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Analysis of Application of Massive Transfusion Protocol for Trauma Patients at a Single Tertiary Referral Hospital (단일 3차 의료기관에서 외상환자에 대한 대량수혈 프로토콜 적용 분석)

  • Kim, Hyerin;Yoo, Dong-Won;Kim, Hyerim;Shin, Kyung-Hwa;Lee, Hyun-Ji;Chang, Chulhun L.;Kim, Hyung-Hoi
    • The Korean Journal of Blood Transfusion
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    • v.29 no.3
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    • pp.262-272
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    • 2018
  • Background: Massive hemorrhage due to trauma is one of the major causes of death in trauma patients, and the quick supply of appropriate blood products is critical in order to reduce the mortality rate. We introduced a massive transfusion protocol (MTP) for safe and rapid transfusion of trauma patients. Using records collected since its adoption, we compared the characteristics of MTP applied group (MTP group) and MTP not applied group (non-MTP group) to determine whether there is an indicator for predicting patients to be treated with MTP. Methods: We retrospectively reviewed the electronic medical records and laboratory findings of patients who received massive transfusions in the trauma emergency room of a single tertiary hospital from February to August 2018. We analyzed various laboratory test results, the amount and ratio of the transfused blood products, and the time required for blood products to be released for the MTP group and the non-MTP group. Results: Of the 54 trauma patients who received massive transfusions, 31 were in the MTP group and 22 in the non-MTP group. There was no significant difference in initial vital signs (except blood pressure) and laboratory test results. Also there was no difference in the amount and ratio of blood products, but the time required for blood product release was shorter in the MTP group. Conclusion: There was no significant difference in clinical findings such as initial vital signs and laboratory test results between the MTP and non-MTP groups, but required blood products were prepared and released more quickly for the MTP group.

Studies on the Nutritional Effects of Locally Produced Dried Formula Milk and Fermented Milk -1. Comparative Studies on the Nutrients Content of Dried Formula Milk and Fermented Milk- (국산(國産) 조제분유(調製粉乳)와 발효유(醱酵乳)의 영양효과(營養效果)에 관(關)한 연구(硏究) - 1. 유제품(乳製品)의 영양소(營養素) 함량비교(含量比較)를 위한 연구(硏究) -)

  • Paik, Jeong-J.;Han, In-K.
    • Journal of Nutrition and Health
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    • v.9 no.1
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    • pp.84-91
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    • 1976
  • Chemical determination were made to analyze the concentration of nutrients including proximate composition, vitamins, minerals, amino acids and fatty acids in three kinds of locally produced infantile formula milk(DFM) and one fermented milk(FM). An attempt was also made to compare the analytical values of nutrients against guaranteed values. The results obtained are summarized as follows; 1. The analyzed value of protein and fat content in DFM-A.B.C was slightly lower than that of guaranteed values and a reverse trend was observed in the case of total carbohydrate. There were no differences in proximate composition among the three kinds of DFM. It was found that the FM contained less protein and fat than the fresh milk, but it seemed that a considerable amount of sugar was added to FM. 2. The analyzed values of vitamin $A(2{\sim}3\;times)$ and $E(4{\sim}6\;times)$ contents in DFMS were higher than those of the guaranteed values except niacin. There were a little differences in vitamin contents among DFMS analyzed. 3. In the case of minerals, the analyzed values were similar to the guaranteed values except the calcium concentration that analyzed value was much higher than guaranted value. When the DFMS were diluted to 15% by adding water to compare with the human and fresh cow milk, it was found that the diluted DFMS resembled the human milk rather than cow milk in the content of energy, carbohydrates, protein and ash. The higher contents of iron and most vitamins in the diluted DFMS than the human milk or cow milk would indicate that they were fortificated with these nutrients. When these diluted DFMS were compared with the Korean R.D.A. for infant, it was clear that they could supply sufficient amount of the nutrients required by R.D.A. except the niacin which failed to reach the recommended level. The fact that iron content of DFM-C was not sufficient while vitamin A supply was excessive by 6 fold would indicate that further studies for the improvement may be necessary. 4. There was a little difference among DFMS in amino acid composition. The similarity of the essential amino acids composition between DFMS and cow milk indicated that there was no modification of the essential amino acids. However, present data showed that the amino acid compositon of FM was similar to that of the cow milk. 5. There was no difference among DFMS in the degree of saturation of fatty acids. The similar or higher levels of essential fatty acids contents of DFMS as compared with human milk revealed that essential fatty acids were added to DFMS during the course of process. From the experimental results described above, it may be concluded that the nutritive effects of three kinds of locally produced DFMS were much alike. It was also found that macro and micro nutrient composition except amino acid composition of locally produced dried formula milk was very much similar to that of the human milk. Moreover, fortification of iron and vitamins resulted in improving their nutritive values as the single form of infantile food, but it seemed that more consideration should be given on the fortification of some nutrients.

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A 1280-RGB $\times$ 800-Dot Driver based on 1:12 MUX for 16M-Color LTPS TFT-LCD Displays (16M-Color LTPS TFT-LCD 디스플레이 응용을 위한 1:12 MUX 기반의 1280-RGB $\times$ 800-Dot 드라이버)

  • Kim, Cha-Dong;Han, Jae-Yeol;Kim, Yong-Woo;Song, Nam-Jin;Ha, Min-Woo;Lee, Seung-Hoon
    • Journal of the Institute of Electronics Engineers of Korea SD
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    • v.46 no.1
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    • pp.98-106
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    • 2009
  • This work proposes a 1280-RGB $\times$ 800-Dot 70.78mW 0.l3um CMOS LCD driver IC (LDI) for high-performance 16M-color low temperature poly silicon (LTPS) thin film transistor liquid crystal display (TFT-LCD) systems such as ultra mobile PC (UMPC) and mobile applications simultaneously requiring high resolution, low power, and small size at high speed. The proposed LDI optimizes power consumption and chip area at high resolution based on a resistor-string based architecture. The single column driver employing a 1:12 MUX architecture drives 12 channels simultaneously to minimize chip area. The implemented class-AB amplifier achieves a rail-to-rail operation with high gain and low power while minimizing the effect of offset and output deviations for high definition. The supply- and temperature-insensitive current reference is implemented on chip with a small number of MOS transistors. A slew enhancement technique applicable to next-generation source drivers, not implemented on this prototype chip, is proposed to reduce power consumption further. The prototype LDI implemented in a 0.13um CMOS technology demonstrates a measured settling time of source driver amplifiers within 1.016us and 1.072us during high-to-low and low-to-high transitions, respectively. The output voltage of source drivers shows a maximum deviation of 11mV. The LDI with an active die area of $12,203um{\times}1500um$ consumes 70.78mW at 1.5V/5.5V.

Speed-up Techniques for High-Resolution Grid Data Processing in the Early Warning System for Agrometeorological Disaster (농업기상재해 조기경보시스템에서의 고해상도 격자형 자료의 처리 속도 향상 기법)

  • Park, J.H.;Shin, Y.S.;Kim, S.K.;Kang, W.S.;Han, Y.K.;Kim, J.H.;Kim, D.J.;Kim, S.O.;Shim, K.M.;Park, E.W.
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.19 no.3
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    • pp.153-163
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    • 2017
  • The objective of this study is to enhance the model's speed of estimating weather variables (e.g., minimum/maximum temperature, sunshine hour, PRISM (Parameter-elevation Regression on Independent Slopes Model) based precipitation), which are applied to the Agrometeorological Early Warning System (http://www.agmet.kr). The current process of weather estimation is operated on high-performance multi-core CPUs that have 8 physical cores and 16 logical threads. Nonetheless, the server is not even dedicated to the handling of a single county, indicating that very high overhead is involved in calculating the 10 counties of the Seomjin River Basin. In order to reduce such overhead, several cache and parallelization techniques were used to measure the performance and to check the applicability. Results are as follows: (1) for simple calculations such as Growing Degree Days accumulation, the time required for Input and Output (I/O) is significantly greater than that for calculation, suggesting the need of a technique which reduces disk I/O bottlenecks; (2) when there are many I/O, it is advantageous to distribute them on several servers. However, each server must have a cache for input data so that it does not compete for the same resource; and (3) GPU-based parallel processing method is most suitable for models such as PRISM with large computation loads.

Effect of LI4-LI11 Electro-acupuncture on Regional Cerebral Blood Flow in Healthy Human - Evaluated by $^{99m}Tc-ECD$ Brain SPECT - (합곡-곡지 전침치료가 정상인의 뇌혈류에 미치는 영향 - Brain SPECT와 SPM을 이용하여 -)

  • Ryu Jong-Man;Kim Young-Suk;Park Sung-Uk;Jung Woo-Sang;Ko Chang-Nam;Cho Ki-Ho;Bae Hyung-Sup;Kim Deok-Yoon;Moon Sang-Kwan
    • The Journal of Korean Medicine
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    • v.27 no.2 s.66
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    • pp.36-43
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    • 2006
  • Objectives : Acupuncture has been widely applied to rehabilitation after stroke by Oriental medical doctors in Korea. It has been reported that acupuncture increased cerebral blood supply and stimulated the functional activity of brain nerve cells. In addition, a correlation between activation of specific areas of brain cortices and corresponding acupuncture stimulation at the therapeutic points had been well illustrated. rill now, however, there were few studies which evaluated a correlation between activation of specific areas of brain and frequently-used acupuncture therapy for stroke, such as LI4-LI11 electro-acupuncture (EA) for paresis after stroke. This study was undertaken to evaluate the effect of LI4-LI11 EA on regional cerebral blood flow (rCBF) in normal volunteers using Single Photon Emission Computed Tomography (SPECT). Methods : In the resting state, $^{99m}Tc-ECD$ brain SPECT scans were performed on 10 normal volunteers (8 males, 2 females, mean age $25.6{\pm}2.3$years; age range from 24 to 31 years). 7 days after the resting examination, 15 minutes of electro-acupuncture were applied at LI 4 and LI 11 on the right side of the subjects. Immediately after LI4-LI11 EA, the second SPECT images were obtained in the same manner as the resting state. Significant increases and decreases of regional cerebral blood flow after LI4-LI11 EA were estimated by comparing their SPECT images with those of the resting state using paired t statistics at every voxel, which were analyzed by Statistical parametric mapping with a threshold of p=0.001, uncorrected (extent threshold: k=100 voxels). Results : EA applied at right LI4-LI11 increased rCBF in right frontopolar area (Brodmann area 10) and left middle frontal area (Brodmann area 46). Interestingly, all the areas showing increased rCBF corresponded to the territories of both anterior cerebral arteries. However, LI4-11 EA decreased rCBF in the left occipital lobe (peristriate area, Brodmann area 19). Conclusions : The results demonstrated a correlation between LI4-11 EA and rCBF increase in the frontal lobes. It is also suggested that there may be a correlation between LI meridian and the territory of the anterior cerebral arterties.

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Manufacturing Location and Linkages in the Suburb of Metropolitan Pusan (부산시 근교의 공업입지와 지역적 연계)

  • Lim, Yeong-Dae
    • Journal of the Korean association of regional geographers
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    • v.6 no.1
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    • pp.1-28
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    • 2000
  • The purpose of this study is to clarify the suburbanization of manufacturing, and location and linkages of decentralized manufacturing from Metropolitan Pusan by means of case study on manufacturing location and linkages in the suburb of Metropolitan Pusan. Kimhae city and Yangsan-Gun toward which heavy decentralization of manufacturing from the Metropolitan Pusan has been done. Both hard data and soft data were used as the basic data. Hard data are the statistical data in statistical yearbooks and firm list in directories. The former consists of the number of establishments and employees classified by product type, firm size and unit area. The latter consists of owner's names, addresses, employee number, products and headquarters of firms. Soft data are the results of the interviews with the 242 owners of firms in the four case study areas selected by Proportional Stratified Sampling Method. The major findings are as follows: 1. The spatial variations of manufacturing in the suburb was regularized in the latter half of 1970's. The primary processes to decentralize manufacturing from Metropolitan Pusan were the birth, relocation and establishment of branches of the firms. Among them the relocation of small outer-oriented single-location firms from Pusan was the most important. 2. The spatial variations undergoing spatial expansion of manufacturing distribution and increase of agglomeration degree of manufacturing, proceeded from the adjacents of Metropolitan Pusan to the outer areas along the main transportation route. 3. The main factors which caused manufacturing to decentralize from the Metropolitan Pusan were firm policy and land for this policy. The main locational factors which induced the decentralizing manufacturing into the suburb were land, market and transportation. 4. The strength of linkages with the outside of the study area is stronger than that of linkages with the inside. There is distance-decay-function in the strength of linkages with the outside, and linkages with short distant areas are stronger than those with long distant areas. 5. The ranges of spatial linkages in procurement of materials, in subcontraction and in marketing are wider than those in ordering. 6. The main factors which cause the formation of linkages are different by types of linkages: monopolistic and oligopolistic supply are important in procurement linkages; characteristics of products and the subsequent marketing difficulties, in subcontraction linkages; fluctuation, cost reduction, insufficient facility and characteristics of products, in ordering linkages; subcontract, characteristics of product and the subsequent marketing difficulties, in marketing linkages. 7. The changes of linkages owing to locational changes of firms were great, and were greater in long distant areas than in short distant areas. 8. The main factor influencing on the changes of linkages was the easiness in the transportation of goods, movement of labour and contacts with customers. In conclusion, some facts described above were proved to be consistent with the results of proceeding studies in the other areas: influence of relocation of decentralizing firms on the suburbanization; the factors of manufacturing decentralization; spatial characteristics of linkages; linkage changes owing to relocation of firms. Some were proved to be partly consistent: locational factors inducing decentralized manufacturing into the suburb were proved to be inconsistent. I think that the results of previous studies on the other areas can be applicable to the explanation on the decentralization of Metropolitan manufacturing from the viewpoint of the suburb. For the better explanation on the decentralization of Metropolitan manufacturing, more empirical case studies on the suburbanization of manufacturing are necessary.

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Effect of LI4-LI11 Transcutaneous Electrical Nerve Stimulation on Regional Cerebral Blood Flow in Healthy Human Using SPECT and Statistical Parametric Mapping (뇌 SPECT와 SPM을 이용한 합곡-곡지 TENS 치료의 뇌혈류에 대한 효과)

  • Jeong, Dong-Won;Kim, Young-Suk;Park, Seong-Uk;Jung, Woo-Sang;Park, Jung-Mi;Ko, Chang-Nam;Cho, Ki-Ho;Bae, Hyung-Sup;Kim, Deok-Yoon;Moon, Sang-Kwan
    • The Journal of Korean Medicine
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    • v.29 no.4
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    • pp.205-212
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    • 2008
  • Background and purpose: So far it was reported that acupuncture increased cerebral blood supply and stimulated the functional activity of brain nerve cells. A previous study demonstrated a correlation between LI4-11 electro-acupuncture (EA) and rCBF increase in frontal lobe. However, there remained a need to study further using various controls in acupuncture research. Transcutaneous electrical nerve stimulation (TENS) has been used as a non-invasive control in acupuncture study. This study was to evaluate the effect of LI4-LI11 TENS on regional cerebral blood flow (rCBF) in normal volunteers using single photon emission computed tomography (SPECT) and statistical parametric mapping (SPM). Methods: In the resting state, $^{99m}Tc-ECD$ brain SPECT scans were performed on 10 normal volunteers (9 males, 1 female, mean age 26.6$\pm$0.5 years; age range from 26 to 27 years). On the other day, 7 days after the resting examination, 15 minute TENS were applied at LI 4 and LI 11 on the right side of the subjects. Immediately after LI4-LI11 TENS, the second SPECT images were obtained in the same manner as the resting state. Significant increases and decreases of regional cerebral blood flow after LI4-LI11 TENS were estimated by comparing their SPECT images with those of the resting state using paired t statistics at every voxel, which were analyzed by statistical parametric mapping with a threshold of p = 0.001, uncorrected (extent threshold: k=100 voxels). Results: TENS applied at right LI4-LI11 increased rCBF in the left somatosensory association cortex (Brodmann area 5, 7). However there was no area where LI4-11 TENS decreased rCBF. Conclusion and suggestions: These results demonstrate that right LI4-LI11 TENS increased rCBF only in corresponding somatosensory association cortex, which was different from the previous results using LI4-11 EA. It is suggested that there be a different mechanism between TENS and EA.

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A study on the Regulatory Environment of the French Distribution Industry and the Intermarche's Management strategies

  • Choi, In-Sik;Lee, Sang-Youn
    • The Journal of Industrial Distribution & Business
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    • v.3 no.1
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    • pp.7-16
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    • 2012
  • Despite the enforcement of SSM control laws such as 'the Law of Developing the Distribution Industry (LDDI)' and 'the Law of Promoting Mutual Cooperation between Large and Small/medium Enterprises (LPMC)' stipulating the business adjustment system, the number of super-supermarkets (SSMs) has ever been expanding in Korea. In France, however, Super Centers are being regulated most strongly and directly in the whole Europe viewing that there is not a single SSM in Paris, which is emphasized to be the outcome from French government's regulation exerted on the opening of large scale retail stores. In France, the authority to approve store opening is deeply centralized and the store opening regulation is a socio-economic regulation driven by economic laws whereas EU strongly regulates the distribution industry. To control the French distribution industry, such seven laws and regulations as Commission départementale d'urbanisme commercial guidelines (CDLIC) (1969), the Royer Law (1973), the Doubin Law (1990), the Sapin Law (1993), the Raffarin Law (1996), solidarite et renouvellement urbains (SRU) (2000), and Loi de modernisation de l'économie (LME) (2009) have been promulgated one by one since the amendment of the Fontanet guidelines, through which commercial adjustment laws and regulations have been complemented and reinforced while regulatory measures have been taken. Even in the course of forming such strong regulatory laws, InterMarche, the largest supermarket chain in France, has been in existence as a global enterprise specialized in retail distribution with over 4,000 stores in Europe. InterMarche's business can be divided largely into two segments of food and non-food. As a supermarket chain, InterMarche's food segment has 2,300 stores in Europe and as a hard-discounter store chain in France, Netto has 420 stores. Restaumarch is a chain of traditional family restaurants and the steak house restaurant chain of Poivre Rouge has 4 restaurants currently. In addition, there are others like Ecomarche which is a supermarket chain for small and medium cities. In the non-food segment, the DIY and gardening chain of Bricomarche has a total of 620 stores in Europe. And the car-related chain of Roady has a total of 158 stores in Europe. There is the clothing chain of Veti as well. In view of InterMarche's management strategies, since its distribution strategy is to sell goods at cheap prices, buying goods cheap only is not enough. In other words, in order to sell goods cheap, it is all important to buy goods cheap, manage them cheap, systemize them cheap, and transport them cheap. In quality assurance, InterMarche has guaranteed the purchase safety for consumers by providing its own private brand products. InterMarche has 90 private brands of its own, thus being the retailer with the largest number of distributor brands in France. In view of its IT service strategy, InterMarche is utilizing a high performance IT system so as to obtainas much of the market information as possible and also to find out the best locations for opening stores. In its global expansion strategy of international alliance, InterMarche has established the ALDIS group together with the distribution enterprises of both Spain and Germany in order to expand its food purchase, whereas in the non-food segment, it has established the ARENA group in alliance with 11 international distribution enterprises. Such strategies of InterMarche have been intended to find out the consumer needs for both price and quality of goods and to secure the purchase and supply networks which are closely localized. It is necessary to cope promptly with the constantly changing circumstances through being unified with relevant regions and by providing diversified customer services as well. In view of the InterMarche's positive policy for promoting local partnerships as well as the assistance for enhancing the local economic structure, implications are existing for those retail distributors of our country.

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Seasonal Variation of the Quantity and Quality of Seston as Diet Available to Suspension-Feeders in Gosung and Kangjin Bays of Korea (고성만과 강진만에서 현탁물 섭식자에 유용한 입자물질 양과 질의 계절 변동)

  • LEE Pil-Yong;KANG Chang-Keun;CHOI Woo-Jeung;YANG Han-Seob
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.34 no.4
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    • pp.340-347
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    • 2001
  • Seasonal variation of the elemental and biochemical composition of the suspended particulate matter (SPM) was investigated in terms of quantity and quality of diets for suspension feeders from July 1999 to August 2000 in two coastal bay systems of Gosung and Kangjin Bays in Korea. No clear patterns in the seasonal variations of SPM concentration were found in these two bay systems. The results indicated that the seasonal variation of SPM could not be considered the variation of food available to suspension-feeders. The simultaneous peaks in chlorophyll a and biochemical components in summer indicated that the quantity of the particulate organic matter primarily depended on phytoplankton productivity. However, no correlation between chlorophyll a and biochemical components [particulate protein (PPr), carbohydrate (PCHO) and lipid] were found, indicating that other processes might also contribute to the particulate organic matter in the period when the phytoplankton biomass was low. High C: Chl a and C:N, and carbohydrate peaks during the autumn to spring period suggested that resuspension of surface sediments was a probable process to supply the particulate organic matter. The food material, represented by summing up the total quantity of three biochemical components, was highest in spring with minor peaks during the period from autumn to the next spring, The food index, calculated as the ratio of food material to total SPM, did not generally exceed $6\%$ with short peaks during the year. Therefore, nutritional quality of SPM in the bays are relatively poor than in other more productive coastal waters in the world. Our results confirm that the measurement of a single chemical variable cannot describe fully the nutritive value of the seston available to suspension-feeders as previously proposed, and the biochemical composition of SPM can provide effective information on its origin and nutritive Quality.

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A 10b 25MS/s $0.8mm^2$ 4.8mW 0.13um CMOS ADC for Digital Multimedia Broadcasting applications (DMB 응용을 위한 10b 25MS/s $0.8mm^2$ 4.8mW 0.13um CMOS A/D 변환기)

  • Cho, Young-Jae;Kim, Yong-Woo;Lee, Seung-Hoon
    • Journal of the Institute of Electronics Engineers of Korea SD
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    • v.43 no.11 s.353
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    • pp.37-47
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    • 2006
  • This work proposes a 10b 25MS/s $0.8mm^2$ 4.8mW 0.13um CMOS A/D Converter (ADC) for high-performance wireless communication systems such as DVB, DAB and DMB simultaneously requiring low voltage, low power, and small area. A two-stage pipeline architecture minimizes the overall chip area and power dissipation of the proposed ADC at the target resolution and sampling rate while switched-bias power reduction techniques reduce the power consumption of analog amplifiers. A low-power sample-and-hold amplifier maintains 10b resolution for input frequencies up to 60MHz based on a single-stage amplifier and nominal CMOS sampling switches using low threshold-voltage transistors. A signal insensitive 3-D fully symmetric layout reduces the capacitor and device mismatch of a multiplying D/A converter while low-noise reference currents and voltages are implemented on chip with optional off-chip voltage references. The employed down-sampling clock signal selects the sampling rate of 25MS/s or 10MS/s with a reduced power depending on applications. The prototype ADC in a 0.13um 1P8M CMOS technology demonstrates the measured DNL and INL within 0.42LSB and 0.91LSB and shows a maximum SNDR and SFDR of 56dB and 65dB at all sampling frequencies up to 2SMS/s, respectively. The ADC with an active die area if $0.8mm^2$ consumes 4.8mW at 25MS/s and 2.4mW at 10MS/s at a 1.2V supply.