• Title/Summary/Keyword: Time-to-event

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Determination of Practical Dosing of Warfarin in Korean Outpatients with Mechanical Heart Valves (인공심장판막 치환환자의 Warfarin 용량결정)

  • Lee Ju Yeun;Jeong Young Mi;Lee Myung Koo;Kim Ki-bong;Ahn Hyuk;Lee Byung Koo
    • Journal of Chest Surgery
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    • v.38 no.11 s.256
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    • pp.761-772
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    • 2005
  • Background: Following the implantation of heart valve prostheses, it is important to maintain therapeutic INR to reduce the risk of thromboembolism. The objective of this study was to suggest a practical dosing guideline for Korean outpatients with prosthetic heart valves managed by a pharmacist-run anticoagulation service (ACS). Material and Method: A retrospective chart review was completed for all patients enrolled in the ACS at Seoul National University Hospital from March, 1997 to September, 2000. Patients who were at least 6 months post-valve replacement and had nontherapeutic INR value (less than 2.0 or greater than 3.0) were included. The data on 688 patients (1,782 visits) requiring dosing adjustment without any known drug or food interaction with warfarin were analyzed. The amount of adjusted dose and INR changes based on the INR at the time of the event were calculated. Aortic valve replacements (AVR) patients and mitral or double valve replacement (MVR/DVR) patients were evaluated separately. Result: Two methods for the warfarin dosage adjustment were suggested: Guideline I (mg-based total weekly dose (TWD) adjustment), Guideline II (percentage-based TWD adjustment). The effectiveness of Guideline 1 was superior to Guideline II overall in patients with both AVR and MVR/DVR. Conclusion: The guideline suggested in this study could be useful when the dosage adjustment of wafarin is necessary in outpatients with mechanical heart valves.

Stressful Life Events, Physical Symptoms, and Anxiety in Adolescents (청소년의 스트레스 생활사건, 신체적증상과 불안에 관한 연구)

  • Yun, Kyu-Wol
    • Korean Journal of Psychosomatic Medicine
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    • v.8 no.1
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    • pp.20-30
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    • 2000
  • Objective : This study was designed to investigate the frequencies and the relation of stressful life events and health problems and evaluate the influence of stressful life events on the physical symptoms and anxiety in adolescents. Method : Newcomb's 39-item life-event questionnaire and Newcomb's 19-item health problems questionnaire were administered to 475 adolescents. The frequencies of stressful life events and health problems which had actually occurred to them during the previous 12 months were investigated. Items of stressful life events were classified in 8 dimensional scaling factors(Family/parents, Accident/Illness, Sexuality, Autonomy, Deviance, Relocation, Distress, Items not in scales) and items of health problems were classified in 5 health problems(General, Heart and Lung, Nervous system, Anxiety, Psychosomatic symptoms) and the correlation between them was analyzed. Result : 1) The average number of events occurring during the past year for the 475 adolescents is 3(7.7%). The most frequent item of stressful life events was 'Thought about suicide' and dimensional factors of "Distress" and "Autonomy" were the most frequent life events in multidimensional sacling analysis. There were more factors of "Family/Illness" and " Autonomy" in male, while there was more factor of "Distress" in female. There were more factors of "School violence" and "Deviance" in younger students, while there were more factors of "Sexuality" and "Autonomy" in older students. 2) The most frequent item of health problem was 'excessive fatigue' and "anxiety" was most frequent health problem in multidimensional scaling analysis. There were more health problems in female than those in male. The higher grades the students became, the more health problems they have reported. 3) There was significant relationship between 7 factors of stressful life events except one factor of "Relocation" and 5 health problems. Conclusions : These findings suggest that as adolescents grow older, they are engaging in more controllable behaviors related to autonomy and sexuality and at the same time are experiencing increased difficulty with distressful or discomforting events, and their stressful life events are significantly related to decreased health and psychological functiong.

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A Study on the Knowledge and Awareness of Dental Hygienists and Dental Hygiene Students about Hepatitis B (치과위생사와 치위생과 학생의 B형 간염에 대한 지식과 인식에 관한 조사연구)

  • Kim, Jeong-Suk;Choi, MI-Hye;Kang, Eun-Ju
    • Journal of dental hygiene science
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    • v.8 no.4
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    • pp.233-239
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    • 2008
  • The purpose of this study was to survey the knowledge and awareness of dental hygienists and dental hygiene students about hepatitis B in an attempt to lay the solid foundation for the prevention of hepatitis B and infection control, as dental hygienists were highly likely to be exposed to HBV during job performance. The findings of the study were as follows: 1. 32.5% of the dental hygienists and 15.6% of the dental hygiene students were aware of their own HBsAg and HBsAb states. The dental hygienists who were cognizant of the states statistically significantly outnumbered the dental hygiene students who were (p=.000). 2. As for vaccination against hepatitis B, 71.8% of the dental hygienists and 47.3 % of the dental hygiene students were inoculated against it. The dental hygienists who were vaccinated against it outnumbered the dental hygiene students who were, and the disparity between the two was statistically significant (p=.000). 3. In the event of those who were vaccinated against hepatitis B, the dental hygienists were better cognizant than the dental hygiene students of the right time for the vaccination, required vaccination frequency (three times) and confirmation of the formation of hepatitis B antibody (p=.000). 4. Regarding awareness of hepatitis B infection route, the dental hygienists knew significantly better than the dental hygiene students that hepatitis B might be infected via blood (p=.030), sexual relations (p=.000), contaminated needle sticks (p=.000), mothers with hepatitis B positive during delivery (p=.000), toothbrushes/razors (p=.000) and exchange of drinking cups (p=.000). 5. As to the relationship between health status and knowledge on hepatitis B infection route, the respondents who were in bad shape had the best knowledge about that, followed by those in an average state of health and healthy respondents. And the dental hygienists had a significantly better knowledge than the dental hygiene students (p=.001). 6. Just a small number of the dental hygienists and students knew about the hepatitis B-related past experiences of their families, and the gap between the two was insignificant.

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A Study on Preschool Teachers' Dental Health Recognition and Behaviors about Preschoolchildren Dental Health Care (어린이집 교사의 구강보건실태와 유아구강보건관리에 대한 인식)

  • Lee, Hyang-Nim;Shim, Hyung-Sun
    • Journal of dental hygiene science
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    • v.8 no.4
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    • pp.283-289
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    • 2008
  • This study was performed to obtain data about dental health to develop childrens' dental health education program. This research surved from from 22 July 2008 to 11 August 2008 and questionaire given to 140 teacher from Gwangsan-gu and Buk-gu and Dong-gu in Gwangju city. Collected data were analyzed with SPSS 12.0 program. The results of this study were as follows: 1. The dental health condition which teacher is recognizing is most with the facility 52.9% which is healthy, one day toothbrush qualitative number of times 3 times 67.1% and the dental floss qualitative number of times is 49.3%. Uses most the oral hygiene device which plentifully is 51.4% with the dental gargle solution, the dental problem which is knowing dental caries with 45.7% to be highest, perception dental sensitivity was 30.7%. 2. Periodical dental prosecuting says that 93.6% is executing, also the case which a dental inspection result in the parents notifies was 78.6%, after notifying treat, the case which confirms was 60.7%. The case which is the toothbrush qualitative time which is systematic was 95.0%, about dental healthily and food the case which executes an education was 93.6%. 3. About educational background by infantile dental health care of teacher with recognition currently the effectiveness of dental health care is higher from below junior college graduating (p < 0.05). dental hygienic relation experience event participation intention (p < 0.01) comes from the above of university graduation from infantile dental health care from important degree of teacher role was higher the junior college graduation group (p < 0.05). 4. Recognition there was not a difference which is beneficial with an educational background by about career by infantile dental health care of teacher. For the buccal cavity hygiene management of the infants thinks with the fact that also the development of the curricular material and the educational program and teacher buccal cavity hygiene education will be necessary.

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Bone Metastasis after a Curative Resection for Gastric Cancer (위암의 근치적 절제술 후 발생한 골 전이)

  • Kim Jin Jo;Song Kyo Young;Chin Hyung Min;Kim Wook;Chun Hae Myung;Park Cho Hyun;Park Seung Man;Park Woo Bae;Lim Keun Woo;Kim Seung Nam
    • Journal of Gastric Cancer
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    • v.5 no.1
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    • pp.23-28
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    • 2005
  • Purpose: Bone metastasis is not a common event in patients with gastric cancer. Therefore, most studies of bone metastasis in such patients have been in the form of case reports, so the clinical features of the bone metastasis are not well understood. To clarify metastatic patterns, the efficacy of radiation or chemotherapy, and the prognosis, we analyzed 29 cases of patients with bone metastases after curative surgery for gastric cancer. Materials and Methods: Twenty-nine (29) gastric cancer patients with bone metastasis who underwent curative resection from January 1989 to December 2002 at the Departments of Surgery, Kangnam St. Mary's Hospital and Our Lady of Mercy's Hospital, The Catholic University of Korea, were analyzed. Results: Nineteen (19) patients were males and, 10 patients were females. The mean age of the patients was $53\pm12$ years. There were more Borrmann type-3 and type-4 cancers and more undifferentiated histologic types. Most of the original cancers were stage III or IV. The most frequently involved bone was the spine. Treatment after recurrence was done in 16 patients ($55.2\%$). The median survival time after recurrence of the patients who received treatment was seven (7) months ($0\∼75$ months in range), which was significantly longer than that of the patients who did not received treatment (P=0.019). However, there was no difference according to the treatment modality (P=0.388). Conclusion: Bone metastasis after a curative resection of gastric cancer tends to occur in Borrmann type-3 and type-4 cancers, cancers with undifferentiated histology and, in stage III/IV disease. The prognosis of bone metastasis is dismal, and aggressive treatment is the only way to prolong survival.

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International Liability for Damage Caused by Space Debris (우주잔해 손해에 대한 국제책임)

  • Kim, Dong-Uk
    • The Korean Journal of Air & Space Law and Policy
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    • v.23 no.2
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    • pp.173-205
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    • 2008
  • Space debris have frequently caused damage to space objects like satellites in orbits and sometimes have fallen on the earth. Such increase in space debris will lead to the high possibility of threatening space activities of mankind. However, it is not so easy for the damage caused both by identified and by unidentified space debris to be recovered since in the regime of the current international law, there is no legislation of prescribing the damage done by space debris. For overcoming the limitation it seems desirable that either the Liability Convention should partly be amended or new international law regime should be established. For instance, 'space debris' should be included in the new definition of 'space object' and the range of launching should also be defined clearly by making the concept of 'launching' somewhat more specified. Moreover, the subject of international liability for damage caused by space debris should be divided into two classes: the subject before and after registration. While in case of before-registration launch states should be held liable for any damage jointly or individually, in case of after-registration 'the state of registry' or 'owner' of the space debris should be. In the event of damage being caused elsewhere than on the surface of the earth to a space object of other State, 'fault-based liability' is currently applied. But it needs to be changed into 'absolutely liability'. In this paper, 'Liability Pool', 'Insurance', 'Market-Share Liability' are presented as aid devices of the damages resulting from unidentified space debris. They should be defined through the amendment of the Liability Convention or another international treaty. Some day there comes a time when our country shall possess many of the astronomical price of satellites. It means that we can't be free from the damage by the increasing number of space debris. Provided that our satellites are damaged by such space debris, it will do the satellites damage and cause impaired functioning or troubles in operation. As a result, if we are not paid for the damage by space debris, we will be confronted with tremendous economic loss because it is necessarily connected with the excess burden of taxation. Thus, an international agreement regarding the measures of the compensation for space debris damage must be made very soon.

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An Experimental Study on the Pore Structure and Thermal Properties of Lightweight Foamed Concrete by Foaming Agent Type (기포제 종류에 따른 경량기포콘크리트의 기포구조 및 열적특성에 관한 실험적 연구)

  • Kim, Jin-Man;Choi, Hun-Gug;Park, Sun-Gyu
    • Journal of the Korea Institute of Building Construction
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    • v.9 no.4
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    • pp.63-73
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    • 2009
  • Recently, the use of lightweight panels in building structures has been increasing. Of the various lightweight panel types, styrofoam sandwich panels are inexpensive and are excellent in terms of their insulation capacity and their constructability. However, sandwich panels that include organic material are quite vulnerable to fire, and thus can numerous casualties in the event of a fire due to the lack of time to vacate and their emission of poisonous gas. On the other hand, lightweight foamed concrete is excellent, both in terms of its insulation ability and its fire resistance, due to its Inner pores. The properties of lightweight concrete is influenced by foaming agent type. Accordingly, this study investigates the insulation properties by foaming agent type, to evaluate the possibility of using light-weight foamed concrete instead of styrene foam. Our research found thatnon-heating zone temperature of lightweight foamed concrete using AP (Aluminum Powder) and FP (animal protein foaming agent) are lower than that of light-weight foamed concrete using AES (alkyl ether lactic acid ester). Lightweight foamed concrete using AES and FP satisfied fire performance requirements of two hours at a foam ratio 50, 100. Lightweight foamed concrete using AP satisfied fire performance requirements of two hours at AP ratio 0.1, 0.15. The insulation properties were better in closed pore foamed concrete by made AP, FP than with open pore foamed concrete made using AES.

The Study of the Two-Dimensional Suicidal Type Based on Psychological Autopsy: A Focus on Suicidal Behaviors and Suicidal Risk Factors (한국형 심리부검 기반 이차원적 자살유형 연구: 자살행동과 자살위험요인을 중심으로)

  • Sung-pil Yook;Jonghan Sea
    • Korean Journal of Culture and Social Issue
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    • v.29 no.1
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    • pp.75-99
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    • 2023
  • The current study aimed to explore the suicidal behaviors and risk factors of completed suicides using psychological autopsy and use them as index variables to classify suicidal types. In addition, this study looked into the influential factors that affect each suicidal type. related to suicidal behaviors and suicidal risk factors by psychological autopsy. In addiction, the distinctions among the classes were analyzed. For this, psychological autopsies were conducted on the families and the close ones of 128 completed suicides. Then, the index variables were finally chosen for classifying suicidal types. The selected index variables for suicidal risk factors were mental disorders, suicide/self-harm, significant changes in physical appearance, marital conflict, adjustment and relationship issues at work/school, unemployment/layoff, jobless status and serious financial problems. The selected index variables for suicidal behaviors were expressing their suicidal attempts, writing suicidal notes, asking for help, the time/place/method of suicidal behavior, past suicidal/self-harm experience and the first person who witnessed the suicide. The Latent Class Analysis(LCA) and the 3-step method were used for classifying suicidal types. Then external variables(financial changes, cohabitation, existence of stressors, changes in stress level or relationships and family members with mental disorder/alchohol problems/ physical disorders, and work/school stisfaction) were applied for distinguishing classes. As a result, 5 classes(financial problems, adjustment problems, complex problems, psychiatric problems, and response to event[s]) were revealed on suicidal behaviors and 3 classes(residence- suicidal attempt- found by family, nonresidence- nonsuicidal attempt- found by acquaintances, residence- nonsuicidal attempt- found by family) were presented on suicidal risk factors. External variables such as gender, marital status, cohabitation, changes in relationships significantly differentiated among the 3 classes. Especially, class 3(residence- nonsuicidal attempt- found by family) tended to cohabit with others, were married, and had a significantly high level of interpersonal conflicts. When comparing the 5 classes of suicidal risk factors, auxiliary variables such as economic changes, cohabitation, stress, relationship changes, and family-related problems, and school/work satisfaction significantly differentiated the 5 classes. Especially class 3 (complex problems) experienced comparatively less family-related problems, but showed an aggravating level of personal stress. Suicial prevention strategies should be provided considering the characteristics of each class and the influential factors.

Opelative Risk and Results of Reoporation for Heart Valve Prostheses (인공심장판막 재치환술에 대한 수술 위험 인자 및 결과)

  • 김철환;김경훈
    • Journal of Chest Surgery
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    • v.30 no.10
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    • pp.973-978
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    • 1997
  • We reviewed data of 64 patients who underwent reoperation because of prosthetic valve malfunction from January 1991 to December 1995. The indications for reoperation were prosthetic valve failure(primary tissue failure: 53 patients, 82.8%), prosthetic valve thrombosis(6 patients, 9.4%), paravalvular leak(3 patients, 4.7%), prosthetic valve endocarditis(2 patients, 3.6%). Prosthetic valve failure developed most frequently in mitral portion(40 patients, 75%), prosthetic valve thrombosis also in mitral portion(4 patients, 67%), paravalvular leak significantly in aortic portio (3 patients, 100%). Explant period was longest in prosthetic valve failure(mean 107.4 $\pm$ 24.6 months), shortest in prosthetic valve endocarditis with prosthetic valve thrombosis(1 patient, 1 month). Mean explant period, defined as from first valve replacement operation to redo-valve replacement operatopn, was 109.2$\pm$ 10.7 months in mitral portion, 97.8$\pm$ 10.4 months in aortic portion, 109.5$\pm$ 10.4 months in total. Overall hospital mortality was 9.38%. The most common cause of death was the low cardiac output(4 patients), other causes were bleeding(1 patient), CNS injury(1 patient). Preoperative NYHA class IV(P=0.011), emergency operation(P=0.011), prosthetic valve endocarditis(P=0.001) were the independent risk factors, but age, sex, explant period, ACC time, double valve replacement, valve position, second reoperation did not appear to be significant risk factors. Mean follow up period was 28.8 $\pm$ 17.8 months. Actuarial survival at 3 year was 92.0$\pm$6.2%, 2 year event-free survival w s 84.3$\pm$6.1%. We propose that patients undergoing reoperation because of prosthetic valve failure are carfully controlled and selected in regarding to above mentioned risk factors NYHA class IV, emergency operation, prosthetic valve endocarditis in preoperative state. About other risk factors possible, there is necessary of following study.

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Metamorphism and Deformation of the Late Paleozoic Pyeongan Supergroup in the Taebaeksan Basin: Reviews on the Permo-Triassic Songrim Orogeny (태백산분지에 분포하는 후기 고생대 평안누층군의 변성-변형작용: 페름-삼첩기 송림 조산운동의 고찰)

  • Kim, Hyeong-Soo
    • The Journal of the Petrological Society of Korea
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    • v.21 no.2
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    • pp.151-171
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    • 2012
  • The Permo-Triassic Songrim orogeny in the Korean peninsula was a major tectonic event involving complicated continental collisions at the eastern margin of Eurasia. Based on the previous studies on the metamorphic and deformations features of the Songrim orogeny, this paper presents metamorphic and structural characteristics and timing of the Songrim orogeny in the Taebaeksan basin, and discuss about correlation of the tectono-metamorphic evolution of the Taebaeksan basin with the Okcheon basin and the Imjingang belt with a combined analysis of bulk crustal shortening direction, metamorphic P-T and T-t (time) paths. The metapelites in the Pyeongan Supergroup in the northeastern margin of the Taebaeksan basin have experienced lower-temperature/medium-pressure (LT/MP) regional metamorphism followed by high-temperature contact metamorphism due to the Jurassic granite intrusion. The earlier LT/MP regional metamorphism produced two loops of clockwise P-T-d (deformation) paths combined with four deformation events ($D_1-D_4$). The first loop concomitant with $D_1$ and $D_2$ occurred at $400-500^{\circ}C$, 1.5-3.0 kbar, and related with growth of syn-$D_1$ chloritoid and andalusite, post-$D_1$ margarite, Ca-rich syn-$D_2$ or post-$D_2$ plagioclase. The second loop accompanying $D_3$ and $D_4$ occurred at $520-580^{\circ}C$, 2.0-6.0 kbar, and associated with the growth of syn-$D_3$ garnet and staurolite, and syn-$D_4$ and/or post-$D_4$ andalusite porphyroblasts. Furthermore the syn-$D_1$ chloritoid and andalusite porphyroblasts grew during E-W bulk crustal shortening, whereas the syn-$D_3$ garnet and staurolite, and the syn-$D_4$ and/or post-$D_4$ andalusite porphyroblasts have grown under N-S bulk crustal shortening. The similarity in the characteristics and timing of the metamorphism and bulk crustal shortening directions between the Okcheon and Imjingang belts suggest that the peak metamorphic conditions tend to increase toward the western part (Imjingang belt and southwestern part of the Gyeonggi Massif) from the eastern part (Taebaeksan basin). The E-W bulk crustal shortening influenced the eastern part of the Okcheon belt, whereas the N-S bulk crustal shortening resulted in strong deformation in the Imjingang and Okcheon belts. Consequently, the Permo-Triassic Songrim orogeny in the Korean peninsula is probably not only related to collision of the North and South China blocks, but also to the amalgamation of terrane fragments at the eastern Eurasia margin (e.g., collision of the Sino-Korean continent and the Hida-Oki terrane).