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Nasal Continuous Positive Airway Pressure Titration and Time to Reach Optima1 Pressure in Sleep Apnea Syndrome (수면 무호흡 증후군에서 지속적 양압 치료시의 최적압 및 그 도달기간)

  • Lee, Kwan-Ho;Lee, Hyun-Woo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.1
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    • pp.84-92
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    • 1995
  • Background: Nasal applied continuous positive airway pressure(CPAP) is a highly effective method of treatment for obstructive sleep apnea syndrome. More than a decade of accumulated experience with this treatment modality confirmed that it is unquestionably the medical treatment of choice for patients with obstructive sleep apnea syndrome. However it takes long time to reach optimal CPAP pressure. To save the time to reach optimal pressure, it is necessary to clarify the time to reach optimal pressure for treatment of obstructive sleep apnea syndrome. Method: CPAP pressure is titrated during an overnight study according to a standardized protocol. Just before the presleep bio-calibration procedures, the technician applies the nasal mask and switches on the clinical CPAP unit. Initial positive for pressure is typically 3.0 centimeters of water pressure. After sleep onset, the technician gradually increases the pressure until sleep-disordered breathing events disappear or become minimal. The pressure must maintain maximal airway patency during both NREM and REM sleep to be considered effective. Before recommending a final pressure setting, sleep recording and oximetry data are reviewed by an American Board of Sleep Medicine certified Sleep Specialist and a Registrered Polysomnographic Technologist. Results: We examined the time required to reach optimal pressure during routine CPAP titration in 127 consecutively evaluated individuals diagnosed with sleep-disordered breathing. Results indicate that 33% of patients required more than four hours to attain satisfactory titration. This indicates that a four-hour session is marginally enough time, at best, to determine a proper CPAP pressure setting. Moreover, 60 of 127 patients required further adjustment after optimal pressure was reached. These additional pressure trials were needed to confirm that higher pressures were not superior for eliminating sleep-disordered breathing events. Conclusions: The data presented underscore the logistical difficulty of titrating CPAP during split-night studies without modifying the titration procedure. Futhermore, the time needed to reach optimal pressure makes it improbable that proper CPAP titration can be performed during a 2-3 hour nap study.

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Effects of Surface Finishes on the Low Cycle Fatigue Characteristics of Sn-based Pb-free Solder Joints (금속패드가 Sn계 무연솔더의 저주기 피로저항성에 미치는 영향)

  • Lee, Kyu-O;Yoo, Jin
    • Journal of the Microelectronics and Packaging Society
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    • v.10 no.3
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    • pp.19-27
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    • 2003
  • Surface finishes of PCB laminates are important in the solder joint reliability of flip chip package because the types and thicknesses of intermetallic compound(IMC), and compositions and hardness of solders are affected by them. In this study, effects of surface finishes of PCB on the low cycle fatigue resistance of Sn-based lead-free solders; Sn-3.5Ag, Sn-3.5Ag-XCu(X=0.75, 1.5), Sn-3.5Ag-XBi(X=2.5, 7.5) and Sn-0.7Cu were investigated for the Cu and Au/Ni surface finish treatments. Displacement controlled room temperature lap shear fatigue tests showed that fatigue resistance of Sn-3.5Ag-XCu(X=0.75, 1.5), Sn-3.5Ag and Sn-0.7Cu alloys were more or less the same each other but much better than that of Bi containing alloys regardless of the surface finish layer used. In general, solder joints on the Au/Ni finish showed better fatigue resistance than those on the Cu finish. Cross-sectional fractography revealed microcracks nucleation inside of the interfacial IMC near the solder mask edge, more frequently on the Cu than the Au/Ni surface finish. Macro cracks followed the solder/IMC interface in the Bi containing alloys, while they propagated in the solder matrix in other alloys. It was ascribed to the Bi segregation at the solder/IMC interface and the solid solution hardening effect of Bi in the $\beta-Sn$ matrix.

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A Study on the Health Effects of Pesticide Exposure among Farmers (농약살포 농민의 농약노출로 인한 건강피해에 관한 연구)

  • Lee, Kyoung-Mu;Min, Sun-Young;Chung, Moon-Ho
    • Journal of agricultural medicine and community health
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    • v.25 no.2
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    • pp.245-263
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    • 2000
  • This study was conducted to provide the basic data about the health effects of pesticide exposure among farmers for agricultural health study. We analyzed 412 self-administered questionnaires collected from the male farmers who spray pesticides in Kyoung-ju area, Korea. Survey questions were about chronic symptoms, acute symptoms while pesticide spraying, pesticide intoxication accident, safety rules, protective equipments etc. The correlations among the variables related to pesticide exposure and the factors in acute pesticide poisoning and chronic symptoms of farmers were also analyzed. For chronic symptoms, the prevalence of 'tiredness and languor', 'lumbago', 'nocturia', 'shoulder pain', 'numbness', and, for acute symptoms while pesticide spraying, the experience rate of 'itching sense of skin', 'dizziness/headache', 'fatigue', 'eye glaring' were high compared with other symptoms. For 'experience of intoxication accident by pesticide in family', 7.1% of the subjects experienced the accident and the causes were pesticide spraying, food contamination by pesticide, suicide etc. Among safety rules, 'take a bath after spraying', 'change clothes after spraying' were kept relatively well, and, for protective equipments, hat, boots, mask, gloves, protective clothes(lower) were put on relatively well. The factors associated with acute pesticide poisoning were the extent of keeping safety rules, spraying time, orchard cultivation, agricultural area and spraying days per year etc. And the factors associated with chronic symptoms were acute symptoms while pesticide spraying, agricultural area, farming career, extent of keeping safety rules, extent of agricultural work and the pesticide exposure index etc. From these results, it is suggested that to reduce the health effects by pesticide exposure among farmers, the education to promote to keep safety rules and wear protective equipments, and information services should be recommended. And further studies on the long term health effects of pesticide exposure among farmers are required.

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Position Uncertainty due to Multi-scattering in the Scintillator Array of Dual Collimation Camera (복합 집속 카메라의 섬광체배열에서 다중산란에 의한 위치 불확실성)

  • Lee, Won-Ho
    • Journal of radiological science and technology
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    • v.31 no.3
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    • pp.287-292
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    • 2008
  • Position information of radiation interactions in detection material is essential to reconstruct a radiation source image. With most position sensing techniques, the position information of a single interaction inside the detectors can be precisely obtained. Each interaction position of multi-scattering inside scintillators, however, can not be individually measured and only the average of the scattering positions can be obtained, which causes the uncertainty in the measured interaction position. In this paper, the position uncertainties due to the multi-scattering were calculated by Monte Carlo simulation. The simulation model was a 50 by 50 by 5 mm $LaCl_3$(Ce) scintillator(pixel size is 2 by 2 by 5mm) which was utilized for the dual collimation camera. The dual collimation camera uses the information from both photoelectric effect and Compton scattering, and therefore, position uncertainties for both partial and full energy deposition of radiation interactions are calculated. In the case of partial energy deposition(PED), the standard deviations of positions are less than $1{\sim}2mm$, which means the uncertainty caused by multi-scattering is not significant. Because the effect of the multi-scattering with PED is insignificant, the multi-scattering has little effect on the performance of Compton imaging of dual collimation camera. In the case of full energy deposition(FED), however, the standard deviation of the positions is about twice that of the pixel size of the 1stdetector, except for 122keV incident radiations. Therefore, the standard deviations caused by multi-scatterings should be considered in the design of the coded mask of the dual collimation camera to avoid artifact on the reconstructed image. The position uncertainties of the FEDs are much larger than those of the PEDs for all radiation energies and the ratio of PEDs to FEDs increases when the incident radiation energy increases. The position uncertainties of both PEDs and FEDs are dependent on the incident radiation energy.

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CT Simulation Technique for Craniospinal Irradiation in Supine Position (전산화단층촬영모의치료장치를 이용한 배와위 두개척수 방사선치료 계획)

  • Lee, Suk;Kim, Yong-Bae;Kwon, Soo-Il;Chu, Sung-Sil;Suh, Chang-Ok
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.165-171
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    • 2002
  • Purpose : In order to perform craniospinal irradiation (CSI) in the supine position on patients who are unable to lie in the prone position, a new simulation technique using a CT simulator was developed and its availability was evaluated. Materials and Method : A CT simulator and a 3-D conformal treatment planning system were used to develop CSI in the supine position. The head and neck were immobilized with a thermoplastic mask in the supine position and the entire body was immobilized with a Vac-Loc. A volumetrie image was then obtained using the CT simulator. In order to improve the reproducibility of the patients' setup, datum lines and points were marked on the head and the body. Virtual fluoroscopy was peformed with the removal of visual obstacles such as the treatment table or the immobilization devices. After the virtual simulation, the treatment isocenters of each field were marked on the body and the immobilization devices at the conventional simulation room. Each treatment field was confirmed by comparing the fluoroscopy images with the digitally reconstructed radiography (DRR)/digitally composite radiography (DCR) images from the virtual simulation. The port verification films from the first treatment were also compared with the DRR/DCR images for a geometrical verification. Results : CSI in the supine position was successfully peformed in 9 patients. It required less than 20 minutes to construct the immobilization device and to obtain the whole body volumetric images. This made it possible to not only reduce the patients' inconvenience, but also to eliminate the position change variables during the long conventional simulation process. In addition, by obtaining the CT volumetric image, critical organs, such as the eyeballs and spinal cord, were better defined, and the accuracy of the port designs and shielding was improved. The differences between the DRRs and the portal films were less than 3 mm in the vertebral contour. Conclusion : CSI in the supine position is feasible in patients who cannot lie on prone position, such as pediatric patienta under the age of 4 years, patients with a poor general condition, or patients with a tracheostomy.

Development and Animal Tests of Prototype Oxygen Concentrator (국산 산소 농축기의 개발 및 동물실험)

  • 변정욱;성숙환;이태수
    • Journal of Chest Surgery
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    • v.31 no.7
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    • pp.643-649
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    • 1998
  • Background: For the patient with chronic obstructive pulmonary disease requiring long-term oxygen therapy, oxygen concentrator machines are already widely available for use in home. In this study, we used mongrel dogs as test subjects to compare the functional efficiency and safety of the oxygen concentrator developed by our own research team with those of the imported FORLIFE(TM) machine made by AIRSEP Corp. Method and method: To test mechanical reliability, the concentrations of oxygen delivered were measured after 4 hours of continuous operation. Sixteen mongrel dogs were divided into two equal groups. Mongrel dogs in group A were given oxygen using the imported oxygen concentrator, and those in group B using the machine developed. 5 l/min of oxygen were given, after which vital signs were analyzed, arterial blood gases measured, and blood chemistry tests carried out. Results: After 4 hours of continuous operation, the imported model performed better, giving 98${\pm}$3% oxygen, compared to our model, which gave 91${\pm}$1%. In the animal experiments, oxygen concentrations were measured at the inlet of face mask 1, 2, 3, and 4 hours after continuous administration, and there was no statistically significant difference(repeated measures of analysis of variance p=0.70) between the values of 70.6${\pm}$2.5%, 67.1${\pm}$2.9%, 68.2${\pm}$2.6%, and 64.9${\pm}$3.9% that were measured from group A, and the values of 65.1${\pm}$4.8%, 65.2${\pm}$3.6%, 68.7${\pm}$4.3%, and 66.0${\pm}$5.0% measured from group B. Before oxygen administration, and at 1, 2, 3, and 4 hours after oxygen administration, arterial blood partial pressure of oxygen 87.2${\pm}$2.5 mmHg, 347.4${\pm}$29.3 mmHg, 353.4${\pm}$21.2 mmHg, 343.0${\pm}$28.8 mmHg, and 321.6${\pm}$24.4 mmHg, respectively, were read from group A, which were not statistically different (p=0.24) to the values of 102.5${\pm}$9.6 mmHg, 300.3${\pm}$17.1 mmHg, 321.6${\pm}$23.7 mmHg, 303.4${\pm}$27.4 mmHg, and 273.5${\pm}$25.9 mmHg read from group B. Nonetheless, the arterial blood partial pressure of oxygen values appear to be somewhat higher in dogs that were given oxygen using the imported oxygen concentrator. Conclusions: From these results the prototype oxygen concentrator developed appears to function relatively satisfactorily compared to the imported, established model, but may be criticized for the excessive noise generated and poor long-term endurance or consistency, which need improvement.

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The Effect of Nasal CPAP in Obstructive Sleep Apnea Syndrome (폐쇄형 수면무호흡증후군 환자에서 Nasal CPAP의 치료 효과)

  • Kim, Chi-Hong;Kwon, Soon-Seog;Kim, Young-Kyoon;Kim, Kwan-Hyoung;Moon, Hwa-Sik;Song, Jeong-Sup;Park, Sung-Hak
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.5
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    • pp.501-508
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    • 1993
  • Background: Sleep apnea syndrome is a common disorder which is estimated to affect about 1~4% of adult male population. And if untreated, sleep apnea can cause significant sequelae, such as hypertension, nocturnal cardiac arrhythmia, daytime hypersomnolence, and cognitive impairment. Various kinds of treatment for obstructive sleep apnea (OSA) have been developed. Among them nasal CPAP, first introduced by Sullivan et al in 1981, has received widespread interest and acclaim as a treatment of OSA, and is currently recommended as first-line treatment for OSA. We evaluated the effect of nasal CPAP in OSA and the side effects of nasal CPAP hindering patients from using nasal CPAP. Methods: We performed sleep studies in 20 OSA patients at 2 consecutive nights; baseline night at first day and CPAP night at second day. We compared apnea index, lowest oxygen concentration during apnea, maximal apnea time, and total apnea duration per total sleep time before and after CPAP. We also evaluated the side effects of CPAP with inquiry to the patients. Results: 1) Apnea index was significantly decreased after CPAP in 17 out of 20 OSA patients (85%) and increased in 3 patients (15%). 2) Average apnea index was significantly decreased after CPAP ($34.1{\pm}18.9/h{\rightarrow}15.4{\pm}10.3/h$, p<0.01). 3) Total apnea duration per total sleep time was also significantly decreased after CPAP ($28.5{\pm}16.0%{\rightarrow}11.9{\pm}9.3%$, p<0.05). 4) The lowest oxygen satuation and maximal apnea time were not significantly changed after CPAP. 5) The most frequent side effect of nasal CPAP was mask discomfort (80%), and the next was drying of nasal passages (65%). Conclusion: Nasal CPAP is an effective treatment for OSA. Futher studies should be concentrated on long term follow up of nasal CPAP for its therapeutic effects and the study of methods to enhance patients' compliance.

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A Survey on the Workplace Environment and Personal Protective Equipment of Poultry Farmers (양계 농업인의 작업장 환경 및 개인보호구 착용 실태조사)

  • Kim, Insoo;Kim, Kyung-Ran;Lee, Kyung-Suk;Chae, Hye-Seon;Kim, Sungwoo
    • Journal of Environmental Health Sciences
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    • v.40 no.6
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    • pp.454-468
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    • 2014
  • Objectives: This study was conducted to investigate the actual condition of the farm work environment and personal protective equipment as part of the effort to improve livestock work for the safety and health of poultry farmers and provide basic data for establishing plans to improve and develop personal protective equipment. Methods: For this purpose, a questionnaire survey on general information about stables, the poultry work environment, accidents, the wearing of work clothes and personal protective equipment, and the level of awareness related to personal protective equipment was conducted among 148 poultry farmers. Results: As a result, it was found that poultry workplace environment was exposed to such risks as fine dusts; organic dusts; poisonous gases; odorous substances; chicken excrement; contact with chickens, bacteria or viruses; and accidents related to machine operation. Thirteen percent of respondents suffered severe respiratory diseases, and the most frequently injured sites due to accidents were the hands (25.7%), knees (23.8%), arms (17.3%), and head (10.9%). The most frequent type of accident was collisions between the body and obstacles or machinery during movement (36.4%), followed by erroneous machine operation such as feeders and electric shocks (8.5%). Regarding the wearing of work clothes and personal protective equipment, 51.7% of the respondents wore worn-out clothing or everyday clothes, whereas only 32.0% wore work clothes. The percentage of farmers who wore proper protective equipment for the work environment during poultry work was 48.4%. The most frequently used type of protective equipment was boots (38.9%), followed by mask (36.7%), gloves (36.3%), appropriate work clothes (22.6%), quarantine clothes (17.6%), helmets (13.4%), and goggles (12.6%). The rate of wearing goggles was low because they were considered inconvenient and lowered work efficiency. Furthermore, they purchased everyday products available on the market for their personal protective equipment which were not appropriate for maintaining safety in an actual harmful environment and its consequent risks. As a result of the survey of the awareness level related to personal protective equipment, their levels of awareness of accidents and attitude proved to be average or higher, but the practice of wearing protective equipment and the level of knowledge and management of personal protective equipment were lower. Conclusion: This survey found that the wearing status of personal protective equipment among poultry farmers was insufficient even though they were exposed to risks. Most respondents were aware of the necessity of wearing personal protective equipment and of the potential for accidents, but they did not wear proper protective equipment. Their wearing rate was low due to a lack of knowledge about protective equipment, as well as the inconvenience of wearing it. Therefore there is a need to improve and develop specialized personal protective equipment for respiration, hands, and eyes, as well as work clothes that can protect farmers from major harmful matter that is generated in the poultry workplace. Based on the results of this investigation, we will conduct further studies on the required performance and design directions of personal protective equipment while collecting more objective data through field-oriented assessments.

INFLUENCE OF SEVERAL POSTS AND IPS-EMPRESS INGOT THICKNESS ON THE FINAL SHADE OF ALL-CERAMIC CROWNS (수종의 post와 IPS-Empress Ingot 두께가 전부 도재 수복물 최종색조에 미치는 영향)

  • Bok Won-Mi;Choi Keun-Bae;Park Charn-Woon;Ahn Seung-Geun
    • The Journal of Korean Academy of Prosthodontics
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    • v.42 no.5
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    • pp.514-523
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    • 2004
  • Statement of problem: All-ceramic restorations have been advocated for superior esthetics. Various post and core systems have been used to improve the strength of damaged teeth, but it is unclear whether they affect the final shade of finished all-ceramic restorations. Purpose: The influence of different types of post and core systems on light transmission through all-ceramic crowns was assessed by spectrophotometric analysis. Also the masking effect of different thickness of ceramic ingot was evaluated. Material and Methods : Forty-five sample disks (15mm in diameter) at several thickness(1.0, 1.5, 2.0mm) and value(shade 100, 200, 300) were made in heat pressed ceramic(IPS-Empress). Background specimens simulating gold-alloy cast posts(Type III casting gold alloy), metal posts(Ni-Cr casting alloy) and ceramic posts(CosmoPost) were fabrica-ted. Resin composite(Z250, A3 shade) was used as a tooth substrate reference. For each combination, the change in color was measured with a spectrophotometer. Readings were performed for 2 conditions (1) ability of ceramic to mask the core in relation to its thickness(1.0, 1.5, or 2.0mm) ; (2) influence of post and core types on the final color of the ceramic. Data were recorded according to the CIE $L^*a^*b^*$ systems and color difference($\Delta$E) was calculated. Results: 100 shade ingot: when ceramic thickness was 1.0mm, $\Delta$E value for ceramic post larger than 1 but $\Delta$E value for metal and gold post was larger than 2. For ceramic thickness of 1.5mm, only $\Delta$E value for metal was larger than 2, and the other samples' $\Delta$E value was smaller than 2. For ceramic thickness of 2.0mm, $\Delta$E values for all specimens was smaller than 2. 200 shade ingot: when ceramic thickness was 1.0mm, $\Delta$E value for ceramic post was smaller than 1 but $\Delta$E value for metal and gold post was larger than 2. For ceramic thickness of 1.5 mm, only the $\Delta$E value for metal was larger than 2, and the other samples' $\Delta$E value was smaller than 2. For ceramic thickness of 2.0mm, $\Delta$E values for all specimens was smaller than 1. 300 shade ingot: when ceramic thickness was 1.0mm, only $\Delta$E value for metal was larger than 2 and the other samples' $\Delta$E value was smaller than 2. For ceramic thickness of 1.5mm, $\Delta$E values for all specimens was smaller than 1. For ceramic thickness of 2.0mm, $\Delta$E values for all specimens was smaller than 1. Conclusion: The final esthetic result of the IPS-Empress glass-ceramic restoration was not affected by the presence of different core materials when the thickness was more than 2.0 mm. When ceramic thickness decreases to 1.5mm, it is advised to take the substrate aspects into consideration. If the ceramic thickness is less than 1.0mm, using the tooth color matched substrate is strongly recommended.

The Sensitivity Analysis according to Observed Frequency of Daily Composite Insolation based on COMS (관측 빈도에 따른 COMS 기반의 일 평균 일사량 산출의 민감도 분석)

  • Kim, Honghee;Lee, Kyeong-Sang;Seo, Minji;Choi, Sungwon;Sung, Noh-Hun;Lee, Darae;Jin, Donghyun;Kwon, Chaeyoung;Huh, Morang;Han, Kyung-Soo
    • Korean Journal of Remote Sensing
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    • v.32 no.6
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    • pp.733-739
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    • 2016
  • Insolation is an major indicator variable that can serve as an energy source in earth system. It is important to monitor insolation content using remote sensing to evaluate the potential of solar energy. In this study, we performed sensitivity analysis of observed frequency on daily composite insolation over the Korean peninsula. We estimated INS through the channel data of Communication, Ocean and Meteorological Satellite (COMS) and Cloud Mask which have temporal resolution of 1 and 3 hours. We performed Hemispherical Integration by spatial resolution for meaning whole sky. And we performed daily composite insolation. And then we compared the accuracy of estimated COMS insolation data with pyranometer data from 37 points. As a result, there was no great sensitivity in the daily composite INS by observed frequency of satellite that accuracy of the calculated insolation at 1 hour interval was $28.6401W/m^2$ and 3 hours interval was $30.4960W/m^2$. However, there was a great difference in the space distribution of two other INS data by observed frequency of clouds. So, we performed sensitivity analysis with observed frequency of clouds and distinction between the two other INS data. Consequently, there was showed sensitivity up to $19.4392W/m^2$.