• 대기
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• 제29권1호
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• pp.61-74
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• 2019

To investigate the observational environment, sky line and skyview factor (SVF) are calculated using a digital elevation model (DEM; 10 m spatial resolution) and 3 dimensional (3D) sky image at radiation site, Gangneung-Wonju National University (GWNU). Solar radiation is calculated using GWNU solar radiation model with and without the sky line and the SVF retrieved from the 3D sky image and DEM. When compared with the maximum sky line elevation from Skyview, the result from 3D camera is higher by $3^{\circ}$ and that from DEM is lower by $7^{\circ}$. The SVF calculated from 3D camera, DEM and Skyview is 0.991, 0.998, and 0.993, respectively. When the solar path is analyzed using astronomical solar map with time, the sky line by 3D camera shield the direct solar radiation up to $14^{\circ}$ with solar altitude at winter solstice. The solar radiation is calculated with minutely, and monthly and annual accumulated using the GWNU model. During the summer and winter solstice, the GWNU radiation site is shielded from direct solar radiation by the west mountain 40 and 60 minutes before sunset, respectively. The monthly difference between plane and real surface is up to $29.18M\;m^{-2}$ with 3D camera in November, while that with DEM is $4.87M\;m^{-2}$ in January. The difference in the annual accumulated solar radiation is $208.50M\;m^{-2}$ (2.65%) and $47.96M\;m^{-2}$ (0.63%) with direct solar radiation and $30.93M\;m^{-2}$ (0.58%) and $3.84M\;m^{-2}$ (0.07%) with global solar radiation, respectively.

• 대한임상독성학회지
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• 제16권2호
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• pp.141-148
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• 2018

Purpose: The Korean government approved selected nonprescription drugs (Over-The-Counter drug; OTC drug) to be distributed in convenience stores from 15. Nov. 2012. This study examined the changes in the incidence and the clinical outcome of acute pharmaceutical drug poisoning after the deregulation of OTC drug sales. Methods: This study analyzed the data of Emergency Department based Injury In-depth Injury Surveillance (EDIIS), Korea Centers for Disease Control and Prevention, from 2011 to 2014. The following items were examined: age, gender, intention, alcohol association, pharmaceutical drugs resulting acute poisoning, the clinical outcomes in emergency department, and the admission rate of intensive care unit (ICU). This is a retrospective cross section observational study. Results: A total of 10,162 patients were subject to pharmaceutical drug poisoning. Acute poisoning by acetaminophen and other drugs were 1,015 (10.0%) and 9,147 (90.0%) patients, respectively. After the deregulation of OTC drug sales, acute poisoning by other drugs increased from 4,385 to 4,762 patients but acute poisoning by acetaminophen decreased from 538 to 477 patients (p<0.05). The rate of admission of acetaminophen poisoning increased from 36.1% (194/538) to 46.8% (223/477). The admission rate to the ICU by acetaminophen poisoning increased from 4.6% (25/538) to 11.3% (54/477) after the deregulation of OTC drug sales (p<0.05). Conclusion: Since the deregulation of OTC drugs sales, pharmaceutical drug poisoning has increased but acetaminophen poisoning has decreased. The rate of hospitalization and ICU admission by pharmaceutical drug poisoning with or without acetaminophen has also increased.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.27-34
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• 2019

Background: Understanding the burden of disease is important to establish cost-effective treatment strategies and to allocate healthcare resources appropriately. However, little reliable information is available regarding the overall economic burden imposed by chronic obstructive pulmonary disease (COPD) in Korea. Methods: This study is a multicenter observational research on the COPD burden in Korea. Total COPD costs were comprised of three categories: direct medical, direct non-medical, and indirect costs. For direct medical costs, institutional investigation was performed at 13 medical facilities mainly based on the claims data. For direct non-medical and indirect costs, site-based surveys were administered to the COPD patients during routine visits. Total costs were estimated using the COPD population defined in the recent report. Results: The estimated total costs were approximately 1,245 million US dollar (1,408 billion Korean won). Direct medical costs comprised approximately 20% of the total estimated costs. Of these, formal medical costs held more than 80%. As direct non-medical costs, nursing costs made up the largest percentage (39%) of the total estimated costs. Costs for COPD-related loss of productivity formed four fifths of indirect costs, and accounted for up to 33% of the total costs. Conclusion: This study shows for the first time the direct and indirect costs of COPD in Korea. The total costs were enormous, and the costs of nursing and lost productivity comprised approximately 70% of total costs. The results provide insight for an effective allocation of healthcare resources and to inform establishment of strategies to reduce national burden of COPD.

• 대한응급의학회지
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• 제29권5호
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• pp.430-436
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• 2018

Objective: The purpose of this study was to evaluate whether or not the d-dimer level indicating hyperfibrinolysis could be a predictor of early poor outcome (massive transfusion, death within 24 hours) associated with trauma-induced coagulopathy in blunt trauma without significant brain injury. Methods: This study was a retrospective observational study using 516 blunt trauma patients without significant brain injury. The poor outcome group, including patients receiving massive transfusion and those who died within 24 hours, consisted of 33 patients (6.4%). The variables were compared between the poor outcome group and good outcome group, and logistic regression analysis was performed using statistically significant variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the poor outcome prediction ability of the initial d-dimer level. Results: The poor outcome group showed more serious anatomical, physiological, and laboratory data than the good outcome group. In the ROC curve analysis for evaluation of the poor outcome prediction of the d-dimer level, the area under the curve value was 0.87 (95% confidence interval [CI], 0.84-0.90) while the cut-off value was 27.35 mg/L. In the logistic regression analysis, the high d-dimer level was shown to be an independent predictor of poor outcome (adjusted odds ratio, 14.87; 95% CI, 2.96-74.67). Conclusion: The high d-dimer level (>27.35 mg/L) can be used as a predictor for the poor outcome of patients with blunt trauma without significant brain injury.

• 대한응급의학회지
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• 제29권5호
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• pp.493-499
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• 2018

Objective: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. Methods: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. Results: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all P<0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all P<0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69-0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91-0.99; P=0.034). Conclusion: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.

• Endocrinology and Metabolism
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• 제33권4호
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• pp.459-465
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• 2018

Background: Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. Methods: This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. Results: The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. Conclusion: The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.

• 대한응급의학회지
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• 제29권6호
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• pp.624-635
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• 2018

Objective: This study examined whether emergency department (ED) crowding influences the timing of the initial assessment and treatment in severe trauma patients, as well as their mortality rates. Methods: This retrospective, observational study was conducted between January 2015 and October 2016, and included adult severe trauma patients who presented to the ED. The emergency department occupancy rate (EDOR) was used to measure ED crowding. The patients were divided into four groups using the EDOR quartile. The timeliness of the initial assessment and treatment in the four groups as well as the mortality rates were compared. Results: This study investigated 307 patients. The timing of the first computed tomography (CT) and laboratory test order, CT and laboratory test result acquisition, first transfusion, and patient transfer from the ED to the operating room were similar in the four groups. Multivariable logistic regression analysis did not show a significant difference in mortality between the groups. Conclusion: ED crowding was not associated with delays in the initial assessment and treatment of severe trauma patients, or in their mortality rates.

• 대한응급의학회지
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• 제29권6호
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• pp.679-686
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• 2018

Objective: The aim of this study was to identify the clinical characteristics and risk factors associated with the admission of patients in the emergency department (ED) within 30 days after discharge. Methods: A retrospective, observational study was conducted on adult patients presenting with abdominal pain to the ED of a single, urban, university hospital, between January 2014 and December 2015, who revisited the ED within 30 days after discharge. Data was collected on the emergency severity index level, time to contact doctors, physical examination, laboratory tests, use of computed tomography (CT), and patient disposition on revisitation. The primary outcome was hospital admission following an ED revisit in the 30-day period after the first visit. Results: During the study period, 19,480 patients visited the ED with the chief complaint of abdominal pain, and 13,577 were discharged. A total of 251 patients (1.29%) revisited the ED within 30 days, of which 89 were eligible for the study. The primary outcome was associated with not performing a CT scan on the initial visit and an increased C-reactive protein (CRP) value. Receiver operating characteristic curve analysis showed that a cut-off baseline CRP value of >0.35 mg/dL can predict the primary outcome with a sensitivity and specificity of 75% and 62.1%, respectively (area under the curve, 0.701; 95% confidence interval, 0.569-0.833; P=0.007). Conclusion: An increased CRP value and not performing abdominal CT were associated with a higher rate of admission following ED revisits of patients with abdominal pain. Future prospective studies on the role of abdominal CT imaging in patients presenting to the ED with abdominal pain will be needed.

• 대한간학회지
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• 제24권4호
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• pp.384-391
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• 2018

Backgrounds/Aims: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. Methods: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ${\geq}7.9kPa$. Results: A total of 214 patients were included in the analysis, and 62% of them had a BMI ${\geq}25kg/m^2$. During follow-up, 4% of patients showed transaminase elevation (<1.5 times normal). Most patients had a viral DNA level <2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P<0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ${\geq}25kg/m^2$ versus 56% of patients without SF (P<0.05). Conclusions: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.

• 대기
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• 제31권2호
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• pp.241-249
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• 2021

최근 들어 늘어나고 있는 도시기상에 대한 미래수요 활용 방안을 위해 적합한 관측과 모델 분야의 고려요소와 기획연구 방향에 대해서 관측과 모델, 공간정보 활용 방안에 대해서 확인하였다. 도시기상 관측의 높은 공간해상도 요구사항을 기존 종관기상 관측망을 통해서 만족하기가 어려우며, 사용하고 있는 기존 측기의 유지 관리에 대해서 어려움이 높을 것으로 예상되기 때문에 기존측기보다 소형화된 간이 측정기를 통해 공간해상도를 보완함과 동시에 간이측기의 장기 검보정을 위한 도시규모별 유, 무인의 검보정 시스템이 필요할 것으로 보인다. 또한 UAM과 같은 차세대 교통체계의 실용화 등의 운용방안에 맞춘 기상정보 지원을 위해서 영공을 포함한 도시 지역 예보가 필요할 것으로 보인다. 이를 위해 복잡한 도시의 지면 효과를 반영하는 빌딩 규모 모델의 개발이 필요하며, 이에 대해서 중규모모델과 LES의 결합이 된 다중스케일 모델 개발 과 개선이 필요할 것으로 보인다. 추가적으로 이러한 다중스케일 모델의 연산속도 향상과 성능 개선을 위해서 GPU 등을 이용하여 모델 계산속도를 높이는 노력이 필요할 것으로 예상된다. 이러한 관측과 모델의 정보를 공간정보로 활용하기 위한 방안은 최종적으로 소규모 지역의 고해상도 실시간 기상정보를 제공하여 기상자원정보의 시너지 향상과 도시생활의 시너지 효과를 이루어낼 수 있는 정보 활용이 될 수 있을 것으로 예상된다. 스마트시티에 대한 기상자원의 활용과 융합에 대해서 국내 스마트시티 계획 지역인 부산과 세종의 현재 구축된 자료를 이용하여 그 융합을 사례 적용하였다. 특히 교통에 영향을 많이 줄 것으로 보이는 안개에 대해서 실제 과거 발생일수의 분석을 통해 스마트시티 지역 내에서 발생할 수 있는 재난 상황을 판단하고, 지역별 지형 및 기상 특성을 고려하여 관측과 예보에 필수적인 기상 인자를 최적화하고, 도시계획 과정에서 관측소의 최적입지를 선정하여 기존 도시인프라와의 융합 활용을 통해 도시기상자료를 고해상도로 구축하는 방안이 필요할 것으로 보인다.