a day, check dam of open type is an alternative plan to recover river biological diversity and ecosystem through sediment transport while maintaining the function of disaster control. The purpose of this paper is to verify sediment erosion progress of river bottom and bank as first step for river restoration after dam slit by cross-sectional shear stress and critical shear stress. Study area is upstream reach of slit check dam in mountain stream, named Wasada, in Japan. The check dam was slit with two passages in August, 2010. The transects were surveyed for four upstream cross-sections, 7.4 m, 34 m, 86 m, and 150 m distance from dam in October 2010. Sediment size was surveyed at river bottom and bank. Sediment of cobble size was found at the wetted bottom, and small size particles of sand to medium gravel composed river bank. Discharge was $2.5\;m^3/s$ and bottom slope was 0.027 m/m. Excess shear stress (${\tau}_{ex}$) was calculated for hydraulic erosion by subtracting the values of critical shear stress (${\tau}_{c}$) from the value of shear stress (${\tau}$) at river bottom and bank (${\tau}_{ex}=\tau-{\tau}_c$). Shear stress of river bottom (${\tau}_{bottom}$) was calculated using the cross-sectional shear stress, and bank shear stress (${\tau}_{bank}$) was calculated from the method of Flintham and Carling (1988). $${\tau}_{bank}={\tau}^*SF_{bank}((B+P_{bed})/(2^*P_{bank}))$$ where $SF_{bank}=1.77(P_{bed}/p_{bank}+1.5)^{-1.4}$, B is the water surface width, $P_{bed}$ and $P_{bank}$ are wetted parameter of the bed and bank. Estimated values for ${\tau}_{bottom}$ for a flow of $2.5\;m^3/s$ were lower as 25.0 (7.5 m cross-section), 25.7 (34 m), 21.3 (86 m) and 19.8 (150 m), in N/$m^2$, than critical shear stress (${\tau}_c=62.1\;N/m^2$) with cobble of 64 mm. The values were insufficient to erode cobble sediment. In contrast, even if the values of ${\tau}_{bank}$ were lower than the values for ${\tau}_{bottom}$ as 18.7 (7.5 m), 19.3 (34 m), 16.1 (86 m) and 14.7 (150 m), in N/$m^2$, excess shear stresses were calculated at the three cross-sections of 7.5 m, 34 m, and 86 m distances compare with ${\tau}_c$ is 15.5 N/$m^2$ of 16mm gravel. Bank shear stresses were sufficient for erosion of the medium gravel to sand. Therefore there is potential to erode lateral bank than downward erosion in a flow of $2.5\;m^3/s$. Undercutting of the wetted bank can causes bank scour or collapse, therefore this channel has potential to become wider at the same time. This research is about a potential of sediment erosion, and the result could not verify with real data. Therefore it need next step for verification. In addition an erosion mechanism for river restoration is not simple because discharge distribution is variable by snow-melting or rainy season, and a function for disaster control will recover by big precipitation event. Therefore it needs to consider the relationship between continuous discharge change and sediment erosion.

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