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The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting

  • Kim, Dong Jung;Sohn, Bongyeon;Kim, Hakju;Chang, Hyoung Woo;Lee, Jae Hang;Kim, Jun Sung;Lim, Cheong;Park, Kay-Hyun
    • Journal of Chest Surgery
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    • v.53 no.1
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    • pp.8-15
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    • 2020
  • Background: We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. Methods: Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity-matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). Results: Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. Conclusion: A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.

Estimation of Applicability of Empirical Design Procedure for Predicting Seismic Response of Buried Gas Pipelines through 3D Time-history Analysis (3차원 시간이력해석을 통한 매설가스배관 종방향 지진응답 예측을 위한 경험적 설계법의 적용성 평가)

  • Kwak, Hyungjoo;Park, Duhee;Lee, Jangguen;Kang, Jaemo
    • Journal of the Korean Geotechnical Society
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    • v.31 no.9
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    • pp.53-68
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    • 2015
  • Longitudinal strain is an important component of seismic design for buried pipelines. A design procedure which determines the wavelength from site natural period and shear wave velocity of the soil layer and closed-form solutions of pipelines under a harmonic motion is typically used in design. However, the applicability of the procedure has not yet been thoroughly investigated. In this paper, displacement-time histories extracted from 1D site response analyses are used in 3D shell-spring model to accurately predict the response of pipelines. The results are closely compared to those from the design procedure. The area of interest is East Siberia. Performing a site response analysis to determine site specific displacement time history is highlighted. The site natural period may be used to predict the predominant period of the acceleration time history, but cannot be used to estimate the predominant period of the displacement time history. If an accurate estimate of the predominant period of the displacement time history is provided, it is demonstrated that the design equation can be successfully used to predict the response of pipelines.

Design of Convergence Contents information quality of u-convergence tourist information3.0 using flow Theory (플로우 이론을 이용한 u-융복합 관광정보3.0 의 융복합 콘텐츠 정보품질 설계)

  • Sun, Su-Kyun;Lee, Seung-woo
    • Journal of Digital Convergence
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    • v.13 no.9
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    • pp.191-199
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    • 2015
  • The Journal of Digital Policy & Management. This space is for the abstract of your study in English. In this paper, we propose a u-convergence Tourist Information 3.0 System using Flow Theory. It generates a sense of u-challenge and u-skills to maximize the enjoyment of tourists is u-convergence Tourist Information 3.0. This is a challenge to good sense and adjust the rating of the Convergence Contents information quality(CCIQ) analysis to maximize the enjoyment of tourists. Convergence Contents information quality(CCIQ) of the conductive continuity of the content closed antecedents u-conductive sense, the tourist synchronization adequacy may generate data that can be analyzed. Content Information Quality of rating is the leading factor in the ability of the u-skill mastery of tourists, can generate data availability. The result is to create a meta-model is referred to as content information to reach the best quality maximize enjoyment. Design a sense of u-challenge the skill of the information quality of the tourist information content has the advantage of being able to identify the data formation has the pleasure of tourists. By applying to future national competent standard it is expected to maximize the enjoyment of the job.

GEOTECHNICAL DESIGNS OF THE SHIP IMPACT PROTECTION SYSTEM FOR INCHEON BRIDGE

  • Choi, Sung-Min;Oh, Seung-Tak;Park, Sang-Il;Kim, Sung-Hwan
    • Proceedings of the Korean Geotechical Society Conference
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    • 2010.09c
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    • pp.72-77
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    • 2010
  • The Incheon Bridge, which was opened to the traffic in October 2009, is an 18.4 km long sea-crossing bridge connecting the Incheon International Airport with the expressway networks around the Seoul metropolitan area by way of Songdo District of Incheon City. This bridge is an integration of several special featured bridges and the major part of the bridge consists of cable-stayed spans. This marine cable-stayed bridge has a main span of 800 m wide to cross the vessel navigation channel in and out of the Incheon Port. In waterways where ship collision is anticipated, bridges shall be designed to resist ship impact forces, and/or, adequately protected by ship impact protection (SIP) systems. For the Incheon Bridge, large diameter circular dolphins as SIP were made at 44 locations of the both side of the main span around the piers of the cable-stayed bridge span. This world's largest dolphin-type SIP system protects the bridge against the collision with 100,000 DWT tanker navigating the channel with speed of 10 knots. Diameter of the dolphin is up to 25 m. Vessel collision risk was assessed by probability based analysis with AASHTO Method-II. The annual frequency of bridge collapse through the risk analysis for 71,370 cases of the impact scenario was less than $0.5{\times}10^{-4}$ and satisfies design requirements. The dolphin is the circular sheet pile structure filled with crushed rock and closed at the top with a robust concrete cap. The structural design was performed with numerical analyses of which constitutional model was verified by the physical model experiment using the geo-centrifugal testing equipment. 3D non-linear finite element models were used to analyze the structural response and energy-dissipating capability of dolphins which were deeply embedded in the seabed. The dolphin structure secures external stability and internal stability for ordinary loads such as wave and current pressure. Considering failure mechanism, stability assessment was performed for the strength limit state and service limit state of the dolphins. The friction angle of the crushed stone as a filling material was reduced to $38^{\circ}$ considering the possibility of contracting behavior as the impact.

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Seismic Performance Assessment of a Composite Modular System Considering Stiffness of Connections (접합부 강성을 고려한 합성 모듈러 시스템의 내진 성능평가)

  • Choi, Young-Hoo;Lee, Ho-Chan;Kim, Jin-Koo
    • Journal of the Korea institute for structural maintenance and inspection
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    • v.22 no.2
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    • pp.105-114
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    • 2018
  • Modular system can be divided into two types based on the methods of resisting load. The one is the open-sided modular system composed of beams and columns. The other is the enclosed modular system composed of panels and studs. Of the Modular systems, the use of open-sided modular system is limited because it consists of closed member sections. In order to solve this problem, Choi et al.(2017) proposed a composite modular system with folded steel members filled with concrete. However, it was assumed in the previous study that the connections between modules are composed of rigid joint. Therefore it didn't identify the effect of connection behavior in structure. This study used finite element analysis to calculate stiffness of the connections in the proposed modular system. The linearization method presented in FEMA 440 is used for seismic performance assessment of structures, considering the connection stiffness computed in this study. The result of analysis shows that the capacity and story drift ratio obtained in the model considering stiffness of connection are less than those in the model not considering connection stiffness. Based on this observation, it is concluded that the stiffness of connection has a considerable effect on structural behavior.

Study on Applicability of Stereophotogrammetry to Rock Joint Survey (입체사진측량기법의 암반절리조사에 대한 적용성 연구)

  • Han, Jeong-Hun;Song, Jae-Joon
    • Tunnel and Underground Space
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    • v.17 no.2 s.67
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    • pp.139-151
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    • 2007
  • Stereophotogrammetry is a method to extract information of an interested area by constructing a stereo-image from two or more photos. In this study, the stereophotogrammetry was adopted to obtain the joint orientation and trace length from a sampling window and its measurements were compared with the result by a clinocompass and measuring tape to evaluate the applicability of the stereophotogrammetry to rock joint survey. A commercial stereophotogrammetry program, ShapeMetriX 3D, was used for this purpose. Firstly, the accuracy of the measuring method using ShpaeMetrix 3D was evaluated by a model test. Secondly, joint orientations on a rock slope and tunnel were obtained by using ShapeMetriX 3D and compared with the measurement by a clinocompass. Finally. the effect of base-depth ratio in photographing was evaluated by comparing images with various base-depth ratios, and the usefulness of closed-up photographing on a rock exposure to increase the measurement accuracy was tested. The dip and dip direction of each model plane obtained by ShapeMetriX 3D showed an error ranged between $-5^{\circ}\;and\; 5^{\circ}$ on the basis of the results by the measuring tape. Base-depth ratio proved not to influence the analysis result by ShapeMetriX 3D if all the images were taken without any hidden area. The close-up photographing turned out useful to obtain the detailed images and therefore precise result when ShapeMetriX 3D was adopted.

The Economic Impact of a Rural Hospital to Local Economy (한 병원이 지역사회에 미치는 경제적 영향 분석)

  • Kang, Im-Ok;Lee, Sun-Hee;Kim, Han-Joong
    • Journal of Preventive Medicine and Public Health
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    • v.29 no.4 s.55
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    • pp.831-842
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    • 1996
  • Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.

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A Study on the natural Convection and Radiation in a Rectangular Enclosure with Ceiling Vent (천장개구부를 갖는 정사각형 밀폐공간내의 자연대류-복사 열전달에 관한 연구)

  • Park Chan-kuk;Chu Byeong-gil;Kim chol;Jung Jai-hwan
    • Journal of the Korean Institute of Gas
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    • v.2 no.1
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    • pp.28-39
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    • 1998
  • This study investigated the natural convection and radiation in a rectangular enclosure with ceiling vent experimentally and numerically. A heat source is located on the center of the bottom surface. The analysis was peformed a pure convection and is combination of natural convection and radiation. The shape of the considered two dimensional model is a square whose center of ceiling($30\%$) is opened. The numerical simulations are carried out for the pure natural convection case and the combined heat transfer case by using the SIMPLE algorithm. For the turbulent flow, Reynolds stresses are closed by the standard $k-{\epsilon}$ model and the wall function is used to determine the wall boundary conditions. The experiment was performed on the same geometrical shape as the computations. The radiative heat transfer is analized by the S-N discrete ordinates method. The results of pure natural convection are compared with those of combined heat transfer by the velocity vectors, stream lines, isothermal lines. The results obtained are as follows 1. Comparing the results of pure convection with those of the combined convection-radiation through the shape of stream lines, isothermal lines are similar to each other. 2. The temperature fields obtained by numerical method are compared to those obtained by experimental one, and it is found that they are showed mean relative error $8.5\%$. 3. Visualization bt smoke is similar to computational results.

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An Interpretable Log Anomaly System Using Bayesian Probability and Closed Sequence Pattern Mining (베이지안 확률 및 폐쇄 순차패턴 마이닝 방식을 이용한 설명가능한 로그 이상탐지 시스템)

  • Yun, Jiyoung;Shin, Gun-Yoon;Kim, Dong-Wook;Kim, Sang-Soo;Han, Myung-Mook
    • Journal of Internet Computing and Services
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    • v.22 no.2
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    • pp.77-87
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    • 2021
  • With the development of the Internet and personal computers, various and complex attacks begin to emerge. As the attacks become more complex, signature-based detection become difficult. It leads to the research on behavior-based log anomaly detection. Recent work utilizes deep learning to learn the order and it shows good performance. Despite its good performance, it does not provide any explanation for prediction. The lack of explanation can occur difficulty of finding contamination of data or the vulnerability of the model itself. As a result, the users lose their reliability of the model. To address this problem, this work proposes an explainable log anomaly detection system. In this study, log parsing is the first to proceed. Afterward, sequential rules are extracted by Bayesian posterior probability. As a result, the "If condition then results, post-probability" type rule set is extracted. If the sample is matched to the ruleset, it is normal, otherwise, it is an anomaly. We utilize HDFS datasets for the experiment, resulting in F1score 92.7% in test dataset.

Seismic Performance Assessment of a Composite Modular System Considering Stiffness of Connections (접합부 강성을 고려한 합성 모듈러 시스템의 내진 성능평가)

  • Choi, Young-Hoo;Lee, Ho-Chan;Kim, Jin-Koo
    • Journal of the Korea institute for structural maintenance and inspection
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    • v.23 no.1
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    • pp.9-18
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    • 2019
  • Modular system can be divided into two types based on the methods of resisting load. The one is the open-sided modular system composed of beams and columns. The other is the enclosed modular system composed of panels and studs. Of the Modular systems, the use of open-sided modular system is limited because it consists of closed member sections. In order to solve this problem, Choi et al.(2017) proposed a composite modular system with folded steel members filled with concrete. However, it was assumed in the previous study that the connections between modules are composed of rigid joint. Therefore it didn't identify the effect of connection behavior in structure. This study used finite element analysis to calculate stiffness of the connections in the proposed modular system. The linearization method presented in FEMA 440 is used for seismic performance assessment of structures, considering the connection stiffness computed in this study. The result of analysis shows that the capacity and story drift ratio obtained in the model considering stiffness of connection are less than those in the model not considering connection stiffness. Based on this observation, it is concluded that the stiffness of connection has a considerable effect on structural behavior.